Surgery - fitting in

On 18th, we made mental calculations about which surgery unit we would be posted to, when they would have OT, etc. and then reached surgery office around 9. There was a table full of dates written against our names according to which the first half would have general surgery straightaway, being divided into units in order (A,B,C,D,E,F,A,B,C,D,E). The first half of the other half would be in Anesthesia. 3 of the remaining people would be in pediatric surgery and the last 3 would be posted in neurosurgery or plastic surgery. As expected, me and Abdu were in C unit of general surgery (headed by Dr Madhu). (After all the diarrhea cases we took together in pediatrics, one more joint venture for us).

Right next to the postings matrix were the wards displayed. I saw that our unit had the wards 10 & 15. I headed to 10th ward and there on a chart paper was displayed prominently what days were what for our unit - "...Friday - OT..." it read. And we ran to the operation theatre.

Friday: Minor OT

I quickly changed into  OT scrubs and went inside where the PGs were preparing cases and waiting. I introduced myself and was asked to first report to our HoU. By then Abdu came and we saw the anesthesia interns sitting and writing letters to their HoD and we wrote a letter each too. When Dr Madhu came in, he congratulated us on passing and asked us to work hard and signed our letters saying we did report on 18th.

Then the OT work started. Our main work in the OT is to enter surgery details in the OT register, send specimens for histopathological examination, give test dose of local anesthetic (patients come directly from OPD to minor OT to get minor swellings, etc removed), watch surgeries and try to learn, and be around and be helpful (help surgeons scrub in, get vicryl, spirit swab, etc, bring tablets, injections, etc from the patient's attenders outside, collect case sheets, attend phone calls for the surgeons, etc).

I knew how to open vicryl without making it unsterile. And that's all I knew. One of our nice PGs, Dr Pradeep, taught us everything else.

First, we get a plastic container from the patients' attenders to put their specimen in. We also get the ubiquitously useful Transpore™ (which is a surgical tape that you can tear with your hands). Then, as soon as a thyroid nodule, appendix, cyst, or swelling is out, we take them in this container, add formalin to it and label it. Subsequently, we fill the "histopathology requisition form" with the details of the patient, the specimen, the preservative used, etc. and brief history which we give the patient's attenders outside along with the specimen so they can take it to the pathology department for evaluation.

For patients coming from OPD to get their swellings removed under local anesthesia, we need to give a test dose of the local anesthetic to ensure they don't have an allergy against that. I saw Dr Pradeep doing 5 of these in less than 2 minutes and I did the next 2 in 2 minutes each. Spirit, 0.5mL in syringe, push intradermal, withdraw, throw the syringe and needle. Repeat.

Inside the OT that day we had a laparoscopic appendicectomy, some thyroid swellings, and many swellings here and there. I was too dazed that day to remember anything. But I do remember assisting in excising a cyst in the arm of a person. Mopping up blood, cutting suture thread.

After OT, the PGs made sure we ate puffs before running back to our wards to do a quick round. Around each bed the faculties would be on the right side of the patient, the PGs on the left, and us interns and nurses at the foot of the bed. The senior PGs briefly present the patient's condition and the unit chief gives orders on what to do for the day for each patient. One patient was just being shifted from OT and I was asked to put a Ryle's tube for that patient! I was stunned but the PGs told me they would help. Then we went to the female ward and the PGs put Ryle's tube for a patient there (which she kind of aspirated first).

At the end of the rounds, the unit chief asked us interns to split ourselves in between our two wards and exchange after 15 days. I decided to stay in the male ward where I waited for the PGs who disappeared to put the Ryle's tube for my patient. They were surprised to see me waiting when they returned and put the tube swiftly. Then, I was about to be asked to put a urinary catheter, but that patient didn't need it.

The PG then told me that the primary duty of house surgeons is two things - BP & BT (Checking blood pressure, and making blood transfusions happen.) I was supposed to go to hospital by 8.20 next morning to check the BP of all patients.

That day was only the first day I started skipping lunch. Maybe the energy and enthusiasm that first day brings, I didn't even go to Aroma bakery for an egg roll. Back at hostel I realized that I would be scared of not knowing how to do catheterization, how to give blood transfusion, etc that I better do it quickly and be comfortable about doing it again. I would soon get a chance to do both.