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Monday, March 28, 2016

Surgery - the rush

Wednesday: OPD

 My first OPD.

Showered and left early to the ward to finish work there and be at the OPD on time. It was a continuous rush of patients from 9 o'clock till the time PG asked me to go have lunch.

There was everything - Road Traffic Accidents (RTAs), healing and non-healing wounds to be dressed, deep gaping wounds to be sutured, pain abdomen of various kinds.

My first sutures were on the leg of a patient. Neat 3 of them (or 4?). Dr Mayank encouraged me saying "You're a surgeon, ha?" But those were the easiest sutures that day.

While we were incising and draining abscesses, dressing more wounds, etc. a serious RTA patient came, unconscious. The PGs took direct laryngoscope and intubated him, called up ICU duty doctors for emergency, gave a slew of drugs, gave CPR multiple times, etc. But he couldn't be saved. I was pressing on the AMBU bag for a while and I don't even remember when I handed it over to someone else.

Nothing would stop more patients from coming in. The rules of work applied quite strongly here. Nobody else would do our work and we had to do them sooner or later.

After lunch, the rush mellowed a bit. But there was still work for everyone. Students filled in holi colours needed suturing. Quite close to the eye. I was scared to touch the temporal artery. Left it to PG.

While debriding a wound in another patient there was a bleeding artery. And the PG just ligated it in a second.

Evening came in quite soon. We had one patient with pain abdomen and history of typhoid fever that we had to do an emergency OT for (for intestinal perforation). I went to the OT, submitted the list. There was an orthopaedic surgery going on from 3 apparently which was still going on to go on till 8. Our patient would have to wait for that to be over.

Things like these and it was night quite soon. I stayed in the OT to watch the laparotomy and saw the surgeons closing the ileal perforation. They biopsied the edge of the perforation which I sent for evaluation. I went straight to a hotel from there to have dinner. It was 10.30 in the night by then.

Back in the OPD there were only occasional cases coming in. By now, the casualty OT became the place for Ortho, ENT, and surgery. We had a few more road traffic accidents and assault later in the night.

There was a child who had a scalp wound and there was a lot of blood draining and turns out you can stop bleeding and suture all in one.

There was a goonda gang in which one person got hit by a wicket and had a wound on the scalp. I had to suture it and the scalp was pretty thick but somehow I managed to get one suture through. The rest had to be put by the PG. I would later realize that I should have been locking the needle holder every time I hold it for better control. The entire gang came in to take photos while I was dressing this guy up and I had to ask them to go outside (because they were scaring me).

Around 12, the PGs gave us an algorithm to manage cases that come up in the night. Mostly pain abdomen. We then started taking turns to sleep. I slept from 12 - 4 in the Unit Chief's room (where there were 3 others sleeping, including one on the table).

After 4 there were only three patients who came in, with pain abdomen. I managed them and it was morning by then!

Thursday: Dressing

 At 8, Abdu would come back from sleep and let me go to hostel to become fresh. I rode my cycle slowly, took a shower walking like zombie, and came back. I had to go to the endoscopy room to write down the reports. Saw the duodenal opening of stomach and ?Ca esophagus and things like that.

Joined dressing after that.

If I remember correctly I gave a blood transfusion today for a patient with lipoma in his forearm and low haemoglobin.

Friday: Good Friday 

There was no OT today because "Good Friday". Went to JK grounds in the morning for our second match in Kreida '16 football. The first match was on Wednesday morning which we lost 0-1 to 2k14. Today we drew 1-1 with 2k15 and our only goal was on technicality (the defender touched the ball while it was a goal kick and we kicked it into the goal and something along that line).

Today I had two work after dressing. One was to monitor hourly the abdominal girth of a patient whom we are suspecting intestinal obstruction. And the second was to give blood transfusion to a patient who was losing blood in stools and had grown pale.

The latter guy didn't have any attender but I took his consent and started blood transfusion. The sister scolded me a lot for this because apparently if something happened to him the question that would be asked would be "Why did you do blood transfusion without having an attender? Whom did you ask before doing so?" etc. Apparently, patients can't make decisions for themselves here. Weird world. Anyhow I've decided no more blood transfusions without permission of the entire family.

The former guy also needed a Contrast Enhanced CT scan so we could confirm it is intestinal obstruction and figure out a cause too. I was supposed to talk to the radiology department and get it done on an emergency basis. His creatinine, urea, etc were normal so there was no contraindication for using IV contrast. But it was 1 o'clock by then and they asked me to come and convince the next day's staff.

Saturday

This day from morning my work was to make sure to get the CT done. I managed to convince today's staff even though they first said that surgeons should be bold to open the patient since the X-ray showed clear signs (multiple air-fluid levels) of obstruction. Nevertheless, they fixed 2pm as the time and asked us to be punctual or forget the CT. We got it done and there was indeed obstruction and some free fluid in the peritoneum with nothing much except these in the report.

Sunday

We did emergency surgery for that person today and saw that there was a perforation which led to peritonitis which led to ileus which lead to obstruction and distension of abdomen. There was a lot of suctioning of fecal matter to be done before the abdomen was closed.

Monday, the 28th

Major OT. Meanwhile the patient with blood in the stools got esophageal banding done in the endoscopy room. Now the esophagus can't bleed any more. But he still has to find an exchange donor for the blood I transfused him.

In the OT we had a lot of cases. Goiters, Thyroglossal cyst (sistrunk's operation), the lipoma in intramuscular plane in forearm, Ca Breast, Appendicitises, Haemorrhoid, and a hernia.

By the time I took the case sheets from the anaesthesia PG the rounds were over and there was no work left.

In the night some of us went to Kalamandira to see this drama called "Top" (in Kannada) which nobody understood (even Kannadigas).

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