Thursday, 20 April 2017

A Week in The Vascular Department, at QA Hospital

by Monideep Ghosh

After fortunately securing a one-week work experience programme at the vascular department, I set out to for a brief consultation followed by my first observatory operation- an EVAR (Endovascular Aortic Repair). This was required due to a 5.6cm intrarenal aortic aneurysm and was treated with the placement of an endovascular stent graft. Admittedly, it was a slightly mundane spectacle, however it allowed me to clearly understand the intricacy and sheer precision required at this level of professional healthcare and was executed perfectly by the experienced consultant. The afternoon held in store a huge contrast and was much more graphic and vivid than the previous procedure. As a result of frequent drug abuse, the patient required a ‘Bilateral Transmet Amputation’ which is essentially both feet being chopped off after being blackened and as the anaesthetist said too much of the team’s amusement, ‘It’s good old, fundamental surgery- if it’s dead, it’s gotta go!’. After applying the spinal anaesthetic to cancel any nerves to the lower side of the body, the surgeons, fairly brusquely, picked up a scalpel and just began sawing the feet of much to my horror and gradual excitement. The wound was left open and was swiftly dressed with the anticipation that the granulated skin exposed on the side of the leg would eventually reappear in the operated area. The patient was awoken and was troublesome with her psychological issues seen as she questioned the entire surgery. The consultant gently explained the extreme necessity of the procedure and offered her painkillers for back relief which was met with gratitude and understanding by the patient.

Day 2 began with a ward around which was useful, in particular for me, as it gave me a chance to speak to a couple of junior doctors. They did state that they feel ‘like a bit of a spare part’ but the enjoyment of working in a team sometimes does overshadow that. Administrative tasks such a taking clinical notes is a key part of the work they do but the variety of patients they see allows them to develop adequate knowledge in a variety of medical situations which will obviously aid them in the future when they begin to choose specialities etc. A flurry of hernia related operations followed and further reinforced this idea of accuracy and precision that all surgeons must have when performing such operations. The afternoon entailed a ‘de clotting of the left PTFE graft’ which partly had to be undertaken due to the patient’s lifelong type 1 diabetes. The patient, aged 65, has had regular treatment in the department with some of them related to general age.

The next day involved a different side to the department- the assessment unit (lab). This is the area in which suspected patients receive scans in order to investigate certain conditions such as one patient required one for DVT (deep vein thrombosis) which is blood clot that has developed in the lower leg of the body. The symptoms include deep swelling, reddening and warmth in the area in question. The scan was taken by the clinical scientist and the waveforms were analysed to check for irregular patterns in the blood flow and hence check if there was a clot. The Doppler effect is used for this and I gained a brief insight into how technology is an integral part for the detection of disease as well as the fact it isn’t just doctors who are responsible for the curation of infection in the hospital.

The penultimate day to my experience began with me witnessing a ‘carotid bypass’ which the 50-year-old patient required due the artery on the right side leading to the brain being affected and thus leading to a recent stroke. As a result of this, the left side of the face was slightly distorted- showing a key symptom of a stroke. The visibility of the jugular vein was apparent and the ex-smoker had a pain in the right arm. A graft was applied between the thyroid and strap muscles which was an excellent suggestion by the head of the head and neck department at QA. This further appealed the prospect of studying medicine as it showed me that problem solving is a key part of being a doctor as well as the never end of learning in terms of knowledge and in this instance techniques. Following this, I observed a ‘carotid endarterectomy’ which is a procedure that patient undergoes in order to reduce the chance of stroke. To my surprise, the patient had to be kept awake during the operation in order to prevent the patient from having a stroke as well as asking questions in order to see if the patient was responsive. To allow this, a potent anaesthetic called ‘remifentanil’ was given to avoid any excruciating pain. The lining of the artery to the brain was removed and the surgery was a success.

My final day began with a quick ward round where I saw a patient who had undergone a ‘below knee amputation’ and therefore had maggots attached to his leg in order to heal the wound. Antibiotics could not be prescribed as it would literally kill all the healing ‘mechanisms’. A brief period in clinic followed, where a women aged 89 years old, was extremely healthy but suffered from a mini stroke a month ago. As a result, she was recommended to have a small operation which would clear her artery. She was very apprehensive about the treatment as she had never had any problems with her body before and therefore asked the registrar the risks and results that would be obtained. After a brief discussion, she agreed to the procedure but stated if she did change her attitude she would cancel. This showed me that ultimately it is always the patient that comes first and it is a duty for doctors to always lay out the outcomes whether positive or negative for any surgical treatment. Lastly, I saw a ‘Femoral Popliteal Bypass Surgery’ which was expertly done by the consultant and did take longer than expected. The patient had a hole in the side of the foot, which was due to the decreased blood flow and when sleeping or in a resting position the natural position of the foot is faced down on that area. With a prompt bit of suturing, my time at the department had, unfortunately, come to an end.

The experience was thorough, thought-provoking and inspiring as it did indeed confirm my choice of applying to study Medicine at university in October.

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