poplitea: surgery (Default)
 Well, almost nothing...

I was scheduled for a robot assisted cystectomy today. However that wasn't the only thing to be done. Because of metastasis we were also supposed to remove the rectum and a lot of the pelvic floor muscles.

And so we started with the robot. And it went better than the nurse who was guiding me expected (she was not expecting a lot there to be honest, because the patient'd had radiation therapy as well). We'd set everything up and gotten started in an okay time. The surgeon stapled off the sigmoideum and started to dissect the rectum and around there we were relieved for lunch.

When we got back it was to bright lights, robot de-attached, and the patient supine again. Apparently it wasn't working after all so they decided to convert to open laparotomy. Tens of thousands of crowns wasted...

And my "guide nurse" (the one who's supposed to show me how new things are done) said "it's no big deal, you'll manage just fine on your own :)"...Ah. Ha. Ha... At that point in time I'd done a total of TWO abdominal laparotomies. Two. Never alone. Four months ago at least.

And at this new work place I've only done urologic surgery where the number of instruments sometimes can be counted on just two hands. And now switch to four new instrument sets, one of which had around 30 instruments in it... My mind felt a bit melted. I had no idea what was going to happen in the procedure, more than "de-attach a piece of intestine. Sew fast two ureters... Make a uro-stoma.Then make a colo-stoma"... Yeah....

But it went okay on my end at least. I'd warned the surgeons I "was a bit rusty" (HAHAHA!), and two of three surgeons were urologist anyways so they weren't exactly in their comfort zone either. 

At one point I thought I'd lost TWO needles. And then I panicked for 0,5 second and then made a recount (twice) and concluded that I'd counted wrongly the first time and all the needles were there O.O And at the end I had five packs of standard cloths up and four more of weird shapes/sizes and I counted them again and again and again. And luckily kept check of all.

When I finally could go home (after staying on for a while) the patient had just been flipped to prone and the plastic surgeons were on their way to do the last part; resect the last of the rectum and pick that and the bladder out and then sew the bottom shut in some fancy way. 

When I left the patient had been in surgery for seven hours and at least one to two more were expected (O_o)...

Ughh...

EDIT: ha, no, my estimation was way off! They weren't even finished when I wrote this I later heard. It ended up being eleven hours of surgery in total o_o 

poplitea: surgery (Default)
is our main textbook for surgical nursing and it's really great. Problem is, when you're actually interested in a textbook it's a little bit like just going for "a quick" look through wikipedia. Usually doesn't end that way!

I was just supposed to check it real quick, and write up a reference for the thesis; I ended up reading about pediatric surgery for 30 minutes instead. Oops? O_O
poplitea: surgery (Default)
 I had it today! Our uni calls it Triple jump because it has three separate parts needing completing and I did part 1 and 2 today.

Part one was having a pre-op "counseling" (kinda) with the patient I'd have for part 2, and then talking again with them post-op.

Part 2 was to independently take part in a surgical procedure, for me a partial mastectomy with SNB, with a representative from the uni observing. I thought I messed it up in the beginning because I'd forgotten to lay out some things I'd need and it took a little extra time getting everything ready. Over all I didn't feel like I had a good flow when preparing the sterile field and such. When the surgery got started it went fine, I knew the surgeon since before. She was aware of this being a test for me so tried to be considerate and not grab all the instruments but make sure to ask for them and leaving me time for counting when I needed. We had a good teamwork going :)

And then afterwards I had to wait over an hour for my evaluation because the examiner had to do it with another student first. Uuughh, nervous!

Then it was finally my turn! And I was a little shocked because the examiner remarked she thought I kept good time with the preparations...!! What?!?! O_O Okay then... And everything else went without a hitch so I passed, phew!

And now... I have part 3 left, which is written and due in less then a week -.-


poplitea: surgery (Default)
 Had to go in to the clinic on a saturday this week for my hours to add up which meant being on call. It was a fairly calm day though only 2 OR were open.

The only interesting thing to happen were a male with urinary retention where the urological ward nurses couldn't get a catheter in because of swelling in the penile head. And they sure as hell know how to do it usually. So he came down to have his foreskin cut during local anaesthetic and get a catheter.

Only when the urologist got started what he'd thought was the "top" of the head and where the urethral opening was supposed to be was actually some kind of lump... And the actual urethral opening was way down to one side which was why they hadn't been able to insert a catheter earlier; poking in the wrong spot! ;)

So when the poor guy finally got a catheter the bag filled with over a litre in 10 minutes o_o ouch
poplitea: surgery (Default)
 One of my supervisors got us in on a biiiig open abdominal surgery (resection because of Mb Crohn) today. I'd never done one of those and she thought it'd be fun. However I was nervous as fuck and the 3 (!) surgeons were all grumps which luckily for me meant that my supervisor didn't leave me to my own as it sounded like she had planned at first (*gasp* no not on this please!) becuase the head surgeon doubted my abilities. I've never been so glad to have been doubted about, I didn't have a clue about anything!

The sweat flowed freely and my heart beat fast ó_ò but it went well in the end. Enough excitment for one day!
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 Because open hernias are one of the most boring things I've ever had to do unless I'm at least alone with the surgeon but usually there's a trainee there as well... *snore* nothing to do but wait...
poplitea: surgery (Default)
 Got to see a previously operated compartment syndrome today! I got to disinfect and drape and then the surgeons cleaned it out a little more and then applied a negative pressure wound therapy dressing, also very interesting (and fantastic!) how those things work! :)
poplitea: surgery (Default)
 that keep on falling and breaking thier hips ;-; well, at least we can fix it okay nowadays, though it still hurts like ever loving fuck! ó_ò

So yes, got to do another variant of the oh so common hip fracture. An intramedullary nail this time, and then another unipolar hip replacement.
poplitea: surgery (Default)
 Today was a butt day again :3



And I started taking the bicycle to the hospital today. It is, just barely, warm enough outside, but plenty light enough at least. And it's 12 km per day so it's good training.
poplitea: surgery (Default)
 I'll be having a practical clinical exam at the end of this and yesterday I found out that it's going to be with a breast cancer patient. Which is good because I've had a chance to do lots of those on my last clinical buuuut not for a few weeks so I panicked a little inside.

But then! :D me and my supervisor got the emergency OR today and the first patient were a transfer from the outpatient clinic because they were short staffed and it was a partial mastectomy with SNB and I got to do it all by myself, so! Confidence for the last exam okay again and panicking pushed to a small and obscure corner of my mind :D

And then! We got to do a unipolar hip replacement which is a very common procedure (and as a nurse I work in orthopedic rehab so I've taken care of more of those then I can count post-op) but I've only watched it done from afar a couple of years ago and now I got to get close up and dirty my hands with it! :D

Very good day indeed! ^w^
poplitea: surgery (Default)
 This is the first time I've been on the evening shift in the OR actually. Got to meet another of my main supervisors (really nice ^-^) and we spent a few hours finishing of a couple of surgeries so others could get home, and then it was a lot of waiting and then we prepared for a hip fracture but didn't get to handle it :(
poplitea: surgery (Default)
 Started off with a cholecystectomy, nothing strange there, but then! I got to rule it with an appedicitis! :D

I know, it's one of the most common things to do an unscheduled surgery for but so far I hadn't gotten to see one!

It was done laparoscopically and when the surgeon found the app it literally looked like a giant prawn... I will never forget that! XD And then he resected it and all was fine and he irrigated a bit and then, oh right! Gotta get it out as well! Only... It had disappeared! It was lying loose somewhere among the small intestine and the surgeon had to fish around for like 10 minutes before he found it again XD and then it was out and all was well ;)

As a finish to this day me and my family are going up north to my fathers birth city. His brother's wife's mother (my in-wed aunts mother that is) has passed away (because of surgical complications ironically enough) and the funeral is tomorrow :( on my brothers birthday... hurray..
poplitea: surgery (Default)
 Both literally and ironically as today I got to start out with a shoulder arthroscopy (-.-) and then finish off with 2 radius fractures (^-^) 
poplitea: surgery (Default)
 They really do heap 'em on each other... After this one is done I'll be writing an essay for 2 months (a useless waste of time in my opinion).

Anyways! For the last clinical I'll be staying in the same hospital but moving from the outpatient surgery ward to the main OR-ward where they do a little more heavy stuff.

Like today i started straight in helping as best as I could with a shoulder joint replacement. Then for the second surgery I got to run things more while trying to remember in which order all those bloody tools were supposed to be used in. It was exhausting but fun to get to do something more advanced (even though it was a shoulder).
poplitea: surgery (Default)
 Managed to corner my second supervisor into actually supervising me today. We got the butt room! Where the agenda for the day was hemorrhoids. It was actually quite fun but it is a little horrific. And not because of the hemorrhoids but because of how... it's very crude? I don't know, the wounds are often left open to heal and meanwhile you will be pooping and stretching the scabs and yeah... Will be glad if I go through life without having anything like that done to myself. 

And puncturing a perianal abcess was fun but I pity the poor suckers who have to go through it :(

Edit: Also I have found the most glorious phone case! Warning nsfw! :D

Sigh

Jan. 23rd, 2015 17:38
poplitea: surgery (Default)
 I have not gotten into a groove again yet and while my supervisor is really sweet and nice she hasn't had a student for like 10 years and is really hesitant to let me do stuff on my own and also think I am way to shy and timid. Which is because I don't know anyone here yet, don't know their names, don't know how things work etc etc... I'll pick it up sooner rather than later!

So, this is an outpatient clinic. The patients aren't very ill to begin with or they'd be sent to the main OR-ward. Lots and lots of breast cancer, hernias, and cholecystectomys, so basically a bit of repeat from last clinical but also with the opportunity to do some orthopedic things!! Looking forward to try that. :)

Also, I picked up a new ID card and it looks just as crappy as ID card photos usually do -.- 
poplitea: surgery (Default)
 Aw, yeah, second clinical, ready to rock all those things I learned last term!

Except I feel like I've already forgotten everything!! O_O

There was a waaaaay to long intro this morning though. Like, I don't care about the boss' boss' boss name at this hospital and how many patients you treat each year or what the new shiny ward/department will do, I'm here to assist with surgeries!! Ò_Ó

(Although. Interesting fact. The health care sector is very much a female dominated area of work in this country. Around 50% of the doctors are female and of the other work groups in this sector I'd say 80-90% are female. But of the 6 highest bosses in this hospital, 2 are female... So it's okay for the workers to be female but the biggest jobs with the biggest pay still goes mainly to males... ugh.)

Met my 2 main nurse supervisors as well. One is really sweet and nice and the other doesn't not seem to want a student at all. So we'll see how that turns out!
poplitea: surgery (Default)
Got to do a repeat kind of from that epic fail a few weeks ago, meaning I assisted at a laparoscopic sigmoidectomy again and with the same surgeon. But it went so much better this time. So much, it was such a relief! Saw a ureter several times, they look hilarious, like a little wavy worm :D

The next patient got struck because a more urgent case came up; an aortic dissection which was then sent along to the bigger and more specialized hospital anyways. My supervisor then shuffled me in on a partial mastectomy again where I proceeded to try to disinfect and drape with three scrub nurses watching and commenting about how/what I should and shouldn’t do. Needless to say their instructions clashed rather often…

poplitea: surgery (Default)
 Got to go down to the hybrid room today! It’s specialized with a lot of x-ray equipment to be able to do angiographic surgery. The first patient was an 80 year old male with stage 5 kidney failure who needed work done on his arteriovenous fistula which had a severe stricture.

So. Got to work with 2 new vascular surgeons who were actually rather nice if a bit annoying. They have these glasses with intense magnifiers on them to be able to see what they’re actually doing but because of their very limited field of view they pile up instruments which I have to somehow retrieve and keep in order while they ask for ones literally 2 cm away from their own hand.

And I’m not very fond of vascular surgery. To itty bitty everything and risk of catastrophic errors o_o

Number 2 was very old, very sick and very confused lady with bleeding oesophageal varicose veins which we got to shoot glue into. That glue was some strong stuff. The drops we spilled are never going to go away.

poplitea: surgery (Default)

Got to join my fourth different supervisor in as many days. Not okay when I’m supposed to go with just 2 different one for them to be able to keep check of my progress and areas that need improving.

What a fucking epic fail this day turned into.

The nurse I was joining had no idea. Of course. She starts off by saying we’ll disregard the things I am supposed to be focusing on as a new scrub student and go by what she feels is important today. Which was planning and how well we had to do it because we were short on time before the start of surgery, a laparoscopic sigmoidectomy, which take quite a few hours.

We then proceed to the equipment room the grab some things in a hurry, except she meets a colleague she hasn’t seen in a while and stops to chat. Hurry much?

In the OR she then hurries along and does all the things that I need to do for practice. And then we had to redo some things because we hadn’t communicated enough with the nurse aides on the plan.

When the surgery starts I at least get to assist on my own but then manage to drop a very expensive one-use-only piece of equipment. Alrighty, continue on when a new one has been fetched. The surgery goes on well enough for a while until it’s time to use the intestinal staples, which I’ve never used before. Turn to ask my supervisor. Who is nowhere near. Who is in fact not even in the OR. Who hasn’t told anyone that she’s leaving for awhile or where we can reach her so the nurse aide has to go running to look for her because the surgeons doesn’t know how to put the staples together from scratch either.

Oh, but I’m not done yet!

A while later it’s time to raise the patients legs up to be able to get at the anal area and insert a circular staple through the rectum. The nurse aide crawls down under the sterile draping to work the leg extensions on the operating table. It does not go well. In fact she manages to dislocate one of her thumbs(!!!).

From there on everything actually(!) goes according to plan. But everyone was tired, cranky and in a piss poor mood not to mention the nurse aide with her aching thumb which she’d popped back on her own.

I will remember this day for the rest of my fucking career I swear.

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