Poplitea

 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 

 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 -.-

 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!

 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! :)

 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.

 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 :(

 Both literally and ironically as today I got to start out with a shoulder arthroscopy (-.-) and then finish off with 2 radius fractures (^-^) 

 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

 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!

 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.