A Pleasant Surprise

Despite my initial trepidation, this week on orthopaedics has been a fantastic learning experience. Yes, I'm still completely convinced that I couldn't stand being an orthopaedic surgeon, but it has been great being in a department here the doctors are eager to teach. There have been lots of interesting cases for me to see, as well.

On Wednesday I saw a child with a classic median nerve palsy following a proximal radial fracture. It's fascinating for me to see things that we've learnt about, and examining for the signs that we all read about in the textbooks. The child was displaying the Benedictine sign, and had loss of flexion of his thumb and lateral two fingers, as well as loss of sensation over his lateral two fingers and the lateral half of the ring finger.

I also had the chance of examining a newborn with dislocatable hips. Two weeks ago, on paediatrics, I'd been taught how to do neonate health checks, and one of the routine things we check is the baby's hips, so it was interesting to feel it, and learn about the management. If they're caught as a neonate, management is pretty simple - 8 weeks in a von Rosen splint, which keeps their legs in a flexed, abducted and externally rotated position, enables the acetabulum to develop so that the hip becomes normal. After 8 weeks, they can come out of the splint and be fine!

Yesterday, one of the registrars taught me how to do a proper hand examination, with the patient being an elderly person with severe rheumatoid arthritis. It's so much easier to learn the signs when there's a patient in front of you who actually has them!

The other great thing about the week has been the practice reading x-rays, CTs and MRIs (although there were only a couple of MRIs, as they're not done nearly as often, being much more expensive), and learning to describe fractures properly. Whilst I'm not going to go into orthopaedics, I'm sure this is still an essential skill.

Scrub, Scrub, Scrub

I've confirmed that I'm definitely not going to be an orthopaedic surgeon, but I'm still managing to thoroughly enjoy my week in orthopaedics. Funnily enough, the orthopods are the nicest group of doctors I've met in the hospital yet - who'd've thunk it! They are lovely to everyone - nurses, other staff, other doctors, patients, even us mere students - and consistently appear genuinely interested in teaching.

I scrubbed in for the first time yesterday, which was quite an ordeal. The procedure was a total knee replacement, so as well as the standard gown and gloves I also had to put on a visor with a hood to shield myself from the spatter that happens when the surgeons are sawing and drilling - you pretty much end up looking like you're wearing a hazmat suit. When scrubbing in, I felt that I must pretty much be the clumsiest person ever. There's a very particular way of putting on the gown, whereby you have to make sure your hands are still inside the sleeves (so they're not out the cuffs at the end), and then somehow get your gloves on over the cuff and wriggle your hand out into it. Quite tricky! And because I am particularly talented, I managed to get my second layer of gloves on the wrong hands!

The operation was really interesting to watch. One of the surgeons, who is also the director of the department, said that it's pretty much like carpentry, and I certainly saw what he meant. They use so many different tools, and do up lots of jigs to make sure they're getting the angle right.

As well as getting my first experiences in an operating theatre, I'm also getting loads of practice looking at x-rays, CTs and MRIs - which is invaluable to me, considering I'm so bad at interpreting them. It's much more interesting to look at them when it's in a clinical context, and I'm finding that gradually I'm getting better at picking up what isn't quite right about an image. I've certainly still got a long way to go, though!

On another note, I'm missing MBF so much! While I am really enjoying myself here, and learning a lot, I'm also glad to be going home to him soon. We've planned a week away at the beach next month, which we're both really looking forward to. Our apartment has our own private spa, which will be quite a treat, I'm sure!

New Week, New Ward

With a new week started, I'm finished with Paediatrics and off to Medicine. While there was a lot of waiting around on paeds, when we were doing things we had a lot of fun - and learnt a lot, too, of course! I think the highlight of the week was going around the Maternity Ward with the Special Care Baby Unit (SCBU) resident, doing neonate checks on all the newborns before they could be sent home. One thing's for sure - finding the femoral pulses on a newborn is a LOT harder than on an adult! So now I know how to do a newborn check, as well as what to do if some of the results are not quite normal.

We also looked after baby girl who made the national news, after her father poured petrol over her mother and his two children before setting them alight. Thankfully, all patients are fine, but last report I heard the baby had been sent to another city to be looked after by a specialised burns unit, to ensure her burns healed well and there was no significant scar tissue.

Medicine has been very busy - I'm just shadowing the resident and registrar, but it is quite an effort to keep up! I'm on the endocrinology service for the week, which seems like it will be great as a learning experience, as the patients all have multiple co-morbidities and are complex cases. I hope that doesn't make me sound too cold-hearted, saying that patients with many problems are a good thing - it's just the way medical education is, that we need to take the best opportunities to learn that we can.

It was a draining day. The residents have all just rotated into the department, and the endocrine reg for the next couple of days is doing relief cover, so the three of us were completely unfamiliar with the patients. This meant we spent the entire day rounding on patients. The resident said things should settle down, though, once the regular registrar is back mid-week.

The resident I'm with is eager to teach, which I am grateful for. She's suggested I have a think about what I'd like to learn, and I can give her a list tomorrow and she'll try to make the time to teach me later in the week. I've only got a few things on my list so far, so I guess I'll try to add over the next couple of hours! Although, on second thoughts, what I have got should keep me plenty busy, so a few things for one week are probably enough.