Surgery...

Hey guys,

I've now completed 6 weeks of medicine, and am 4 weeks into my 6-week surgical rotation, so thought it'd be the ideal time to indulge in a bit of surgery chat...

In the Oxford 4th year we do three 2-week surgical specialities; I was allocated to do vascular surgery, breast/endocrine surgery with surgical emergency unit shifts and finally a 2-week placement in Banbury, where they have a mix of several specialities.

Vascular surgery's pretty cool - it's all about whether or not to chop off gangrenous cheesy-smelling legs... well kinda. Most of the patients seen under vascular surgeons have one of 5 main diseases: aneurysmal disease (usually an abdominal aortic aneurysm or AAA), venous disease (e.g. varicose veins), carotid disease, acute limb ischaemia or chronic limb ischaemia. You learn a completely new schema for how to examine the patient from a vascular point of view, and also get to play around with cool Doppler ultrasound probes to try and measure blood pressures and blood flow in both arteries and veins.

Being in theatre is generally the high-life of surgery, provided you're not standing right at the back and being completely ignored whilst watching an 8-hour procedure... There are definitely some cool operations to see - in vascular, one of the ways of dealing with carotid artery disease (where patients have cholesterol plaques in their neck arteries, that may increase risk of stroke), is to do something called a carotid end arterectomy, where the carotid is cut and the scummy atherosclerotic plaque is literally scraped out. To top it off, all this is done under local anaesthesia, whilst the patient is still awake!!

After vascular I was on the Surgical Emergency Unit (SEU) for a week. This was probably the most fun I had on surgery, as you actually get to play doctors and follow the surgical house officers around, taking bloods, putting in cannulas and catheters, clerking emergency referral patients and generally getting to grips with what F1 doctors do! Over the week we were assigned SEU shift rotas, either 8am-4pm, 4pm-midnight or (the killer) midnight-8am! The best shifts were probably the evening ones, when all sorts of weird and wonderful patients come sailing through the doors.

Last week I did breast/endocrine surgery. This week was split into going into breast clinics (and getting to practise breast exams), endocrine clinics (mostly people with thyroid or adrenal disease) and watching some pretty interesting operations in theatre. One patient had a phaeochromocytoma (a type of adrenal gland tumour) that was a particularly intersting operation to watch!

This week I'm at the Horton hospital in Banbury, and it's a bit more relaxing (though hospital accommodation does take some getting used to)! I've also got a nasty 3000-word surgical case report to write up by the end of next week, so I'm sure that'll keep me preoccupied for a while!

Will keep y'all updated soon with more surgical banter!

K