The Plastics Diet

1AM in the morning, in the ED with my plastics Reg, who by the way is the nicest surgeon a student will ever meet, not to mention her charming English accents and lovely manners; I've decided that all English girls, like their emblem the English Roses, are made of elegance and grace, but that's a story for another time.

Anyway, 1AM in ED, talking to the patient while waiting for X-ray to come through, we realised that it's been more than 12 hours ago since either of us had anything to eat or drink. I had 20 minutes at lunch time to scoff down half a mini baguette and chomped on an apple on the way to clinic; then 5 minutes for glasses of water on the way to theatre at ~ 6pm. It's been a busy day, but that's the plastics diet.

Monday morning ward round (7:30AM) generally takes longer than usual as all the plastics consultants are present, so soon after 9AM when everything is done, we rushed down to clinics to start chipping away at the list of patients. Monday also means consultant paper round, theatre list review and pathological meeting. So by the time my Intern had a chance to shout me coffee, it was 12:45, then some odd jobs around the ward while stealing some down time for my baguette and back to afternoon clinic at 13:30.

It's actually been one of the most exciting day since I've started medicine. Cut out a BCC on a leg, sutured another one on the back, and saw 2 infected sebaceous glands that were dealt poorly. For my own benefit: in the first case, the RMO had cut through the gland without realising it is there, resulting in release of pus everywhere in the wound, it took quite a while to clean and debride everything soon as the Pandora's box is opened. In the second case, an infected sebaceous gland resulting in an abscess/haematoma. I think he should've ultrasounded it first, I would, to check the dimension of it. From experience of having pimples, the sebaceous gland go through stages of infection when at a 'mature' stage, the keratin top of it becomes weakens, then becomes ready to be 'poped' and released. This was much angrier than a pimple of course, but the principle should be the same. Anyway, a cut was made, not much came out, so another cut turned it into a hole, then the gaping hole grew wider and deeper as we frantically try to debride as much as possible. In the end, the deep wound is impacted with gauze, and patient given ABx. I have my doubts on whether that will heal at all.

Saw an old gentleman of 80 on my own, who had lacerated his index finger while curving ham. His finger had functions that are largely in tact and the sensations were absolutely normal, so on the surface it was an over-zealous referral, but exploration under local confirmed the suspicion that there were tendon involvement, and Kessler repair ensued. Interesting and rather stoic grandpa, we chatted about ancient legends and myths while I was allowed to suture him back up. One of his ancestors was accused of murder and some serious crime or rather, that he was locked up in the Tower of London in the 16th century for a couple of years. Now you don't hear a story like that everyday.

Theatre paged, it's preped and ready to go. A lady's wound from previous breast reduction operation had dehessed and became infected, the wound needed debridement and re-closure. wound edge debrided, sent for culture, closed. Easy enough. Hardest part was to remain inconspicuous and seem totally innocent while checking out the scrub nurse, I'm pretty sure it's unprofessional to hit on your scrub nurse.

Then a dude who's tip of index finger was bitten off by his partner. She had stabbed him a couple of weeks previously, and I guess he must've retaliated, because she's actually in hospital as well after being beaten up, and he was seen walking around the ward this morning with blood EtOH of 0.1. Anyway, too little flap left for an effective stump for the distal phalanx, so we took it off. Got to give my first ring block for the finger, and sutured the rest of his finger into a nice little stumpy index finger.

When we got back to ED, there were 2 patients who had already been waiting to be seen for hours. Both had fractures of the hands that needed to be admitted, but we didn't have time to fix either right on the spot. One had punched something and fractured his 5th metacarpal bone, which was funny cause we'd see another bloke with multiple metacarpal fractures from the same mechanism in a couple of hours time. Lots of locals (Ropivacaine; Naropin), manual reduction and hours later, it's 1AM in ED, my Reg and I sitting in a room talking to a patient who had punched a wall out of frustration. We are both looking forward to going home, have something to eat, and collapse in bed.

I Wiki'd it

Apart from last Thursday where there was no theatre list, I have been in theatre everyday since I started this year. It's both exciting and daunting to be on the table with the surgeon, be it with the Reg or the consultant. Exciting because I'm scrubbing in every time, not that I actually get to do anything other than cutting sutures or holding the hook, but you are an actual assistant to the surgeon rather than standing back and watch over the shoulder. Some surgeries can take a long time, and in these long hours, there are plenty of time for the surgeons to grill you to bits if they are feeling particularly nasty. Luckily, I haven't had that this year. Anyway, the point is, I am finding myself having to look up surgical procedures a lot, and as I don't really know many surgical textbooks, this is quite a challenge.

When you find that Wikipedia doesn't answer your questions anymore, it probably indicates that the knowledge you seek is so specific, that it will never have any practical value outside that particular field. Definitely won't help you in trivia at the local pub.

p.s. the surgical nurse was hot, I shall try and chat her up when I'm not covered in blood, infected green tissue slough and bits of fat.

TRAMtastic!

I started 4th year on plastic surgery 4 days ago, it has been a blast! I remember not being able to sleep on Monday night from the excitement and worry about the grueling grillings that the consultants may do to me. But so far the people had been friendly, the two regs I met on the first day are rather indifferent to my presence, but on the third day another reg joined our rank, and she has been nothing but friendly and approachable.

Apart from the early ward rounds, all-day clinic on Thursday, I've been living in the theatre. There were a lot of holding hooks and cutting sutures but eventually, hang around long enough, they throw you a scrap once in a while. I got to cut out a BCC on Tuesday, and today, sutured a belly button.

I got to assist in a free TRAM flap today. TRAM stands for transversus rectus abdominus myocutaneous flap. It means taking the fat and skin of the abdomen to reconstruct a breast for those underwent mastectomy. It is a major operation, took us from 9am to finishing at 6pm with about 30 minutes break in between. It took every bit of concentrations to dissect away layers of skin, fat and muscle, all the while keeping an eye out for the blood vessels as we were trying to harvest them. Then about 2 hours of micro-surgery anastomosing the artery and vein that were about 3mm in diameter with 9/0 sutures that were about 50% thinner than hair. Follow by urning the tummy flab into breast, and lastly stitch everything up.

Being a good boy that I am, I got to suture the new belly button for the patient. She was worried about whether she will still have a belly button yesterday when we saw her pre-op. I will have to ask her how she likes her new belly button when I see her next.

Dumplings, Houses and Marriage

That pretty much summed up my short holiday. Let me explain.

Since my family immigrated to NZ, we have gotten used to being on our own. We have always had a large, closely-knit family back home, with up to 20 relatives meeting up for dinner at my grandparents almost weekly. It was hard to adjust to the change. My mum, brother and I lived together, and dad came as frequently as he could, but medicine is one of those profession where vacation is both fleeting and scarce. With my departure to Aus, and my brother studying in South Island, mum had been on her own. So it became such a luxury to spend time with family, we sat down at the same dinner table for the first time in about a year.

Dad is a passionate self-taught cook and the keeper of family recipes. Besides golf, I spent my time this summer making dumplings. Making dough, hand-rolled with wooden rolling pin into little circular pastry dumpling skins, each dumpling is then made by hand. It is a fortunately complicated production that requires more than 2 people, and it was perfect for us to spend time together. While your hands are occupied, your mouth is freed up.

One of the things I did this summer was spend time with my family.

I met up with a close friend who had recently gotten married, one recently engaged, and another who is in a relationship where the wedding bell is about to toll. Naturally my state of freedom stands out and perhaps, cause of concern, because apart from mum's intention to introduce friends' daughters to me, my friends have joined the cause. It may be an interesting novelty, but these match-making efforts can hardly agree with me.

Just before meeting up with my newly-wed friend, I was reading a classics, The Adventures of Tom Sawyer. I was quite indulged in the world of the childish worry-free ventures. When I met my friend however, we spent the morning talking about buying houses, investing in properties and all these genuine grown-up stuff. Things I have never put too much thought into, but rather, left to worry for the future. It was quite a contrast. Here I am still at school, reading novels, and worry about which cafe I shall try before leaving for Aus again; when he spends his time reading investment books, looking up properties, and worry about providing for his new bride and coming family.

I remember at some point during the breakfast, I took a silent moment to lament over the lost innocence, last I saw him, he was telling me about the new phone that he bought. I am also glad though, that at least some of us are maturing and taking on responsibility.