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.