Surgery Internship 101

Internship 101

I began my day anxiously wondering how will i cope in the department. I  had met the HOD previous day to report me joining into the surgery department. I was late 1 week from schedule due to self declared holiday. That week i thought i should spend my days with my baby sisters whom were in high school. Well, more of slept more-quality timeless-holiday. All because, i spent ALL my money during RAYA. By the end of first of raya, i am pennyless and helpless against my family needs and desires. No more shopping spree or going for a short break holiday at any beach or hotel etc... This time, i went only to my grandparents house in Puchong,Selangor and Pontian,Johor. If not because of our tradition of going convoys to relatives houses, i didn't even get a chance to spend my holiday going away from Segamat. 

Today, i got the money and yes, i have the mood to update the blog after so long." I need to plan my money properly." A resolution i made every time i received the money. 

Surgery Internship 101

My first day in surgery wasn't that bad. Just like a sponge, i had to absorb everything at once. It was splendid because we get to go home early after finishing our work. WORK!!! Finally, i'm a worker in society. I am no longer a full time student of exam but rather full time student of medicine, i hope. Everything was blurry at first but things began to take shape and form once you do it repeatedly. 

Today was my second day. I ran almost all the time. Yesterday, sir taught me about dressing and doing wound debridement of diabetic foot ulcer using different method step by step:

1.  Prepare all items needed,making sure everything is kept sterile. 
2. Use unsterilised glove and take savlon and pour it over the wound. Immerse cotton swab into savlon in cup and scrub the wound and surrounding area like washing with soap.
3.  Add savlon with hydrogen peroxide in 3;2 ratio.Clean the wound properly. Finish with saline.
4. Use sterilised gloves.Curette the wound. Remove all slough untill the wound surface became concave and all granulation tissue appearing like cauliflower growth is removed.The wound be filled with oozing blood and blood clots upon curretage. ( Do keep a change of clothes for this matter!Its blood splattering all over!!! Remember remove your pretty watch too! o_0)
5. . Immerse cotton swab into betadine with hydrogen peroxide and apply generously to wound.The wound should appear pink or red with healthy granulation tissue on its  concave surface.
6. Next, immerse cotton swab into betadine ,squeeze it thoroughly so that it wont stain the dressing in the outer layer.Keep the swab properly into the wound and add another white cotton swab over it to prevent soaking. 
7. Take a roll gauze and big cotton pad to cover the wound properly.
8. Tape the ends of bandage with micronized  pore cellotape. 

On the next patient, we learn to install a cost effective VAC unit to large foot ulcer in a diabetic patiet. The vacuum unit is kept for 3 days and by using this method and appliances, the total cost is reduced from staggering Rs5000 to only rs400 for ensuring the wound healing.This VAC unit helps to remove the dead tissues and pus from the wound for three days without a change of dressing. I wished we had some kind of hydraulic machine to hold the patient foot so both of us, the patient wont get leg cramp from lifting his leg far too long and the doctors in charge wont get back pain from supporting the leg and bending over the bed. Fuhh! 

Yesterday we went back by 1.30pm. Today, 3pm. If everyday like this, i should think of another hobby to fill up my empty day in the evening. Or, shall i driving lessons? Maybe i will. 

Pray for me. Wish me to be better in life and hereafter. 

Lesson of the day:

• Arrange your priorities
• Check your work.
• Consult and ask if in doubt.
• Smile even if tired.
• Focus to seniors/staffs instructions
• Know when to say no .
• Do discharge previous day, so you can give it to staff for corrections.
• Again, always check your work with co intern and staffs.

Future me, be strong! Don't loose faith and hope!!! 

Surgery Note

Hernia 

• Herniotomy 
• Herniorhaphy-approximate the inferior border inguinal ligament 
• Hernioplasty 
• Incisional hernia  
• Children inguinal hernia-rx:herniotomy, coz no post wall 
• Must know-anatomy of inguinal ligament. 
• Pure tissue repair 
• Mesh,sutures used 

Varicose vein  

• Tests 
• Hemorrhage  
• Complications  
• Investigation 
• Treatments 

Carcinoma of stomach 

• 
  

Appendicitis 

• Left iliac fossa pain radiating to right aggravated on hip flexion n adduction 

Gall Bladder palpable  

• Troisiers law, in jundiced pt, any palpable gallbladder is not due to stones. 

Jaundice  

• Obstructive jaundice 
• Achylorius jaundice 
• Typhoid Mary : enteric fever 
• Back pressure 
• Surgical jaundice 
• Congenital hyperbilirubinemia 
• Splenectomy 
• ERCP 
• Charcot's Law:  
•  itching 
• Parts of CHD : supra,retro.inferior,intra 

Umbilical hernia 

• Infant: no surgery,self limiting 
• Linea alba,  
• Vertical vs transverse incision  
• Induce hernia, child n adult. Cough n cry baby 

Colon 

• Choletectomy 
• Choletotomy 
• Valvulos colon 
• Haustra 
• Sigmoid colon,maize 
• Congenital mega colon 
• Hiershsprung disease,ganglia... 

Epigastric Hernia 

• Many multiple defect 
• Weakness over the fascia 
• Linea alba is further defect 
• Mesh sutured around,the defect 
• Below or above the umbilicus 
• Paraumbilical vs umbilical hernia 

Just take it

Kalau dah kena marah masa kelas, just take it.

Bear it for the moment.

Widened your eyes,
Wrinkled your forehead,
Tightened your lips,
Look your teacher into their eyes
Then,nod to whatever they say.

Next time,

Be honest.

Just say,

"I don't know, sir."

"Sir,no idea."

Or you just geleng kepala.

This is what Kak Tasya called, ILMU TAK TAHU.

Don't dig your own grave.

Think carefully before saying anything.

Say sorry if you've spouted the wrong terminology.

 

Surgery 9th term: Bedside class

Today we have a class with Dr. RCP who is an excellent physician. So,they say. He has this chubby happy grandpa look-a-alike.

"You are terrific but sometimes terrible."

Sigh.

 "You read,but you don't read carefully."

Was what has been said by THE Dr AK. He was realy popular among students. I even got a lovely smack on my head with a roll of A4 paper.

Today, as i was standing beside Dr RCP, my mouth just keep spouting answers and he HAD TO STOP ME and remind me to give others the chance to answer.He was also like AK. He gave me a proper smack with his fist on my shoulder.

I think old people tend to do that. They can't help themselves. Its instinct and in nature of a parent as well as a teacher. They just care about us. At least someone do care teaching us something. Guide us where we should read. Or at least  to have an idea of what to read.

They know what we dont know and what we know. We know that they know what we dont know. Lalalala~~~


Finally,i can understand the pathogenesis of cholecystitis gall bladder and hepatomegaly.
He even taught how beautiful JAUNDICE development in many case scenario.

So, buckled up dear self.
That was your First class with him.

p/s: Dont be tempted to bunk anymore class. Even with finals exam are nearing,please spend 5 high quality hours daily on clinicals is far much better than studying alone in your room and not understanding anything.

Surgery 9th term: OPD day

It's raining heavily last night.

All my targeted topics to be read hadn't been accomplished due to a huge compulsion to sleep on the bed. I was getting rest for 10minutes and fortunately my housemate woke me up at 4am telling me
to switch off the lights. The inverter wont be able to supply enough energy to illuminate the room as she has an upcoming university BDS exam today. Luckily,i managed to finish few topics before going to sahur and Subuh prayer.

We were supposed to have OPD(Out Patient Department) today. In Malaysia it would be the clinics in the government hospital or maybe there were some like these in private hospitals.Nah,I've never been to one. So,i didn't know how private hospitals works.

It seemed that no one is willing to come outside today. Hence,we the medical students were left jobless in the demonstration room. With no one to supervise and teach some surgical knowledge, here i am updating this junk blog.

My two other unitmate was deeply immersed with Greys Anatomy season 7 on tablet. The other tried to find some kind of job or things to read.

Finally,
The one and only Dr in charge,with the minions male and female PGs and two junior interns joined him in the OPD and we final year medical student finally have something to observe from the side.

I can't forget the disappointed -hopeless face when we couldn't get the answers right. Plus, he was looking at me in the eyes.Me, the one and only Malaysian and a foreigner in the batch. I supposed he had a high expectation of me. Sigh....

I need to prove them that we somehow worthy to be here and its worthwhile to spend some time teaching us. Before he can teach us something, i need to read first.

Although,i am hugely tempted of bunking the posting for the sake of university exam which will be around the corner, i need the set my priority straight. Its not about prioritizing the schedule. Instead,its scheduling the priorities you had in you life.

As for me, 8-1pm daily is reserved for final year subjects. The rest of the day, i just have to utilise each second optimumly for my carried paper subjects.

Rabbuna Yusahhil.


Do pray for my istiqamah in studies.

Amin...
 

Surgery 101

Today we had an incisional hernia surgery observation. Most of us 9th term-ers, were excited and focused on the surgery.

Dr Rohan seemed to be immersed in teaching the new PG who recently won the seat for surgery post graduate. He seemed composed and silent. Not the bullying type of staff,hopefully.

Tonight,it rained again as usual and i had to go to OT as soon as finish drying my clothes on the rack and went off while hoping it wont be raining.

I have lots of things to read and endless topics to by heart. Not to mention about the hypochondrium pain I'm having since yesterday. I am so lazy to go and consult the doctor for this while we recently finished the gall bladder topic. It was just the cholecystitis(inflammation of the gall bladder).I know I'm intolerant to oily meals and never knew that one piece of fish fillet would make me suffer so much pain. I need to get my self together and bear the pain. Painkillers wont work for me and i have been feeling that anti-spasmodic drugs would make me hypotensive instead of relief of pain.

Had to go study now. Tata...