Scalpel's Edge

A surgeon's notes

A Tansen Friday in June

I’m going to try to keep sharing random days, so my first world and non-medical friends can get an idea of what I do all day.

We meet at 7:45 with all the doctors from all departments.  We start with with a Bible reading (currently reading the story of Ruth) and a prayer for one of the hospital departments.  This morning we prayed for the anaesthetists.  Then we hear the handover from the medical/paed and surgical night resident and have the opportunity to discuss the cases.  Today there were no deaths overnight, but we usually discuss those, too.  

After morning report, we do a surgical ward round.  We see the patients in the surgical HDU together.  This morning there were two patients – a 40 year old female day one post hydatid cyst evacuation, and a 79 year old lady who had a laparotomy and small bowel resection two days ago.  Both are doing well.  We split into two surgical teams for the rest of the ward round.  I am in the “Blue” team with one other surgeon and one resident.  The resident has seen all of the patients in pre-round.  We see all the preoperative patients, our own patients and the paediatric burns cases.  “Green” sees the adult burn ward.

After ward round, we normally hit the canteen for chiyya (chai or spiced tea) and have some breakfast.  Nepalis generally eat two meals a day, so they always like to have a plate of food at about 10am.  Its also a time to chat to any doctors who are around as all the various groups (medical, paid, maternity and surgical) usually hit the canteen after rounds.

Friday for me is usually an operating day, and today I shared this task with one of the other Nepali surgeons, Dr Arun.  Patients are booked about a week or two in advance, and we don’t necessarily operate on patients that we ourselves have booked.  We also operate on any emergency cases that have come in overnight, and any caesars required.  Although we had five overnight general surgical admissions, none require surgery.  

2015 05 26 17 07 21

This Friday, I did an:

  • Inguinal hernia (77M)
  • Bilateral submandibular abscess drainage (65F)
  • Breast lump excisional biopsy (39F)
  • Lap cholecystectomy (40F), during which our only working diathermy lead shorted, and I had to do most of the operation with scissors only.  Luckily, the staff were able to find a spliced wire in the back of the supply cabinet to complete the case.  I would have felt sad to convert to open because of equipment availability.
  • Exploration of discharging hip wound under ketamine, which looks like an old haematoma or abscess that broke down over the ASIS and discharged spontaneously.  It’s now granulating well.  There’s a big cavity, and I wish we had access to negative pressure dressings, but this should heal well with time.

I think Arun was busier than I was in the second theatre, because he got through a hydrocoele, a nephrolithotomy, a LUSCS/LSCS for foetal distress (baby and mother well) and split skin grafting to a burns patient.  I left at about 4pm when my cases were finished.  One of the orthopaedic surgeons is on call overnight.  If there are any seriously ill general surgical patients we will get called.

Home is two minutes from the operating theatre.  After the kids were in bed, we had a friend over to chat and listen to music and we went to bed about 10pm.  Its still really hot here, so sleep is patchy until thunderstorms arrive in the night..

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