Yesterday was the first acute day the surgical team I'm with had since I've started the run. Started at 8am and ended probably close to 11pm the same day. Most of the time was spent in the ED though, in the workup area, where the patients that would end up being under our care would be sent to from the main receiving area (complicated~).

It was pretty confusing at first, since we had no idea what to do. The Jr Reg didn't show up at the ward where he told us to meet up. I ended up floating around a little and finally made my way to the OT where he was doing a laparoscopic appendisectomy (a mouthful, and took me some time to think out the spelling lol). After that then toddled after him into ED where after some time he realised that I needed something to occupy myself with, told me to go take a history off one of the patients.

I can't say I take very good histories. Despite having been told the order and what to cover, I still end up skipping stuff. Simply because... because I get stuck somehow in between. I'm resisting the temptation to take out pens and paper and slowly write and question as I go along. It would certainly help with recall, for I know that when trying to report back I have to stop and think for a loong loooong time for things to come back to me and having notes to prompt me would be immensely helpful (not to make sure that I don't look like an annoying and idiotic fourth year). But writing certainly slows me down a lot, and I don't want to seem like I'm not interested in what the patient has to say by writing while he/she's talking. And I can't write and listen at the same time. And I want to practice my recall skills. What should I do I wonder? So terribly annoying.

More annoying is when a group mate who knows that the patient is assigned to you tries to take the history himself. Good thing M is there to back me up, but considering there's another 8 weeks to go in this run as a group, I might as well let it go I guess. *rolls eyes* Another thing though, with this incident, is that I seem to be rather blur perhaps? I have no idea what's exactly so very funny with my remarks sometimes. But they do make M and the jr reg laugh sometimes. I didn't realise I asked myself questions out loud. I thought I was asking the jr reg. No?? I need to make recordings of myself one day. Lol. But just as well, rather than the whole bunch of us being in ED being solemn scary zombies. And seeing others laugh makes me wanna laugh, which makes us all happy. But yes, zombies. Maybe not the others, but towards the night, after dinner time, I was starting to feel rather zoned out. I just wanted to get back, have this whole acute thing over and sleep.

Another interesting thing during the acute night as well was that I was given the perfect chance to put an IV line in. Yipee! The hs asked if I would want a 'babysitter' and I said no. Right. I so regretted it later. The guy was a pretty fit and in his prime. Rugby player sort of built. Hairy as well. And had pain due to what I later found out was a pilonidal abscess (even after doing a wiki search, I'm still not very satisfied about it. Somehow it makes no sense to me). So with my whole vampy paraphernalia by my side, I made the first poke. I used a green cannular. Curses to the lady who advised me to use that. IT was SERIOUSLY BIG and before I started I whispered to M that it didn't look good. Seriously, it's size freaked me out a little. Ok, maybe not that big, but I was pretty sure my ex-TI had used a smaller one. But it was really hard to insert and even after I thought I was pretty sure I was in, there wasn't any blood. The patient was hurting I could tell from the way his hand trembled a little. Pulled it all out and blood started oozing out. Press it down and on goes the sticky. Embaressed. And feeling dreadfully guilty. Try another time on the back of the hand. Went in. Blood filled the tip a little, so lower it and push further and the filling stopped. Pull needle out. Nothing. Shit. What now? Pull out cannula a bit hoping to pop it back into the vein but obviously the poor guy, had he been really nasty, could just have whacked me on the head. It probably would have made me feel better as well. Get it all out, sticky on, PAGE! PAGE! PAGE THE HS! And the patient was saved from me. Despite the pain I caused him, atop whatever pain he already was suffering from, he was still it's alright don't sweat it to me. And I saw the hs use the smallest, the pink cannular. 22? No idea. But I think it's 2 sizes down. The heck. That woman. Because of her I could have well ended up killing a patient by hurting him to death. T_T I'm still not sure if I want to go back and check up on him considering all that's happened. Not sure if he would want to see me....

But for the first time, the morning ward round took ages to complete. Two hours maybe? Not sure. But long enough. X-ray meeting. Student teaching. Apparently Mr W is one of the few surgeons who actually don't mind teaching us. Though this second session was mostly on what next if the patient gets diagnosed with breast cancer. Then lunch. The endoscopy at the Gastro department. Saw a PEG put in, apparently it's like a feeding tube, straight into the stomach. Gastroscopy. Colonoscopy. (I'll never be one, I can't imagine doing many colonoscopy... don't mind watching, but I don't want to do it myself heh heh). And whatever the last one was called, flexi? It's just the last one I watched, because the last patient on the list could possibly be having some transmittable disease and Dr B practically chased me away. Out of concern of course, though I would have liked watching it. I'm now tasked to follow up two of them and report back to him. Dr B's nice, despite being a bit loud and rather blunt. And loud is good I guess. I wonder if my hearing is going off a little, because I don't seem to hear as well as I think I should. But yes, blunt indeed. I need to talk louder. He made me tell one of the patients that there was nothing abnormal seen during the procedure. The poor guy was old and probably hard of hearing. And I had difficulty raising my voice enough to get it acceptably loud. And one cute little old lady was found to have rather diffuse gastric cancer. At the end of it all, Dr B told me she probably had three months left. Why? How do you tell? Because of her age and her anaemia and how it was diffuse and how she was vomitting blood occasionally. I guess it's reality, but somehow it hurt a little hearing that. I could get over it of course, since I'm not attached to her, but even then, she seemed a nice thing, and she didn't even know about the cancer and 3 months left thing, and ... it's just wrong? At least she didn't seem to be in pain. But this brought the question I had in my mind for a long time back to attention. How on earth does cancer kill someone? Unless it affects something major, the stomach thing could be side-stepped by all sorts of ways though. And how does one determine the max tumour load a person can take? Why 1 kg?

I noticed as well. During the PEG, even though it wasn't anything really horrible, it was a tad disturbing that the procedure which involved puncturing the stomach, the patient wasn't actually konked out the whole while. Just slightly ... sedated? And it takes a bit of getting used to with being able to see his face. Compare it to patients in OT. All I see is a boob, or small bit of stomach. And I know the patient is well under anaesthesia. It does make things a lot less uncomfortable, knowing that they won't feel a thing until later when the anaesthesia and pain killers wear off a little. But to tell the truth, it's quite intersting and fun to watch. Like... discovery channel almost. Almost. Just no animals.