Amputation

This morning I went to listen to reconstructive surgery lectures.

In the afternoon, I went to watch a destructive surgery.

This morning we learnt of a case where an old lady is suffering from plethora of diseases, which according to our lecturer, will make a good pathological muzeum.

This is a dark joke to some but it is a reality.

If you don't get the joke, don't worry much.

Anyway, when Dr Asqar proposed for us to go into amputation surgery, I just know that I am not ready for it.

I have a rough idea what amputation means and I don't think going to watch one on a short notice is a good idea.

Still, we changed into our scrub and went into the OT.

It's above knee amputation for a 84 y.o. man suffering from Diabetes Mellitus type 2.

Basically, this surgery is done under epidural anesthesia (where you will not feel half down of your body) and some sedation. So, the patient was coughing even when they are scraping his thigh bone.

We were there when they prepare the patient and I couldn't escape from thinking about that man.

I mean, the very man who's lying in front of me, all four limbs attached is going to lose one leg. How must he be feeling right then.

It's very disturbing to me.

I handle other surgeries pretty well ~ I can watch surgeon drills, hammers, sews, punches or cut through skin.

But I know even before it starts, that sawing someone leg or transplanting faces is a bit too much for me.

Thanks Allah for those shoulders that I can embrace, watching the sawing and the bloodsquirts.

Enough with the emotional part.

I hope I won't be visiting any amputation again anytime soon.

The amputation went well. The patient was coughing sometimes that at some times, that causes the blood squirts. The mega blood squirt came last, when they cut through the collateral artery.

Surgeon will ligate the arteries by suturing both walls on the same artery to prevent the suture from slipping down the vessel.

The upper thigh is raised using a long white cloth placed from below the thigh while the surgeon saw through the femur (the thigh bone). They then smoothes the cut just like how you file your nail and stick a wax into the hollow opening on the cut bone.

The amputated leg itself is put into a black plastic and put on the corner. (Imagine having your limb in the same room but not attached on your body)

Draining tube is put under the fascia to drain all the fluid that will accumulate postoperatively and they will clean the wound using peroxide before sewing the two flabs together.

End result looks like an overfilled pillow.

Patient will be given morfin for sometime after the peration to help with the ubearable pain.

Even after recovery from operation, there will be phanthom pain. On what it is, kindly google it up.

Traumatology Operation Room

Has learnt my lesson.

All this while, I've roamed aroun the hospital comfortably in my white coat, student ID and sport shoes. So just you know, the Czech students go around the hospital in white shirt, white pants and student ID wearing socks and sandals.

I think many non Czechs agree with me that socks and sandal aren't in but in Czech it's a normal sight.

So, since I didn't do as the Romans do in Rome, I got to wear socks and plastics. Thanks Allah we changed into our scrubs. Hehehe.

Anyway traumatology operation room is interesting.

The are usually drills, screw driver and racks of screws of different sizes on the scrub tables.

There is always C-arm (the x-ray machine) and lots of blood.

I like the fact that we get adequate access to the x-ray images and about what's going on thanks to the camera and large screen in the OR.

Surgeons are the serious lots and do a lot of standing while anesthesists are the fun ones, sitting and monitoring the patients from the above.

First patient was an old lady with multiple fractures after she fall down.

She has osteoporosis and she broke her arm, both thigh bones and the right shin.

Surgeons operated on both legs.

Osteosynthesis was put into the femur with respect to the osteoporosis.

Still doctor said with her weight and her fractures, she won't be able to get on her two feet and has to be on the wheelchair.

Second patient was a man after bike accident.

He broke his tibia on two places and had multifragmented fracture on his fibula.

Surgeons had to do reduction and put the fibula back precisely on its physiological position so that the foot can function physiologically (means to say the foot can can rotate and distribute the pressure evenly )

Since the was torn ligament, they have to fix the fibula temporarily.

It's because when the ligament heals, there will be micromovements which can interfere with the fibula which hasn't healed completely.

I like it that our surgeon is willing to explain many things eventhough I catch only 70% of those explanation.

Let's face it, I'm a general medicine student and most of the time I have no idea what should I ask.

They did 180 degree x ray imaging on the ankle and all of us evacuate the OR (which means there's only the patient on the operating table in the OR) and watched the imaging procedure went by.

I had good times and I hope I'll experienced much more and gained a lot from my upcoming summer practicals.

Pulling Out Your Organ

Neurosurgery had been so so but when we swapped to a general surgeon, it has been fun with the surgery.

The only downside of general surgery is the filter. It was cramped and dark and I was concerned about my coat and clothes of the day get in smelling like a softlan and get out smelling like the armpit of someone who hasn't bath for a week. And the scrub is rather revealing : knickers, chest and armpit. Not sexy!

Anyway we were supposed to be in Dr Asqar operation room but the TV crews have been responsible for us to be in the next few situations.

First, we were waiting to get in the operation theathre after the patient has been prepared for surgery. But then the ECG came out not normal, which means the operation has to be cancelled and since it will take some time for another patient to be wheeled in and prepared for cholecystectomy (removal of gallbladder), we went into another OR to watch a vascular surgery.

I like it.

First and foremost, I get to see the operation.

Bad luck if you got surgeon with big stature coz u'll always end up seeing his back 90% of the time if you are lucky or seeing nothing except the instruments if you are unlucky.

Anyway, this operation is about dealing with the varicose veins.

The valve in the great saphenous vein has been insufficient.

The plan is to get rid of the varicose and the great saphenous vein.

Varicose vein, if untreated can cause compression to small arteries supplying the leg and will bring about varicose ulcer, pigmentation and ugly/uglier leg.

Basically, u can clearly see the varicose vein the patient is standing but when patient is lying on the back, u can't see it (it's all about the gravity that cause the blood to fill in the vein and making it looking like coils of snakes on your leg).

So, to make sure u can keep track of the varicose vein when the patient is on the table, u shall draw some lines corresponding to the vein position when the patient is standing prior to surgery.

To remove the varicose veins, surgeon will make an incision, put the designated instrument into the now accessible varicose vein, and screw it out.

As for the great saphenous vein, it's a superficial vein of the leg.And as known, the leg i supplied by deep venous system and superficial venous system.

This makes removing the great saphenous vein is possible without costing you your leg.

That's why for bypass surgery, we use this vein. And when we have a patient suffering from varicose vein due to insufficiency of valve of great saphenous vein, we can totally remove this great saphenous vein.

Surgeon will make an incision on inguinal region (it's the groin), clamp the vein, cut them, and tie both ends. Anothe incision is made in the calf slightly below the knee. They gonna pull the vein down through this incision in the calf. After both incisions are done, the surgeon put a wire into the great saphenous vein. The wire looks like this. The lumpy end is situated at the inguinal end and the small one is on the other end, and then zap, they pull it out.

When you pull out this great vein, it will take time for your leg circulation to adjust itself. I mean most of the blood has been travelling out of the leg through this great saphenous vein and now, it's gone. It's either you just suture back the incision you made, which mean you don't even bother to tell the blood that this way is closed already. And since blood doesn't think for itself, it'll just accumulate in the tissue causing hematoma. So as someone who can think for ourselves and for other beings, we must bandaged the whole leg to prevent blood pooling.

Done with the vascular surgery, we once again hung over the corridor, watching another surgery behind the see through door. And we saw the freaking gallbladder and were all excited over it (medical students are hyperexcited to see your organ and we really look forward to anything to do with poking the insides of living human bodies ). The gallbladder looks just like a ballon filled with 30ml of water and the colour composition is just like the inside of your cheek.

I have so many things to write down and let's hope that I remember every detail of the procedure that I had the opportunity to look. And unfortunately I decided to ditch my camera and rely solely on my brain to remember the crucial moments I have seen in the hospital.