London Medical Elective 2021 (II)

london, westminster, county hall, hospital, medicine, students, electives
The lion just opposite Tommy's

Part 2:

i) The wonderfully satisfying number of textbook knowledge but actually in real life

ii) Making the most of this elective

iii) Memorable moments

iv) Final thoughts

The wonderfully satisfying number of textbook knowledge but actually in real life:

It is one thing to learn about it and to do exam questions on these but still strangely satisfying when you see it in person.

  • XRs: bowel distension, bowel obstruction, lateral decubitus free air, ‘football sign’, ‘rigler’s sign’, pneumatosis intestinalis, dextrocardia, intestinal malformation, and more…

  • Syndromes: how can this get anymore textbook? T21 baby + VSD + Hirschsprung + intestinal malrotation + duodenal atresia + all the facies. DiGeorge Syndrome: craniofacial + ENT malformations + cardiac abnormalities + HPV papillomas in the upper airways

  • Presentations: Bilious vomiting! (literally… all over the hallway) and dextrocardia (picked up 9 weeks after birth oh my… had a listen to the heart – hopefully I’ll never miss something like this) Classic appendicitis: Rovsings’ sign, McBurney’s Point…

  • Anatomy: it is always about ‘layers’ in surgery. Especially in paediatric surgery, the children generally have very pristine untouched anatomical structures + are nice and neat to operate on. As I assisted in an open inguinal repair of an inguinal hernia, the layers were strikingly clear (albeit tiny of course in babies!) even the inguinal ligament was the size of…a floss. The view as the assistant was brilliant! Even retraction and cutting the sutures were fun…

And of course, as a specialist children’s hospital, we do get very complex cases. By complex I mean, requiring general surgeons, general paediatricians, paediatric urologists, plastic surgeons, paediatric cardiologists + more… It was a rare case of coarctation of the aorta (picked up antenatally) and anorectal (and genitourinary) malformation (picked up after birth). My goodness! It was a 2 surgeon effort (plus 1 supervising consultant and plus 1 registrar who came in on his off-day just to observe the surgery – a stoma formation to ‘sort and stabilise the baby on the back end before any cardiac surgery was to be undertaken’). Rather notably, this was the surgery where one of my (very valid) question received a very exaggerated eye roll from the consultant! Ha! I mean… I still stand by my question! And another question from the consultant: How to differentiate the sigmoid from the tranverse colon? (My question after that was how to differentiate the descending colon from the sigmoid? (No, this was not the question that elicited the slow motioned eye roll) 😉

london, westminster, county hall, hospital, medicine, students, electives
View from the Evelina operating theatres staff coffee room

Making the most of this elective:

“Have you not heard of Netflix?” one ENT reg asked me today! As entertaining as Netflix is (not going to lie, the content there is pretty good), here are my two cents on making the most of my elective (after the dearth of (rare presentations) clinicals and also foreseeably if I’m not based in London anymore!)

Sometimes there is a lot of waiting around in surgery as one priority surgery supersedes your team’s or another surgery takes longer than expected, or it is just a quiet day (especially since plenty of elective surgeries if not all, have been cancelled) it can be helpful to pop in when the anaesthetists are doing their magic (arterial lines, jugular lines, and cannulas on babies are very much aided by ultrasound) + pain control + (in the case of the coarctation baby, prostaglandin to keep the ductus arteriosus patent).

And sometimes you can evidently see the (Horror? Amusement? Horrified amusement?) in the consultant’s eyes when 3 med students show up on a Monday morning to join the team. And hence, although I was meant to be with gensurg, I decided to join the ENT team (and hurrah, they were happy to have me) + and some random ortho ward round (essentially one post spinal surgery scoliosis patient – spinal surgery is astounding - as one SHO says "the patients come shorter than me, then leaves taller than me!" But on a serious note, lots of rehabilitation, pain, and neuro complications to say the least!) Again, some nifty airway anatomy on the MLB (microlarygngoscopy and bronchoscopy) - never thought I'd be that invested in vocal cords abducting!

Possibly some research or audit opportunities in the near future as well…

Memorable moments:

There are some true gems in the team. And of course, some rather colourful characters as well. All part of the excitement! It was especially brilliantly mind-blowing when the surgeons took the time prior to the surgery to go through the case (past surgeries, past investigations, and the actual upcoming procedure – what anatomy? What steps?) with me. # GOALS for when I am actual somewhat more accomplished in this field. (Throwback to my previous Acute Care placement when again, some excellent guidance + work ethic from the F3s + also somewhat thrown into the deep end by the consultant)

Looks like one of the kids had a great time with daisy-eye snowman

Final thoughts:

If you have made it this far, you may be wondering what are my final thoughts?

1) GP life is still the ‘best’ (arguably) life

2) Paeds training + MRSA exam + even more ridiculous SJT questions regarding an overworked GP and having a piece of cake.

3) Oh dear. Started out decisively wanting to rule out surgery but now this steadfastness has been swayed. And so my preconceived notion that I will never ever need to entertain the thought of a surgical e-logbook has been challenged. But undeniably also how realistic is this? And how is this impacting on my other interests? How is it that there are more questions than answers?

4) A quote from Busted but actually from Einstein: “Life is like riding a bicycle, to keep in balance you must keep moving.” Here’s to that momentum, but also to being courageous and kind to myself and loved ones! Feeling much more 心有平衡. Hoping everyone is as well despite evident or not so evident difficulties – what are the small but certain happiness/things we are grateful for?

P.S. Always have a black ballpoint pen with you. Preferably one you are willing to part with. Eat a good breakfast always.

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