Surgery

I’ve started my internship from the Surgery periphery departments. So far I’ve done two weeks of casualty, one week of pediatrics surgery, one week of ENT, one of ophthalmology, two of orthopedics, one of anesthesia , one neurosurgery and finally my optional ward was urology (which I chose over radiology).
Next week I start my two months of general surgery. Some departments have been exciting and tough to say the least. Orthopedics was physically demanding. Neurosurgery was a lot to take in, what with people dying as soon as they were brought in. Pediatrics, really tough cause we didn’t want to take chances with those small kids.

Surgery was never my strong subject. I am more comfortable with internal medicine. I can get by in obstetrics and gynecology. We wanted to start our internship with gynecology but they didn’t have any placements so we started smack dab in the middle of the toughest wards of surgery. We hit the ground running and learned as we went along.

I did one week of ENT. Ear, nose and throat. It was a quiet ward. The morning round was easy. We didn’t have to do follow ups to any of the patients. Six days went by quickly without incident. I didn’t learn much.I was learning the important bits of surgery and I didn’t really spend time with ear, nose and throat that much. I knew something about tonsils enlargement, tracheotomy, some basic ear conditions. That was pretty much it. My final day in ENT I got night duty. I was planning to take Friday off and relax. The duty was unexpected. I wasn’t really worried though. ENT has been slow and boring the whole week. What possibly could happen one single night, right? I figured I’d sleep my duty off in the intern room.

I arrived at 10 pm for duty. Told the ward attendants that I’d be in the intern room and left. I switched on the TV, tucked the mosquito net in on all the corners of the bed (this is mosquito country central) and lay down. They were showing lord of the rings return of the king on cable. It was getting to my favorite scene too. Where the king draws his sword in the underworld and asks whether they would fight for the king?

A knock. Alrighty then. What possibly can it be. The ward attendant was at the door. He gestured in the direction of a lady standing outside. I didn’t know much Bangla and he didn’t know English. OK. I followed to the mini operating theater. He sat her down and indicated at her throat. He showed he this long bent scissor looking instrument. It seems that the lady has got a fish bone stuck in her throat. I was supposed to take it out. My one week here and this happens to me on the last day??? :s

I’ve never done anything practical in this ward. Sure I’d read about some of the conditions of the patients who were admitted. But this is an outpatient. I’ve never used this instrument. I’ve never even seen it. And I’m supposed to put it into someones throat.
I told the ward boy to do it himself. That I’d watch. These guys practically grew up inside the ward. They knew all the procedures by heart and they had enough practice to do it blindfolded. In fact they showed most interns how to do the procedures. They were not educated or literate though. They didn’t know why they were doing what they do, but they were damn good at doing it.

The ward boy tried many times to remove the offending bone. The lady gagged every time. Finally he gave up. He called the Medical Officer on duty for ENT. The doctor arrived. He tried many times as well. Finally he gave up. They quarreled in Bangla for a while and the lady left in a huff. I asked him what happened. He told me that if that bone was really irritating her she would keep quiet and let him remove it. The fact that she kept gagging and could talk normally and breathe meant that it was a really small bone and it would go away by itself.

Cool. I guessed this was an isolated incident. Back to watching my LOTR. One hour later. I was quietly nodding off. Knock knock
Oook. Come on. How many ENT emergencies could there be in one night??
A lady had something stuck in her ear. Fine.off I went to the mini OT.

I watched the ward boy remove it. It was a bloody end piece of an ear bud. I wrote off some medications and signed her papers. Only a doctor can sign any official document in the hospital. I knew the medications well enough.

Something stuck in the throat, something in the ear , now all I needed was some kid shoving something up his nose then my ENT would be complete :p. it was 12 in the night though. ENT is supposed to be a cool ward!!! I’m sure nothing else would happen tonight.

1 o’clock in the night. Sleepwalking to the mini OT with the ward boy. He removed a moth from a persons ear. IT WAS STILL FLAPPING ITS WINGS AND IT FLEW OFF WHEN IT WAS REMOVED. Come freaking on. Seriously? A moth. Flew into a persons ear. At one clock in the night. On my night duty.

Fine. Fine. I figured I’ll stay awake and watch some TV. I drifted off after some time though.

Three freaking o’clock in the night. Knock knock knock.
An old man. His son was standing next to him. The old guys beard was so long it reached mid chest.
He indicated to his throat. I gathered from his bangla that he was having difficulty swallowing. Dude! You realized that now? at 3 o’clock Friday night?? That you had difficulty swallowing? What were you trying to swallow at 3 am??? Wouldn’t this be a chronic condition? Why didn’t you come in the morning? When you know all the professors and PG doctors and people who gave a frick about ENT surgery were on duty? Huh? Huh? Why? Why?

Ahem. I read his previous medical records. He’s had a thyroid condition before, he was taking meds for it. Ahem. I have to inspect this guys throat. And there was a huge Santa clause like white beard blocking my view.
Hmmm. I clutched the beard in my hand. Lifted the entire thing up until I could see his throat. It was 3 in the night. I was sleepy. I was tired. I made a show of inspecting his thyroid gland for enlargement. I checked his lymph nodes too. Fine. I told the ward boys to admit the guy. The old guys kept talking. I knew enough bangla to make a decent patient history. But not that much to follow rapid bangla. He was asking me whether he would need an operation. Not a good idea at your age dude I thought. I told him to get admitted and we’ll find out during the morning round.

Back to sleep.

I get off duty at 8 in the morning. It was four am. Four hours of sleep. Come on. I had to start a new ward next morning. I had to be fresh.
5 o’clock in the morning. A guy with a bloody face. Blood coming out of his nose. Scarred. He’s been in a fight. I had the ward boys clean him up. Stitched up his cut face. His X ray didn’t show any fractures. Still it was a case for the police. I told the ward boys to keep him till cops show up.

Six o’clock . Road traffic accident. Bloody face. Referred from the neurosurgery department. More stitching while half asleep.

Seven in the morning. I got one hour of sleep. One hour. In the ENT ward. Supposedly the coolest and easiest ward in the surgery peripheral units.
Now you have to ask yourself. How was it in the toughest wards??