On Tuesday I had my second day of work experience at the Lister, in a chemotherapy ward with the nurses. The room was small and had 6 armchairs in for the patients to sit whilst their blood was taken or whilst they were in therapy. The atmosphere was calm and the nurses were very friendly and patients we made comfortable with volunteers making cups of tea.
The nurses put the patients' hands in warm water to make the blood vessels come to the surface so they could attach a cannula. The drugs used to be administrated by the chemo nurse using a syringe however recent technologies from the USA has made things easier and reduced any issues with blood pressure. The machine disperses the drugs after giving the patient saline solution and allows the nurse to choose the rate of dispersal. If multiple chemotherapy drugs were being given, saline was used to flush the veins before the next drug was attached. For every drug administrated, there had to be a written record which had to be checked by another nurse. Some patients build up a tolerance to their medication; the nurses are unable to prescribe any drugs, so a doctor would have to be seen if the patient requires a higher dose. Also if the patient's weight changes, the dose will have to be altered to suit their new size.
I got the chance to go into a pre-chemo session with one of the nurses; these sessions are for those patients before they have their first treatment. The sessions take place in a quiet room; the nurse goes through all the possible side effects of the treatment and the patient is give the chance to ask any questions or talk about their worries. The nurse explained to me how important it is to have good communication skills as you cannot tell how a patient will react. Some patients get very emotional in the sessions, you must be a good listener to try and help the patient overcome their fears. The nurse also gave the patient a list of precautions, for example; the patient must avoid the sun and he is not allowed to eat cheese, pro-biotic yogurts or take-away rice due to the chance of bacterial infection, as his immune system will be down. The patient then was required to give his written consent and to have an MRSA swab in his nostril and groin, which would be sent to the pathology lab.
From spending my day in the unit I learnt that being in a ward allows lots of patient contact, unlike in the theatre when the patients were unconscious, and how sitting and talking to the patients can make a difference to them especially is they were in for a full day of therapy. A nurse explained to me how important it is as a doctor to have a good relationship with the nurses; if you have lots of patients to tend to in a ward and there are nurses able to take blood tests and administrate medication then they can co-operate and you can work as a team. Alike in the operating theatre, hygiene and the organised disposal of used equipment was maintained throughout the ward.
Saturday, 15 May 2010
Tuesday, 11 May 2010
Work Experience- Plastic Surgery
On Monday I got the privilege of observing some reconstructive plastic surgery on my work experience placement at the Lister Hospital.
I had to wear surgery blues, 'crocs' and a hat scraping all of my hair back. The first operation I saw was only an hour long; an elderly man was having a skin graft on his scalp after suffering from skin cancer. I found this of particular interest as after suffering from 3rd degree burns as a young child, I also had a skin graft. The procedure is the most minor operation that the plastic surgeons conduct and took place whilst the patient was still conscious. The consultant shaved a thin layer of skin from the patient's thigh and put it through a roller, which gave it a mesh structure, and glued it to the scalp before carefully dressing the wound. The mesh increases the surface area of the skin so it can cover more of the affected area, also blood and other fluids can escape through the holes rather than becoming trapped and preventing the skin graft from working.
The nurses and consultants worked together as a unit to ensure that sterile techniques are maintained; this included the correct disposal of used equipment and dressings.
The next operation I observed was breast reconstruction surgery. Previously the middle aged woman had had her cancerous breast removed and tissue from her tummy had been used for reconstruction, however they had made it too large. An advantage of using the patient's own tissue is that the body does not treat it as foreign matter, unlike an implant where there is a risk of rejection. However when an implant is used it gives the breast a more realistic shape; the surgeons found for an older patient the aesthetic appearance is less important.
In theatre the consultants gave the patient liposuction to reduce the size of the reconstructed breast and removed her 'dog ears' using a tool which had an electric current running through it; this is used to cut through tissue but also to fuse blood vessels together to minimise blood loss. They then later constructed a nipple by carefully sewing the tissue together tightly. This part of the procedure took lots of concentration, measuring and intricate precision; it was the most time consuming part. The longest procedure that the surgeon had ever performed was a hand reconstruction which required a microscope to join tiny hair-like blood vessels together.
A second breast cancer patient was brought into the theatre for a 5 hour operation. The plastic surgeons were going to remove her cancerous breast and reconstruct her one from the tissue on her back, they were also going to give her implants in both breasts. The patient was only 30 years of age and had concerns over the appearance of her body after surgery. Part way through the procedure after the breast had been removed and the silicone implant had been inserted in the healthy breast, the patient needed to be repositioned. It took 8 members of the team to safely turn her on her side, without the risk of neck damage, so the back tissue could be removed. My work experience placement was only until 4pm and the operation wasn't going to finish until 7pm so I did not see the whole of the procedure.
It became obvious that the surgeons had good relationships between each other and had a good social group who spent time together outside the theatre too. Throughout the operations, the consultants, doctors and nurses worked as a team; monitoring heart rates, consulting other doctors on surgical decisions, counting used equipment and filling out paper work. Without co-operation the theatre would fall apart and standards would drop. Although they appeared professional, there were also signs that the members of the NHS were enjoying their work, chatting and listening to music whilst conducting surgery!
I had to wear surgery blues, 'crocs' and a hat scraping all of my hair back. The first operation I saw was only an hour long; an elderly man was having a skin graft on his scalp after suffering from skin cancer. I found this of particular interest as after suffering from 3rd degree burns as a young child, I also had a skin graft. The procedure is the most minor operation that the plastic surgeons conduct and took place whilst the patient was still conscious. The consultant shaved a thin layer of skin from the patient's thigh and put it through a roller, which gave it a mesh structure, and glued it to the scalp before carefully dressing the wound. The mesh increases the surface area of the skin so it can cover more of the affected area, also blood and other fluids can escape through the holes rather than becoming trapped and preventing the skin graft from working.
The nurses and consultants worked together as a unit to ensure that sterile techniques are maintained; this included the correct disposal of used equipment and dressings.
The next operation I observed was breast reconstruction surgery. Previously the middle aged woman had had her cancerous breast removed and tissue from her tummy had been used for reconstruction, however they had made it too large. An advantage of using the patient's own tissue is that the body does not treat it as foreign matter, unlike an implant where there is a risk of rejection. However when an implant is used it gives the breast a more realistic shape; the surgeons found for an older patient the aesthetic appearance is less important.
In theatre the consultants gave the patient liposuction to reduce the size of the reconstructed breast and removed her 'dog ears' using a tool which had an electric current running through it; this is used to cut through tissue but also to fuse blood vessels together to minimise blood loss. They then later constructed a nipple by carefully sewing the tissue together tightly. This part of the procedure took lots of concentration, measuring and intricate precision; it was the most time consuming part. The longest procedure that the surgeon had ever performed was a hand reconstruction which required a microscope to join tiny hair-like blood vessels together.
A second breast cancer patient was brought into the theatre for a 5 hour operation. The plastic surgeons were going to remove her cancerous breast and reconstruct her one from the tissue on her back, they were also going to give her implants in both breasts. The patient was only 30 years of age and had concerns over the appearance of her body after surgery. Part way through the procedure after the breast had been removed and the silicone implant had been inserted in the healthy breast, the patient needed to be repositioned. It took 8 members of the team to safely turn her on her side, without the risk of neck damage, so the back tissue could be removed. My work experience placement was only until 4pm and the operation wasn't going to finish until 7pm so I did not see the whole of the procedure.
It became obvious that the surgeons had good relationships between each other and had a good social group who spent time together outside the theatre too. Throughout the operations, the consultants, doctors and nurses worked as a team; monitoring heart rates, consulting other doctors on surgical decisions, counting used equipment and filling out paper work. Without co-operation the theatre would fall apart and standards would drop. Although they appeared professional, there were also signs that the members of the NHS were enjoying their work, chatting and listening to music whilst conducting surgery!
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