Week 4: Breathing and bleeding

This weeks theme was definitely “sounds”; from the classic “shoOop-dub” of aortic stenosis, to the literal sawing through a patient’s sternum (breastbone) for open heart surgery, sounds are plentiful in heart-lung medicine. This week, however, the most poignant “sound” was the short silence before I volunteered to go first in the simulation training. Turns out taking a year out from medicine has been the best thing I could have done.

This week I was at Royal Papworth Hospital, a wonderful specialist heart and lung centre that was the basis of a recent BBC documentary, Surgeons: At The Edge Of Life. It’s safe to say that much of the daily routine is not quite the showstopper content of a TV programme, but the wonderful staff and amazing medicine that goes on here is undoubtedly worthy of recognition.

Face facts

Day one saw the usual inductions, getting lost eighteen times and also fit testing for masks. The basis behind the test is that a good mask seal will prevent an aerosolised salt solution from entering your mask, which is hooked up to a machine that measures the concentration of this solution. I discovered three things during this:

  1. I am now qualified to use a 3M 9330+ mask
  2. I apparently have a “good, straight Roman nose”
  3. Medicine has now officially tested how well I breathe and how good my face is.

The thick of it

There were two main highlights this week. Firstly, observing an aortic valve replacement was fantastic, especially given the great anaesthetists and the fact I could actually understand the echocardiogram (heart ultrasound) and appreciate how the patient’s blood flow changed from pre- to post-surgery.

Bypass machines are pretty incredible things. You essentially empty and collapse/stop a patient’s heart and lungs, connect the “inflow” and “outflow” pipes of the heart to a machine and use it to pump and oxygenate the blood. Because this is a synthetic machine, you whack in a whopping dose of blood thinners (Heparin) and go to work on the now stopped heart. The patient is alive, but has no blood in their heart, no air movement in their lungs and no pulse.

“You don’t get that in gynaecology” beamed the consultant in our teaching. (Any gynaecologists, feel free to direct me to interesting facts ahead of my obs and gynae placement next year.)

The mannequin challenge

The second highlight was simulation training of advanced life support. The scenario was this man(nequin) was on the ward, groggy and struggling to breathe. This is one of those scenarios you see all the time on medical TV programmes, where the perfectly-jawed protagonist brings the patient back to life by showing his perfectly white teeth and massive Instagram following. Unfortunately, me and my colleagues had to rely on our knowledge.

This was a really great experience, facilitated by two wonderful junior doctors. The scenario started and ended with me, which felt quite good. It turns out (spoiler alert) the patient’s state and slow breathing was due to a hidden fentanyl patch (an opioid), discovered when I suggested we rolled the patient over (the “E” of the advanced life support ABCDE acronym is “exposure”). Even though my performance was far from exemplary, I got that weird sense of accomplishment that comes from getting the “right answer”.

Overall this week was thoroughly enjoyable. As a specialist centre, I got to see some of the more weird and wonderful medical ailments, hear some actual murmurs (and not just nod along to the consultant) and speak to some wonderful patients.

Next week brings a new challenge- Infectious diseases. Let’s see if my Roman nose avoids sniffing up any nasty bugs.

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