Aug. 23, 2014 First laparotomy and overnight ORs

I was really looking forward to this past week for a number of reasons.  First, my girlfriend (who lives in a different city now) is here visiting.  We actually “couples matched” during the residency application process but seeing as we are in different cities that did not work out as planned.  More on that in another post.  Secondly, I spent two days in an outpatient surgical clinic which meant I helped a staff with minor procedures instead of running around the ward doing consults.  Finally, since I was on call Thursday I was allowed to leave a little earlier Friday which means long weekend!

Call shift on Thursday was a bit crazy.  We had two ruptured abdominal aortic aneurysms (AAAs) in one night.  I’ve never seen the OR so frantic before.  There must have been 15 people in there: surgeons, anesthesiologist, nurses, x-ray technicians, medical students, etc.  I would call it controlled chaos.  Lots of yelling, but still organized closed loop communication.  The adrenaline was flowing.

We repaired the first AAA using an endovascular technique, which meant no large incisions.  Unfortunately, the patient was bleeding into his abdomen from the rupture so as the procedure went on his abdomen began to balloon.  We were worried he would develop abdominal compartment syndrome (too much intra-abdominal pressure) so we decided to cut his abdomen open and apply a vacuum dressing.  Essentially he would leave the OR with his abdomen wide open, with a saran wrap-like dressing over top.  Not ideal for the patient, but it was a good experience for me.  The surgeon asked me to come open the abdomen.  I used a scalpel to make a 10 inch midline incision, and then a cautery blade to burn all the bleeders and cut down through all the layers until bowel.  I’ve never been allowed to do the whole thing before.  I can only think of one other occasion where I did the skin.  So, this was a major rush!

We finished the first AAA around 9pm.  I had a couple hours to deal with ward stuff and an hour to sleep.  Then the next AAA came to the hospital and by the time we saw the patient in emerg and got him ready for surgery it was 4am.  We ended up finishing that OR at 9am.  I didn’t get to do as much in the second OR but I really didn’t mind because honestly I was just fighting to stay awake!

All in all, long call shift but I got to do my first laparotomy which definitely made it worth it!

 

NB:  All of the pictures in this blog are publicly available on Google and have nothing to do with me or the patients I see.  I add them for interest sake.