Surgical Notes on a Sunday Night
The time is twenty-one minutes past eleven on Sunday, 12 October.
I had aimed to post once a week but unfortunately failed to accomplish that. I was submerged, in a truly Herculean amount of work in preparation for my surgery end of block examination. I think having got through the general surgical conditions of upper and lower gastrointestinal tract tract, and then the hepatobiliary and pancreatic disease, only to realise that the breast, endocrine organs, skin and soft tissue, neurosurgical disease, trauma and vascular pathology still needed dealing with was at least somewhat akin to the battle with the Hydra.
The test itself didn't go as well as I'd hoped, but we get a second opportunity and only the highest mark is counted so I'll definitely be making use of that "free hit." I'll have to focus on vascular surgery in a lot more detail; surprisingly, it was very heavily weighted.
An Antidote of Movement
Without doing anything particularly novel; this was one of the better weekends I have had in a while.
On Saturday morning, I ran 20 kilometres from Mouille Point to Camps Bay and back with two friends, which was magnificent. The body felt surprisingly good which is reassuring with the Cape Town Marathon coming up next weekend (after a training block that has been nothing to write home about). The run was followed by a cold plunge at Saunders; a refreshing 11 degrees Celsius. We countered the cold immediately afterward with a pilgrimage to the Oranjezicht Market for my standard Harvey Specter sandwich from the Bacon and Brie stall.
This morning involved some serious climbing. Cycled up Kloof Neck Road for the first time and continued up the Tafelberg Road to the foot of Table Mountain. The descent into Camps Bay was pretty sketchy with far too many buses and recklessly driving taxis, in really windy conditions which hadn't been in the weather forecast. A coffee and croissant in Hout Bay settled the nerves before the pedal home.
The Colorectal Reality
The clinical time in the last two weeks on general surgery was a valuable experience. Upon walking in to the acute care surgery ward F1 one is often confronted by 30 or 40 patients in beds, with another 20 lining the corridor on stretchers. The sensory details are unavoidable. If you are not first met by the sound of patients with renal colic groaning in agony, it will only be second or two before your olfactory system is shocked with the pungent smell of pus and blood, or the rather more noxious odour of stoma bags.
I suppose if there is one thing that was well reinforced during my two weeks working on the colorectal firm, it's this:
If you think there's a remote chance that you ought to do a rectal examination, do a rectal examination.
Perhaps I am biased because the subset of patients that presents to Tygerberg's colorectal department probably already have significantly advanced disease that can often easily be felt on digital rectal examination (it's quite obvious), but even so, it is very likely that someone can have an obviously palpable rectal cancer and just not get a diagnosis, because no one bothers to examine him (or her).
My Final Lap and A Personal Promise
Tomorrow, I start my final rotation in medical school: Orthopaedics. I'm looking forward to it, even though I've had next to no previous clinical exposure in the discipline. Of course, this runs alongside studying surgery and prepping for the big exams in urology and ophthalmology in four weeks time. So I'll certainly be busy.
On a less academic note, I played the guitar again two days ago for the first time in several months. I’ve long since lost the calluses on my left hand, so it was painful. But I realised how much satisfaction I get when I can play something that sounds remotely like the original song, which, admittedly, is quite a low bar. I really need to make an effort to play more instead of wasting time on blitz chess.
I’m also slowly making progress on a case report I’ve been neglecting and have just started Yuval Noah Harari’s new book, Nexus. Perhaps it's not that new anymore, I can't remember when it came out.
That's all for my (bi)weekly account of stress and solace. I’ll keep you updated on the world of orthopaedics and the status of my guitar-playing fingers.