Wednesday, 19 November 2014

Miscarriage

Block: Anaesthetics, week 4

(Not sure if this counts as a trigger but uh...if you don't want to read about miscarriages...don't read any further).

It's the middle of the night and I have to be back at the hospital in less than 7 hours, but I can't sleep. I tried and I lay awake in bed for about 30 minutes, but I don't think I'll be able to drop off until I get this off my chest.

Firstly the positives - anaesthetics is so awesome. I've really been enjoying this block so far - it's the perfect mix of practical procedures, applied pharmacology and physiology, and patient contact. You get to do something which makes a massive difference to the patient's experience but you don't have to sit through the grinding dullness of four hour medical/surgical outpatient clinics. Great specialty, great placement, great teaching - seriously, at the moment it's my number 2 specialty choice (after emergency medicine).

I like doing practical procedures - in the anaesthetics room as a med student you can insert cannulas and take part in basic airway management so you can do more than just hang around like a spare part. Until today I'd seen quite a few spinal anaesthetics (where the patient is sedated but not fully knocked out), but today I was excited to see that the list was to include several general anaesthetics. This would finally be a good chance to hopefully get to insert an airway device, which until now I'd only ever done on plastic mannequins.

The first patient came in and was due for knee surgery. I got to have a go at putting in an LMA, but due to the patient's difficult airway I didn't get it in so the anaesthetist put it in instead. Still a decent experience though and at least I got the cannula in on the first attempt.

The second patient was brought in for an "evacuation of retained products of conception" - I read this on the list, but I wasn't fully sure what this procedure was. It was obvious that it was something gynaecology related, but I wasn't sure and I still haven't done my O&G block and I didn't want to ask about something potentially personal or embarrassing in front of the patient...so I made a mental note to look it up later. I figured that since the patient looked generally well and it was a very short operation it probably wasn't that serious. Reading this now, hours later, having looked it up, I can't stop feeling exceptionally naive.

The patient came in and her airway was much easier than the previous guy's. I got the LMA in and I felt pretty good. I observed the operation...from where I was standing, I wasn't really 100% sure what I was observing, and I was also being quizzed by the anaesthetist, but it was all over very quickly and I was riding high on the fact that I'd done a cool practical procedure.

Honestly, I felt pretty damn good whist on placement today. It was only hours later after I left the hospital and looked it up that I realised "evacuation of retained products of conception" is a procedure carried out after a woman has suffered a miscarriage - and I witnessed the whole thing without batting an eyelid, completely oblivious to what was going on. The thought didn't even cross my mind that this might be something related to miscarriage - I was completely and blissfully oblivious.

I don't think being super-sensitive or overly emotional is a particularly good thing for anyone, let alone a doctor. This isn't about being macho by the way since I don't believe in any of that alpha male crap - and I'd be saying the same thing if I were a girl too. Terrible things happen in life and I can't get upset or emotional over all of them, otherwise it would be impossible to function. But when it comes to my work, I want to, for a few moments at least, fully understand the gravity and seriousness of any given situation involving a patient in order to better appreciate what they're going through. As it stands today, I feel like I've watched something quite sad but without fully appreciating it and paying it the necessary respect which it's due - and this is leaving me feeling quite guilty at 3 o'clock in the morning.

Sure, I can sit here and say that it's not my fault (because to be fair, it actually isn't), or I'm just a young guy, what am I supposed to know about miscarriages, I haven't done my O&G block yet, it's not my damn problem anyway, I'm being too neurotic as usual, etc, etc...and I'm not saying that I should have started crying in theatre or whatever...that's definitely not my point...but what I am saying is I wish I'd been completely aware of the whole story behind the procedure. It's perfectly fine for me to be happy about learning a new skill and getting an LMA in...but equally I should have felt sad for a few moments that I was witnessing an "evacuation of retained products of conception". But I didn't, and that leaves me feeling guilty, slightly stupid, and unable to sleep.

But I have to try because in the time it's taken to write this out, there's now less than 6 hours left before I'm due back at the hospital...goodnight.