DEAR DIARY, I’M NOW DOING REAL DOCTOR STUFF – LIKE SEEING PATIENTS & SCRUBBING IN FOR SURGERIES

A quick rundown of my first month in clinical class of med school.

Dec 8, 2024.

I resumed back to school after an incredibly short break. For someone who had not gone home for the last three years, I told myself I’d spend nothing less than eight weeks with my family and friends. Hmm, I only spent two weeks. The surgery posting list and schedule were released a week into the 3-week break and once my family learnt about my resumption, they were the ones literally dragging my bag back to the bus stop. My Grandpa’s reason was “he can’t be paying tuition with others learning and I at home sleeping”. My Grandma wanted me to stay longer but she finally agreed with my Grandpa and was literally in tears when I was about to leave again. “To ba ma padawa sinu ile yii, oti ma di doctor. Won o kuku ni fi’oku e ranse si mi. Alaye lo fi sile n’ile, alaye naa lo ma pada wa ba”. I hate goodbyes, I seriously do. Nonetheless, guess who is back to school doing real doctor stuff?

A senior colleague once told me that there are distinct days a medical student is extremely happy: the day he gains admission to study medicine – finally, the dream is coming to life; the day he resumes into the university – c’mon everyone is happy on this day; the first day of preclinicals – the euphoria of being done with pre-med, wearing labcoats and cutting into dead bodies and studying big textbooks; the first day of clinicals – the joy of finally seeing real patients and getting into theatres and patient’s family calling you doctors and actually diagnosing conditions; the day you see the result of your last exam as a medical student – well, this one is self-explanatory.

Dec 9, 2024.

The schedule says class starts by 8AM till 9:30AM. Then rounds starts. The time is 7:40AM and I am yet to take my bath. In all fairness, this one is not my fault. I got to Sokoto around 7PM on Sunday and I was too exhausted to prepare for the next day. I woke up late, took a hurried cold bath despite the harmattan, and just threw any cloth I could find on. I couldn’t find one of my new beanies so I wore an old one. I couldn’t find my ties and the shoe I liked was unpolished. Basically, again, I looked like someone thrown into clothes and dragged to the hospital.

The class was an introductory one. Sweet and nice. I like the consultant who took it. He looked so young, accomplished, so “I am not the kind of teacher who’d stress you” like. Later on, I learnt he is the head of his unit and I just knew it – this is the kind of doctor I’d want to be if at all I practice. To make things nice, I found out it was his unit I was posted to. Hmm, is that a sign from heavens?

I got to cardiothoracic surgery unit for rounds and we met another consultant who is also very nice. Haa. They are really breeding all the good ones in cardio. I was selected as the unit rep. the conso talked about dress code and he gave us the rundowns of dos and don’ts. Our classes were from Mon – Sat but rounds were daily. What that meant is that I’d be spending literally every day of my life for the next few years inside the hospital.

Mondays were consultant rounds in which the conso lead everyone as we go check up on all the patients, assess their treatments, and other conso stuff. Tuesdays were clinic days so we only stayed in the clinic to see outpatients – these are people whose conditions don’t need immediate admission into the hospital such as patients that have been treated before or new patients. Wednesdays were general rounds. Thursdays were theatre days which is the only day we get to cut except if it is an emergency surgery which can happen on any day. Fridays were senior registrar rounds. Saturdays were registrar rounds. Sundays were house officer rounds.

I like rounds. I get to learn a lot during rounds. On Monday alone, I saw 9 cases. A 30-day old baby with necrotizing fasciitis in the NICU (neonatal intensive care unit). The condition was caused by a group of flesh-eating bacteria and depending on the location and severity, it is a fatal condition. To think that babies do not have strong immune system in the first place, it was a long shot to recovery. I saw patients with gunshot wounds (GSW) admitted to the trauma center, an old man presented with Beck’s triad. Another with empyema thoracis, a young lady with lung cancer, two babies with pleural effusion, an adolescent with difficulty in swallowing.

Dec 10, 2024

Clinic day. Nothing spectacular happened. There were about 27 outpatients that day but because they were not new cases, it was a bit difficult to catch up. The consultant looks at new scans or requests for one; titrate their medication; offer advice and dictate notes for the house officer. He also asks the medical students random questions but mostly about the case on ground. For example when a young mother brought her son for check-up, the consultant after attending to her asked the students about fetal circulation. It turned out the young boy had Tetralogy of Fallot.

Dec 12, 2024

First surgery. It was a vascular exploration and repair on a popliteal aneurysm. Like all exploratory surgeries, it was a case of wandering into the unknown. One thing I love about Cardiothoracic surgery is that we have our own complete suite. Everything related to cardio is within a particular building so we don’t have to be running from pillar to post. The ICU, the theatres, cath lab, cardio ward, anything you could think of are all there.

I got to the suite around 10AM, the surgery did not start until 11AM. We met the chief anaesthesiologist who is a professor. One of our consultants and senior registrars were the surgeons. There were two other anaesthesiologists in the room of different ranks. Two registrars, a scrub nurse, perioperative nurse, and a circulator nurse were around. Then the house officer and the medical students too.

The first hour of the surgery was very scary because the patient was losing blood. Despite the impeccable composure of the surgeons, everyone in the room knew something was going on. Despite the air conditioning, the surgeons and those surrounding the surgical site were sweating buckets. I watched with my heart in my mouth. Of course, transfusion started and within the first two hours, the patient had taken four bags. I was told to call the house officer to bring four more bags and a cross match from the hospital blood bank.

After the first three hours, it pretty much seems like everything was under control. One of the anaesthesiologists started talking to the students, giving us lessons on surgery and telling us what each equipment does. He told us how they keep the patient sedated and asleep, how to clerk patient for surgery, textbook recommendations, monitoring vital signs, etc. the patient was a GSW victim who encountered bandits a couple of weeks prior in Zamfara state and was shot in the back of knee. This was not the first surgery as the bullet had been removed at a general hospital. He was admitted on account of his presenting complaints post initial surgery, a classmate clerked the patient a day prior to his surgery here.

When it was almost 5PM, we were allowed to leave the theatre. The surgery most likely extended for another one hour or so because they were almost rounding up when we left.

Dec 14, 2024

As the unit rep, it was my duty to assign patients to all my classmates in the unit which I did. I did a short clerking a day before which I completed on this day. It was an interactive session between the patient and I. he told me a lot, which I noted then used to form my summary. I presented my clerking on Monday to the consultants.

I attended a presentation a day earlier after the rounds and the senior registrar was kind enough and taught well. Within the weeks I spent in Cardio, I witnessed a couple of surgeries – a PDA ligation on a 14 month old baby, three gunshot-related surgeries, an artero-venous fistula repair, a gastric pull up, a couple of chest tube insertions and removals, and the one I described above.

Apart from the surgeries, I loved that cardiothoracic surgeries were broad, the surgeons were extremely good at their job of operating and teaching, and the whole unit just had this “soft-life” aura. When my classmates in other units complain of slight maltreatments like having to stand all through during clinic days, we in cardio used to sit down. We in cardio were allowed to assist in surgeries, those in other units were not even allowed close to the surgical field. Our conso gave us the permission to leave once it is 1PM even if the rounds are not over, in other unit they stayed until the end.

I loved it in cardio. The doctors were super nice and encouraging; they do not punish students; even when they told us to read up on something and not everyone did, they did not berate us unfairly. Yes, surgery posting was exhausting but damn, I enjoyed every part of it.