Burn Ward

The burn ward came and went. The whole week was so fast and incredible that it felt like longer; you know that kind of time where so much is jam-packed that the morning seems as if it were the entire day yesterday (until you think about it).

I have to say the most amazing part of it seems to be how elite the doctors there were: they do everything. There's all the spectra of care all in one section of the hospital all for burns. In increasing intensity, they have a clinic, an inpatient ward, an ICU and an operating room all staffed by the same team of doctors who take care of it all. I get the feeling that this is way higher than most specialties but I've yet to be able to compare it to anything so for now I'll say that it was impressive to see doctors who were putting IV lines like any nurse, a few minutes later were harvesting skin and implanting it like the most advanced burn clinics in the world.

It was an honour to see people who were excellent do their thing.

Even if the head was a bit. . . .strident. He's well-known to be heavy-worded but fair. He definitely knows what needs to be done but is also fairly condescending when dealing with newer people: he will call you out (and talk you down) when you do something without him asking you to but he will also call you slow if you're not doing anything at all or take no initiative.

I took what I could from the experience and that was A LOT. I learned so much from physiology of burns to care and treatment to management. He really was a pro (as was the whole team) in spite of his attitude.

I was able to see some pretty insane cases too - one involved a girl of 2-something years who had her boyfriend not like something she did - so he set a blanket on fire (by putting gas or something on it? Unclear exactly how) and threw it on her. She was severely burned to 47% of her body (50%+ means you are not likely to survive) and lost all her fingers. She couldn't blink because her eyelids had scarred to the point where they were contracted and barely moveable. She had no lips. It was tragic and I was glad to be able to help her, even in a minimal capacity.

The learning goes on. Would I like to work in a burn ward? Probably. We'll have to see. The funny thing is, I did more surgery in one week at a burn ward than a whole month at that hospital I have a lot of spite for that I did my rotation in.

Came back from surgery today and was awestruck at how some people can make up stories and completely throw off others' perceptions.


We always said: the source of the info is just as important as the info itself.

When it comes to doing a bypass, which is like making an extra road around a vein or artery in the heart that has been blocked by something, you need to bring a vein from somewhere else - a vein that won't be missed.

That's the popliteal vein, and it runs from your groin down to the inside of your ankle.  The funny thing is, there's so many more veins in your leg that can take up the slack that if we remove this vein, your leg won't miss it. 

So we remove it and use it to make a bypass - removing it in English is called "harvesting" which really makes me think of a guy in coveralls with straw in his mouth; no such luck in Spanish, as the nurses and the doctors made fun of me for trying to do a direct translation ("cosechar").

Anyways, our anatomy teacher who happened to be a plastic surgeon mentioned how he was deciding exactly what kind of surgeon he would be and really thought he would like the vascular side of the house.  He did a shadow with one, and described in gory detail how he saw this other doctor make two incisions, one at the top of the leg and one at the bottom, cut the popliteal vein at both incisions, put his leg up to prop himself, and then pull hard to tear the vein right out of the patient's leg!!  You can imagine how we squirmed, and he basically said "and that's when I went into plastics."

Today I assisted in the harvesting of a popliteal vein in a 35 year old man who needed a quadruple bypass and let me tell you - it is the most intricate, detail-oriented surgery I've seen yet.  I helped put tiny staples (about 1/3 normal size) in all the branches of the vein and it took us about 2-3 hours of ensuring the vein was not leaky, was sealed by us, and that the patient was not bleeding at any moment in time. 

Then the doctor I was assisting helped the main cardiac surgeon to do the bypass - and that took another 3-4 hours.  All in all we were there for about 8 hours.  We were all so careful (and I was so happy and glad to be able to partake in such an amazing operation) that the total blood loss, in 8 hours, was about 300-400 mL.

Think about that.

And shame on that anatomy professor - how could you just rip one of the longest veins out of a patient with brute force and NOT have the patient bleed to shock or death?

The source is just as important as the info.