We have completed the so-called comprehensive clinical rotation which included Obstetrics & Gynecology, Ultrasonography, Radiology, Neurology and finally Pediatrics. I have written about the Neurology clinical rotation. There was hardly anything to write about Ultrasonography and radiology because we spent such a short time with them. Pediatrics were the same in that everything seemed ordinary except for a few congenital defect cases that was passed to the surgery department. I’m planning on writing about my obstetrics and gynecology experience.

Surgery

Our group has started the surgical rotations in October 7, 2013. The First three and a half weeks is in the orthopedic department. Traumatology for eight days, Spinal surgery for one week and Joint and Sport medicine for four days. Spinal surgery was by far the most interesting, the teachers genial and welcoming, cases perplexing and the surgical operation techniques unparalleled. Our chief director of the department modestly told us he was the only one who performed such techniques in China and perhaps the world.

Traumatology

I missed the first two days, the Monday was the last day of the Chinese national holiday and on Tuesday, I was busy discharging my roommate from the hospital, where he spent the previous week for a suspected meningitis and other ailments from exhaustion and poor appetite. The first day, we had no surgery. We attended to both preoperative and postoperative patients in the morning rounds. Most came in with fractures due to motor vehicle accident, this is China after all.
We attended to a male patient who had come in with open distal tibia fracture (fracture near the ankle of the leg). He had severed the artery, the foot was infected and the teacher performed distal leg amputation five days ago. Now there was a new infection at the site of amputation. We watched as the attending did irrigation (to do away the infection), débridement and vacuum suction drainage with dressing. The teacher told us antibiotics shouldn’t be used more than three days postoperative according to the hospital regulation, this is due to the problem of over-prescription of antibiotics and the looming danger of antibiotic resistance. We spent the rest of the day with residents changing wound dressings, wound irrigation and wound vacuum suction drainage with dressing.
Second day, one operation. A humeral shaft open fracture . We did an open reduction (correction of fracture) and fixation (fixing and stabilizing fractured bony parts in one position). We didn’t do internal fixation ( fixing fractured bones together with surgical plates and screws) because the wound was small and the risk of infection was high. Third day; Friday, we did morning rounds and a few wound dressing changes.
We attended Saturday at the emergency department for our teachers shift, I was making up for the two days lost. There was little action though, the teacher brushed up our physical and diagnostic examination knowledge. For physical examination, expose the area of complaint and rule out vessel and nerve damage. Start with X-ray and later CT or MRI for definite diagnosis. Due to inactivity, I consulted the teacher with a personal medical problem, he helped me clear a few things up.
For the next week, things couldn’t have been slower. We only had two surgeries, a tibia fracture in which we performed a reduction and internal fixation, and a tibia-patella closed fracture, we did, guess what, an internal fixation. This patient unfortunately had a brain injury. There were other surgeries though, we were regrettably unable to attend them.

Observations

• Some stereotypes about orthopedic surgeons may hold true, none more so than that they are nicest attending doctors to students. Morning rounds were very informal and relaxed, every doctor went to see his own patient while the rest stayed back and did their own thing. They are in the hospital 7 days a week.
• Orthopedic Operating Rooms are like garages, the tools are vast and they are hard to tell apart. Like mechanics, orthopedic surgeons spend a lot of time trying to put the plate and screw for fixation by hammering it into place and checking it with a mobile X-ray. What they lack in skill, they make up for in experience.
• The surgeries were mostly boring for the onlooker, it seemed repetitive and lacked coherence. But for those who were doing, they appeared engaged and hands-on.
• Postoperative surgical infections were very high due to the internal fixation and open fracture wounds, the attending and residents were very keen to reduce the amount of infections through irrigation and drainage. The problem was exacerbated, as I believe, by the avoidance of the use of antibiotics.

I think I have spent a lot of time talking about Traumatology. Write drunk, edit sober – or so the advice goes, in this case I’m writing rabid and editing relaxed. I hope to give the spinal surgery rotation its own post since we learnt a great deal from a top doctor. I’m afraid this post may turn out to be too long for the average reader.