Surgery: Emergency Room and Outpatient Department
November 28, 1998
Saturday
This is the journal for the first two weeks of Surgery. Surgery is gory and bloody and everything you’ve imagined – the most prevalent color here is blood-red. The Surgery-ER/OPD (Emergency Room/Outpatient Department) rotation consists of the first 2 weeks of Surgery (8 weeks). Interns are on duty at the ER in 12-hour shifts (residents do 24-hour shifts), and I thank God that we only do 12 hours! I think I’d go crazy if 1 had to stay there for 24 hours. Stab wounds, bum injuries, vehicular accidents, avalanche injuries (there was this guy who had 100 sacks of rice fall on him, he’s alive but has some superficial and deep cuts on the head and arms) are the more “toxic” cases.
There are also people who come in to get stitches for their wounds (under local anesthesia, of course). Most patients come in for medico-legal reasons. For instance, two people had a fistfight, and want to get a medico-legal statement on their injuries. So we have to examine them write down each and every injury (e g , “laceration, right arm”, “abrasion, left ring finger”, etc.) and issue a provisional slip which they can present to the police or barangay* officials. This is only a temporary record, as the real legal statement would be ready after 3 days from the Medical Records department.
At the OPD, we man the General Surgery clinic – this is the “frontline” for all surgery cases before they get referred to subspecialties (e.g., Plastic Surgery). Common cases are breast masses, hernias, cellulitis (infection of skin and the tissues under it, but not reaching the deeper tissues like bone nor muscles) and abscesses (boils).
[Warning: next segment is gross – you don’t have to read it if you have a weak stomach for such things]
I had the chance to do an onychectomy, which is removal of a finger- or toenail. As long as the nailbed is intact, the nail will grow back. There was this 8-year old who cleaned her finger nail and somehow wounded herself in the process. Then the fingernail got infected, and the infection spread to the whole finger It was so swollen and red, and the tip of the finger was even gangrenous (dead tissue, appears black). So we had to take out the source of infection – the fingernail. Local anesthesia was injected at the sides of the finger’s base, then the nail was pulled out by forceps. In the process of pulling out the nail, spurts (as in SPURTS) of blood and pus came out. YUCKY, YUCKY, YUCKY. Her nailbed was already deformed because of the infection; the nail will grow back, but deformed too. All the while the kid was crying After this her hand had to be x-rayed to rule out the possibility of bone infection.
[ok, end of yucky portion]
The best part of these 2 weeks was our stint in the minor operating room where minor surgical procedures like breast mass excisions are done on an out-patient basis. The patient comes in at 8 AM, gets some surgery done under local anesthesia, and is done in an hour or two. The surgeon on duty supervises all the clerks and interns in 7 cubicles as they excise all these minor masses. Since the surgeon can’t be in all cubicles at the same time, the intern/clerk is largely left alone with the patient and his mass. The minor OR [operating room] is the most fulfilling part of the surgery rotation as it makes you feel like a real surgeon, and you know that your excision of the mass is the definite cure for the patient’s illness (at least for most of the time – there are such things as recurrent cysts/masses which come back some time after excision is done). Of course, the surgeon on duty and nursing staff can be called in case of any trouble.
This coming Thursday is my last day with the ER/OPD part of the rotation. I will be going into surgery wards after that (not as bad as Internal Medicine) for 4 weeks, then to the Burn and Trauma services for my last 2 weeks of surgery. More journal articles to come then.
P.S.: Have I mentioned that I have several reasons for not going into a surgical field? Here goes: (1) sewing and other surgical skills are not my strengths, (2) you always have to be extra-conscious of infection and keeping sterile – although necessary, I don’t think I’d like to waste much brain space thinking about these all the time, and (3) strong family history of arthritis. So there. Surgery is fun, but I don’t think I’d like to do this for the rest of my life.
Notes:
* A barangay is the smallest local government unit in the Philippines, like a village or ward, and multiple barangays make up a municipality/town/city. The word barangay is thought to be derived from balangay, a type of boat used in pre-colonial Philippines.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
