From Blessedness To Bitchiness

It's Maundy Thursday once again and this is the time to do our annual Visita Iglesia.

Come to think of it, I think we always do this every single year without a miss. Although I hope someday we would be able to do this in the province area. Seeing and visiting old churches to do the Visita Iglesia seems fun but of course one must never forget the real reason why we do the Visita Iglesia and that is to contemplate and meditate.

Anyways, today is also my 2-10 HNOD, I know that I have one case in the afternoon but what I didn't know is that I only have two staff. To make matters worse, our anesthesiologist is the bitchiest among them all, and saying that she's bitchy doesn't even describe her attitude.

Anyways, being able to do the Visita Iglesia, helps me to be more patient even if she started being hateful. I'm just glad that we only spent a couple of hours dealing with her.

I'm on the 2-10 Shift

Masaya sana ang 2-10 shift ngayon, dahil mga friends ko ang kasama ko, si Mam Barney at Mam Kim tapos ang HNOD namin ay si Mam TJ pero alam ko rin na imposibleng magkausap-usap kami dahil halos lahat ng kaso nasa hapon at hindi nga ako nagkamali, natapos lang ang mga kaso namin around 9:30pm na so ung bonding moments namin, ayun hindi na natuloy.

Nakakatuwa pa kasi pinaguusapan namin na baka hindi kami makapagusap ng maayos dahil si Sir JA kahit na 6-2 shift e hindi umalis at bantayan itong si Mam Kim.

Anyways, my case for today was the emergency ex-lap of a 2months old baby boy. Hindi ko nga lang alam kung ano ba talaga yung case namin pero yung ang laki kasi ng tiyan nung baby, nagkaroon ata ng intussusception tapos ang weird pa dahil yung intestines nya nakadikit pa talaga sa liver nya. Naawa nga ako sa kanya, ang bata pa pero ganun na yung nangyari sa kanya.

Anyways, okay yung case ko pati nga yugn anesthesiologist ko okay si Dr. Froi kasi ang ayoko lang yung surgeon, hindi naman kasi sya kagalingan pero kung makareklamo parang ewan lang. Ang daming demands tapos sarcastic pa kung mag-comment. Sana nga kay Dr. D or Dr. L na lang napunta yung patient e.

Anyways, hindi pa tapos yung case ko, pinalipat na ako ni Mam TJ ng case, sa URS na daw ako dahil lahat andun na, ako na lang daw ang wala. E sa sobrang bilis ng procedure na yun, wala tuloy akong nasulat sa chart ng patient so lahat yun ginawa ko na lang sa PACU.

After that, pina-relieve na sa akin yung circulating nurse na nasa tympano-mastoidectomy case. Si Mam Kim naman ang nagrelieve dun sa scrub nurse. Buti na nga lang at wala si Sir JA kundi baka magkaroon nanaman kami ng issue.

After that, nagstay ako sa OR at dun natulog per Mam barney's request dahil supposedly iinom kami ng tea sa SB pero dhail parehas kaming dukha bumili na lang kami ng tea sa 7-Eleven.

Vacancies and Overtime

Starting today the vacancies in our area is almost half of the regular staff. Out of supposedly 40 staff, we have already 15 vacancies,4 casuals (with one year contract) and only 21 regular staff. The bad news is, even though we were lacking of staff and it's already Holy Week, the surgical cases won't stop from coming in, and so we don't have any choice but to work overtime.

Anyways, today, I was assigned to the ACL case of Dr. M. The weird thing is it will be my first time to assist in that case of Dr. M, e parang nananadya pa yung HNOD namin and she placed me in his three ACL case. So sabi ko just tell me what to do, the sequence of the things how the surgery is done and I'll be okay. The first time, I was rattled, kamusta naman kasi ang bilis ng pangyayari but the second time okay na ako and I already knew what to do, na-perfect ko na nga in a sense. Although the third time nagulo rin ang buhay ko dahil ang arte nung Ortho resident. Yung first two case kasi ibang ortho resident ang nag-assist at sa kanya simple lang, so mabilis at maayos ang buhay namin but in the third case ang arte nung nag-assist, instead of makatulong yung ginawa niya nagpahirap lang tuloy sa case namin, kahit si Dr. M na-stress.

Anyways, around 4:30pm na natapos yung case namin, and supposedly may fourth case pa dapat ako pero good thing at hindi na sa akin binigay yun. And dahil na-OT rin si Sir Ghe, sabay na kaming umuwi. Kelangan ko rin kasi ang financial assistance from him dahil super duper broke na talaga ako this week at umaasa akong sana medyo mataas naman yung sweldo ko.

Anyways, on the way home I was able to confide to Sir Ghe what happened to me this past week. The clash between me and Sir JA. The problem that my mentor is having. Of course, he also confide to me what happened to his baby. Although, I wasn't able to ask kung ano nanaman ang problem ng misis nya. Pansin ko lang kasi parati na lang sila nag-aaway. Natatakot din ako sa sinabi niyang napapagod na sya sa kakaadjust, ang nasabi ko na lang tuloy wag syang mapagod.

Closer Look: Anterior Cruciate Ligament (ACL) Reconstruction

Never in my whole stay in the operating room have I assisted in an ACL Reconstruction and Mam G knows it. I'd rather scrubbed in shoulder or knee arthroscopy because at least there I know I already mastered it, but in ACL, God knows that I don't know what to do. So when Mam G assigned me in ACL reconstruction, I didn't know what to do, so I just prayed that Dr. M (one of the best ortho surgeon in our hospital) won't be mad at me and throw me the OR instruments that I will be passing to him. And to think I need to endure all three cases of ACL.

Anyways, it's a good thing that all of my senior co-staff helped me to understand the process of ACL reconstruction and with all three cases being assigned to me, now I'm proud to say I already knew how to do it. Here's the closer look of the surgery.

ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION

Definition: Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. The surgery is performed arthroscopically.

Procedure:

This surgical technique uses three very small incisions that are about 1/4 of an inch in length to create "portals" into the knee. A fiber-optic light source illuminates the inside of the knee and a video camera feeds an image to a monitor so that the surgeon can see inside the knee. A sterile saline solution is continuously pumped through the knee via a cannula so that the operative field is always clear.

After the surgeon inspects the knee for damage to the cartilage or the menisci, the remnants of the torn ACL are removed with a high-speed shaver. This tool is a very specialized device that is used to remove torn ligaments or torn pieces of cartilage from the knee. The surface of the intercondylar notch where the ACL normally attaches to the femur is then prepared with a high-speed burr so that the proper location for the tunnel for femoral fixation can be seen clearly. 

Tunnels are then drilled through the bone in the femur and the tibia so that the graft can be placed in the center of the knee in the same position as the original ACL. A separate incision that is about 2 to 3 inches long also has to be made in order to harvest the graft from either the patellar tendon or the hamstring tendons. After the graft has been harvested, it is then prepared by placing several very strong surgical sutures through the graft that are used to fix it in place. Some surgeons will also braid the graft before passing it through the tunnels.

After the graft is passed through the tunnels, it is then tensioned and fixed in place. A variety of fixation techniques have been developed to anchor the graft to the bone. Different techniques are used for different types of grafts, and today, fixation failures, though possible, are very rare.

Once the graft has been fixed in place and any additional damage has been addressed, the incisions are closed and a sterile dressing is used to cover the knee. This dressing will usually stay on for several days while the wound begins to heal.

Instruments and Supplies:

• Sharps
• Tonsil/Adson Curve Clamp
• Mixter
• Mosquito Curve
• blade 15/11
• myerding retractor
• ticron 2-0
• vicryl 0
• vicryl 2-0
• vicryl 4-0
• EB 6" # 2
• Band-aid
• Wadding sheet for pneumatic tourniquet
• pneumatic tourniquet
• camera (scope)
• light source
• water tubings
• suction tubing
• shaver
• RF
• arthroscopic hand instruments (grasper, straight biting, right biting, left biting punchers)
• drill and hose
• endobutton c/o company (as well as instruments for grafting)

Source: ACL Solutions, Wikipedia, Physio4life

Into Mam Barney's Barn

One of the most awaited birthday bash has finally come. Although a little bit too late for the birthday celebration (Mam Barns birthday was really on the 12th of April) but because all of us experienced one hell of a week due to increase of surgical cases, last night was the only time we were able to celebrate it.

What was supposedly a barkada-only get together, turned out to be an OR-infested group birthday celebration. Yung mga taong who were supposedly nandun didn't even come. After nila akong pilitin na sumama, I ended up being there and they were not.

Anyways, due to the toxicity of the Saturday cases, instead of being out of OR around 2-3 pm, we were only able to get out around 5:30pm and so we arrived late in Mam Barney's house. Buti na nga lang din late kami because when we arrived, hindi pa sila tapos sa food preparations nila.

The foods are great and with good people around syempre enjoy ang pagkain ng food. This is one of those moments na gusto mo hindi na sana matapos. As usual our topic in our conversation is all about the OR, the mishaps, the thrills, the experience we all had. Syempre we also had serious conversation pero about other people naman.

Syempre dahil party hindi mawawala ang inuman but we didn't start hanggang dumating si Mam Gara. Sya ang official tanggera namin, syempre sya rin ang taga-mix namin ng drinks. At dahil ako na ang parating bullied, napagtripan din nila akong painumin ng kung anu-ano. Kinabukasan, narealize ko ito pala ang mga ininom namin nung gabi.

Pero himalang sa dami kong ininom, hindi ako nalasing. Nahilo ako pero after 30minutes nawala rin sya agad. But I realized kapag lasing talaga ako ang hyper ko. Sana lang nagiging inglisero din ako kapag lasing.

Anyways, supposeldy mga 5am uuwi kami pero nagising na mga kasama ko around 8am kaya nagbreakfast na lang din kami kina Mam Barns at sumabay na sa kanya nung papasok na sya. At dahil hindi pa kami nag-lunch dumaan muna kaming Yellow Cab para kumain. Then Jops, Rain and I went to Jollibee para isatisfy ang craving namin sa crispy fried chicken, syempre nagkwentuhan ulet kaming tatlo regarding sa mga bestfriend namin. May bago na nga akong tawag sa kanila, ang "utak" at "puso" sa isang relationship.