The Leodisian Life...

[yeliab_cram]

I'm drunk, and why not...

the OSCE is over.

2 days of rat run, performing seal-like examinations over and over, and endless talking... so much talking. And not the bestest of stations came up.

Whilst the 3rd year OSCE is like the FA cup final (one long drawn out affair that extends into extra time) and the 5th year OSCE is like the World Cup final (one immensely important performance). The fourth year OSCE is rather more like the semi-final of the Champuions' league.

At the end of day 1 you know you are half way through. If you are anything like me, you are quite unsure how things really went, but you are hopeful you didn't thoroughly **** up. You are 1-0 up after the home leg, but you could still go dowm on away goals during leg 2.

Today is the end of day 2. We decided the best solution to the OSCE was to drink. As yesturday we all spend the afternoon and evening mulling over (and over) the minutiae of the exam, and realising just how much we had left out. Today was about blunting the brain cells before getting back to revision in the morning.

OSCEs are strange things really. The idea is to remove the examiner bias present in old clinical examinations. However, the grilling consultant has been replaced with a silent and unemotive one, which can be equally disconcerting.

The exam itself was rather frustrating. Despite giving us a list of over 20 potential obstetrics and gynaecology counselling stations, they still decided to come up with a seperate on - brilling. Its a real shame that i spent most of today blagging rather than utilising the revision i had done.

Anyway, its done now. I'm drunk, and we will see what monday brings with the EMQ.

[yeliab_cram]

So, as you might have noticed, if you are an avid reader... are there any avid readers?? i'm thinking probably not, but i digress... then you will have noticed that "monday" came and went without any comment, as did three subsequent mondays. This seems to be a bit of a recurring theme.

I tend to write in the blog when i want a rant. this is usually during revision, away placements, general boredom. So much of the ranting tends to lead up to exams. but once they are done i tend to go and get drunk and spend my time more productively than on here.

so i shall very breifly fill you in. I am currently in Athens, on part une of Marc's European Elective Extrodinaire(y) doing interventional cardiology at the Onassis Cardiac Surgery Center (i know, the name also made me think i would be watching chest sawing open-ness, however, apparently, all the sugeons are on holiday, so interventional cardiology it is) in Athens, Greece.

Given this information, one can deduce that i passed 4th year and jetted off into 5th year. however that was not before undertaking the slideshow and EMQ exams. the slideshow was a bit silly as i recall. whilst all the practice ones were "what is this a picture of?" (and i didnt know back then) this one had pictures which i knew ("woohoo its scleroderma.... wait you dont care") but quite random questions to go with them. hey ho.

The EMQ was ok, until the afternoon session, where all the med-surg stuff was completely rediculous. As it turned out, that is what dragged me down, but still managed a B overall, which i was thoroughly chuffed with, and what i thought i deserved.

post exam time was very odd. all of a sudden all the crap i have been putting off doing came into centre field (allbeit a hazy hung over sleepy field) such as accomodation for my elective, and somewhere to live next year when i get back, you know, little things like that.

That probably goes some way to explain why, as i write this i am sat in what is basically a brothel that is only a hotel by name. but again i digress. The time after the exams was really very odd. none of us had really been thinking about our electives. for 50 weeks, almost solid, we had been working towards these exams. the elective was a mere speck of light at the end of the tunnel, and all of a sudden it was upon us. everyone who we had grown so close to over the final weeks of the year was jetting off across the globe. Literally, we got our results and the next thing i knew, i was on a plane.

For now i will say this: the Greeks are very laid back and drink a lot of coffee. and will explain all another time. but consider yourselves up to date.

[yeliab_cram]

so i am now nearing the end of the second full week of my elective. i am currently at the onassis cardiac surgery centre in athens, one of europe's leading cardiology and cardiac surgery centres, in stark contrast to the rest of the greek medical system.

i am mainly in the cath lab doing interventional radiology. (ooh there is a dr mark bailey talking on CNN behind my head... how exciting... can u tell im in a cheap hotel in europe???) anyway, despite the repetativeness, i am actually learning quite a lot that i just plain didnt even know i didnt know. so thats good.

i have had a slightly odd day today. mostly it was just the normal lead skirt wearing fun and games, however i was at some point suddenly shleped off to see the director of cardiology at the centre, aka the big cheese. now i am not really sure why i was suddenly taken to see him, or indeed who he was, but off i went. completely unprepared.

i arrived at an office and was announced. i went in. i found a small Greek man, sat in a low, but very large leather desk chair in an expensive shirt and tie and white coat, in which his initials were stitched. he sat behind a vast mahogany desk, covered with papers and some strange faberge horses. the walls were covered (and i mean as in the garden state scene covered) with medical certificates. it was surreral. i was in the presence of a real life bob kelso.

he didnt really have a lot to say, but he did talk alot. i thinki managed to avoid looking too confused as he declared i should spend some time at the "city scanner." or as i later realised, CT scanner, as they are one of the first centres in europe to use multi-contrast CT. anyway it was all very odd.

this was partially eclipsed by the fact i was taken out for dinner by my supervisor this evening - which was very nice of him, to a very posh, very expensive seafood restaurant. wood panneled from floor to ceiling and apparently the place to hang out if u are a greek celebrity. i do love turning up dressed in a polo shirt and sandles to an establishment where most people feel a blazer is required.

anyway, the food was bloody good, and well, it probably should have been. Russian baluge whale caviar was on the menu as a starter. a steal at 135 euros a pop. anyway, having just eaten an entire sea bream that i chose from the ice box outside, i feel i should probably get some rest before i have to get up to do it all again. well not the caviar, and hopefully not the city scanner either.

toodlepip.

[yeliab_cram]

Rather interesting time to be in Athens seemingly. seeing as all the news is in Greek i was blissfully unaware until i was sat in a courtyard enjoying a nice frappe, when i started to wonder what the grey and black stuff falling from the sky and landing in my coffee was. i thought it was someone's cigarette ash (everyone in greece smokes, even all the cardiologists, despite a smoking ban!). however, on leaving the courtyard and going outside properly, i noticed the sun was obscured by a cloud of ash. i decided this was not typical so decided to investigate. who better to ask than the head of the parliamentary guards?

so apparently, half of greece is on fire. im still living in a kind-of blissful ignorance, as i only have the reporting from CNN, which is quite brief, and shockingly lacking in any information. so my immidiate concern is where to go and have coffee, so that i dont end up drinking ash. i am ashamed to say the nearest appropriate establishment is starbucks - i know, i know. shameful.

anyway, as the skies fill with ash, my planned activities are no longer particularly appropriate. the beach is out. so is going to the coast to see some ancient temply thing (as its towards the fires, and that cant be a sensible plan). i decided the best thing was to read a book, drink some coffee, and then watch the man u match.

i have not seen any brits for a good long while. so when i bloke in a united shirt came down the stairs this morning, i thought, **** it, im a brit on holiday, why not behave like one and strike up a random conversation with a fellow britisher:

me: so, u english then?
random united fan: no, Irish.
me: ah, very good. what time is kick off tonight?
random united fan: 6 Greek time i think. think its on telly.
me: cool. bit of a shit hole this hotel isn't it!
random united fan: not as bad as where i stayed last night.
me: oh yea, why's that?
random united fan: spent the night in the local nick.
me: oh.
random united fan: yea, that was definately worse than here.
me: well, at least you're seeing a different side to athens, eh!
random united fan: ...
me: so how did u end up in a greek prison then?
random united fan: well, you know there's all these strip clubs round here...
me: (i really hadn't noticed...)
random united fan: ...well we were, you know, doing the rounds (**** me drinks are ten bucks a pop by the way) and i got a bit rowdy and wouldn't leave, and then the police came, and i dont think i was very polite, and then...

im sure you can work out the rest. in future i'm going to stick to not conforming to british tourist stereotypes and pretend to be italian. ciao.

on a seperate note, hargreaves looks like a good solid buy. im pleased about that. but if anyone can explain why exactly chris eagles features so regularly do let me know. i suppose he's less detestable than richardson.

[yeliab_cram]

I have been meaning to write this for ages, but spent far too long trying to get a photo from my phone onto the internet (without any sucess - seriously, stupid Greek computers) that has delayed matters somewhat. but nevermind i shall press on anyway. I have not died and been covered in ash for future generations to excavate and put in an overpriced museum yet, thanks for asking.

This thread is not really about new shoes. well it kind of is. but dont worry, i have not gone terribly mad in the heat. i have gone slightly mad, but not terribly mad.

I must say i am now quite glad i picked an elective in a country (or more accurately contries) in which i understand little or nothing of the language. inititally i thought this would be a great problem, as i would be completely useless. i was right. what a blessing, it means i can **** off and go to the beach / drink coffee when bored and nobody cares. but on a more serious note, it is making me feel like im having a proper elective experience. not knowing what the hell is going on. This morning i ended up doing an all-in-Greek ward round (with the odd helpful comment in english like "sorry, but CCU is a bit of a hospice at the moment. its not normally like this") for example.

Whilst some aspects of the hsopital are new and exciting / worrying / just plain strange. what i am finding most odd are the universal truths. So yes, Greek doctors show up in open necked shirts and jeans, but they do wear white coats. always. They never seem to wear stethoscopes arround their necks. and surgeons are absolutely 100% to be feared. Even by the senior medics seemingly. i was amused to observe that they are colour coded, just like in Scrubs. (surgeons are green and medics blue, if you were wondering. scrubs though, not skin colour). It is also slighty impossible to figure out who is in charge. its more of an american system than british (ie attendings and the like) but the more junior ranks dont appear to have proper titles. so it is quite difficult to figure out who is who. or more accurately, who is what.

Despite all this, i am finding it oddly surreal that out of this barrage of Greek madness appears things i am very comfortable with. For example, all the surgical masks are made by 3M, the nurses are exactly the same. not literally, they dont ship them in from yorkshire, but even though i dont understand them, the same personalities persist. there is the obscenely and hilariously small bitchy nurse, the tall good-looking bloke, who constantly touches all the other good looking female nurses. The obese senior nurse. Its the same story with the doctors. its like you've met them all before. And the clinical stuff, of course also suddenly feels strangely familiar. I am in Greece, understand not a word of what is going on. but im in a cath lab, and oh look there is a 60% stenosis of the circumflex artery... i wonder if they'll stent it, oh it appears they will, la de da de da.

However, the most consistant universal truth is theatre clogs, or the lack thereof. I honestly can't remember if i have used this before, i probably have, but humour me. The problems in england are sumarrised by the following encounter in Bradford with one of the more fearsome orthopods in a small theatre changing room:

Me:Excuse me Mr B, there aren't any spare clogs around, and idea who's i can wear?
Bastard Orthopod:not a clue marc, and quite frankly, i couldn't give a toss, but if you wear mine, i will have to kill you.
Me: oh. thanks.

it is slowly becoming a recurring theme of my medical training. it reminds me of a nightmare (bit of a strong term, recurrent bad deam?! euch too american) i used to have when a little kid. i would be at school and for some reason suddenly realise i had no shoes on. completely unaware how this had happened i would search all over for them, only to find they were well and truly gone. then the teacher would announce we were about to do something for which one really, really needed to be wearing shoes (i forget what) but you get the idea. the theatre clogs problem is approaching this sort of level now. it happens every time.

In England, i usually just read who the shoes belong to and wear the ones of the consultant im least scared of or who i know isnt in today. in Greece i suffer from a considerable disadvantage. Not only do i not know who most of the ?attendings are, but i dont really understand all of the Greek alphabet so can't even read the names. Also, the changing room is usually filled with lots of large Greek men smoking, who may hurt me if i steal their shoes. Anyway, good news. after spending day 1 in scrubs and my smart shoes, i vowed to solve the problem once and for all. 10 Euros bought me a theatre clog esque type of shoe thing from the market. I rapidly scrawled my name on them with the first marker pen i came across. Marc 1 - 0 Medicine. HA!

[yeliab_cram]

Firstly an apology. apparently, Beluga caviar isn't from a beluga whale. i made that up. it just seemed to make sense, as i once saw some beluga whales in Canada. It is actually from the Beluga sturgeon that resides in the Caspian sea (says wikipedia. i guess it makes more sense that it was called Russian Beluga caviar now. alas, i digress, more that usual (wow Wikipedia really is the font of all knowledge).

So i am getting a little bored of my lead skirt and apron, its really not a good look. i was hoping to have a nice picture to show you by now, but apparently today was not a good day for picture taking. i was intending to dig my camera out for the last patient of the morning, i am glad i forgot. today, i got to learn first hand what exactly the feared "no-reflow phenomenon" is all about. I had heard this term banded around in the cath lab over the last few weeks and had generally figured out (despite a rather rudimentary understanding of Greek) that this was a bad thing. What i did not realise was a more accurate name was "oh shit, he's having a heart attack on the table, bring me a catheter with a really ****ing big balloon on it right now. NOOOOOOOWWWW!!!!" pandamonium. I shall leave the rest to you imagination. dont worry, nobody died, but it really wasnt the time to start snapping pretty pictures. maybe tomorrow. There is a certain feeling that i cannot entirely describe that occurs only when in theatre as a medical student (ie not really doing anything useful, and mostly getting in the way) when the shit hits the fan. I now know, that this feeling is compunded several times when the shouting occurs in another language. it is at times like this i am glad that we are made to wear surgical masks. because otherwise people would be able to see the look of immense discomfort on your face.

anyway, after such gruelling escapade, as in England, the team retreats to the equivalent of the surgeons lounge, staff room thing for a break. Back home, there would be tea and biscuits all round (you know its true). In Greece however, one consoles oneself with "French" coffee (?!) Feta and tomatoes. I am not joking. This brings me onto another thing about Greek medical practice that doesnt really agree with my Britishness. There is no lunch. i will say that again, no lunch break. shocking.

in the NHS lists tend to happen from 8 or 9 until 1 and then from 2 until 5... roughly. However, in Greece i am told the generally philosiphy is "we dont like being at work, and we see taking a break to eat as a waste of time, as we would prefer to eat outside the hospital." The result being that from 8 until whenever, 6:30, 7, 8, the doctors work flat out, drinking coffee and eating feta between cases. Crazy. Whilst we are on cross cultural divides, the other thing that is annoying me is the inability of Greeks to que. you will be waiting at a counter for coffee, with two people behind you, then, 3 more people will enter the shop and que from the opposite end of the counter and manage to get served first. how rude. speaking of rude, there seems to be some trouble with the translation of the word "pardon." When you ask a greek person a question in english (which i fully admit, i am very grateful most understand a bit) that they dont fully understand, they shout "WHAT?!" at you, with a hint of contempt. i am trying to teach them the merits of using the more polite "I beg your pardon" its not going well.

Whilst i am on the subject of contempt, i feel it is an appropriate time to talk about a certain doctor who we shall call capital N. He is a contemptuous bastard. I am not really sure who he is. He is always around, but never does much apart from waltz into whichever department i seem to be in, have an important sounding conversation and leave - very dramatically, causing papers to fly. He sees me everyday and has never spoken to me (only at me once - when told by the director of the department that i was an english medical student he replied "i know, we've met" lying bastard) how rude.

i am not sure what his role is. he doesnt seem to be an attending, as he has none of his own lists. but he seems not to be a trainee, as he talks down to them (except the fit female ones) and is never with an attending, or doing any lists under supervision. i have a theory that he is the director's son, and can therefore do whatever he likes, but i am still unsure what that is. most days he is in scrubs, but never enters the cath lab. It is uncanny how like a bond villain he is. he is very tanned, has graying black hair with a white forelock and is always sporting designer stuble. Contemptuous bastard. Maybe he is just there to exude slime in order to making the punters feel like they are getting their money's worth.

[yeliab_cram]

So, my time in Athens is nearing an end, and i'm actually quite sad. i have quite enjoyed my time here, but i think it is more a case of wanting to stay in my new bubble, even if, in the grand scheme of things its not such a wonderfully comfy bubble. The staff at the hospital are quite nice to me now. i have figured out the multi-cultural language barrier spanning ability of football. Apparently, so long as you know a bit about Greek football (Olympiakos, Rivaldo, sell to AEK, no good, yes) then you can subsequently sustain a good 20 minutes of debate about the premiersip with the male nurses. genius.

Whilst we are on the subject, i must say i was saddened to hear of the retirement of Ole Gunnar Solskjaer. I have always been a fan of his. he really is the model professional. he sat on the bench for all those years and never once complained. he just turned up, and did the business when it was asked of him. Never once did he have a bad word to say, never once did he moan. Legend. Good man. I also notice myself being surprisingly upset (perhaps the wrong word, but you get the idea) when i see Beckham on CNN pissing around (pissing being the operative word) for the LA Galaxy. what a ****ing waste.

anyway, i digress. Today i had one of those lovely experiences, where fresh arterial blood shoots half way across the operating theatre (ok cath lab) whilst you are in the direct line of fire. why is it, when you see the shot of blood coming, your response is not to dive for cover, but to think "oooh, look, there's a bit jet of blood, cool... oh shit." anyway, it only got me across the arm and chest (not in the eye) and the patient wasn't known to be HIV or hep B positive, which is always better than in the reverse situation. Either way, not the most pleasant experience.

This was made up for the fact that i got to sew people up all afternoon after their femoral artery had been used as a port for exporing metal hardware to their coronaries. Although, sometimes i wasnt entirely sure what exactly i was supposed to be sewing to what. but, dont worry, it all sorted itself out in the end.

Definately the best bit of my day though was lunch. my supervisor suggested we get a sandwich from the shop at about 3 (see earlier post on working greek lunch). I was interested to notice that i didnt have to pay for my coffee or sandwich. I was walking out of the shop stealing my lunch apparently. no, no, its ok. my supervisor says he stopped paying about 5 years ago, and they dont seem to care. rock on. There is such a thing as a (guilt free*) free lunch. who knew?

* i am alluding to drug company funded free lunches, which are, apparently ethically dodgy. i think this is bollocks. i eat the free food, i dont prescribe the drug. i really do just eat the free food. i was sent to medical school to critically evaluate these things. do you really think im swayed by a taste the difference turkey sandwich, and chocolate swiss rolls, and onion bajis? or those little M&S flapjacks. no, no, no.

[yeliab_cram]

If you are ever thinking of just nipping across the adriatic and going from say, Athens to Siena, i would recommend leaving yourself plenty of time. You see, it just doesnt look that challenging on a map, but i warn you: it is.

I naively assumed a boat would go from pireus (the port of athens) to some point in italy that would connect via train to siena. easy. no. Here is what actually happened.

1) bus from athens to patras - 3 hours
2) ferry from patras to ancona - 22 hours
3) train from ancona to bologna - 3 hours
4) train from bologna to florence - 1 hour
5) train from florence to siena - 1.5 hours

mission.

anyway, i am not in Siena, safe and sound. and what a lovely city. i never fail to be amazed by the fact that whenever i set foot in italy, i instantly feel underdressed. i am currently in a shirt and tie, and still feel underdressed compared to the locals.

so, first day in the hospital toady. everyone is very nice, but it is somewhat surreal. my supervisor for the week met me in the reception, he would not look out of place in the godfather. he is very tanned and has graying slicked back hair. He took me up to the department where he is one of 6 surgeons. The unit of thoracic aortic surgery. The 6 surgeons, including the director of the unit share 1 room and 1 desk. The room is filled with Madonnas and vascular related artwork. The director of the cardiovascular surgery department, which the unit is part of came in to say hello. wearing scrubs, a white coat, and smoking a pipe. ITs just not the NHS.

Anyway, i was sent home at 1.30 because the docs were just trying to negotiate theatre time for tomorrow, and there were no more patients to see. but once again it is raining, so i am sheltering in an internet cafe. The cafe is near the Siennese university, which totally kicks ass compared to the concrete jungle of Leeds. IT is set in a gothic building, which has flags and statues and all manner of exciting things. i think i shall write a letter to the chacellor of Leeds Uni. If only i knew who he was...

[yeliab_cram]

bonjour tout le mond, je suis en france, il est pluit. merde!

since we last spoke i have finished in siena and just popped across to poitiers in france. i say popped, as this is what i imagined. however once again, my trip planning based solely on my Oxford Schools atlas and cheaphotels.com left something to be desired.

apparently, going the short way, along the mediterranean coast and then up to poitiers, takes several millenia, as there are only silly local trans on that line. it is far more efficient to take the express from florence to milan, then the TGV to paris, and another TGV to poitiers.

fine, no problem. i will stay a night in milan, a night in paris. it will be culturally enriching. bollocks. not only did it take me over 15 hours to do the travelling, but i completely ****ed up my little stay in a 2* Parisian hotel. This is mainly because i am a pillock.

you see, i made a truly classic schoolboy error, but then compounded this with silly decisions on account of being male. i booked a cheap hotel on the web. it said select landmark near where you want a hotel. right, i thought. near the station. looking down the list i say about 10 entries for Gare something or other. one is Gard du Nord. This rings a bell; i assume it is the central train station (despite the fact it is called North Station). i check my gut feeling in my rough guide to Europe (2005) it says "mainline trains pull into Gare du Nord" i stop reading and book the hotel.

If i had read on i would have learnt that mainline trans pull into Gare du Nord from England, Germany and other Northern places. trains from Italy pull into Gare du Lyon, which is in the opposite half of the city. Similarly, trains to Poitiers depart from Gare Montparnasse, also no where near Gare du Nord, but annoyingly near Gare du Lyon.

so i thought, **** it, Paris has a metro, how hard can it be? well not very, but being a bit pissy from the 7 hour trip, and discovering my error en route, i could not find a metro map, the que for tickets was very long and i could not figure out where to go. i had a shit Paris map, i looked and though, hmm, its not THAT far, **** it, i'll walk. backpack and all.

shit.

I would say it started off swimmingly and then went wrong, but that would be a lie. i left the station and walked down the road, arbitrarily. i came to the finance ministry, looked where this was on the map, it was in the wrong direction, so i turned round and off i went. 10 minutes later i came to another finance ministry. bollocks. i walked round in circles for a bit, then found the river, then realised i had been right originally and was now even further from my shitty hotel. my backpack seemed heavy.

anyway, at least now i was going in the right general direction. plod, plod, plod. all going well, nice river, not too hot. not too bad at all. then i ended up separated from the road by a small barrier, then a big barrier, then the pavement stopped as the road approached a tunnel. non pietons the sign said. i had to leapfrog the barrier, avec backpack tres grand and flee across what was now a dual carriageway in rush hour.

managed that, and got to the road that leads to Place du la Bastille. The first step of the journey. suddenly, it became very very busy. busy like when you leave a football match. everyone was too young and wearing too much black and had silly hair. i continued, but progress was slow. As i emerged onto the Place, i realised that beyond (the way i needed to walk) it was chock a block. i ploughed on, but now the mass of people was walking in the opposite direction to me. They were parading, kind-of, around busses, bin lorries, and trucks, each one with a DJ playing Trace. (quite why people who like trance in france dress like people who like indie at home i do not know). I was stuck walking against the flow of a free trance festival, that continued all the way up the road i needed to be on, for 4km. i would have taken a detour, but my Paris map was one of those shitty rough gide ones that only has about three streets on anyway.

long story short: it took me 2.5hours to get to the ****ing hotel. disaster.

But dont panic, i did make it to Poitiers. Whilst the french can be a little moody, they have welcomed me into the department, and are thoroughly enjoying teaching me the subtlties of French swearing. As the Frenchman says in the Matrix, swearing in French is like wiping your ass with silk. and it really is. in english we would say "she takes it up the arse" very crude, dont you think? in French they say "she likes to play in the little dark tunnel behind" poetic, non?

so i have been doing lots of random vascular type things, and it has been much fun. after all that i shall not bore you with too many details. but i will say this. last week one of the internes said "you like pig?" (i said no, i didnt know what he was on about). it came up a few times more, i let it pass.

Then on wednesday "you like pig? yes? you come with me tomorrow, we go play with pig" sure, whatever...

we drove 100km south, towards LaRochelle, and into a field, in the countryside. There is housed the laboratories of experimental surgery. where they play with pigs. For some reason, and i am still not crystal clear on why, vascular surgeons go there twice per week. first they take out the left kidney, then they go back, take out the right kidney, and put the left one, which they have been trying to keep alive back, on the right. comprend? most importantly however, they are pigs, so i get to do lots. "open uuup ze piggeee, yees, make a beeeg cuuut, like zeees. open eeem up, good."

I was stood there, scalpel in hand, thinking, is this morally questionable? should i be doing this?? ah **** it, why not.

[yeliab_cram]

I learnt a very important lesson this week. very important indeed. in fact, i think it is going to impact on my behavior as a medical student, and my own practice when i qualift for ever more. I am never going to wear socks for theatre ever again. and i am also going to search harder for theatre clogs without silly holes in the top.

This life changing moment occured on thursday. It was a fairly normal ward day, where no pig surgery was on the cards. After the ward round, a was yanked into the emergency surgery suite (ooo, fancy, not been in here before) where one of the chef de cliniques (that is chief resident, who does all the "simple" operating to you and me) was finishing off a ruptured AAA that had had the audacity to present at 3AM after the team had just gone back to bed after fixing another old bloke's critical ischaemia an hour before.

He was horrendously obese, and the CT scan revealed a rather impressive 9cm AAA and lots of blood. He had been in theatre for 6 hours and things were looking good. Everyone dispersed and off we went to do some elective work. I elected do go in with the other chef de clinique, rather than the boss as i get to do a bit more, and he and the interne (who had been assisting in the AAA all night) are very funny.

After some retracting and stitching and teaching the doctors "that other english word for masturbation" (wanking is what they were after, or "won-king" as they say), we got a call from ICU.

oh dear, our fat friend with the AAA was not looking so good anymore. Apparently, his fresh new graft has sprung a leak. this means he needs reopening, the copious ammounts of blood filling his abdomen removing and the leak repairing. Not before doing another fistula.

After the fistula, suturing, lunch, coffee making (my two jobs, suturing and making espresso) and then straight back to the emergency theatre. I was told to scrub in, extra hands useful apparently. and off we went. There must have been 3 litres of blood in his abdomen, and as we moved the bowel out of the way, at least half a litre gushed, like a river, over the side of the table all over me and the interne. In all honestly it was quite cool, in a grusome kind of way. I then noticed my feet were wet.

Despite 3 of us suctioning with large bore tubes, there was still blood everywhere. Including in my shoes. Interestingly, once we finally got to the anastamoses, and i was able to keep the blood at bay in order for us all to get a good look at it, it was fine; at both ends. THat wasnt the source of the problem.

We had a look at his bowel, currently wrapped in drapes. It was necrotic. shit. poor guy. The general surgeons came down and we handed over. It doesnt look good.

I suppose you have to look at it like this. AAAs are bad news for people. if one burts, and you do nothing, mortality is 100%. If you makr it to the hospital, mortality is 50%. Its like flipping a coin. you cant expect them all to walk away. but some will; thats what is important.

After descrubbing, we went for more coffee, where i investigated my blood soaked socks. and was laughed at because everyone else was bear foot. Then we all went to Paris for a conference.

I wonder if he lived. i guess the surgeons dont get that attatched to their patients.