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Something interesting I learnt in the operating room…frustration in the middle of the night.

Authors: Rachel Kelly; Foundation year 2, Royal Infirmary of Edinburgh; United Kingdom

It was late one evening on the vascular ward and I was the junior on call. A patient had just been transferred with abdominal pain and a known abdominal aortic aneurysm. One of the nurses poked her head into the office; she was worried as the patient’s blood pressure had shot up to 210 systolic. This immediately raised alarm bells in my head but I reassured myself and went to see her.

The woman described worsening abdominal pain that was now radiating through to her back. My palms start to sweat. I race through differentials in my head but only one stuck out. My instincts start to kick in – lower the blood pressure and give more pain relief. My heart rate increases and I realise I have to summon the on call vascular consultant. I pick up the phone and give him my headline: ‘I’m worried this patient has a ruptured aneurysm’.

Everything moved quickly after that. I met the consultant in the CT scanner with the rest of the team. It is pre-rupture. I watch as the consultant talks through every scenario but it all comes down to one question – operate or not operate? Someone murmurs something about it being a great catch. I focus on the scan and try to picture what the consultant is seeing. He decides to do it. Better to give her a chance than to let the inevitable take hold. We tell the patient her options, the risks involved, how she could die either way. She agrees to go ahead with the operation.

A second flurry ensues. Everything is being prepped downstairs and the three of us – me, the consultant and the registrar, sit in the office and contemplate what we are about to embark on. Coffee is made, it’s now roughly midnight and I have been working since 8am. I push that thought to the back of my mind and focus on the task ahead – a likely 4 hour surgery. It ends up taking much longer, the aorta is heavily diseased and the tissue is more friable than we predicted. The consultant decides to use Teflon to reinforce the posterior wall and try to secure the graft. It is exhausting. It takes 4 attempts. The frustration is palpable as the stitch fails again… but then it holds. I am sweating, reeling after being awake for 24 hours straight. We all slowly wander back upstairs, the last 8 hours a blur.

I learned a lot that night. The importance of weighing up whether or not to operate, being honest with your patients about their survival rates and how to push through tiredness in order to get someone off the operating table. Most importantly I learned surgery is a lot more than technical skill. It is leadership, compassion, emotional intelligence and resilience. It is seeing your patient die despite all your best efforts. It is hard.


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