This is part 2 of a 2 part article. If you missed it, read part 1.
The next morning I met another anaesthetist who was willing to let me assist her, this time with cannulation. I wasn’t expecting this to go very well as I don’t really like needles, especially when I have to have a blood test, so I didn’t know how I would get on doing this procedure on somebody else. The anaesthetist was really patient and supportive, talking me through each step, but to say I fluffed it is an understatement. I got the needle into the vein, but as I was trying to coordinate pulling the needle back and advancing the plastic part further into the vein, I managed to point the needle upwards and puncture the vein, spurting blood everywhere. I felt so silly and really sorry for the man I was practicing on, but he was ever so sweet and said how he understood that everybody had to learn sometime! Needless to say that particular anaesthetist was reluctant to let me try her next cannulation, but she did let me do 2 intubations in the afternoon which were both successful.
By the middle of the week I had tracked down the lady I had worked with on my first day, and together we conquered my cannulation problems. By the time I was finished working with her, the only veins I was missing were the patients who were so dehydrated from not being allowed food or drink before their surgery, or the patients who knew from previous experience that they had difficult veins. It was still useful to have a practice on such patients though, as not every cannulation out on the road is going to be easy. In fact, as the majority of cannulations we do are in life threatening conditions, they are more likely to be difficult as the venous network goes into shutdown, so I needed all the practice I could get. It was reassuring to know that if I was unable to cannulate in hospital, there was somebody else there with more experience who would probably be successful. This will be the same for me during my sandwich year out on the road starting in September, but very soon after that I will be going it alone.
As well as experiencing some difficult cannulations, there also seemed to be an abundance of difficult intubations sent to try me. On my second to last day of placement, one of the anaesthetists told me that he had 3 intubations I was welcome to try; all 3 of them turned out to be difficult. I had a go at getting a view of the vocal cords but just couldn’t see a thing in any case. The anaesthetist told me to put the tube in blind as it had a 50/50 chance of going in the right direction, but this technique failed me each time. It was reassuring that the anaesthetist found all of these patients difficult when he tried them, and it wasn’t just a bad technique preventing me getting a view. This particular day was a very positive learning experience as I experienced the frustration of difficult intubations and got an idea of how the anatomy varies to dictate whether the task is going to be easy or not. It also highlighted that even though intubation is considered the gold standard of airway management, time must not be wasted trying to achieve it. If it looks like it isn’t going to be successful, emphasis must be on adequate oxygenation, and then it is possible to consider other forms of airway management such as LMAs.
As a whole, my time in theatres flew by. On days with short surgical lists up in the main operating theatres, I was allowed to go down to day surgery. I found this particularly useful as I was exposed to a completely different way of working, with different types of operations. The biggest bonus for me in trying to achieve as many of each skill as possible was the fact that these operations were generally shorter than those performed in main surgery, so the turnaround time was quicker resulting in more patients being seen each day.
Despite imagining the worst, everybody I met and worked with was really lovely. They were all very supportive and eager to help me practice and learn, and many of them complimented the career I’m entering into. I found this particularly touching, as sometimes it can feel like hospital staff don’t understand what our job entails or the challenges we can face on a daily basis. On completion of my placement, I felt a lot more confident with the emergency skills to help me appropriately deal with some of these challenges.