SSCTS

My first experience of cardiothoracic surgery

I am a third year medical student at Brighton and Sussex Medical School (BSMS), and I have just started my 8 week surgical rotation. Like many students, I have read the anatomy books, examined the surgical textbooks and spoken to patients before and after their operations, I can honestly say that today was a life changing experience. For today, was my first experience of cardiothoracic surgery in the operating theatre. A day I am sure I will look back on in years to come as one of the most important in my career.

About a month ago, I approached a CT surgeon about the possibility of observing an operation or two to see if the speciality which  have always found interesting in theory, was something which would capture my desires once seen ‘in the flesh’ (no pun intended!!). I was offered the opportunity to come into the theatre to gain some insight and experience of the subject first hand.

I arrived at the CT surgery department at the Royal Sussex County Hospital to be greeted by my consultant who made me a cup of coffee (wrong way round surely??) and talked through the patients for the morning session – 2 coronary artery bypass grafts. I was also introduced to the senior registrar and ST2 clinical fellow, both of whom would be conducting the majority of the operation, with the consultant only being required for the ‘plumbing in’ of the bypass grafts – 2 doctors working towards the same aim but on completely different aspects of the operation, something that is integral to many aspects of all surgery and a great learning experience.

In scrubs and ready to go, I was shown into the theatre where the patient was already on the operating table, ready to begin a procedure that would see his chest opened, heart exposed to the outside, have tubes inserted, heart stopped, operated on, restarted and then chest closed – quite a monumental achievement of science in my opinion.

The operation began and I was offered the opportunity to observe the ST2 find and extract the desired length of the long saphenous vein from the leg and thigh of one lower limb, and the leg of the other. In this particular case the patient required 4 grafts. I was then allowed to stand behind the patients head once things were settled and the anaesthetics team was happy with how things were going. This gave me a front row seat to the most impressive and awe inspiring 3 hours of my life – cardiac surgery less than 1 metre from my eyes!!

Throughout the operation the surgeons all asked me questions and kept telling me what they were doing to increase my benefit from the experience. I was also taught by the anaesthetics team and the theatre nursing team, and the perfusionist (the person responsible for operating the bypass machine - an amazing feat on its own). I was able to stay until the chest was completely closed and the last sutures were in place. I then saw the patient taken off to the HDU ward and discussed the outcomes of such a patient with the surgeons.

As a result of this thoroughly enjoyable and educational experience I am now undertaking my fourth year research project with the consultant CT surgeon and I am actively looking for as many ways to increase both my exposure to the subject and my learning of the discipline as a whole. I am also investigating ways to increase my chances of reaching the training programme at ST3 level, which is very competitive, but with a little application and mentoring towards the selection process, I know I will improve my chances of being accepted.

The experience of watching some CT surgery live may very well have the same effect on you as it did me, or it may have the opposite effect, or, much more likely, somewhere in between these extremes. All I can say is, if you are interested in CT surgery, approach a CT consultant at your hospital and ask to get some experience of the speciality. I know that had I had a very negative experience then I would be just as happy, as I would then know that I did not want to pursue this career and that I could channel my energy into finding my niche in medicine elsewhere. The ultimate question you have to ask is “What do I have to lose by finding out?” and I am pretty sure the answer is not very much at all!

David McGowan