I have always been a person who likes to learn from different people, cultures and environments. Travelling and working the same job in another country helps you to zoom out from your everyday practice and see different ways of doing things that you otherwise would not think about. That is why during my medical school years, I have tried all available exchange programs. I was lucky to have internships in France, Portugal and Finland. When I got into anaesthesiology and intensive care residency, I decided to continue seeking experience from abroad.
It was quite easy to find out about ESA exchange program. From time to time I browse their page and look for events. This is how I found out ESA exchange program. I applied without any hesitation. There are three medical centres you can choose from. I was looking for the centre where I could improve my regional anaesthesia or trauma management skills. Taking into account the reviews from other trainees I chose the Netherlands, Ireland and Slovenia.
I was very sad to receive a letter that I was not selected for the program. However, I was hopeful to try next year. As it turned out I did not need to wait! There were some changes from selected trainees. Some of the them reduced their time for exchange and this is how I got in. I was offered to have exchange at University Medical center Ljubljana (UKCL). It was in the spring time and the only available time to go for exchange for me was August. Thus, I was in hurry to organise my departure from my hospital and university (Vilnius University Hospital, Santaros Clinics, Lithuania). I am very thankful to ESA organisers and Dr. Prof. Vesna Novak-Jankovič head of the Anesthesiology and Intensive care Department in Ljubljana, as they made it possible to deal with all the paperwork in such quick time. Then August came and I was flying to Ljubljana with an adventurous feeling.
On my first day I met the head of the Intensive Care Department Dr. Tomi Mirkovič,. He was a very warm and kind person to welcome me. He showed me around and took me to Dr. Tatjana Babnik the head of Anaesthesiology Department to discuss my exchange. Together we decided that for me to improve in regional anesthesia I will spend most of the time in the Trauma Department.
My exchange officially began the next day when I met Dr. Goran Jeguč in the Trauma Department. I knew that this was his last day before holidays, but Dr. Babnik was very eager that I met him and as soon as I did it was clear why. He was not only the most pleasant doctor to be around – always calm and smiling – but also, he pushed regional anesthesia to its best at UKCL. He introduced peripheral nerve catheters as well as prepared the staff for their management at the wards. That day I observed placement of the interscalene catheter for the first time.
As soon as the last patient was prepared for the shoulder surgery, a doctor from ICU asked Dr. Jeguc some help with dyspneic patient. We rushed together and I witnessed how bedside ultrasound helped quickly reach the correct diagnosis. It was cardiac tamponade! Dr. Jeguc amazed me with his ultrasound skills be it for peripheral catheter placement or echocardioscopy. In my country we started to use ultrasound more and more, especially for regional anesthesia, but compared with the skills they have there we are still quite behind.
The next day I met with Dr. Andrej Gorkič and I followed him the entire time of the exchange. He immediately became the doctor I would like to be one day. Very energetic and always willing to learn and teach others. He improved my single shot peripheral blocks immensely. He always required to review ultrasound anatomy and taught me how to follow single nerves. I learned to look for the nerves “in the way”, when placing peripheral nerve catheters. There were days when I would perform single nerve shots on almost every arm and leg nerves. He himself was a great example of how to learn. When I came, he was learning to preform parasacral sciatic nerve blocks for the patients with a broken femur when spinal or general anesthesia would not be the best options. He scanned every patient and every nurse for this particular block first of all learning just to visualise the nerve.
In general, I really liked how he applied current concepts in anaesthesia. In my country we try to apply them as well, however we lack some technology. For example, in UKCL they have monitors in the OR that show pulse pressure variation. I was eager to apply this parameter to guide fluid therapy.
And lastly, I was lucky to witness and learn from a very rare reaction to cement during femur prosthesis. The beginning of the surgery was uneventful, but seconds after placement of the cement patients’ blood pressure dropped to zero. The CPR was started. It was successful and the patient regain consciousness without any neurological sequalae. We reviewed the literature and learned more about cement implementation syndrome and what could have been done differently. However, it turned out that the only thing would be to avoid cement altogether. But what I learned the most is that a good preparation in a face of unexpected events is paramount. In our case arterial line saved the patient! Because of it we were able to react so quickly and start CPR immediately.
Once again, I would like to thank everyone who helped me to have this experience, especially to ESA and Dr. Gorkič. This exchange was extremely valuable for me and changed my understanding and practice of postoperative pain management. I am very eager to bring and apply these ideas to my country.