Another day as a Portuguese trainee …

Another day as a Portuguese trainee …

  • Issue 71

Diana Leite

It’s Monday and I’m starting a new internship – anaesthesia for neurosurgery (NS). I think we will be three trainees there. In my hospital, we receive colleagues from other (usually nearby) hospitals that don’t have this speciality. Our neurosurgery department has its own operating room (OR) with two rooms that perform routine surgeries all weekdays, ranging from tumours and vascular malformations and aneurysms, to awake craniotomy and insertion of deep brain stimulators.

During the next three months I’ll be doing the routine of the NS OR in 4 shifts of 6 hours weekly, plus my regular shift (12 hours) in the emergency OR and our Friday morning anaesthesia lessons (6 hours). On average, this accumulates a total of 40 hours per week. I’m starting today with a 12-hour shift. I’m really excited as this will be quite different from other internships I’ve done so far. I hope I will have the opportunity to work with some neuromonitoring devices, to improve my handling with target control infusers, and learn more about the neurocritical patients.

When we receive the patient in the OR it’s about 8 a.m. Yesterday, I did a pre- anaesthetic visit so I already know the patient and his comorbidities. It’s a craniotomy for supratentorial tumour resection, planned to last for at least 6 hours. After talking again with the patient I go to the OR and routinely verify all the necessary anaesthetic equipment, including the anaesthetic machine. I complete the security and quality checklist together with all the operative team. Our anaesthesia nurse is preparing the protocol that I’ve previously proposed to the attending anaesthesiologist.

We start the induction and the surgical team is scrubbing outside. Everything went well and now while monitoring the patient, I can discuss with my supervisor the particularities of this case and some theoretical concepts I’ve been reading from the proposed bibliography. When we are in a 12-hour shift we don’t have a lunch break, so we have to take turns to have a quick snack in the lounge room, which is nearby.

As I get back, I check next day OR plan in order to prepare my pre-anaesthetic visit and discuss some particulars with my supervisor. Between that and blood gas assessments, checking the urine output, and prescribing drugs for the current patient there is not much time left! The surgery is over and it’s now time to take the patient to the neurocritical intensive care unit.

Quick time for another snack since the next patient is already here! This case concerns a subdural hematoma that needs to be drained by trepanotomy. I assess the patient and again discuss the anaesthetic plan. The surgery is much faster than the previous one and I’ll be leaving the hospital around 8 p.m.

What a day! Definitely, I’ve learned a lot and I can’t wait for tomorrow. Now, I just need a proper meal and to have a shower. I intend to read a bit about the case I’ll have tomorrow, and I hope I won’t need to stay up much after midnight as I need to rest after such a long day. Tomorrow I’ll have a 6-hour shift so I will have a free afternoon to study and do some research work and … maybe catch some sun at the terrace as spring started with sunny days here in Portugal!

Portuguese Trainee Network Board: Diana Leite, Liliana Paulo, Filipa Marques, Ana Santos, and Nuno Lareiro