Surgery, squash and anaesthesia

Hannah (18) wants to become a doctor. After two days job shadowing doctors and nurses at the Norwegian Radium Hospital, she is even more certain that this is what she wants to do.

If your dream is to become a doctor, it may be a good idea to gain some insight into what the job actually involves before embarking on a long education. But job shadowing a doctor is usually only a possibility if you’re already a medical student.

Truls Ryder is a senior consultant and surgeon at the Norwegian Radium Hospital. He decided to do something about this, and over three days, one theme day that you can read more about here and two days of job shadowing, 18 pupils had the opportunity to experience surgery, morning staff meetings and patient consultations with the best cancer specialists and nurses in Norway.

Hannah Fiksdal is one of these pupils. And I, Elisabeth the journalist, shadowed her on the first of her two days at the Norwegian Radium Hospital. It was a day that neither of us will forget. A day that left Hannah with an even stronger desire to become a doctor.

‘I am incredibly grateful for the chance to shadow two different doctors, and to Truls Ryder for taking the initiative to allow pupils from Ullern to come to the Norwegian Radium Hospital. It gives us some idea of what may interests us before we apply for higher education in the spring. Having had a taste of two different aspects of medicine, I think that surgery and anaesthesiology were probably the things that I found most exciting.’

Hannah Fiksdal.

Hannah Fiksdal starts the day early at the hospital. Photo. Elisabeth Kirkeng Andersen

Tuesday 7 November

07:15 – the Norwegian Radium Hospital, basement level 2 – the corridor outside room AU 230
Sixteen excited pupils, 14 from the natural science and mathematics programme who will be shadowing doctors and two from the healthcare programme who will be shadowing nurses, are standing in a corridor two floors below the main entrance to the Norwegian Radium Hospital dressed in white hospital clothes.

Truls Ryder, senior consultant and prime mover behind the job shadowing scheme, is also here. He quickly reads out where each pupil will be spending the day, and sets of at a brisk pace with everyone in tow.

This is an indication of what is to come.

We go five floors up and then a couple of floors down via the back stairs. On the way, pupils peel off from the group to join other senior consultants and professors who they will be job shadowing today.

Hannah and Tristan are handed over to the anaesthetists at the anaesthesiology department. The department has nine senior consultants, one professor working 50% of a full-time position, and three specialist registrars.

07:34
The morning staff meeting has already started when Hannah and Tristan arrive. Eight doctors and nurses go through the list of patients who will need anaesthesia or pain relief today. Some will undergo surgery in the hospital’s central unit, and some require their services in other parts of the hospital, such as the radiotherapy department.

It is difficult to understand the discussions and information exchanged between the doctors and nurses. The jargon is technical, professional and precise. I wonder how much Hannah and Tristan understand? But it is clear that we have a full day ahead, and that many of the patients are seriously ill with cancer. Some are young, and some patients’ cancer has returned after treatment. Despite the difficult subject, the tone of the meeting is upbeat and friendly. It will remain so for the rest of the day.

08:00
Tristan and Hannah meet their mentors for the day. Tristan will join Senior Consultant Hege for a complicated operation that may take more than ten hours. The patient has a form of cancer that means that the surgeons have to go into the skeleton, among other things.

Hannah will be joining Senior Consultant Anne. Anne has several operations on her schedule today, and Hannah and I will be allowed to tag along and see how she works. Anne’s first patient is having an epidural and then a general anaesthetic. This is also a complicated operation.

Anne and Hege both tell us to be prepared that what we experience may make a strong impression on us and that it is natural to feel unwell. They both share stories about themselves and about medical students who have fainted both during and after visits to the operating theatre.

‘Let us know if you fell unwell,’ is their mantra, ‘and we will help you.’ I think back to the countless shifts I worked at nursing homes during my student days, and hope that they have prepared me for this. But what about young people of 18 and 19 who want to go on to work here?

08:07
Anne gives us green scrubs and a purple cap. We change in her office while she explains that her job can be compared to a pilot flying a plane. There is a lot to do when the operation starts until the patient is under anaesthesia, and then there is a calmer period of observation of the patient, often done by her colleagues, and then she goes back to full focus when the patient wakes up.

We get changed quickly.

8:10
Surgery starts early at the Norwegian Radium Hospital, and the patient arrives at the operating theatre at the same time as we do. Anne explains who Hannah and I are and why we are here. In addition to the patient, there are already five people working here.

Anne jokes and talks to the patient, who she has already met several times before. She explains that she will first be administering a local anaesthetic to the back before putting in an epidural, a form of pain relief given as an injection in the back. After that, a cannula will be inserted into a vein in the patient’s lower arm. When the patient is completely asleep, Anne will place a catheter in the neck that will be used to administer anaesthetics, pain relief, salts and anything else the body may need during an operation.

Anne involves Hannah in the work and explains what she is doing while she works, and she also explains to the patient.

‘It was also really nice to see how caring the doctors and nurses were and how they reassured the patients before surgery. They were very good at creating a pleasant atmosphere to make the patients feel safe despite the seriousness of the situation.’

Hannah Fiksdal.

08:41
Operating theatre 4 is a big, light room, and one of the long walls has big windows with a view of Mærradalsbekken stream and the surrounding forest. The river and the walking path meander side by side. But today, we can hardly see any of this through the darkness and fog.

Anne keeps an eye on the pulse and heart monitor that the patient is connected to, while the theatre nurse is preparing the instruments that the surgeons might need during the operation.

The patient is about to be put under full anaesthesia. Anne and her colleagues place a cannula in an artery in the patient’s lower arm/hand and a catheter in a vein in the neck. Anne is calm and talks to both the patient and Hannah. She explains to the patient that she will soon be asleep. She explains to Hannah what she is doing, and how you can tell the difference between a vein, which carries blood back to the heart: ‘It is darker in colour and pumps slower’ and an artery, which carries blood from the heart: ‘It is light in colour, full of oxygen, and has more force. If I had made a hole in an artery, the blood would have squirted out.’

Despite the number of people working in the operating theatre, the atmosphere is calm and pleasant.

Hannah pays close attention to Anne and asks questions while she is working. Anne is obviously impressed with the pupil: ‘Hannah, you are a tough cookie.’

09:10
The patient has been anaesthetised and is ready for surgery. At this stage, Anne and her colleagues’ responsibility is to ensure that the patient is okay during surgery.

09:40
The patient is in good hands in the operating theatre, so Anne goes to the recovery unit where the patients are taken to recover from the effects of surgery. Patients are closely monitored here. Many complications can arise following surgery, such as bleeding, breathing difficulties, a fall in blood pressure, pain and nausea.

Anne will set up a pain pump for the patient. This is a pump with morphine that Anne programs so that the patient can regulate how much pain relief she needs and wants in the days following the operation. We are allowed to use the staff’s break room while she is programming it. ‘Drink squash with sugar,’ she advises. We do as we are told, and talk a bit about what we have seen and experienced so far. Hannah is pleasantly surprised that she has been allowed into the operating theatre already, and at how open and welcoming everyone is.

‘There was some information about anaesthesia at the theme day yesterday, so I understand what is going on,’ says Hannah, and talks more about her wish to become a doctor.

Anne returns and takes the time to talk to Hannah about medical school and her many years working as an anaesthetist at Haukeland University Hospital. She took up her position at the Norwegian Radium Hospital a month ago, and there is still much that is unfamiliar.

10:01
We return to the operating theatre. There are suddenly a lot of people here, and several surgeons with different areas of specialisation discuss the surgery they are about to perform. It is a complex operation that requires cooperation.

After conferring for a while, the surgeons make a plan. Several of the Ullern pupils on job shadowing come by together with a gastrointestinal surgeon. One of the surgeons takes the time to explain the plan to Hannah and the others.

10:20
A theatre nurse goes through a checklist with the physician, surgeon and anaesthetist Anne. Everything is in order, and the operation can begin. Anne uses all her senses to check that the patient is still doing well.

Two surgeons cooperate on the operation. Hannah stands watching behind them. They talk about this and that while they are working, including the musical Book of Mormon. The actual operation is expected to take five hours. After working and discussing amongst themselves for a while, they ask for another surgeon to be called. They need what is called a ‘second opinion’, or another surgeon’s assessment.

There are suddenly a lot of people in the operating theatre, and several surgeons with different areas of specialisation discussing the case. Truls comes in with a couple of pupils who are shadowing him. Truls confers with his colleagues, and one of the surgeons explains that they are uncertain about the best way to proceed. When the surgeons opened the patient up, they found that the assumptions they had made from the outside were not correct. They have to rethink and make a new plan for the operation.

Anne lets us know that this is very unusual. There are rarely this many surgeons involved in an operation, and they do not often spend this much time discussing what to do. She suggests that we take a break and get something to eat. She has to work, though, both with more of today’s patients and planning for tomorrow, but she thinks that we should eat something.

‘Another thing that surprised me was the doctors’ willingness to show and tell me what they were doing and why. During the first day in particular I learnt a lot that I hope will be useful in my future studies. It was also very clear during the operations that good cooperation is incredibly important in order to achieve the best possible outcome for the patients. Everything from how the senior consultants’ discussed to find the best way to proceed during the first operation to how the two surgeons cooperated without needing to communicate much during the second one.’

Hannah Fiksdal.

11:07 Break room
Since we have green scrubs on, we have crispbread with cheese in one of the break rooms. Otherwise, we would have had to change, leave to eat and then change back afterwards. We also have more squash. With sugar. More pupils come in for a welcome break. Four intense hours have flown by. Two pupils have fainted and woken up again.

Ander Bayer from Oslo University Hospital’s communications department also joins us. He made this video about the job shadowing.

 

11:36 Operating theatre 2
Anne comes to get us. Hannah is going to go with her to another operation. Anne is to put another patient under anaesthesia. Again, Anne explains to the patient and theatre nurses who we are. This patient is also having an epidural in the back, and again, Anne alternates between speaking softly and reassuringly and explaining what she is doing to the patient and Hannah. Fourteen minutes after we entered the operating theatre, the patient is under. Two nurse anaesthetists help Anne by monitoring the patient. The theatre nurses wash the abdomen where the surgeons will open up the patient to remove tumours.

12:15 Operating theatre 4
Anne is needed in operating theatre 4 again, where three surgeons are operating on the first patient. They have now decided what to do.

12:23 Break
We get to take another break and have some squash with sugar, while Anne is preparing a pain pump for the second patient.

12:32
The second patient’s operation is under way. Two surgeons are standing face to face, working together. Anne gets a stool so that Hannah can stand by the patient’s head and watch the surgeons work inside the patient’s abdomen. They have made an incision that is held open by a large tool. There is a smell when the surgeon uses an electrosurgical knife to cut tissue and burn small blood vessels. The cancer they are removing is located around the vein and artery, the blood vessels running to and from the heart and legs. The surgeons show Hannah where they have to be careful. The cancer is removed, and they quickly suture the different layers of tissue before stapling the skin. The theatre nurses perform a routine equipment count. The operation is completed in 40 minutes.

The day in the operating theatre was at least as exciting as I imagined! I had not expected that they would allow us to get so close to the patients and really get a proper insight into what happens during an operation and also how the patients are anaesthetised.’

Hannah Fiksdal.

13:35
Anne returns to make sure that both the patient and Hannah are okay. Anne and her colleagues from the anaesthesiology department wake the patient up. The important thing now is for the patient to start breathing again. Everything goes as it should.

13:40
We accompany the patient to the recovery unit, where the patient will remain for a few hours. Anne’s work with this patient is now finished. We go back to her office to change out of the green sterile scrubs. Anne tells Hannah that she will probably doze off early after such a long and intense day. Anne’s shift will last until half past three, when other anaesthetists will take over for the evening shift. In the hall, Hannah thanks Anne for everything she has taught her and for taking care of her during the day.

14:00
As we leave the Norwegian Radium Hospital through the main entrance, we wonder how the first patient whose surgery we saw in the operating theatre is doing. And Hannah says that she is looking forward to another day of job shadowing tomorrow.

Epilogue
The evaluation results for the theme day and job shadowing were excellent. The pupils and teachers were highly satisfied, and it has already been decided that this will be made an annual event for pupils at Ullern upper secondary school who are considering a career in medicine.

‘Finally, I would like to say that it was very inspiring to see how committed Anne and Anna (Anna Winge-Main, who was Hannah’s mentor on the second day of job shadowing) was to their work and how much they loved their job. It was very clear that they are really dedicated to helping their patients. As Anne said, medical school can be hard and difficult, but once you start working as a doctor, nobody regrets their choice.’

Hannah Fiksdal.

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