It's midweek

Today, like the last couple of days, I was upstairs on the ward, and my doctor was downstairs at consultations. I started like I do every other day, reviewing yesterday’s plan for each patient. I chased up some samples that somehow just went missing. Like, how does a 3-day stool collection disappear into thin air? 

As I was checking the patient's lab results for today, the nurse came by to say that one of our patients was going down to the ERCP. It was a case of GAVE, which stands for gastric antral vascular ectasia and is sometimes referred to as watermelon stomach. It can be treated with Argon photocoagulation of the blood vessels, but the Professor informed me that he doesn’t perform that procedure because it’s a temporary fix for what is a long term problem. Instead, he conducts band ligation. Unfortunately, something went wrong, and the procedure couldn’t be completed. It has been rescheduled for a few weeks.​​

The patient following this was also one of our patients from the ward, so I stuck around to observe this procedure as well. This case was quite interesting. The patient had an external biliary drain meaning there was a catheter that went through the patient’s skin into the common bile duct. The catheter is attached to a drainage bag where the patient’s bile drains daily. 

With this second procedure, other specialists were needed. An Interventional Radiologist assisted the Professor by passing a guidewire through the biliary drain from the skin to the common bile duct. Using an endoscope, the Professor was able to see the guidewire at the major duodenal papilla. He slid a catheter with a balloon on the end over this guidewire. He filled the balloon with a contrast agent, allowing him to dilate the common bile duct and visualise the balloon on fluoroscopy. Then he changed the catheter to one with a stent to remove the gallstones. After this, he switched back to the catheter with a balloon on the end again to dilate a bit more. Lastly, he used another catheter to insert a double-pigtail biliary stent. 

For the procedures, I had to change into scrubs. 

Here I am at the lockers in the changing room before heading to the ERCP.

Oh, in the afternoon the stool sample was found in the freezer at the laboratory. The mystery of the lost stool was solved.

Tomorrow my doctor is off. The plan is that with the supervision of the other doctor on the ward, I’m supposed to see our patients. Since the other doctor also has a list of their own patients to care for, my doctor's patients will mostly be my responsibility. Wish me luck! I’ll of course let you know how it goes.