My Medical School Elective During the COVID-19 Pandemic Hanad Ahmed

Aplan was made, an application approved, a bursary secured from the SCTS for travel to Toronto ... then COVID-19 happened.

The shortfalls of not experiencing an international elective are abundant I am sure, but this article focuses on the tremendous reception and experience I gained during my domestic 3-month clinical elective at University Hospital Southampton.

Like many students, I decided to take the remaining option of completing my clinical elective at my home institution. It was supposed to be a 6-week elective that furthers my interests in the specialty and fulfils the medical school requirement; instead, it turned into a 3-month rollercoaster in cardiothoracic surgery where I breathed, dreamed, and immersed in cardiothoracics. From witnessing lifesaving emergency interventions in neonates to assisting in major trauma cases. It is safe to say that I found my calling and this piece will outline a fraction of my experiences and reflections in each of the subspecialties.

I spent the first part of my elective with my longstanding undergraduate supervisor, Mr Aiman Alzetani.

This block provided an understanding of the complete responsibilities of a surgeon- from operating, to teaching, managing, and conducting research. I was keen on emulating each of these domains and was given the opportunity to do so.

I got uninterrupted time in theatre, starting with the basics of learning to make incisions, inserting ports for VATS, before progressing to closing port sites and being a regular first assistant. When I didn’t have theatre days, I spent my time running surgical skills courses for the junior medical students rotating through cardiothoracic surgery. I discovered the fulfilling nature of passing on skills that I only recently acquired. This experience kickstarted my drive to teach and gave me an appreciation for why it is such an important area of a clinician’s role.

I was fortunate enough to be involved in cases where new techniques and technology was being applied. I found myself engrossed in understanding and writing up these cases after long days in theatre and did so with the realisation that this was likely the spirit through which legends and long-term inspirations such as Professor Michael DeBakey, Professor Sir Magdi Yacoub and Mr Marian Ionescu innovated in the specialty.

A spirit that drives me to continue to carry on discovering interests through research and pursue my dream of following in the footsteps of these giants.

The thoracic block laid solid foundations for the rest of my elective and propelled me into the world of Cardiac surgery with Mr Clifford Barlow.

My time with Mr Barlow and the wider team in cardiac surgery romanticised my interests in the specialty. The vividness of dynamic red flowing through plastic tubes, to the gentle manoeuvres performed by size 8 hands. The entire process of watching valve and coronary surgery was a spectacle. The orchestra between the surgeon, registrar, anaesthetist, perfusionists, scrub nurse and theatre staff was an exemplification of teamwork and surgical leadership. I stood there in awe watching technically challenging tasks being performed with such composure and occasionally a sense of Dutch humour.

Despite the amazing exposure to the technical and clinical aspects of the surgery, what I learnt from Mr Barlow was that to become an extraordinary surgeon, you must do more than just being able to execute the operations.

Much of the extraordinary was achieved outside of the operating theatre, an idea that made logical sense, but one Mr Barlow refocused in my mind. I thank him and the team for welcoming me into their world and for encouraging my ambitions in the specialty.

After my cardiac surgery rotation, I began to appreciate the importance of the anaesthetic and intensive care management of the patients. I was taken under the wing of Dr Tom Pierce. Here I was taught the intertwined nature of the surgery, the anaesthetic, and the post-operative management of the patient. What was interesting was that an almost equal if not greater emphasis was placed on the nontechnical aspects of the patient’s management including the human factors and the importance of a harmonious working relationship between surgeon and anaesthetist/intensivist.

Mutual respect, attention to detail and an appreciation of each other’s role and expertise was key to sailing out of treacherous waters and making the challenging enjoyable. In acute situations it was the collaboration and combined efforts between surgeon and anaesthetist/intensivist that often made the difference, more than what any one individual in that equation could achieve alone.

I appreciated how a positive working relationship benefitted patients and staff by avoiding unchecked clinical errors and staff burnout. I thank Dr Pierce for giving me a perspective I never considered, and one that I now have in the forefront of my mind every time I step into an operating theatre. An experience that can be summarised by the quote “We see only what we know”.

Following the end of my adult block, I spent time on the paediatric side of cardiac surgery and intensive care under Mr Nicola Viola, Dr Michael Griksaitis and Dr Andy Curry.

During this block I experienced the highs of highs watching lifesaving procedures such as the arterial switch with the touching sigh of relief from anxiously waiting parents. I also witnessed the lows of lows with emergency laparotomies and crucial interventions in fragile neonates on PICU.

I tuned into the way clinicians recalibrated the threshold of stress and how the tiniest of movements and clinical decisions made all the difference in outcome. For better or for worse, it often felt like a TV drama, except I was standing in the middle of it!

This rotation embodied teamwork and communication. The intensity of the medicine and surgery meant an even greater emphasis on self-awareness, situational awareness and integrity, a lesson gifted by my long-term mentor, Mr Nicola Viola.

This piece is dedicated to all the staff and supervisors at University Hospital Southampton cardiothoracic department, as well as Mr Ionescu and the SCTS whom made my elective possible. n