Tuesday, November 18, 2008

In Gleaneagles Intan hospital, you have top notch health care facilities equipped with cutting edge surgical equipments, machine, well trained surgical nurses, well design OT and of course world class well renown, esteemed surgeons.

In ACTS clinic, you are short of everything. Even the basic surgical equipments. No retractors, no proper lighting, no proper table to ensure patient's comfortability during any kind of procedures. Doctors are pushed to the limit, they have to improvise, make their way through the procedure without proper equipments, testing their skills to the limit.

I managed to witness a sebaceous cyst removal today with Dr Kamarudin. It was an experience that swear I wont forget for the rest of my life.

Patient presented with a growth at the posterior aspect of the thigh. After inspection, It was diagnosed to be a sebaceous cyst. It is harmless but It causes discomfort and pain to patient and thus Dr Kama decided to excise it. I palpated the cyst. It was hard, boarders were regular and It is movable. Laying my hands for the first time on a cyst is truly breath taking. I certainly do not know how to describe it here, Its a mixed feeling indeed.

Sebaceous cyst- A sac with a fatty white, semi-solid material called sebum. Sebum is produced by sebaceous gland in the epidermis.

Preparation was carried out. As you can see, the table is not an operating table. It is just some old couch that were found inside the store room. Sigh..saline, povidon, 15 blade, gauze, forceps were prepared and placed inside the kidney dish.

Dr put on his gloves while I put on my surgical mask. Holding my camera in one of my hand, I try to recall the basic steps that have to be done prior to any kind of surgery. Local anaesthesia, disinfect the site of incision...Its like a string of pictures, flashing chronologically in my mind.

Local was given subcutaneously. Lignocaine was used. Injected subcutaneously around the cyst.

Povidon was applied around the cyst to disinfect the incision site.

Incision was made using a 15 blade.

The lighting was bad. The room was quite dark so thats why we need a torch light. No OT lamp unfortunately.

I watched each and every process meticulously, jotting down notes and taking pictures. Surgery has always been so interesting for me.

See the whitish thing over there, that's the cyst. Filled with sebum. Due to the improper use of instrument, Dr Kama punctured the cyst and sebum started squirting out. It was grayish in colour, indicating infection. According to Dr Kama, sebum is a perfect reservoir for microorganism to grow.

Extracting the cyst.

Extracted. It took 40 minutes to take out this thing. Patient was relieved.

Irrigation with normal saline.

Suturing using nylon. Interrupted suture.
Patient was given antibiotic in case the wound is infected.
" Medicine is all about anticipation. And anticipation comes with knowledge"
This is a take home message from Dr Kama.
I was satisfied spiritually.
I am having a pretty bad running nose right now. Probably due to the weather and the exposure to patients with common cold and cough. Took ceterizine, a second generation of anti-histamine which I took from the clinic just now. Desperately need some rest.
I auscultated a patient's lung today. The wheezing sound of a patient with asthma is truly amazing. Its still on my mind right now, the feeling of satisfaction, euphoria is uncontainable.
I don't need sex, medicine is truly truly my orgasm.


Winni3 said...

ekk...looks like isn't?

Yong Chuan said...

No winnie, its not. Its actually a sebaceous cyst. A sack filled with fats.

why? Looks gruesome?

Winni3 said... there's smthing like the err sebaceous cyst on my dad's big n thick as a mentos lol.accepted surgery and took it off de..never realized tat it's filled with fats.tot it's sm kind of..birth mark loll

Jeffrey said...

good to hear from a fellow monash medical student.
you should submit this post to SurgeXperiences.

more details are over there. :)

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