In Tansen about 75% of the surgical cases are elective, usually booked about 3-7 days in advance. The other 25% are emergency or urgent cases, booked from the emergency department, maternity and surgical wards.  There is only one operating theatre staffed after 5pm, so “urgent” cases are not done after hours. The rostered surgeons for the day stay until all the cases are complete.
We have only three general surgical residents, and four senior surgeons, at the moment, so the mood of the operating room changes considerably.  For example, today I was rostered with another senior and our “registrar.” So we ran two theatres, with cases running one after another.  We had lots of fun and finished our list (with two extra caesars) at 3pm.

Friday was a completely different mood.  I was operating with a house officer, which means I could really only run one room at a time.  We had two at our disposal, though, so we alternated theatres.  As soon as we were sewing up one case, the next patient would be going to sleep.  You know those scenes in MASH, where they skip from one patient to the next, only washing their hands in between?  It felt totally like that.  (Which means I thought I was Hawkeye Pearce by the end of the day, which does nothing at all for my humility…).

I am continually amazed by how quickly the staff are able to turnover patients.  Few patients have general anaesthetics, and most have spinal or ketamine for their procedures.  Lesser levels of anaesthetics are safer, as well as cheaper for the patients.  In Melbourne, if we had a day where they decided to only do spinal anaesthesia, I bet we wouldn’t get through ten patients.  But here, with trainee staff, the patients are routinely anaesthetised before I realise.  No time for coffee between cases.

On Friday we managed to do TEN operations, including four majors.  A couple of hernias and perianal cases, true, but also three caesars (four babies), one laparoscopic cholecystectomy, and an eight month old with a submandibular abscess (which turned out to be a really massive lymph node, despite ultrasound appearances).

Working in Tansen continually surprises me.  When I look back on an operating list, I can see that more than half the cases are things I would not have felt confident in when I arrived. Most of those things still scare me, but I don’t have to ask for help.  Doctors here have different skills than we expect at home.  At home, we dissect every complication, trying to strive for that extra 10 percent.  Here, we discuss what operation we can offer a patient to get them the closest to their best possible outcome.  Sometimes that means recommending treatment in another centre, but that option is only open to those patients who have the money to travel.  People give their best, and we all work as far out of our comfort zones as we can, in order to get through the cases.

And, more than my last year as a fellow, more than when sitting my exam, more than my intern year, at the end of the day I collapse on the couch, exhausted. Exhausted, but on Friday I fixed 7 people, and helped three mothers meet their babies.  Totally worth it.