Kyle and Kitt in the OR

From Kyle:

It's hard to believe we are already through another week!

After spending most of the week teaching, Kitt and I returned to the CHUK operating rooms today to work with the residents. Three PGY-1s were on the list today, but it appeared that there would not be much going on as CHUK has been in slow down while many staff physicians are away participating in training programs. Only one room was scheduled to run, an elective ENT list with a visiting surgeon; we wondered if there would be much for the residents to do. Of course, several emergencies presented requiring immediate surgery, and by mid-morning one room quickly became four.

Fortunately, there were enough personnel available to accommodate this including nursing staff and surgeons, both Rwandan and visiting. It is impressive to see the composure of the anesthesia residents in these situations. We did not see a staff anesthesiologist all morning. The residents and anesthesia technicians did everything. A clear degree of confidence and strength in the basics of management has developed from this, as the PGY-1s here are more comfortable in these emergent situations than I remember being at that point in my training. 

This independence has its shortcomings, though. Positioning for intubation, proper pre-oxygenation, laryngoscopy technique, ensuring gastric drainage in obstructed patients... there were a few 'near-miss' events this morning. While the close eye of a staff anesthesiologist can often feel overwhelming, frustrating, stifling- it forces you to refine your skills . As the program is training future consultant physicians, we have been impressing the importance of minimizing patient harm during surgery. While we may get away with imperfect technique or incomplete knowledge 90, 95, even 99% of the time, the role of a specialist is to prevent every possible complication. 

We are looking forward to a day free of travel or work tomorrow: maybe a chance to relax and explore our busy neighbourhood and finish up preparation for Kitt's academic presentations on Monday. We are especially excited for the arrival of our friend Amelie!

Window on the OR