Week 5 (Tue/Wed/Thur)

Tuesday:

Clinic in the morning - it's chilly when it's early! Had to wear my hoodie to work. It's the clear skies, apparently, which means it also warms up quickly in the sun. Not that there was much of that today. Rain and wind a plenty though!

Clinic was excellent, as always, and I got to teach a doctor how to use a lit lamp, because I'm apparently "very good" with them. Ha! He was probably just being nice, but teaching it makes you quickly realise your own limitations, so I ended up learning more stuff about them.
Cases seen: a chemical burn to the eye (and teaching on how to manage chemical burns should I ever see one), a 1 day post-op corneal graft, post-trabeculectomy scleral thinning, blocked meibomian ducts, an entropion and the unexpected highlight of a referral to RPH of "viral keratoconjunctivitis".

Normally, when you hear that as a case description you sort of switch off, because it's, well, just viral conjunctivits with some corneal involvement. It's not a big deal. I learnt a few things then:
1) Royal Perth Hospital is a specialist ("tertiary") ophthal centre that takes cases from all over Western Australia. People fly to get to hospital appointments there, routinely.
2) Cases sent to RPH are therefore normally like Ron Burgundy, "kind of a big deal"
3) Severe keratoconjunctivits is icky.

It was bacterial, not viral, so it hadn't spread to this guy's family/kids, which was good. However, severe keratoconjunctivits has a nasty 'special ability' if you will - it forms a membrane over the conjunctiva on the inside of one's lids. This can lead to bands of goop sticking the two conjunctival surfaces together (eyeball and inside of the lid stick together). This chap didn't have any bands, thankfully.

That didn't make his "membrane" better though. Under normal light, it just looks like a pale layer on the inner lid surface. With fluorescent staining and blue light, it glows like one of those stars you used to stick onto your bedroom ceiling. The problem with a membrane is that they are what's known as a reservoir for the invading organism. So they need removing, to try and prevent ongoing infection. With forceps. It peels off like a layer of dead skin, but bleeds profusely because it attaches itself if left for too long. Ouch. They can regenerate in days, at which point they need peeling off again. Ouch. Messy.

Afternoon was spent back in my room, wrapped up in layers of clothing and writing more of my project.

Wednesday

Research all day - it's almost done. I was told that the 1st draft I'd emailed originally was enough to grant me authorship of the paper, so was to finish off the bits I wanted to do today and tomorrow, but email it on Thursday and leave it. The team will sort the rest out, and will organise a mock OSCE 2 exam for me next week if I bring them the info on the stations after the Easter weekend. Awesome.

Thursday

Theatre in the morning - orbitotomy and orbital tumour biopsy (this thing was deep in the infero-nasal orbit and very difficult to tell apart from surrounding fat). Was cool to watch though - I now have a better idea as to how they access the orbit and get around the eyeball in the way - they push it. With a metal paddle/spoon. Saw another blepharoplasty - this one was for an anatomical defect on a young chap, basically meaning he didn't have an upper lid crease on the right side, so looking up caused his eyelid (and lashes) to fold inwards, which as you can imagine, would be pretty annoying.

Japanese lunch with the consultant and reg again - chicken katsu with a rice box and veg. Pretty good - especially when bought for you.

Afternoon research - finished the last bits I wanted to do, and emailed it off. Done. Huzzah!

Easter weekend plans: Beach, King's Park, OSCE 2 revision and collecting information bits for the team (to use against me), shopping, my brother's best man speech, and planning how I'm going to get to the airport in time for my Sydney flight the next Saturday. So it's not like I'm busy or anything...

No time for Rottnest Island the whole time I've been here. A little disappointing, but I'm not too worried - definitely coming back to Oz at some point for a (English) Winter holiday!