When CHARMAYNE ALLISON and LACHLAN DURLING were invited into the operating theatre to witness Australian ﬁrst surgery they were not sure what to expect. But blood and guts aside they watched visiting surgeon Devinder Garewal lead a precision team through groundbreaking reconstructive surgery and it all went like clockwork.
Luke Brennan – surgical assistant
AFTER completing his internship last year Luke is one of the small army at ERH who takes care of patients post-surgery.
And he’s also in theatre with a front row seat to the action, assisting Devinder by pulling back skin, tissue and holding the arm as the Devinder drives the short stem prosthesis into bone.
“Once the cut is made you have to retract and get joints in certain positions while they’re taking out the bone and putting the replacement in,” Luke said.
“Then I manage the patients on the ward postoperatively, making sure they’ve got adequate pain relief and giving them antibiotics to minimise infection.”
Working out of Bendigo, Luke is on a three month placement at ERH and will move on to gain more experience in another regional hospital.
“It’s pretty impressive to be a part of this surgery, I’ve worked with Devinder once before and he’s a really good teacher so it’s good to get some hands-on experience,” Luke said.
Andrew Stubbs – Exactech rep
GONE are the days of the travelling salesman who is there when you don’t need him and disappears when you do.
Andrew was instructing ERH medical staff about the Exactech prosthesis.
It’s information he’s gained from regular training by the company.
“I have a medical science degree and a passion for sales — so this role combined them well,” he said.
“Exactech supply us with this equipment as well as training in the US and cadaver workshops in Australia and overseas.”
He’s also the one who programs the essential navigator technology to the patient, making sure the surgeon has the best location to drill into the bone.
“I bring the navigator equipment along and set it up on the side of the operative table,” he said.
“Then, once the surgery starts I’ll be instructing the scrub nurse to pass over instruments that are important for the shoulder replacement side of the surgery and then controlling the navigation equipment.
“And of course, if there are any technical challenges along the way, we’re there to offer that technical support and help guide the scrub nurse and surgeon through those moments.”
Andrew said he was thrilled to be a part of the surgery.
“It’s pretty exciting. We’ve done quite a few of the navigator cases now so to be able to couple it with the new preserve stem, it’s exciting,” he said.
Rebecca Gray – scrub nurse
A NURSE at ERH, Rebecca – or Bec – Gray’s role was a matter of life or death for the patient.
She was the scrub nurse, which involves opening and inspecting anything to be used on – or in – the patient.
With an eagle eye, she spots torn packaging and other tell-tale marks that show a piece of equipment has been compromised.
“We’re listening (to the surgeon and the rep) and when we’re opening up everything we’re looking at the sterility and integrity and trying to get it in the order the surgeon needs it,” she said.
“There are moments when we open something up and it can’t be used. We open it up and it may be contaminated by damaged packaging.
“We usually can just hand it off.
“It’s rare that we’d ever have to open up a whole new setup (of tools and equipment) because of contamination.
“We’re constantly monitoring everything that gets opened and how far away people are to make sure they’re not contaminating our field.”
The ‘field’ is an exclusion zone of about half a metre around the patient, a table of implements and instruments.
No one but the scrub nurse is allowed to pick up items off the table and no one else opens anything in surgery.
“It was a bit exciting to hear it was an Australian fi rst when we got to work this morning, it was good to be involved in it and it went extremely well.”
Sam Kennedy – anaesthetist
ONE day a month, Devinder Garewal comes to town to complete surgeries. And when that day rolls around, Sam Kennedy is the anaesthetist he turns to.
He’s one of our local GPs and a GP anaesthetist who helps Devinder work away on surgery after surgery throughout the day.
“The list was one of the more challenging we’ve been involved in, there was the challenge of general anaesthesia and ultrasound-guided regional anaesthesia to complement that,” he said.
In layman’s terms, the general anaesthetic to knock the patient out and the regional anaesthetic is known as a ‘block’.
The block numbs the patient’s arm just before the shoulder joint, meaning when they wake up there’ll be little to no pain.
“It’s also challenging because the positioning of the patient leaves them susceptible to low blood pressure, we need to monitor them invasively with arterial lines and Inotropes,” Sam said.
“All of which needs constant supervision to prevent serious complications of anaesthesia.”
Sam said he was attracted to the variety of anaesthetic work ERH offered and so made the move from Melbourne to call Echuca home.
“My internship involved a three month rotation to Echuca where we worked when the hospital wasn’t quite as well staffed,” he said.
“The variety of work really attracted me to come back. It’s been 10 years since I moved back as a full time GP and GP proceduralist.
“Being able to do this sort of anaesthesia also enables us to maintain skills that allow us to provide emergency care to people in the Echuca district.”
The surgery theatre is just like any other workplace and Sam always manages to bring a light-hearted take on life into the room.
“You spend a lot of time at work and so you’ve got to have fun at work. We’re got a really good team here and it’s a good balance of humour and seriousness,” he said.
“We take our job very seriously but at the same time we’ve got good relationships we’ve perpetuated and maintained because we’re all local people working locally."