Tuesday at UZ Leuven

Tuesday morning, I'm taken by a surgery student to an experiment he set up for his Ph.d. He is investigating how the length of ischaemia damages the small intestine due to reperfusion and he is also looking for biomarkers to help devise a test. Leuven has great labs, with some truly remarkable names doing some incredible research. The lab we went to was for student use, it wasn't extensive as that would involve a lot of non-existent financial investment. 

The experiment was carried out on rats that were the same weight, sex and breed to keep the varying factors to a minimum. We discussed the ethics component of the practical. Firstly all involved had passed an ethics examination, where the correct handling of small animals was covered. Then an ethics committee reviews the plan of the practical, they approve the methods and the number of animals used. Then the rats were all tranquillised  put on anaesthesia. When they woke they were put on painkillers. At the end, they would be euthanised. 

Helping out with the study was a fourth year medical student. She informed me of the Belgian medical education system. Incidentally she was also on call to help out with a study that looked at the ways ischaemia affected the kidneys during a liver transplant. In order to do so she had to be present at all the liver transplants during the week. She told me how last week there was three consecutive transplants. Belgium is part of a 'eurodonor' programme.  Where several countries have a joint waiting list, at organs are flown into countries that need them most.After Spain, Belgium is the largest donor of organs. It has a policy of presumed donor unless stated otherwise, however the wishes of the family of the decease is always respected. Livers need to transplanted within 10 hours after removal (a heart keeps for 4 hours and kidneys 24). As a result liver transplants take place at all odd times. Laura's colleague on call, had to manage with a few hours of sleep that week, he was practically inhaling coffee. This however made reflect on the personal sacrifice surgeons make. They are called to the hospital at various times, the job takes a toll on family and social life. Furthermore they have to remain focused and on their feet for several hours (up to eight for a liver transplant.) At least he or she has a little troupe of people for company. 

The transplant I was lucky enough to watch involved a liver from Germany from an anonymous donor. The organ was duly checked for viruses such HIV and CMV (which is a herpes virus that can easily be fatal for people with suppressed immune systems such as organ recipients).

During the operation I witnessed, first hand, the close relationship between surgeon and nurse. I learnt that nurses could specialise in surgery. At the operation, there was one nurse responsible for setting out the multitudes of equipment (surprisingly only three instruments were actual cutting devices, (scalpels).) He was able to hand the surgeon his equipment without the surgeon having to verbally ask for it. There was another 'run-around' nurse who wasn't in sterile uniform, she was picked up the used pieces of cloth used by the surgeon and his two co-assistants, and hung them up. By doing so they could be counted and the doctors could be sure that no textile was left inside the patient.

The surgical procedure involved hooking the patient onto a bypass machine so that the blood from the bottom of the body could go back to the heart. This machine was operated by a specialist. Technology prevailed in the operating theatre. The anaesthesiologists (there was two assistants and a supervisor) set up an electrocardiogram (EKG), they were measuring blood pressure, central venus pressure, heart rate. An anecdote exposed further the integral part that technology plays in healthcare, the coagulator machine which is used to seal tissues and vessels to prevent excess blood loss, wasn't working properly and as a result the operation had to be held for 45 minutes. The performing surgeon certainly wasn't happy as you can imagine as most patients are in a critical condition when suffering from acute liver failure.  

When a patient I'd already so ill it becomes of the utmost importance that their condition doesn't worsen. I was amazed by the level scrutiny by which everything and everyone around were made to be as sterile as possible. The surgeon washed his hands thrice in a particular manner, he wasn't able to touch the lower half of his body, a nurse had to do up his coat and then he covered the section she had touched with a extra piece of material. I heard these precautions were especially needed due to the spread of Methicillin-resistant Staphylococcus aureus (MRSA) through Belgian hospitals. The bacteria can infect deep tissues in the body and in these cases can be fatal. As in the name, the strain of bacteria is resistance to antibiotics as result its spread is hard to control. So big is the problem that a Dutch lady being treated in Belgium wasn't able to continue treatment in her home county the Netherlands due to fear of the bacteria spreading.