Who smiles in a hospital? Reflections from a week in the world of surgical sciences

'Who smiles in a hospital?'

That was the question a lady asked as my mum took a photo of me before I entered the John Radcliffe Hospital on my first day of work experience at the Nuffield Department of Surgical Sciences. At first, I had been smiling out of excitement, nervousness and curiosity about the week ahead. However, seeing the lady with her small child in pain made the question stick with me for a very different reason, and made me reflect more deeply on why I was drawn to medicine in the first place over the course of the week.

Over the week, I saw different patients and families with a range of emotions: hope, grief, uncertainty, determination, fear and many others. It reminded me that while I was entering the hospital to learn, many others were there during some of the most vulnerable moments of their lives. That initial moment helped to shape the way I viewed my overall experience, allowing me to view first-hand the range of careers within surgical sciences; from its operative aspects to its foundations in research and innovation.

Having already developed an interest in surgical anatomy, particularly the thoracic cavity, this week allowed me to gain greater clarity about my future career prospects. It brought me closer to understanding the kind of future I may want to pursue, whether it was one I thought was clearly within the operating theatre or one which was largely in laboratories or even one which included both! Over the course of this blog, I hope to detail the range of experiences I found extremely fascinating and invaluable that supported me in gaining clarity about whether a career in surgical sciences was right for me.

The week began as I met the five other successful candidates for the first time at the reception of the John Radcliffe Hospital. Everyone seemed so capable, and I could not help but wonder whether I would fit in and whether I would get along with everyone. Thankfully, my worries were quickly put at ease. We all quickly became close with each other, discussing all the sessions we had in detail in breaks and even after the sessions ended. It was reassuring to meet people who were far more welcoming than I had initially imagined and who shared similar interests, making the experience much more enjoyable.

On the same day, we entered the QUOD biobank facility where Letizia Lo Faro spoke to us about transplantation methods and how researchers aim to reduce organ degeneration by using methods such as normothermic machine perfusion. We conducted a BCA assay, a method I was previously unaware of which included finding a sample protein concentration within the kidney. However, I quickly began to love it as we also used equipment such as a Gilson pipette and technologies such as spectrophotometers that I hadn't previously had any experience with. These initial experiences made me realise the level of precision required to work in lab facilities and the level of organisation required alongside. It made research feel like a path I could imagine pursuing in the future.

As the week progressed, our sessions began to be more intense yet also eye-opening to the range of careers in surgical sciences. We had ward interactions within the Urology Department at the Churchill Hospital, learning about the wide prevalence of prostate cancer and learning about procedures such as nephrostomies. Speaking to doctors at the hospital revealed the unglamorous side of medicine including the intense rigour required for it, where they also guided us towards alternative and more niche career fields we could also potentially enter in based on our individual academic interests.

Later, we saw the HIFU facility led by Professor Feng Wu. This was one of my favourite sessions of the week, as learning how advanced ultrasound technology can target and ablate tissue and tumour cells with remarkable precision was especially insightful. Additionally, learning more about how sonotherapies could become the future approach to treating cancers intrigued me and helped further develop my interest in non-invasive treatments. Having the talks on global surgery showed me the realities and inequalities that healthcare professionals must confront. Though I did not expect myself to enjoy global surgery as much, I realised the wide scope it has in addressing these issues in the world, for example the use of locally available materials such as betel leaves could support stoma-care in resource limited settings. All of these sessions helped me to understand how healthcare can give birth to life-saving technologies but also remain as a field where injustice remains widely present in many parts of the world.

Following from the introduction to these technologies and issues in healthcare, we continued with outpatient clinics in the Department of Vascular Surgery at the John Radcliffe Hospital. Having seen patient-doctor interactions that required careful understanding, clarity and professionalism, I learnt about the wide prevalence of peripheral vascular diseases seen especially in elderly patients. Learning about forms of treatments for varicose veins for example or even using equipment such as the Doppler machine to detect blood flow oddly fascinated me. I did not expect myself to enjoy talking to the patients so much or shadowing the surgeon as much as I di

One of the most memorable sessions was the clinical trials session, where we explored how evidence-based practice is built in healthcare based on the PICO framework shown by Jessica Scaife. Learning about the SENTINEL skin flap study and how organ rejections could be prevented post lung transplants was astonishing as it showcased the potential to improve survival and patient outcomes. A particularly memorable part was the ECL-1 trial as a treatment to acute-on-chronic liver failure (ACLF) which seemed like a promising approach, similar in principle to kidney dialysis in order to support patients with liver failure. We had a hands-on practical where we enacted the ECL procedure using a grapefruit, even doing a skin grafting technique on the grapefruit guided by our lead Thanos Karategos. Doing the practical made me feel certain that operative work is something I could imagine exploring further, considering the immense dexterity and focus required for it.

Further lab-based sessions - the TRIG session and the Oxford Prostate Cancer Biology Group session - allowed us to learn more in depth about adherent and suspension cells in relation to cell culture media and their translation into organoids for better targeted cancer therapies. Learning about initiatives such as OxOrgPro was particularly interesting, knowing that there is direct patient interaction with the researcher in an attempt to make personalised medicine possible more widely. I particularly enjoyed learning how to count cells using the clicker in the TRIG session with Adam McNee and further about regulatory cells. Both of these lab-based sessions were really informative in helping me understand the continued checks and discipline but also patience required when doing such practicals.

Ultimately, I have been able to take away such valuable skills such as precision and curiosity from the week and also realised how passion is so crucial when considering entering professional fields such as healthcare. After the life-changing experiences this week has exposed me to, I find it difficult to imagine a future that does not involve science, healthcare or research and innovation in some form for me. I am deeply grateful to Louise King for organising a fantastic and insightful week for us, as well as to the friends, doctors, researchers I have met and all the lessons I am carrying forward. This experience has given me greater clarity about my future; one that may bring both medicine and research together. Above all, I have learnt that healthcare is a field that aims to reduce suffering in the world, restore hope and ultimately bring smiles back to people’s faces.