SCTS Ionescu Medical Student Fellowship 2019 – Congenital Cardiac Surgery Alder Hey Hospital, Liverpool

Tom Eadington, FY1, Manchester University NHS Foundation Trust

Ihad originally organised a visit to Fortis Hospital in Mumbai for my SCTS medical student fellowship. However, this goal looked improbable when in April 2020, I received the news from my medical school that all our electives were to be cancelled due to the COVD-19 pandemic and India was closed to all international travel. Instead, like most of the UK, I spent much of that summer shut inside my house – at least my garden was grateful for the attention!

I had optimistically hoped that I would be able to visit Mumbai the following summer, as surely things would have settled down by then? When this clearly became unrealistic, I started searching for an institution in the UK at which to undertake the placement. Luckily Mr Dhannapuneni kindly agreed to supervise me at Alder Hey Hospital, so after finishing medical school I was to spend four weeks in the slightly less exotic destination of Liverpool.

Alder Hey is one of the largest congenital cardiac centres in the UK, performing approximately 450-500 operations per year. This fellowship represented a fantastic opportunity for me to gain experience in a field I had always been interested in, but had limited exposure to.

During my time at Alder Hey I spent time in the intensive care unit, assisting in theatre, attending MDT meetings and clinics, as well as being involved in departmental and audit meetings. Entering such a highly specialised clinical environment was a steep learning curve but this was made easier by the friendly and welcoming nature of all the staff. I was very well supported and quickly felt like part of the team.

In the intensive care unit, I learnt about complex post-operative management as well as the acute management of emergency admissions. I had previous experience of ECMO and mechanical circulatory support in adult patients however, seeing this technology utilised in neonates and children was fascinating. I was amazed at the resilience and fortitude of these young patients and their families, with some of the most challenging patients often undergoing multiple operations and enduring long intensive care stays. How these parents were counselled through these difficult times was inspiring to witness and demonstrated the importance of putting patients at the centre of care.

I had excellent exposure in theatre. I gained experience in a wide range of procedures including complex mitral and aortic valve surgery, aortic surgery for hypoplasia and coarctation, atrial and ventricular septal defects, Fontan procedures, Tetralogy of Fallot, pulmonary atresia and PDA closure. The range of patients from impossibly small neonates to teenagers who closer resembled adults made every day different. Each case presented a new challenge, with wide variations in anatomy even for different examples of the same pathology. The level of technical skill displayed in performing these operations was inspiring, however these were not solo efforts. As was the case in all aspects of this placement, teamwork was the key to being able to deliver these life-saving interventions. This was particularly evident during the more challenging cases, where there were often multiple surgeons, cardiologists and anaesthetists all working together to decide on the best way to proceed.

The effect this team had on the patients and their families was immeasurable, and it was humbling to witness. Combining innovation and expert technical knowledge with empathy and compassion to deliver some of the most advanced healthcare in the world – everything that attracts me to a career in cardiothoracic surgery. This fellowship gave me an immersive experience in congenital cardiac surgery. The days were often long and always challenging, but the rewards were worth every minute. I loved it.

I would like to thank Mr Ionescu for his generous support in making this fellowship possible. I would also like to thank Ram Dhannapuneni, Rafael Guerrero and the rest of the team at Alder Hey for welcoming me so kindly into the department and giving me such a valuable and enjoyable experience. n