IZ MOG UGLA... -dr Tijana Nastasović
 Da ću putovati u London saznala sam drugog dana Kongresa anesteziologa i intenzivista Srbije 2018.godine, po povratku sa seminara u Salcburgu, posredno, od mlađe koleginice koja mi je značajno saopštila: „Dobila si nagradu!“. Proglašenje stipendista od strane Prof.Dr Zoke Milan bilo je na svečanom otvaranju kojem ja nisam prisustvovala jer sam te večeri doputovala u Beograd. Prvo što sam učinila bilo je da pronađem Dr Milan koja je bila predsedavajuća na sesiji o transfuziji i koagulaciji i srdačno mi potvrdila da će dobitnici stipendije boraviti mesec dana u Londonu, u King’s College Hospital.Mom oduševljenju i ushićenju nije bilo kraja. Činjenica da mi je pružena prilika da mesec dana budem gost u prestižnoj evropskoj bolnici bila je tako nestvarna i sjajna, da sam poželela da se istog trena nađem u Londonu. Ipak, s Dr Milan smo se dogovorile da moj boravak bude u maju sledeće godine. Krenule su pripreme za London, podnošenje zahteva za vizu, prijava za „observership“. U svoj toj akciji, vreme polaska je brzo došlo. Na dan Vaskrsa, letom iz Beograda stižem na aerodrom Hitrou, potom vožnjom podzemnom železnicom do stanice Viktorija. U trenutku kada sam sišla na Denmark Hil padala je kiša, ali je moje raspoloženje bilo kao da je divan sunčani dan. Već sutradan je bio moj prvi dan u bolnici. King’s College Hospital je univerzitetska bolnica u južnom Londonu, najveća u tom delu grada, poznata kao jedna od vodećih iz transplantacije jetre. Moj boravak je obuhvatio rad na odeljenju hepatobilijarne hirurgije i transplantacije jetre sa Dr Milan kao mojim mentorom, ali s obzirom na činjenicu da se bavim neuroanestezijom, dobar deo mog „observershipa“ odvijao se i na odeljenju neurohirurgije. Na odeljenju neurohirurgije obavljaju se najsloženije operacije iz ove oblasti: neurohirurško i endovaskularno zbrinjavanje akutnih, krvarećih intrakranijalnih aneurizmi, kraniotomije uz upotrebu neuromonitoringa i u budnom stanju, operacije lezija u zadnjoj lobanjskoj jami, transsfenoidalna hirurgija, najsloženije neurohirurške operacije u dečjem uzrastu. Takođe, u ovoj bolnici se rade i operacije iz tzv.“funkcionalne“ neurohirurgije i duboke nervne stimulacije koje mi u našoj ustanovi još uvek ne radimo. Sve ove intervencije zahtevaju specifične tehnike anestezije. Najmlađi pacijent kojeg sam imala bila je beba stara svega 24 sata kojoj je operisana meningomijelocela. Multidisciplinarni pristup svakom pacijentu uz primenu savremenih dijagnostičkih procedura i protokola omogućavaju ispunjavanje najviših standarda u lečenju. King’s College Hospital je i centar za edukaciju, čija su vrata otvorena lekarima različitih specijalnosti iz celog sveta. Otvorenost i pristupačnost za svako pitanje i nedoumicu glavni je utisak koji sam ponela iz ove bolnice. Kao i raniji stipendisti, pohađala sam kurs „Otežan disajni put“ u organizaciji ovog univerzitetskog medicinskog centra koji je po kvalitetu nadmašio mnoge druge kurseve u kojima sam učestvovala (upoznala sam se sa tzv.“hibridnim“tehnikama u obezbeđivanju disajnog puta, tehnikama za slučaj „can’t intubate, can’t ventilate“, ultrazvukom disajnih puteva kao i upotrebom tzv.Optiflowa). Takođe sam pohađala i kurs „Ultrasound in critical care medicine“ u organizaciji Udruženja anesteziologa Velike Britanije. Boravak u bolnici King’s College je jedno neprocenjivo iskustvo koje mi je pomoglo da naučim nešto novo, proširim svoje vidike i steknem dodatno samopouzdanje u svom svakodnevnom radu. Ovim putem najsrdačnije se zahvaljujem Prof. Dr Zoki Milan, osnivaču fondacije „Svetlana Ceca Erdeljan“ koja je ustanovila ovu nagradu, na podršci, gostoprimstvu i predusretljivosti. Ova nagrada znači podstrek mojoj daljoj karijeri i razvijanju, ali znači i mojim pacijentima jer zahvaljujući njoj i sama sam bolji anesteziolog i bolji čovek. Iz mog ugla Klin.asist. Dr Tijana Nastasović, Klinički centar Srbije, Beograd |
In November 2018, on the second day ofthe Serbian Congress of Anaesthesiologists and Intensivists, I found out that I won Dr Svetlana Ceca Erdeljan charity’s fellowship and that I would be travelling to London for one month placement at King’s College Hospital. I was both excited and delighted. The fact that I hadtheopportunity to be a guestof aprestigious European university hospital was so unreal and wonderful that I wanted to be in London that very moment. However, wearranged with Dr Milan that I wouldgoto London inMay 2019. I started preparing. Iapplied for a visa and prepared theobservership forms. In all thehurry, the moment ofdeparture came as a surprise. On EasterDay, I took off from Belgrade’s airport andlandedatHeathrow. I then took the underground to Victoria station. It was raining as I travelled on to Denmark Hill station, but I was so cheerful thatit might as well have been a bright, sunny day. The next day, I would startmy placement. King’s College Hospital is a teaching hospital situatedin south London, and it is the largest and busiest hospital in that part of the city. It is the leading hospital for liver transplantation in the United Kingdom. My placement included working atthe Department of Hepatobiliar Surgery and Liver Transplantationwith Dr Milan as my mentor. But, considering the fact that I am a neuroanaesthetist, anotherpart of my placement took place at theDepartment of Neurosurgery. The most complex neurosurgical operations are carried out in the Department of Neurosurgery: neurosurgical and endovascular treatment of ruptured intracranial aneurysms, craniotomies with the use of neurophysiological monitoring, “awake” craniotomies, posterior cranial fossa surgery, transsphenoidal surgery and the most complicated paediatric operations.Functional neurosurgical procedures and deep brain stimulation, which still are not performed at my institution, are alsocompleted there. All this intervention demands specific anaesthetic techniques.The youngest patient I sawwas a 24-hour-old babywho was operated on because ofmeningomyelocele. A multidisciplinary approach forevery patient,together with the use of modern diagnostic procedures and protocols,ensuresthe highest standards of treatment. King’s College Hospital is also ateaching centrethatopens its doors to doctors withdifferent specialities from all over the world. The main impression I got of this hospital was that openness and accessibility metevery question and concern raised. Likeprevious scholars, I attended a Difficult Airway Management course organisedby the university’s medical centre, which was superior to any other course on thetopicI had attendedpreviously (I learned aboutso-called “hybrid” techniques for difficult airway management, techniques for “can’t intubate, can’t ventilate” cases and ultrasound-guided airway management, as well as the use ofOptiflow).I also attended a course called Ultrasound in Critical Care Medicine organised by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). My placementatKing’s College Hospital was a priceless experience that helped me to learn new things, expand my horizons and gainextra self-confidence in my everyday work. I would like to thank to Prof.Dr Zoka Milan, founder ofthe Svetlana Ceca Erdeljan Foundation, who established this scholarship for her support, hospitality and affability. This prize will stimulate my career and development, but it is also important for my patients because I have become abetter anaesthesiologist, as well as a better person, as a result. I hope that I will be able to implement new anaesthetic techniques, as well as new principlesof teaching, in my hospital and in Belgrade School of Medicine. |
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