Wednesday, October 28, 2009
Friday, October 9, 2009
"Suck it right here, please" is not appropriate in any setting other than the OR.
And even then...questionable.
Glad I did not have this insight earlier in the rotation -- a case of the giggles is not exactly the most professional/impressive exhibition.
Tuesday, October 6, 2009
I write to you in the familiar situation of status-post-too-long-accidental-nap. This nap was supposed to be a quick refresher after a long, slow day. Tucked in at 5:30. Woke up at 7. Yikes.
So, though my first week of peds surgery kind of dominated my spirit, God heard my pleas and sent me a fourth-year med student. He started on service the second week, and then the third and final week we got another third-year med student. Oh what a difference company makes! Someone to look at when you feel utterly. ashamed. and. uneducated/inept. Someone to provide a "student presence" when you need to run to the bathroom/eat lunch/sit/other such human things. I am so grateful for these guys who came on service.
After I recovered from my illness, I decided to get all of my on-call experiences out of the way. As much as I feel like I dread being on-call, I always learn SO much and always feel SO much more comfortable in my working environment after being there for a 24 hour period. I regret that I can't recap all the details of my experiences on peds surgery, but needless to say I got to see LOTS of cool-to-see/unfortunate-for-the-patient conditions and operations.
Highlights of Peds Surgery: free limitless soft drinks w/ pellet ice at every nurse's station, patients who would cutely (not creepishly) grab your finger during rounds, plenty of exams on patients who were "resting comfortably in no apparent distress" aka sleeping and did not wake during check-up's, working with some of the brightest surgeons in the field (as I learned that peds surgery is a VERY competitive fellowship, UAB's program attracting many internationally competitive residents), getting to learn my way around children's hospital before my general peds rotation.
Low points of Peds: diagnosing kids with horrible tumors and other conditions that you know are going to drastically change the quality of the rest of their lives, getting relentlessly (and i mean RELENTLESSLY) pimped (see previous entry for definition) on EVERYTHING including the minutiae of classic rock music...DAILY, scrub/circulating nurses with personal vendettas against yours truly, the hours (4:30am - sometimes 6:30pm = not cool), CRAZY mothers/lazy parents.
All in all, I really ended up enjoying my time on their service. The longer I worked with the surgeons, the more they trusted me, and therefore the more they let me do (don't worry -- babies were still getting the best care) and see during operations. The residents, fellows, and attendings were very encouraging toward the end of my time there, and, as much as I hated the pimping, it forced me to study EVERY DAY. And so, I learned a lot as a result.
OK so I'm going to sleep now, but I must say...So far, cardiovascular surgery rotation is disorganized and full of surgical physician assistants, nursing first-assists, and PA students (all sorts of allied health professional peeps) to climb over in order to actually SEE the surgeries, BUT...if you can convince anesthesia to let you stand at the head of the bed and look over the curtain...YOU CAN SEE THE BEAUTIFUL OPERATIVE THEATRE THAT IS CV SURGERY. And, of course, the heart. Personal testimony: it's beautiful. Superior to other organs (although infant stomach's are pretty beautiful, too).
Next update will come sooner, I promise :)
Thursday, September 17, 2009
Now for a long list of "One time I's".... because I just couldn't choose a winner for the title: In no particular order, one time I...
-got ridiculously sick from being around kids and working my tail off for fewer than 3 days.
This is the current situ. I write you from my couch, having spent an entire day at home (shock) trying to rest and beat whatever has attacked me back into place. I began my peds surgery rotation on Monday, and boy has it been a hot mess. I am NOT in kansas anymore! To start, I am the only med student on the rotation--not fun. Crazy amounts of pimping (pimping: when attendings, fellows, or residents ask you very pointed questions, related to medical knowledge, a patient's history or current data, 80's music...anything, really; usually preceded by someone saying, "where's the med student? get her up here!"), VERY early rounds (5:30 two days of the week), foreign computer programs full of inaccessible patient data, and a seemingly limitless OR schedule welcomed me into the arms of pediatric surgery. Don't get me wrong--the residents are very nice. Anyways, just as I was starting to get my bearings around the catacombs that are Children's Hospital, about midday Tuesday I started feeling pretty crummy --fever, aches, chills, headache, sore throat, the whole bit. Woke up Wednesday at my 3:00AM wake up time still feeling ill, and resolved that I'd tell my residents how I felt, do my notes, and go home. Well, I got to the first step and told my jr resident...and he just stared back then continued his work. Later that day, as I continued to work (taking extra germicidal/germ-containing precautions), an attending asked me how I was doing after a coughing fit during surgery. When I responded saying I was pretty sure I was sick, he responded with "Yeah, it's pretty normal to get sick after the first couple days around kids." No precautions. No "Go home" or "Get out of my OR." I got home late that afternoon feeling horrible, and forced myself to reread the flu/fever protocol email we got from our dean of students, who happens to be an infectious disease doctor. As I reread this email (which says clearly that we are not to report to work if we have a fever and not to return until afebrile for 24 hours) and began the internal struggle to call my sr resident to tell him I wasn't coming in the next day, I was struck by something I'd been told my whole life from my doctor-parents and grandparent, by word and occasional example, about physicians not taking good care of themselves. After discussing my plan of action with my mom, dad, and even a peer over gchat, it was a near act of congress for me to actually page my resident to let him know the news. Looking back (ha as it was just last night), I have to laugh, thinking to myself "who am I kidding? what do I actually offer that is important enough to outweigh the risk that I pose to contaminating these already-sick kids?" However, I can't explain how real my feelings of inadequacy were/are for having been afflicted in a totally human way. I actually apologized when I was talking to my resident. And he accepted. Still processing this, but for now I'm working on becoming a doctor who does not demand superhumanness, of myself or others. And I'm working on getting better.
-got to take care of my cousin (Tally) at Children's, including scrubbing in on her surgery!
Tally is my dad's sister's daughter, a very sweet, cool teenager. It's not cool that Tally had to have surgery, but it is kind of neat that I got to children's just as she got admitted. Not sure how much I should share about her on the internet...HIPAA and all, but it was a quick and successful minor procedure that should make her feel much better. Got to put her to sleep and wake her up (none of which she'll remember)--and she didn't even do anything goofy! That aaaaaaand next time I see her at Christmas, I'll think about what her insides look like :)
-got to amputate a lil baby's extra "finger" (aka nubbin)
Little cutie with loads of other issues was on the OR list for other repairs with a tag-on "REMOVAL OF RIGHT EXTRA DIGIT." As the attending finished up the complicated stuff, he said to me/about me, "Yeah the med student's gonna remove the little nubbin'." I thought, "yeah, right." I'd heard all the action you get on peds is removing staples and spreading out blankets (That's right, people. unlike at UAB, at children's, your kids' surgeries actually stay in the hands of fully trained professionals...or at least fellows.). Needless to say, I was surprised when he handed me the suture and told me to take care of business.
-saw my first circumcision.
After attending the international AIDS conference last summer where there was lots of research talk about the potential protective effect circumcision might have on contracting HIV, I realized I'd never actually seen a "circ," as they're called in the biz. There was lots of chatter at this conference from the opposition regarding the unknown lifelong effects of such traumatic pain during the first few months of life. Anyways, not going to debate all that here, but I must say...it looked unpleasant. Luckily this baby was under general anesthesia because the circ, too, was a tag-on to another procedure, thereby preventing the crying that usually goes on. But man...that did not look pleasant. One of the guys I was working with remarked that the rate of circ's in Holland has dropped at least by half over the last couple years, because it's no longer covered by insurance companies. What would happen here if we did that?
-acquired a pair of the much-sought-after navy scrubs available only (probably not) at children's hospital.
Ok even though there's more...I must go to sleep. At least rounds are at 6 rather than 5:30 tomorrow.
Tuesday, September 8, 2009
OK this one will be brief. I was on call last night and slept a grand total of ZERO minutes. Went through my morning expecting to get out around 10:30....when our course director mentioned that he wanted to have a little mini-lecture/discussion with us at 11:00. Boo. So, I made it through the chat (barely and with a few moments of nodding off), came home around noon-thirty, and CRASHED. Again, woke up at an ungodly hour (9:45), and here I am. About to go to sleep, though.
On a serious note, I had my first experience with death up close and personal yesterday. A young man, senselessly shot, went downhill on his eight minute ride to the hospital and was more or less dead when he got to the trauma bay. His mom had been shot and killed within the last month when people shot blindly into this young man's house, presumably to kill him. I had never seen so much blood. We had been reading international news before this happened, about war-torn countries and horrific reports of lawlessness, and this young man's premature demise made me wonder about how different our country really is (or isn't).
After that first sad patient, the rest of call was a non-stop night of GSW's, MVC's, MCC's, and transfers. I missed the one surgery that went to the OR last night because I was sewing up this lady's leg & elbow for TWO HOURS. Not because of the extent of her injuries, really (though they were deep), but because I'm so stinkin slow and such a perfectionist! Anyways, I really wish I'd taken a photo of my finished work, but as it was on her inner thigh and elbow and she IS a patient...I decided that'd be inappropriate.
OK cocoa puff...
I was in the OR last week prepping a patient for his ostomy reversal. I was talking with my friend, the previously offended scrub nurse, and she asked me, "Is this Cocoa Puff?" Taken aback, I replied that I didn't know what she was talking about and asked if she was making a racist joke (as the patient is an attractive black man). Not so. Nurse friend proceeds to tell me this title story...
Apparently this guy was being scheduled for this surgery now for a third time. First scheduled surgery, he showed up fifteen min late. Who does that for surgery? Second scheduled surgery, as the anesthesiologists were doing their pre-op assessment, they asked if he had eaten/drank anything after midnight. He replied, "I had a beer and a cocoa puff."
The resident retorted, "Excuse me, how does one eat just one cocoa puff?"
The patient laughed and explained that a "cocoa puff" is a large marijuana cigarette (a fatty) laced with cocaine.
I've been laughing about this all week, and hope you do, too!
Friday, September 4, 2009
Maybe that title's too long, but oh well it describes how I am feeling :)
The last two weeks on trauma/burn, I've been working on the NICU floor (neurology ICU, shared by neurology, traumatically brain injured pts, and neurosurgery patients...many patients are candidates for multiple services). This normally involves getting there around 5 or 5:30, rounding on my patients and assimilating their information, and pre-rounding with my chief resident. Well, on Thursdays, I have a suture/surgical skills workshop/lecture from 6:30-8am. Last week, I went early, saw my patients, and pre-rounded before skills workshop, but this week I was feeling like I could slack a little (because my resident could care less if I'm there in the mornings...as long as I've outlined his notes for him the previous afternoon) and my sleep schedule was still kind of out of whack as per my previous post...so I just went to the workshop. Well, when I arrived back after my skills workshop, my scary attending was waiting for me, and my oh so competent and all-responsible resident was no where to be found. Turns out he was doing some cool surgery that definitely trumped the importance of rounds. So, back to my attending. She's been really nice to me, but has a reputation for creating a miserable work environment for most -- she's who you'd want to operate on you if you came in after a car wreck all sliced and diced, but she's not who you'd want to spend your free time with. I was told day 1 of the service (before I realized I'd be working with her for 2 weeks) that her name was "the trauma mama," that she would "put a saddle on me and ride me," and that she'd been known to dislike medical students for such reasons as "being too tall," "standing too close," or "clicking their pen too many times." That said, when I got back from my workshop and saw that it'd be just the two of us for rounds, she grabbed my arm, grabbed a piece of paper from the printer tray of the computer, and said "come on, young doctor, let's go round. write everything i say down so that you and hoffman (my resident) don't screw everything up." Of course this would happen on the day that I hadn't pre-rounded with my resident! I had very little information about my patients' overnight experience, much less any clue about the patients on the rest of the floor. So, nervously, I followed her and tried my very best to offer input, show chest x-rays at appropriate times, gather information and meticulously record the plan for each patient. When it was all over, I sat down and immediately rewrote my notes into cohesive bulleted plans (surgery "plans" are notorious for being fewer than 10 words, e.g. "vent wean, continue antibiotics for UTI, possible OR tomorrow." they must be brief and comprehensive, and these "plans" are how we communicate about patients in giant rounds [see previous post]). Feeling brave, I paged my resident. I nervously but swiftly ready my plans for our whole list of patients. As I hung up the phone, a former resident (one of the sweet PGY2's from neurology, my previous rotation) came over and said "Who was that you were passing off (telling plans) to just now? You sound like an intern!"
heart = warm. I had experienced some sort of rite of passage. 99.9% of the time I feel like any thought I have about a patient or his/her management has already been thought, acted on, and probably even second guessed by my resident. sometimes when you have that much of a safety net, it's hard to think that A) your thoughts matter, or B) that it's even worth having them/doing a good and thorough job, or C) that you'll ever be able to think and act as quickly and responsibly as your residents do (granted, I'm working with a chief resident...I find many interns very relatable.). but, because I was given responsibility, I was able to see/remember what I could do. I returned to work early today, convicted to do good, more thorough exams on my "brain dead, vegetable, circling the drain" patients. And I found that one of my patients, a fifteen year old girl who wrecked a car and put her sister into a similar comatose state, had improved drastically neurologically overnight.
And to think, I might not have noted that change had I not slept in and slacked off Thursday AM...
OK now for our feature of favorite clinical moments: This will read more like a bloopers reel...
-I called the lungs the liver while looking at a CT...WITH AN ATTENDING.
-I made the incision to put in a chest tube and an attending said, "Fran, that's a paper cut by scalpel." Needless to say, I did better the second time.
-I called the superior mesenteric artery the superior celiac artery...there is no superior celiac artery.
-I took scissors off a scrub nurse's table without asking (she seemingly wasn't paying attention)...rookie mistake. no children or med students were harmed in this incident, but it was a close call. we're buddies now, it's ok. I apologized for my grievous error.
-I saw a guy in trauma follow-up clinic who had a surgical history of a gsw (gun shot wound) s/p (status post) cardiorrhaphy (heart repair) with a clamshell incision. As I started to examine him, I saw his scar that spans his whole chest transversely. And yes, clamshell incision means he was opened up in half like a clamshell. Chief complaint in clinic? occasional shortness of breath (very minor). YOU GOT SHOT IN THE HEART AND OPENED LIKE A CLAMSHELL. he will likely always experience shortness of breath, but HE HAS BREATH. whew. pretty rad scar.
-I will include this as a blooper but I really don't know what to make of it... At least four or five times so far during my surgery rotation, I've been told that I'd make a good orthopod. that's what they call orthopedic surgeons. residents, attendings, and non-orthopod residents have made these comments. don't know if i should be insulted, complimented, or just ignore it.
that's all for now. hoping for some more funny stories soon :)
Tuesday, September 1, 2009
So, after a long night on call (8/31-9/1), I ran a couple of errands, ate some lunch, and climbed in bed around 1:00 pm for my now-standard postcall nap. I felt so free not setting an alarm and it had worked so well last time, I didn't give it a second thought. Well, I remember waking up and seeing that it was 4:00 pm, but the next thing I remember is waking up AT 8:45 pm!!!
After realizing I'd missed the day and become a creature of the night, I proceeded to do some life maintenance chores (bills, emails, etc). And create a blog. About to hit the sack (again) so I can begin my life again for tomorrow (9/2).
and now, a feature of my new blog: favorite case moments from the last couple days
As we're about to begin surgery, I'm prepping the patient and helping the nurses get the room/patient ready for the surgeons. We're kind of discussing the patient, and I realize I've heard about this person during giant rounds (when our 3-page, size 8 font, master excel document LIST is discussed) I'm familiar with only~20% of those patients; however, the interesting stories catch my attention. This lady had some sort of abdominal surgery a couple weeks ago. For unknown reasons, she stuck a Q-tip in her incision (a 8" midline vertical incision that she definitely had to undress in order to access)...my guess = an itch. Somehow she "lost" that Q-tip in the incision, so she went for a second Q-tip. After losing that, she went for a tiny pair of shaving tweezers ~2", plastic. And, after losing those, she goes for the big boys -- a standard metal pair of eyebrow tweezers. The first three objects do not show up on CT, meaning we do not know where the heck they are. Our job as surgeons? retrieve the objects. It was kind of fun, but mostly dissatisfying -- we only got the metal ones. Follow up step 1: put on one labyrinth of a bandage, hoping she can't bust up in there. Step 2: psych consult. Step 3: if she fails step 1 and busts up in there, she's getting bilateral casts on her arms.
Can't make this stuff up.