Tuesday, August 25, 2009

Last Day in the OR

Surgery is almost over!!! The only thing left is the test tomorrow, at 9am. We had today off to study. I woke up at a glorious 10:30, when the sun was already out, and I got literally 2x as much sleep as I normally do in a night. Let's talk about my last day in the OR, shall we?

Here's the good part - I spent all day with the pediatric surgeon who is in charge of the surgery program from our standpoint. He makes the test at the end, is in charge of call, etc... In other words, he knows what's up. He cares about the students. I scrubbed into all 3 of his surgeries Monday. The first was a simple little esophageal dilation. No biggie. They consecutively stick these flexible tubes down little babies esophaguses? esophagi? in increasing diameter in order to dilate their precious little throats so food will go down and stay down. It's pretty fast, relatively painless, good times. The next one was an umbilical hernia repair. Super fast surgery. He let the intern do most of it.

The next surgery of the day was THE BIG ONE. Although it was about the same length of time as most of the cardiothoracic surgeries I scrubbed in on, it was the most physically exhausting. Partly because I hadn't scrubbed on a long one in a while. Partly because all I'd eaten that day was 2 brownies. Thirdly because I was actively doing something the entire surgery. We did a laparoscopic colectomy with ileostomy and ileostomy pull-down. This means the attending and chief resident took out this little girl's colon, connected her ileum to her anus, and also connected part of her ileum to an ostomy - or bag on the outside of her stomach. She had ulcerative colitis that left her colon an ulcerated, bloody mess. Taking it out decreases her chances of colorectal cancer.

Doing a surgery laparoscopically cuts down on healing time and huge scars, but it takes FOREVER. You're working through very tiny holes, which means the tools you put in are very tiny, which means you have to take tiny little bites at the tissue. So essentially they managed to get 95% of her colon taken down this way. It took about 6 hours. Then, for the last little bit, when her colon goes down into her pelvis, they couldn't take it down. Her pelvis was just too narrow. So at this point, at 5:30pm, we have to switch to OPEN. If we had started open, this surgery would've taken maybe 3-4 hours.

On the upside - I learned how to run the camera for the laparoscopic surgery. On the downside, we were in the OR forever. Dr. S did give me a 3 minute water break at one point which was nice since I had the unfortunate issue of food poisoning the night before. Don't want to get graphic here, but going to the bathroom 5x in 3 hours and losing 2 lbs worth of fluid just doesn't make a happy camper! Was definitely feeling a little woozy.

Okay, so we switched to open, made the ostomy, connected the ileum to the anus. I retract like a rockstar, get super sore, get to put in a couple of stitches, and then leave the hospital at 7:30pm. I got home at 8:00. I'm EXHAUSTED. I have less than 48 hours until the surgery test. I could study for an hour before passing out, or I could eat and go to bed. Guess which one I picked?

It was a rough day, but I think it was a good way to end surgery. The case was exhausting for everyone. The attending and I were the only 2 who were there for the whole thing except for our 3 minute water breaks. There's something about tough days in the OR like these that really suck, but it's such a rush when it's over that it's worth it. You really get to know the people you're working with because you're stuck in an area of 3-4 square feet and they can see your work ethic firsthand. They know if you follow instructions, if you listen, if you retract hard enough, how you treat the people around you, if you have a sense of humor, what kind of music you like, etc... I don't think I necessarily want to do surgery because I don't think I could sustain this kind of work ethic for the rest of my life, but I do think I'll miss it sometimes when I'm on services like internal medicine where we hardly touch the patients. Time will tell.

Good luck on the test everyone! I've had little time to study and now I'm wasting it writing this post, so I'm sure I won't do too well. Let's just hope I don't have to repeat this mess all over again :)

Sunday, August 16, 2009

Putting My Running Shoes On

I'm not actually going running. Lord knows I haven't done that in 2 weeks. I'm getting ready for peds surgery. I was really excited about it until I found out the other 2 medical students who were supposed to be on the service with me switched off because... get this - "they wouldn't have enough time to study." If you're not ready for a rant, please stop reading.

Here's the thing. On most services, every patient has to be seen in the morning by an M3 BEFORE the intern/resident sees them. You generally meet the afternoon before or the morning of and divide the list of patients to be seen. Since I've just come off an incredibly busy service where I was seeing 6 pts every morning before 6:40am, I really feel I deserve a break. I've had NO time to study - at all. Some nights I go home and don't even eat dinner. I just sleep. And now I'm going onto one of the busiest services with absolutely no help. It would have been fine with the 3 of us to see patients I'm sure. Now it's going to be hell. I'm really not sure how I'm going to survive. This, my friends, is why I'm counting down the days to family medicine. I've already been given the first day off by my preceptor because he'll be post-call and not seeing patients that morning. Gotta love it :)

I think I've decided I'd like to do some sort of primary care when I "grow up." I like the idea of knowing the patients you're going to see and work with instead of hurriedly brushing up on their history in the 5 minutes before you go do a consult on them. So most likely it'll be family med, peds, or ob/gyn. Can't wait to do ob/gyn because I think c-sections would be really fun. I enjoy short surgeries, love opening the abdomen, love closing at the end, but just don't really care too much about the colon or liver. I also enjoy patients who are healthy enough to have walked into clinic to see you that day. ICU patients really intimidate me.

Anyway, on to happier thoughts. I managed to somehow get this weekend off. When I told my 2nd year resident I was leaving Friday afternoon at about 3:00 (the M4 was on call and covering us the rest of the day since she had to be there anyway) he just could not understand why I'd want to go home. He questioned me for 5 minutes. It was comical. Then he got really upset when he realized there wouldn't be another M3 coming onto the service. Ha ha. Goodbye cardiothoracic surgery!!!

Went home Friday night for a birthday diner celebration with my in-laws. Spend Saturday morning moving my grandmother's furniture into her new place of residence. Then spent Saturday night at an engagement party for a friend of mine. Today I plan on doing a little cleaning, a little exercising, a little studying, and definitely dinner out with the hubs and watching Mad Men at 9:00! Hooray for fun weekends :)

Thursday, August 6, 2009

What a Week...

Here's how my week on cardiothoracic surgery has played out so far:

Mon - arrived at 4:45am. Saw 2 pts, wrote notes, rounded with team at 6:45. Scrubbed into a CABG x 4 (quadruple coronary artery bypass graft) at 7:30. The chief resident becomes ill and has to scrub out. Haven't seen her since Monday. That leaves the 2nd year resident, the 4th year med stud, and me. Snuck away at 3:00p and went home. (The chief states that she would like the 4th year and I to alternate scrubbing on cases)

Tues - arrived at 4:45am. Saw 4 pts, wrote notes, rounded at 6:45. Hung around and waited on CABG X2 to start. A heart transplant bumped it. Heart transplant finishes at 2:00. I was told not to scrub in, but to observe. The 2nd year resident informs us that he would like one of us to scrub, and the other to observe every case. Nice... Left hospital at 8:45pm.

Wed - arrived at 4:45am. Saw 4 pts, wrote notes, rounded at 6:45. Hurriedly changed clothes and went to M&M conference at 7. Go observe a mitral valve replacement from 9-2:30. I didn't get to go to the book club discussion :( because at 3:00 the resident informs me that even though I don't go on call until 7:00pm, I'm "stuck there." Yet he provides no instructions as to what he wants me to do. So I went and got "stuck" in the on-call room and attempted to rest up before call. 7p - call starts. Nothing happens. I study. Nothing happens. I sleep from 11p-1:30am, and THEN the page comes in. *18 y/o fell off his horse. Why was he riding his horse at night? (*info has been changed because I'm afraid of the HIPAA monster.)At 2:15 or so, my fellow M3 on call and I decide to fulfill some of our technical skills we have to do before we graduate. These include things like inserting Foley catheters, starting IVs, venipuncture, arterial puncture, insertion of NG tubes, etc... I'd already done tons of Foleys, but really needed to stick some people. They had the perfect patient for us. He needed arterial blood gases drawn, was comatose and heavily sedated. Awesome. I really didn't want to stick someone's artery that was aware that it was my 1st time and awake. I watched my M3 counterpart stick the artery with incredible ease. Then my turn came. I had to stick twice, along with some rearranging of the needle once inside the skin. Not very encouraging. Then it came time of the venipuncture. Here's how it went down on the very quiet SICU.

Female nurse #1: Well, we don't have any pts that need venipuncture, but *John here has great veins.

Female nurse #2: Oh yeah, they're like ropes. I'll go get some needles. (M3 counterpart and I laugh, thinking they're obviously joking)

Female nurse #1 then reappears, with John in tow. "Here he is!"

Me: You're not serious, are you? Really?

Nurses: Oh yeah, it's fine. He lets people practice on him all the time.

Then my partner and I proceeded to stick this guy 4 or 5 times while sitting at the nurses station with a group of nurses around us in order to each get in an IV and venipuncture. The entire time he was giving us instruction. It was bizarre. Can you imagine telling someone where to stick you? To push DEEPER into your flesh with a needle? He ended up leaving one of the IVs in because he was dehydrated and planned on taking in some fluids.

Then it was 4:00am before we knew it. 2 more trauma pages came in. Old lady with dementia who fell and then young guy who got in a fight. Typical stuff. Overall it was most definitely the lightest call night I've had so far and actually pretty enjoyable.

Then 5:15am rolls around. Time to see my now 5 patients and get notes written on them before 6:45. We go round and the M4 states that she's forgotten to see one of the pts. I have to be in class at 7:00 and she tells me to go do it. NICE... Whatever though. Went and checked on him. Went to class. Decided to stay lost for a while and take a breakfast break. We had another CABG today, but I peeked in and saw 2 attendings, a resident, and an M4 scrubbed in. I refuse to observe another one, especially post-call. I'm about to make like a banana and split! 6 more days of Cardiothoracic surgery!!!

Tuesday, August 4, 2009

"What are you on?"

It's the first question all of us M3s ask each other when we pass in the hall or meet in the "student surgery lounge" - aka McDonald's in the hospital. It just strikes me as funny because I'm sure passersby are wondering if we're all asking each other what illicit drugs we're partaking of.

Speaking of illicit drugs... I've joined the M3/M4 book club and our book of the month is Mom's Marijuana. It's written by a psychologist, Dan Shapiro, who was diagnosed with non-Hodgkin's lymphoma in his late teens or early 20s. His mother is your typical anti-drug mom, but when she finds out that marijuana will help with the side effects of chemo, she begins growing it in her garden of sunflowers for her son. The book is really great so far. I'm also anti-drug of course, but I think it's really interesting. The best part is that Dan Shapiro is actually coming to discuss it with us tomorrow at 3:00. I hope I'll be able to get out of whatever surgery or clinic they'll have me crammed in.