Quick Tips for the VA Rotation

Disclaimer: You might not want to read this post if you're not a med student at my school. The information will be boring and useless. However, if you are, you might find it of a little value. I'm post-call though, so be warned.

How the VA Works:
*Disregard most of this for tomorrow. They're just going to spend the whole day giving you the tour and getting you set up on the VA computers.

*M/W/F are surgery days. T/Th are clinic and education round days.

*If you don't have VA scrubs, show up the 1st day in blue scrubs, go down to the basement to the OR control desk, and ask for VA scrubs. They will give you a pair. You will not have access to a machine, so you will have to wash them yourself.

*When you arrive on a normal morning, you will go to the residents' cubby hole in either 2045 or 2035 (sorry, can't remember!) and pull up the list. You will then put your initials by the pts you would like to see.

*Print several copies of the list and leave them laying by the computer you were just working at. Be warned, the list will print at the nurses station, about 30 ft away. Just go grab them and put them by the computer in the residents cubby hole or be sure you have 2 copies with you - one for yourself and one for the chief when it comes time to "dry round."

*Go see your pts (usually 2, sometimes 3.) Check the white board on the floor before you barge into the room. They switch rooms a lot without letting you know.

*Once you've seen both of your 2 pts and asked about pain/f/c/n/v/BM/flatus/diet/ambulation/check drains, tubes, and restraints, find a computer. There's 3 in the room where you'll sit around and do the dry round in the morning. There's more at the nurses station or on the 4th floor.

*At the computer, find your pt. Sign in under the resident's name that is seeing the pt (because we're not allowed to have our names on charts at the VA). Don't worry. The resident has to review the chart and sign it before an attending sees it.

*Everything you need, such as vitals and labs will be posted on the computer. Vitals will already be filled in on the note when you go to write it. Then just do the whole SOAP note thing. It's got a template there for you. You CAN look back at older notes while in the middle of writing yours and it won't close yours out. So if you get confused, just look back at an older one.

*Be prepared to do a quick run-through of your pt at dry rounds, but the residents will most likely do it. We did it 2-3 times in our 2 weeks there, towards the end when they figured we were competent.

*For T/Th education rounds, you need to know your patient's medical history pretty well. You don't have to KNOW it, but you do have to have it available on a sheet in front of you. Especially know their vitals and presentation on admission, as well as their normal and current weight and bathroom habits (diarrhea today, but have they had it for 30 years? Is that normal for them? For a lot it is...) Know family/social history as well. You can find A LOT of this by digging around in their chart on the computer. Also, have a differential, but don't mention it in your presentation. You'll probably get asked about it. Know how you would rule out those possible diagnoses - what tests/procedures you would use. This sounds overwhelming, but the attendings are usually nice about it all. If they're quizzing you, it's so they can teach you something you don't know.

That's about all my info. If y'all have questions, post them in the comments and I'll try to answer them. Good luck and have fun!!!

P.S. - Dr. Wofford might be the cutest little old retired cardiothoracic surgeon I've ever seen. He's going to give y'all lessons 2x a week. He repeats himself a lot, but he's really funny and you'll probably learn something.

It's a PASS!!!

Never in my life have I been so happy to have passed a test!!!

Sorry the posting has been pitiful lately. Surgery is working me to the bone. That being said, today was an incredibly rare exception to the rule and we were finished with surgery by 10:00 this morning. Checked our STEP scores (in the surgery lounge, where I screamed "PASS!!!" and slammed my fist on the table. Then my good friend A came running up and we sort of did a jump/chest bump/hug in mid-air. I thought I got a pneumothorax from one of her pens jabbing me in the chest. The surgery residents thought we were crazy.) Then after the crazy rush of it all we had to give presentations and then we went with our team (residents + us M3 students) to Mugshots to have some burgers. All in all it's been a pretty good day so far.

Decided I should treat myself to a little reward, so I stopped at my favorite boutique - Target, and got a nifty bag that I can put my laptop, pens, wallet, books, and a change of clothes in. Essential for the surgery rotation. I've needed it the last 6 weeks!

To make the day even better, I got home and Netflix had brought me Bride Wars. Cha ching! About to sit back in the recliner with the fan on, a blanket, a pup, maybe a cold beverage, and a movie. Does it get much better?

Hope everyone else's day has been wonderful and if it hasn't, I'll be sending up some special prayers for you :)

Hoping, Wishing, Thinking, and Praying

that call this weekend won't be as draining as it was the 1st time I was on call. Either way, it's on the weekend so I get to go home by 7am on Sunday. Wahoo!

Finally

I finally ENJOYED one of the surgeries I scrubbed in on! Wahoo!!! Apparently I really like vascular surgery. Never EVER would have guessed that in a million years. I just really liked watching them tease out the arteries and veins and SO wanted to get my hands in there and do it myself. It's so much different in a living pt than in a cadaver. Finding arteries and veins was not my idea of a good time during Gross lab.

Today we made an AV fistula in the arm for a patient's hemodialysis access. The surgeon also moved the vein more superficial than it was originally to allow for easier access for the nurses who will be sticking the pt when it's time for dialysis.

The best part of the case: You get to SIT DOWN during vascular cases. Score. Also, the attending and resident were really nice and I only got asked one question, which of course I didn't know the answer to. Once again, nice attending, so it wasn't completely mortifying - just a "teaching experience" as they call them.

Exciting part: I got to suture the underlying tissue together and then staple the incision. It was my 2nd time suturing, and a different technique than the one I did the 1st time, so I was glad to learn how to do it. Surgeons make it look easy, but there's very subtle differences in how they hold the tools, tie the knots, etc... which can make us look very clumsy comparatively. Anyway, it's now time to get in the bed. Gotta be up at 3:00 :)
7 more days at the VA - wahoo!

Cool Side Note

Today I got to see an A/V fistula created by one of the vascular surgeons at UMC for dialysis access. The cool part:
*I felt a "thrill" over it - a buzzing sensation
*I heard a bruit! Finally! I've been wanting to hear a bruit for the last year or so. It's just a little "whoosh" type sound you can hear with the bell of your stethoscope (the smaller side). You hear it in the carotid arteries when there's blockage and also in AV fistulas.

I'm more excited about these things that I saw in clinic rather than in surgery. All the surgeons HATE clinic, but I really prefer it to most of the other things we do. Perhaps it's a sign.

Dear Surgery,

I want my life back.

Signed,
Your pal - Chazing Zebras

Ahem, Make that 13.3

So, a few of us thought that half marathon seemed a little long in the last 3 miles. We were CORRECT! Turns out one of the miles was actually 1.2 miles. So that leads us to a grand total of 13.3. That almost makes up for my time discrepancy. (I wanted to finish in 2:30:00 and finished in 2:38:03ish).

I would post about my day today, but after driving home, eating dinner, and checking my e-mail and checking on my pts, it's time for me to get in bed. Gotta be up at 3:30:) I think today I decided surgery is NOT for me! Maybe I'll change my mind, but I doubt it.

Goals for Today (in no logical order)

*cook dinner
*get a new phone (because AT&T doesn't pick up in the hospital)
*recover from the half (knees ok now, hips might fall off - could barely walk yesterday!)
*clean house
*do stupid EBM assignment for school
*throw together 5 minute presentation on diverticulitis for tomorrow
*figure out financial aid's hangup
*pack lunch for tomorrow
*pay bills

Not sure if it's the week of surgery or the half marathon, but I've been walking around in a daze trying to figure out what I should do at any given moment and therefore getting nothing done. Hope everyone else's weekend was fabulous!

13.1

Ran and finished my first half marathon this morning. I'm gonna be honest - I'm glad it's over! I don't think my body can withstand 80 hour weeks at the hospital and running this much. The only reason I spent ~80 hours at the hospital this week is because I was on call though, so that should ease up hopefully.

As for the half, I ended up seeing a lot of people I knew. That was fun. People I went to high school with, college, then some dental school kids as well. My cousin A and I ran it together. It got kind of warm towards the end and was in full sun for about the last 2-3 miles. My body did not like that! I was getting cold chills and just praying I didn't keel over right there on the pavement. I really got an adrenaline rush at the 13.0 mile marker and was so relieved to cross that big finish line. It took me 2:38:03. I was 636/1055, so pretty much right in the middle. That's fine with me!

Now it's time to rest, hydrate, eat, rest, hydrate eat. I haven't left the bed yet the few hours I've been home this week and I don't plan to until Monday. I'll post about a typical day on Acute Care Surgery later.

Preparedness FAIL

So after I leave my house at 7:00am tomorrow (Tuesday) morning, I might not be home until 5:00pm Wednesday night. Why, you ask? Because I'm ON CALL! Now, I did see something that said if you're on call during the week, you're supposed to leave around 1:00pm the next afternoon. However, we have an entire day full of surgery lectures and I'm not really sure what the protocol is. Also, I'm not really sure what I need to take with me tomorrow morning. We're supposed to be in professional dress for the lectures, but definitely in scrubs overnight for call. Guess sometime between the two I'll do a switcheroo. Feel like I'm packing for a slumber party.

Runner's, er... Walker's Log

Taking it easy. Kris and I walked 40 minutes. No clue how far or how many calories burned, but it was very relaxing :)

Headed to the BEACH Y'all

I'm leaving for the gorgeous blue waters and sandy white beaches of Florida tomorrow morning bright and early. It's me and three of my fellow back-row-sitters. It should be a blast.

Today I made my mama's oatmeal pumpkin muffins and my very own chocolate chip cookies for snacks/breakfast options on the trip. I'm excited because Future Pathologist is going to be making yummy dinners at the condo at night and I'm pretty sure Future Pediatrician has got some things up her sleeves as well. I'll just play seux chef since I really only know how to bake.

Here's what I'm reading:







I was going to be reading House of God, but it didn't arrive in time:

And Then I Checked My E-Mail

and I'm not on call either of the 2 weekends I was worried about!!! Wahoo!!! Life is good :)

So I Just Checked the Mail

and there was a shiny check from the IRS in it. Funny how things work, no?

The IRS Hates Us

Kris and I had been planning to receive our tax refund sometime this week. That's what the website said. That's what the 1st IRS official we talked to 3 weeks ago said. Now, they've decided to "review" our refund since we filed for the first time homebuyers' credit. But no fear, they're mailing out the rest of our refund - this Friday. And we need to allow 3 weeks for it to get here. What the heck? BROKE. Grrr....

The Time Has Come

for you to PRAY!!! Now back to my last day of studying :) Hooray!!!

Future Career Choices

USMLE World breaks down where your strengths and weaknesses are by how many questions you get correct in each subject. It's displayed in every possible way - by percentage, using colors (red and green), etc...

Here's what I'm good at:
Behavioral Science (psych)
Histology (what stuff looks like on a microscopic level, CELLS!)
Reproductive System
Musculoskeletal System
Genitourinary System

Looks like I'm going to end up being a sex therapist for athletes. Not sure what the job market is for that.

Now I Know

exactly how long it takes me to get a caffeine withdrawal headache. It's 36 hours, in case you were wondering. On the upside, I slept pretty good last night and was actually sleepy and wanted to get in bed before midnight. Not sure if it's worth it.

Just heard from a friend who took the STEP. She said it was really weird. It mostly tests things you may or may not have learned in the last month while studying - things you were likely to actually learn along the last 2 years. It made me feel a bit better. I have absolutely NO motivation to study today. Don't think it'll get much better tomorrow. Just ready to get it over with and then it's BEACH time! Wahoo!

Sleep

Sleep is one of my favorite things. I've never had a problem falling asleep. Now, oftentimes I choose to go to bed very very late, but once I get in bed, I fall asleep. Enter my friend the STEP. He has different plans for me. It started about a week ago. My mind would race a little before bed, but after about 30 minutes I was out. Sunday night I took 1 benadryl and it took me 2 hours to go to sleep. Last night I took 2 benadryl and it took me 1.5 hours to go to sleep. Normally 2 benadryl will knock me out in about 5 minutes. I'm beginning to worry about how well I'm going to sleep the night before the STEP. I'm thinking I may have to go to dinner, play tennis or run, then watch a movie and do some yoga. Then maybe some nice calming tea. I don't know. Open to suggestions.

Now it's back to USMLE World. I'm so sick of reading First Aid that answering questions is a welcome relief. It's a sad, sad life.

Runner's Log (a day late)

Leisurely walk, then run. Guessing about 2 miles in all. Kris walked with me for about 20 minutes, then I ran for 10.