So I'm back on a regular surgery team meaning... back to the OR... dern
This week is little strange, we have less patients per resident so I have to be rounding by 520-530a.. just to get three in before a resident follows up in front of me.
So let's segue quickly into fasting while on Surgery, it's tough. I'm reporting in before fasting even begins, but I've bypasses that obstacle by packing protein shakes and caffeine. What gets brutal is standing around the OR when you start to get sleepy... and you can't caffeinate up, caffeine is key to surgery, you need several boli throughout the day.. usually before lectures...
Other than that, more of the same. Trying to avoid the OR but ending up being in on one or two cases a day.. which by my luck has ended up begin 2-4 hrs... ehhhh I've learned to love clinic duty which surgeon-types don't usually like..
I've been in on lumpectomies/biopsies.. which means I'm holding a breast for extended periods of time. This is alot less ..provocative as it might sounds...
So my team has two interns who are two of the coolest people I know. One is cool... she actually reads my notes and asks me why i make certain recommendations.. the other is a really cool dude from Texas who always gives you little thumbs ups when you show up in the OR, just a really nice guy to work with. One day I tried to get all of us to put our hands in the middle and say "Team C" on the elevator.. i didn't catch...
Night Call
So this week was my 7th night call out of 8. ( As my surgery peers repeatedly tell me, I could've avoided 8 calls if I didn't so eagerly volunteer for Sept 5.. the Friday of labor day weekend.. oh well)... So let's review night call
First thing, is page or tell the intern/2nd year that you are the student to page
Second, the waiting game: you wait for that first page from the intern or the trauma code
once you're paged...you're usually out and about for a bit.. sometimes it'll be a one hit wonder and others that could be the last time you're in our student lounge. I remember one saturday where I was paged at 430p and didn't go back to the lounge till 4 or something ridiculous.
Trauma Codes/ Consults: ATVs are dangerous but probably won't kill you or compromise your vitals.. meaning i see more of these on consults.. but man.. some wicked lacerations and stuff. Motorcycles are dangerous but more on the code end...
Oh and I've learned that some nurses eat up the surgery look. One of my residents who is married totally had three nurses just swarming around him.. which turned out to be awesome for me when this hot one started talking to me.. too bad i was too nervous and replied in one word answers....
...well that's it for now
let's see what next week has to offer
Sunday, August 30, 2009
Sunday, August 23, 2009
Weeks 3 and 4 of Surgery
Week 3 Vascular - at our program vascular week = do whatever you want week... but it's a little more enigmatic than that. we still have to attend lectures so you can't get away with too much but you definitely don't have any patients to round on.. so i was able to sleep in till after 6a. Things I saw: CABG -Coronary Artery Bypass Graft- long procedure but pretty awesome. I mean you dissect out an artery and vein and then you plug in some tubes into the right atrium and aorta.. put them on the heart lung machine which is wild because when you split the sternum you can see the lung inflating and the heart beating.. then nothing.. they both stop... you hook up the artery and vein.. to bypass.. punch some holes into the aorta.. stick in the other ends of the graft.. and then put blood back in.. and lo and behold.. praise God.. they start pumping and breathing... that was awesome to watch... I saw two AVG graft revisions.. meaning grafts for hemodialysis fixed because they can get clots (on one of those procedures.. I tried to scrub in but didn't realize my resident wasn't there and the doctor totally called me out for not introducing myself... it worked out fine.. but let me tell you ...how sheepish i felt for the next two hours .. standing off to the side) lastly i saw a below the knee amputation .. this particular doctor lets students and residents do alot.. so I ended up helping suture and staple at the end.... this was actually the first time I'd seen my chief resident... who totally wanted me to two hand tie the sutures... which i can't...
Week 4 Peds Surgery- best week ever. I'd like to end there but let's hit some high points.
First.. it's awesome to see patients who are just as pissed as you are about waking up early. An example - I usually round by 530/540a so I can see 3-4 patients before my resident.. who is one of the coolest guys ever. i'll get to him later... but yeah.. I rounded on my patients, one of them has leukemia.. but has a bit of a tude... but it just makes for more fun... and he totally told my resident that he wasn't having abd pain this morning... but did after my "not soft palpation"... hahahaha... so I totally apologized for it the next day and we've been much better after that... barring early morning wake ups... Pediatric patients are just cool, I mean you can laugh in the room and have fun when rounding. That's key for me. If I can't laugh and goof around a little in the field I choose, then I can't do it...
So the rest of the week was rounding which I haven't really done till now because of the way my rotation was set up.. so if i were to summarize rounding.. it's like a small gang roaming the hospital tending to each patient on the service. I like to thing of ourself as a gang.. I saw a bunch of different procedures and fixes for congenital defects : right hemicolectomy for NEC, pullthrough for Hirschsprung, gastroschisis , pyloric stenosis repair, some I and Ds.... interesting stuff...
Oh and the NICU... has to be one of the most space-age areas ever.. I guess it's just something else to walk in there and some babies have the blue UV lights for jaundice... so there's this faint blue glow throughout.. and most of the beds are "Giraffe" beds = they open up.. like a spaceship...
Peds Surgery was just awesome for me. I mean.. my Resident told me to consider it and the locum tenens doctor from Atlanta complimented me.. It's hard to feel competent your first rotation in your third year and in surgery for me especially but I felt I did something right this week. And I want to be just like my resident: He's a southern guy , Christian, married and just nice as ever. His form of critique is like a little lesson from Mr. Rogers... , never curses or insults anyone.. thanks patients and staff... just unreal..
To end.. he told me the rules of surgery:
Eat when you can, sleep when you can, pee when you can and don't mess with the pancreas.
Then he added.. some people use the eff-bomb with the pancreas...
Hahaha, he literally said that... awesome.
Oh since this is my halfway mark..and I have my clinical skills bit tomorrow.. let me pro/con some of surgery
Pros
Very organized.. it's not that hard to find patients .. procedures and you know reasonably well... where you need to be
Procedures can really impact people's livelihoods, it's high yield
The residents are awesome in my program
Night call can be quite exciting with traumas
Clinic is fun (which I've learned most residents and people interested in surgery would not say... hahahah.. must be the meds/peds coming out)
Cons
Early mornings.... I repeat.. getting up before 430a.... wears you down
Hours - anywhere from 55 hours on vascular to 81 hours last week
OR - my mind wanders so readily it's not even funny.. as a student you can't do a whole lot so I imagine the inactivity of standing for hours.. brutal
Week 4 Peds Surgery- best week ever. I'd like to end there but let's hit some high points.
First.. it's awesome to see patients who are just as pissed as you are about waking up early. An example - I usually round by 530/540a so I can see 3-4 patients before my resident.. who is one of the coolest guys ever. i'll get to him later... but yeah.. I rounded on my patients, one of them has leukemia.. but has a bit of a tude... but it just makes for more fun... and he totally told my resident that he wasn't having abd pain this morning... but did after my "not soft palpation"... hahahaha... so I totally apologized for it the next day and we've been much better after that... barring early morning wake ups... Pediatric patients are just cool, I mean you can laugh in the room and have fun when rounding. That's key for me. If I can't laugh and goof around a little in the field I choose, then I can't do it...
So the rest of the week was rounding which I haven't really done till now because of the way my rotation was set up.. so if i were to summarize rounding.. it's like a small gang roaming the hospital tending to each patient on the service. I like to thing of ourself as a gang.. I saw a bunch of different procedures and fixes for congenital defects : right hemicolectomy for NEC, pullthrough for Hirschsprung, gastroschisis , pyloric stenosis repair, some I and Ds.... interesting stuff...
Oh and the NICU... has to be one of the most space-age areas ever.. I guess it's just something else to walk in there and some babies have the blue UV lights for jaundice... so there's this faint blue glow throughout.. and most of the beds are "Giraffe" beds = they open up.. like a spaceship...
Peds Surgery was just awesome for me. I mean.. my Resident told me to consider it and the locum tenens doctor from Atlanta complimented me.. It's hard to feel competent your first rotation in your third year and in surgery for me especially but I felt I did something right this week. And I want to be just like my resident: He's a southern guy , Christian, married and just nice as ever. His form of critique is like a little lesson from Mr. Rogers... , never curses or insults anyone.. thanks patients and staff... just unreal..
To end.. he told me the rules of surgery:
Eat when you can, sleep when you can, pee when you can and don't mess with the pancreas.
Then he added.. some people use the eff-bomb with the pancreas...
Hahaha, he literally said that... awesome.
Oh since this is my halfway mark..and I have my clinical skills bit tomorrow.. let me pro/con some of surgery
Pros
Very organized.. it's not that hard to find patients .. procedures and you know reasonably well... where you need to be
Procedures can really impact people's livelihoods, it's high yield
The residents are awesome in my program
Night call can be quite exciting with traumas
Clinic is fun (which I've learned most residents and people interested in surgery would not say... hahahah.. must be the meds/peds coming out)
Cons
Early mornings.... I repeat.. getting up before 430a.... wears you down
Hours - anywhere from 55 hours on vascular to 81 hours last week
OR - my mind wanders so readily it's not even funny.. as a student you can't do a whole lot so I imagine the inactivity of standing for hours.. brutal
Saturday, August 8, 2009
Surgery in two weeks
So I am about to round out my second week on my Surgery Clerskhips.. time to muse and reflect
1. You are up early. Let's define early: Early is.. the time you usually wind down from a late night out..4am... Early is.. you're driving and there's nobody on the road.. 15 min trips can take 10 minutes ... early is .. you're not even really sure it's morning... early as in if you call anybody at this time except your friends at the hospital.. you will be injured... purposely
2. It's not fair to call surgeons stupid jocks who "heal with steal." I have met some smart surgeons , men and women who can just as easily function as internists if they so desired. However... this is not the rule per se.. so let's define surgeon as I have seen
The older you are, the more likely you are to embrace tradition whether it's sitting in certain places and whatnot. Older surgeons have a bad habit of referring to "back when" or how they could have done it "better"... and of course .. they are chauvinistic to say the least. Also, surgeons can be incredibly rude and impatient which is ironic in a way because they are very meticulous in the OR and incredibly intolerant of rudeness or anything you do to detract from listening to their lectures/pimping sessions with rapt attention.
3. The OR - you need to like the OR to like surgery. A lot of my distaste for the OR has to do with the fact that I am not very active in the procedures aside form retracting, cutting sutures and handing things... but I'm also MIA mentally when you hit the 2-3 hr mark, sometimes the 1 hr mark....
So let's highlight some of my own personal ... anecdotes
Week 1 - Alot of retracting and awkwardness. I spent a few minutes on each floor ending up staring at the end of a hallway without a door to the stairs or I'd take the longest route possible to get to where I needed to get going. On my first case, I was asked by my resident to tie a knot using a clamped hemostat... I decided to tie a regular.. run of the mill knot.. not knowing how to tie a two handed surgical knot.. so he showed me quickly and I couldn't do it.. this lasted for a good 5-10mins....
Week 2 - More early mornings. I learned that your hold scissors with your fourth finger, I was called out for holding them like a grandmother. There's more stories.. but I'm drawing a blank and I don't want to get too descriptive.
Now - it's 1020 something and I'm sitting in my student lounge. I was rounding till 8ish... and informed my weekend intern of my pager number. Then I napped/caught another hour of sleep --> breakfast --> do some boards questions... I imagine Saturday will be like Sunday... not a whole lot during the day.. then picks up at night with trauma calls and whatnot....
1. You are up early. Let's define early: Early is.. the time you usually wind down from a late night out..4am... Early is.. you're driving and there's nobody on the road.. 15 min trips can take 10 minutes ... early is .. you're not even really sure it's morning... early as in if you call anybody at this time except your friends at the hospital.. you will be injured... purposely
2. It's not fair to call surgeons stupid jocks who "heal with steal." I have met some smart surgeons , men and women who can just as easily function as internists if they so desired. However... this is not the rule per se.. so let's define surgeon as I have seen
The older you are, the more likely you are to embrace tradition whether it's sitting in certain places and whatnot. Older surgeons have a bad habit of referring to "back when" or how they could have done it "better"... and of course .. they are chauvinistic to say the least. Also, surgeons can be incredibly rude and impatient which is ironic in a way because they are very meticulous in the OR and incredibly intolerant of rudeness or anything you do to detract from listening to their lectures/pimping sessions with rapt attention.
3. The OR - you need to like the OR to like surgery. A lot of my distaste for the OR has to do with the fact that I am not very active in the procedures aside form retracting, cutting sutures and handing things... but I'm also MIA mentally when you hit the 2-3 hr mark, sometimes the 1 hr mark....
So let's highlight some of my own personal ... anecdotes
Week 1 - Alot of retracting and awkwardness. I spent a few minutes on each floor ending up staring at the end of a hallway without a door to the stairs or I'd take the longest route possible to get to where I needed to get going. On my first case, I was asked by my resident to tie a knot using a clamped hemostat... I decided to tie a regular.. run of the mill knot.. not knowing how to tie a two handed surgical knot.. so he showed me quickly and I couldn't do it.. this lasted for a good 5-10mins....
Week 2 - More early mornings. I learned that your hold scissors with your fourth finger, I was called out for holding them like a grandmother. There's more stories.. but I'm drawing a blank and I don't want to get too descriptive.
Now - it's 1020 something and I'm sitting in my student lounge. I was rounding till 8ish... and informed my weekend intern of my pager number. Then I napped/caught another hour of sleep --> breakfast --> do some boards questions... I imagine Saturday will be like Sunday... not a whole lot during the day.. then picks up at night with trauma calls and whatnot....
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