So my first week of family medicine was kinda lame as beans.
I mean how many lectures do I have to sit through, and do they not think 3hrs is a long , painful lecture? There are quite a few studies showing retention of a lecture after x amount of time....
We actually had such a long break in family medicine, that I went over with a friend to help out in the surgery clinic b/c the students on surgery were doing orientation and they needed some help. That was alot of fun.
But the thing is, it's easy to be jaded or a little critical. Surgery is very .. busy.. get there early, round, hit the OR up, floor duties.. just go go go and when you're not busy.. you're reading or just recovering.
Family is just a different pace. I begin my inpatient duties next week so I'm looking forward to that.. seeing patients again and being part of the hospital. That's the other thing, the hospital was home base in surgery and family has their own clinic and building so you feel kind of outcasted.
But we do some unique, cool stuff. We did a substance abuse workshop where we had "patients" where we counseled them on substance abuse.. Turns out they were all active AA members who had real life stories. It was an amazing experience to hear their stories and learn what is effective for substance abuse counseling.
The thing about choosing your future field as a doctor is that there are questions you have to ask yourself. Will this offer me the lifestyle I want? Will I be as enthusiastic about this 15-20yrs down the line? Will I kick ass at it, will I be the best I can be and do right by my patients?
While I think it'd be crazy to be a trauma surgeon, I can't imagine getting up early or spending time in the OR day in , day out or being limited to seeing my patients in 10 minutes spurts spread over 5-7 hours because of all the little things that come up during the course of the day. I need to see my patients, I love explaining things to them and I thrive off that. The anesthetized patient .. well... they're dead to me ( literally, figuratively)
I guess I've learned alot about friends and love and stuff like that. It's one of those cathartic weeks. Also, with all this time off and breaks, you get to thinking. So here are some observations and random ones too:
Friends are friends for life, if they're not.. they're not really friends in the truest sense of the word. Time and space can't break a friendship. Your friends will always remind you of the good in you and keep you honest about the bad.
Love the person that loves you first. This is counterintuitive but makes sense. Not everyone can love you like you love them. They just can't.
Work hard , it's what the world needs and it always makes a difference.
Enjoy everyone around you. Don't miss an opportunity to talk to someone new or someone old.
Working out feels great.. except when your butt hurts from those glute exercises.
90s, best music ever.. hands down.. amazing replayability
Everybody likes a rap song with a heavy beat and heavy laden with innuendos
Every important relationship and most things that are important are simple.. complexity is unhealthy.
Girls are smart, and smarter than we think.. and often.. smarter than they let on... realize this. Stick to the ones that stick with you.. and be skeptical of the rest..
Guys are straightforward and simple.. some.. mainly girls, would call this dumb. Inferences and lack of clarity = mystery = we don't really get it.
God made sisters to keep their brothers honest. They always want the best for their brothers but are also the ones to correct them and to tell them which girls to avoid.
We're not all born with the ability to sense or feel out others.. so if you have a friend who can.. always consult them.. haha
...more to come...
Sunday, September 27, 2009
Friday, September 18, 2009
Last Week of Surgery, some regret
So this week, I only had two days of surgery. Two days left on the trauma team. Two days of introducing myself as Robert, the medical student on your surgical team.
A few weeks ago, I would've said: no way, surgery is not an option. they're all pretentious asses who couldn't care less about their patients and would slice and dice to solve any problem.
This definitely is not the case. I have learned to appreciate surgery and the surgical approach especially when it comes to trauma. See, trauma is both simple and complicated. A patient comes in with any number of abrasions, breaks, bleeds, etc but the approach is very simple. ABC that Jazz: Airway, Breathing, Circulation --> disability, extremities....
Monday wasn't too crazy , few things here and there. I got to see a Swan-Ganz catheter placed , that was actually pretty cool since they are putting them in less and less and the whole placement is based on the pressure waves that are generated as you advance the catheter through the atrium, into the ventricle and then the PA and hopefully wedges nicely into a pulmonary capillary.
Tuesday was my last day, all I came in to do was round on my patients. I actually spent some time explaining an IVC filter to a patient and really connecting with her. One thing that's hard to do is appreciate that feeling that perhaps a patient doesn't know what all is going on and I sensed this, and I had a breakthrough. Mrs. "Smith" has a few questions and then she started asking me about my schooling and telling me about her family, it was a great way to end my surgical clerkship.
Wednesday we had our oral exam, I'm happy to say that I rocked out the Trauma cases. Our orals consists of three different docs giving us a variety of cases to work thought and do next step/management type questions. The resident doing trauma wasn't really able to stump me, gave me a "very good."
Thursday, I went and visited the 9th floor, kind of a farewell to the 9th floor nurse, a farewell in my last day as a member of the trauma team.
Farewell Surgery , perhaps you'll see me on a Trauma elective. You have the coolest docs and residents...
A few weeks ago, I would've said: no way, surgery is not an option. they're all pretentious asses who couldn't care less about their patients and would slice and dice to solve any problem.
This definitely is not the case. I have learned to appreciate surgery and the surgical approach especially when it comes to trauma. See, trauma is both simple and complicated. A patient comes in with any number of abrasions, breaks, bleeds, etc but the approach is very simple. ABC that Jazz: Airway, Breathing, Circulation --> disability, extremities....
Monday wasn't too crazy , few things here and there. I got to see a Swan-Ganz catheter placed , that was actually pretty cool since they are putting them in less and less and the whole placement is based on the pressure waves that are generated as you advance the catheter through the atrium, into the ventricle and then the PA and hopefully wedges nicely into a pulmonary capillary.
Tuesday was my last day, all I came in to do was round on my patients. I actually spent some time explaining an IVC filter to a patient and really connecting with her. One thing that's hard to do is appreciate that feeling that perhaps a patient doesn't know what all is going on and I sensed this, and I had a breakthrough. Mrs. "Smith" has a few questions and then she started asking me about my schooling and telling me about her family, it was a great way to end my surgical clerkship.
Wednesday we had our oral exam, I'm happy to say that I rocked out the Trauma cases. Our orals consists of three different docs giving us a variety of cases to work thought and do next step/management type questions. The resident doing trauma wasn't really able to stump me, gave me a "very good."
Thursday, I went and visited the 9th floor, kind of a farewell to the 9th floor nurse, a farewell in my last day as a member of the trauma team.
Farewell Surgery , perhaps you'll see me on a Trauma elective. You have the coolest docs and residents...
Friday, September 11, 2009
Surgery Week 7, Begin TRAUMA TEAM
So my last two weeks of surgery and I end with Trauma Team. This is interesting because my team happens to be the very people I took most of my night call with. Recall, Night Call/Float is the surgery team that covers everything surgical from consults to trauma codes to floor duties .
First things, first our attending is this bad-ass doctor who goes by his initials. For the sake of anonymity , I'll say it sounds like B.A. which he pretty much is. This guy is one of those pointers. The point to a nurse and say, yo, what's up... I mean... he's an older guy.. i don't know 50s and balding but his white coat says Trauma/Critical Care .. and his coffee smells amazing.This is what he drinks: http://us.myflavia.com/home/index.jsp
His only downside, he's easily distracted or gets sucked into some side conversation. There wasn't one day where rounds didn't take more than 2-3 hrs. The problem is , Trauma team can't continuously round because if a code gets called or an operation needs to be done or chest tubes/lines placed... then things get hairy.
Let's talk about rounding. This is the first time I've rounded with a full team (Me, Intern, 2nd year Resident, 4th year Resident, NP, and PA Student sometimes AND B.A.) on every patient and trauma has a bunch of patients under our care 20+
I feel like we're a little gang. We're all decked out in white coats and we hit floors in our little pack. Some of us scurry head to gather charts like nobody's business. Then we stick them in a little cart and roll out, literally. Basically, B.A. leads the pack and we enter the room. THE TRAUMA TEAM... it just sounds cool. I mean.. the TRAUMA team thinks you're read to go home.. THE TRAUMA TEAM.... even when i'm rounding on my own or checking a patient.. I tell them I'm the student on THE TRAUMA TEAM. The bulk of our patients are ortho type deals and we're just dealing with pain management, airway control, volume resuscitation... the basics. I remember one time , a nurse was saying that the "Trauma team" was coming to see some patient, and I was like... I am on the Trauma Team.... = Bad Ass
Nothing really exciting happened, just random things here and there. Today, we got a code at 745am.... which really cut into morning rounds...
It was unremarkable, just some methheads, shooting each other up. After that I just chilled until rounds, then I assisted with random floor stuff since we were missing our intern . I got to assist on two chest tube insertions which was kinda cool.
Some quote-ables from B.A.:
"Suck on that" (he was explaining that the patient can have ice)
" If it's big enough, I'd like to tap it" (referring to doing an IR percutaneous drainage of some abdominal fluid)
Update on 9th floor nurse - saw her only once this week, I guess having only one or two patients up there .. ... oh well But she's not really the apple of my eye currently, there's someone else...
That's it for now avid readers... a little relaxation and some major cramming for my Surgery Shelf Exam next week.
God Bless and remember to honor friendships and that chivalry is not dead.
First things, first our attending is this bad-ass doctor who goes by his initials. For the sake of anonymity , I'll say it sounds like B.A. which he pretty much is. This guy is one of those pointers. The point to a nurse and say, yo, what's up... I mean... he's an older guy.. i don't know 50s and balding but his white coat says Trauma/Critical Care .. and his coffee smells amazing.This is what he drinks: http://us.myflavia.com/home/index.jsp
His only downside, he's easily distracted or gets sucked into some side conversation. There wasn't one day where rounds didn't take more than 2-3 hrs. The problem is , Trauma team can't continuously round because if a code gets called or an operation needs to be done or chest tubes/lines placed... then things get hairy.
Let's talk about rounding. This is the first time I've rounded with a full team (Me, Intern, 2nd year Resident, 4th year Resident, NP, and PA Student sometimes AND B.A.) on every patient and trauma has a bunch of patients under our care 20+
I feel like we're a little gang. We're all decked out in white coats and we hit floors in our little pack. Some of us scurry head to gather charts like nobody's business. Then we stick them in a little cart and roll out, literally. Basically, B.A. leads the pack and we enter the room. THE TRAUMA TEAM... it just sounds cool. I mean.. the TRAUMA team thinks you're read to go home.. THE TRAUMA TEAM.... even when i'm rounding on my own or checking a patient.. I tell them I'm the student on THE TRAUMA TEAM. The bulk of our patients are ortho type deals and we're just dealing with pain management, airway control, volume resuscitation... the basics. I remember one time , a nurse was saying that the "Trauma team" was coming to see some patient, and I was like... I am on the Trauma Team.... = Bad Ass
Nothing really exciting happened, just random things here and there. Today, we got a code at 745am.... which really cut into morning rounds...
It was unremarkable, just some methheads, shooting each other up. After that I just chilled until rounds, then I assisted with random floor stuff since we were missing our intern . I got to assist on two chest tube insertions which was kinda cool.
Some quote-ables from B.A.:
"Suck on that" (he was explaining that the patient can have ice)
" If it's big enough, I'd like to tap it" (referring to doing an IR percutaneous drainage of some abdominal fluid)
Update on 9th floor nurse - saw her only once this week, I guess having only one or two patients up there .. ... oh well But she's not really the apple of my eye currently, there's someone else...
That's it for now avid readers... a little relaxation and some major cramming for my Surgery Shelf Exam next week.
God Bless and remember to honor friendships and that chivalry is not dead.
Saturday, September 5, 2009
Week 6- Last Week of any General Surgery, only 6 days of Trauma team.. no more night call
So I guess a good question is what is a normal day on the Private Surgery? I'll use a good surgery Robert/ bad surgery Robert scenario:
Good: Show up early so you can pre-round on your patients, a good amount is usually 4-5 patients. To beat our residents, this could be showing up anywhere from 4a-5a.
Bad: My best time has been 515a, but I'm usually on the floor with my printed list anywhere from 525a-540a....you'd think this wouldn't be a huge difference but depending on the day it can be. See if the residents have any early meeting or the both of us have conference.. then rounding commences early and one day I wrote only 1 progress note up
Good: After rounds, we usually have some sort of lecture(s)
Bad: I attend my lectures , I guess the bad is only when I get sleepy...
Good: After lectures/morning stuff, you check the OR schedule, pick a doc and kinda tag along with them.
Bad: Robert loves the floors and consults, so I've actively tried to avoid the OR by signing on to do histories on consult patients and assisting the intern. See the interns get least priority to go to the OR, they're obligated to the floor so help them = more floor time. Of course, this doesn't always work when you're asked to scrub in on something or your chief expects you....
Really, for me I tried to be on the floors as often as possible. If I wasn't there, I was reading in our student lounge. The perfect student would somehow be in the OR all the time and study between cases.. yeah not so much for me....
Here's how most OR experiences go. You wait around for the doc to show up. Then he does, usually 30mins-1hr30mins after the posted time... then the procedure starts. The doc / resident might tell you to scrub in or you may not scrub in. So let's discuss pros/cons scrubbing in vs. pros/cons of not scrubbing in but observing
Scrubbing
Pros:
You can get pretty close to the procedure, if not immediately adjacent depending on the patient and how many other people there are.
You can assist.
You can suture ate the end.
You can feel stuff... like "feel this thingy here"
Cons:
It's not so easy to leave, because you'd have to scrub out.. and that's very conspicuous.
You can break sterility... so you have to stay in a certain area and when you can't rest your hands on the drape.. you have to hold them in front of you like a Trex or crossed in front of your chest like a gang sign. [one of my classic breaks in sterility was touching a tube that was in the field.. but the tube itself wasn't sterile... so then I moved in the observe category]
Observing
Pros:
You can leave when you want to
You have more freedom of movement
You can answer phone calls and hand stuff in like a scrub nurse
Cons:
You can't get close, so sometimes observation = endless pacing/standing .. pretending to see things
So after the OR day has ended, random things can pop up like consults or floor jank. Some attendings round, some don't. I've enjoyed rounding.
So some notable moments in my week:
The colorectal surgeon that wasn't an ass:
So I was semi-warned that this particular surgeon was kinda mean and not worth scrubbing in on. Too bad my chief was all about me scrubbing in, but it turned out great. I mean I got some of the questions right and I mean the doc was really nice. I'm guessing he's either turned a new leaf or I'm just crazy. One of the funniest moments in rounding with him was walking in on a patient dropping a deuce , we totally just pretended like that was totally normal.. which I guess if you're a colorectal surgeon.. makes sense.. kinda
Floor doodie (duty):
So one day the OR was just not on and poppin like usual, so there was more random floor stuff to take care of. My intern thinks it was tedious but I was always just running to go do a consult or a decompression (= finger in butt, scooping poo). My intern was much humored by my enthusiasm as I rolled in the observation unit with gloves in hand and "let's do this"...
She really hit the nail on the head when she saw me with our other intern. She asked if I'd like to scrub into a breast case.. I was like errrr... I was helping with something else.. and she said " Yeah, you love that floor and consult stuff.. not the OR, you're weird like that" - truer words haven't been spoken
Night call:
I love night call for the most part. First , it's at night... I feel like a vampire roaming the empty halls and because there's less docs, you look even more balla in the scrubs/white coat combo... My last call night was awesome. First of all I had the chillest call team ever.. hard working dudes and gal but just chill.... I was doing some random stuff from 630ish to 1030ish Consults : Car V Tree and GSW to neck, then slept till 145a... totally didn't feel my pager go off in my pocket but woke up and rolled on down the ER. My last case that night was a young dude, got stabbed .with this really ridiculous story... ... hmmmm...... but that lasted till 430a.. just checking the CTs... etc... making sure he didn't have a pneumo.. turns out he had some pneumomediastinum but no reason for a chest tube so he was sent to the floor and a swallow study was ordered to make sure his esophagus isn't perforated....so then I grab a shower... and then I'm rounding by 530a on the floor to help out my team... then I get the "go home dude, you've been on call from my senior resident and I peace out" and begin Labor Day weekend, no more surgery call.. kind of bitter sweet...
The nurse on the 9th floor without a ring:
So my friends have explained to me the importance of checking for a ring.. and I happened to be rounding on the 9th floor where the bulk of my team's patients are and I notice her. She was the cutest, shyest, most amazing thing before 6am ... So I totally wanted to talk to her. Bear in mind, I usually have an open invitation to talk to any nurse if I want to "check on my patients" or ask about labs or something but she didn't cover any of my patients. My classic Robert/awkward moment was trying to find a computer to pull up some labs to stick in my progress note. I ended up finding one of those portable stations without a chair.. and it was right behind that nurse sitting down. I couldn't sit so I awkwardly leaned against the wall with my chart on the mini desk and tried to write my note.. looking like a tard..Then on my way back to the nurse's station, I ran into something... Smooth.....
Perirectal abscesses
For some reason, I have knack for ending up with all the clinic patients with perirectal abscesses. There's nothing much to add to that except the smirk the residents give me before I go into examine these patients...
Ah, being a junior medical student... is awesome
Good: Show up early so you can pre-round on your patients, a good amount is usually 4-5 patients. To beat our residents, this could be showing up anywhere from 4a-5a.
Bad: My best time has been 515a, but I'm usually on the floor with my printed list anywhere from 525a-540a....you'd think this wouldn't be a huge difference but depending on the day it can be. See if the residents have any early meeting or the both of us have conference.. then rounding commences early and one day I wrote only 1 progress note up
Good: After rounds, we usually have some sort of lecture(s)
Bad: I attend my lectures , I guess the bad is only when I get sleepy...
Good: After lectures/morning stuff, you check the OR schedule, pick a doc and kinda tag along with them.
Bad: Robert loves the floors and consults, so I've actively tried to avoid the OR by signing on to do histories on consult patients and assisting the intern. See the interns get least priority to go to the OR, they're obligated to the floor so help them = more floor time. Of course, this doesn't always work when you're asked to scrub in on something or your chief expects you....
Really, for me I tried to be on the floors as often as possible. If I wasn't there, I was reading in our student lounge. The perfect student would somehow be in the OR all the time and study between cases.. yeah not so much for me....
Here's how most OR experiences go. You wait around for the doc to show up. Then he does, usually 30mins-1hr30mins after the posted time... then the procedure starts. The doc / resident might tell you to scrub in or you may not scrub in. So let's discuss pros/cons scrubbing in vs. pros/cons of not scrubbing in but observing
Scrubbing
Pros:
You can get pretty close to the procedure, if not immediately adjacent depending on the patient and how many other people there are.
You can assist.
You can suture ate the end.
You can feel stuff... like "feel this thingy here"
Cons:
It's not so easy to leave, because you'd have to scrub out.. and that's very conspicuous.
You can break sterility... so you have to stay in a certain area and when you can't rest your hands on the drape.. you have to hold them in front of you like a Trex or crossed in front of your chest like a gang sign. [one of my classic breaks in sterility was touching a tube that was in the field.. but the tube itself wasn't sterile... so then I moved in the observe category]
Observing
Pros:
You can leave when you want to
You have more freedom of movement
You can answer phone calls and hand stuff in like a scrub nurse
Cons:
You can't get close, so sometimes observation = endless pacing/standing .. pretending to see things
So after the OR day has ended, random things can pop up like consults or floor jank. Some attendings round, some don't. I've enjoyed rounding.
So some notable moments in my week:
The colorectal surgeon that wasn't an ass:
So I was semi-warned that this particular surgeon was kinda mean and not worth scrubbing in on. Too bad my chief was all about me scrubbing in, but it turned out great. I mean I got some of the questions right and I mean the doc was really nice. I'm guessing he's either turned a new leaf or I'm just crazy. One of the funniest moments in rounding with him was walking in on a patient dropping a deuce , we totally just pretended like that was totally normal.. which I guess if you're a colorectal surgeon.. makes sense.. kinda
Floor doodie (duty):
So one day the OR was just not on and poppin like usual, so there was more random floor stuff to take care of. My intern thinks it was tedious but I was always just running to go do a consult or a decompression (= finger in butt, scooping poo). My intern was much humored by my enthusiasm as I rolled in the observation unit with gloves in hand and "let's do this"...
She really hit the nail on the head when she saw me with our other intern. She asked if I'd like to scrub into a breast case.. I was like errrr... I was helping with something else.. and she said " Yeah, you love that floor and consult stuff.. not the OR, you're weird like that" - truer words haven't been spoken
Night call:
I love night call for the most part. First , it's at night... I feel like a vampire roaming the empty halls and because there's less docs, you look even more balla in the scrubs/white coat combo... My last call night was awesome. First of all I had the chillest call team ever.. hard working dudes and gal but just chill.... I was doing some random stuff from 630ish to 1030ish Consults : Car V Tree and GSW to neck, then slept till 145a... totally didn't feel my pager go off in my pocket but woke up and rolled on down the ER. My last case that night was a young dude, got stabbed .with this really ridiculous story... ... hmmmm...... but that lasted till 430a.. just checking the CTs... etc... making sure he didn't have a pneumo.. turns out he had some pneumomediastinum but no reason for a chest tube so he was sent to the floor and a swallow study was ordered to make sure his esophagus isn't perforated....so then I grab a shower... and then I'm rounding by 530a on the floor to help out my team... then I get the "go home dude, you've been on call from my senior resident and I peace out" and begin Labor Day weekend, no more surgery call.. kind of bitter sweet...
The nurse on the 9th floor without a ring:
So my friends have explained to me the importance of checking for a ring.. and I happened to be rounding on the 9th floor where the bulk of my team's patients are and I notice her. She was the cutest, shyest, most amazing thing before 6am ... So I totally wanted to talk to her. Bear in mind, I usually have an open invitation to talk to any nurse if I want to "check on my patients" or ask about labs or something but she didn't cover any of my patients. My classic Robert/awkward moment was trying to find a computer to pull up some labs to stick in my progress note. I ended up finding one of those portable stations without a chair.. and it was right behind that nurse sitting down. I couldn't sit so I awkwardly leaned against the wall with my chart on the mini desk and tried to write my note.. looking like a tard..Then on my way back to the nurse's station, I ran into something... Smooth.....
Perirectal abscesses
For some reason, I have knack for ending up with all the clinic patients with perirectal abscesses. There's nothing much to add to that except the smirk the residents give me before I go into examine these patients...
Ah, being a junior medical student... is awesome
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