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

Week 5

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

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

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....

More

Rapid Strep anybody with a sore throat, 99% of the time, it will be negative. If this is the case, it's probably viral (see prior rule)

Juice is bad.

Babies need tummy time.

Babies get GERD for several reasons: shorter esophagus, lying down all the time and drinking mulk alot.

When we get an upset stomach or constipated, we deal and take meds. Babies get irritable and fussy.

Similac is the shit.

"It's okay for the doctor to look down there" .... precedes the most awkward of things.

When the doc says: you should see this.. it's never really good,especially when it involves fondling balls.

Things I Learned From Kids

So, I'm on my community medicine deal meaning I work on a project over the summer and shadow/ work with a Doc for four weeks. So I thought I'd share my revelations/observations. This will be ongoing..

Little kids hate ear exams, you'd think we were slowly advancing to them with a butcher knife the way the scream and writhe. It doesn't help that we pin down their arms but the irony is, the stiller the are... the less likely they'll be scraped or hurt.

If they're strep negative, afebrile, or we can't figure it out = it's viral.

People still don't grasp the idea that antibiotics don't work on viruses.

Viruses do what they want, when they want and even better, they like to set the ground for their buddy.. Mr . Superimposed Bacterial Infection.

Babies have the most paralyzing, disarming stares ever.

I love watching siblings interact. Maybe it's because I'm a big brother but when they laugh at the other one getting a shot/examined.. it just makes me giggle inside.

It's pretty damn obvious I'm not a regular.. I'm the only one in a white coat.

While, we're supposed to say we are medical student which I do, parents still prefer to call you doctor.. it makes you seem like you're legit.

Immunizations , most likely won't cause autism in your child but I can assure you poliovirus will cause polio and Hib will cause meningitis.

Mongolian spots are normal.. aka those random dark patches on kids... will go away with time.

Dysmorphic = looks weird

Kids love lollipops.

Quotes from Facebook

So in order to save these quotes, I'm porting them over from facebook to here.

"Can you come back later? I have some business I'm conducting with the Prince of Nigeria" - House MD

"2 things that aren't forgiven shirk and being in hufflepuff" - Nooreen Fatteh (fellow Ravenclaw)

"I don't have a favorite color. I think all colors are beautiful." - Nira Patel

"i recall a certain [insert medical student name] not leaving room for jesus when he was all up on me" - Jenny Thomas

"What friends" - Elizabeth Almon [in reference to anything I might say with the word "friends" in it]

"Your face...." - Helen King [i don't remember the exact context but it was a brilliant and well timed rebuttal leaving me disgraced]


"I hope they all die from a curry disease" - Andrew Mohamed

"1....2.....3.." - Robert Abdullah [2/17/09 - First Rectal Exam]

IHOP. [for Jenny and Umangi]

we can try to be happy broke bitches. - Umangi [referring to our future as doctors]