General Surgery: Friday Call, Last Day

Today was my last day of general surgery, but since I was scheduled to be on call, I didn't know whether I'd be allowed to leave early or not. Sure, I'd told JB that I didn't want to stay overnight, but would he remember? One thing he did remember: he brought me a bundle of books that he used in med school to help me for USMLE2 and the shelf exams. Wow, talk about generous! Afterwards, I rounded on two of our patients, one of whom I've been seeing almost every day for this entire month. He was an overweight man who accidentally fell in his driveway and ended up with a C3-C4 spinal contusion that left him with very little strength in his arms and legs. Now he just lies helplessly in bed, waiting for a nursing home or rehab center who will take him, and lately he's been vomiting a lot and had explosive diarrhea last night (but not C. difficile). I'm sorry I won't be able to follow up on him and see where he ends up, as I have with other patients that I've seen since day one. A couple who got hurt in a MVC got sent to rehab centers in San Antonio. A young woman with gastric cancer keeps coming back to JPS every time she has abdominal pain, but today we turned her away for the 3rd or 4th time. A 15 year old who was hurt in another MVC is still in a vegetative state. And sadly, the 19-year-old African American girl who was shot on MLK day was taken off life support; this evening they took her to the OR to harvest her organs for donation. I didn't even know they were donating her organs until I saw "Life Care: Organ _________" on the OR board, and identified her by her ICU room (which I knew all too well) Still, at least some good comes from this tragedy. For patients who need heart, liver, lung, or kidney transplants, someone has to die for others to live, and tonight or tomorrow, someone's beeper will go off alerting them that they have an organ available. I've always been a strong supporter of organ donation, so for all its sadness, there's also some hope.

My first surgery was a Heller myotomy, used to treat patients with achalasia. The outer muscles of the esophagus are cut to relax the LES, and then a Dor fundoplication (fundus is wrapped around the front of the esophagus) was done to prevent reflux. The staff attending was also Corey's preceptor, but I got to scrub in while he stood in the background and watched. The myotomy was really cool, but the doctors made one mistake by accidentally slicing through the inner layer of the esophagus (that had to be sewn up). After that, we had a brief lunch break (JB got some pizza from the OR nurses and shared it with the rest of us). Only after talking to RB did we realize that BR never showed up at work today, and only then did JB check his voicemail to hear that BR was sick with gastroenteritis. BB thought that was suspiciously inconvenient since all general surgery residents have an exam to take tomorrow, and said that BR had better not be pretending to be sick in order to study. "No, he does sound sick," said JB, and to be sure, he called BR on the phone to see how he was doing. BB and RB jokingly made snide comments within earshot, but JB said, "The others are giving you grief over here, but I know you're not that kind of guy" and proceeded to ask BR if he was feverish and "which end it was coming out." Apparently BR can't stop throwing up, but said that he'll try to come to work when he's ready. *sigh* Poor guy. It sucks to be a resident b/c you can't really miss work.

After lunch, we did an emergency open appendectomy on an HIV/Hep C patient. Because of his blood status, we all double-gloved except for the attending; he didn't think double-gloving made much difference. It was clear that something nasty was going on; yellowish fluid was suctioned almost immediately from his abdomen (the attending called it ascites) and the operating area soon smelled like a really bad fart. After shifting through lots of bowels, the residents found the culprit: a perforated appendix complete with a round fecalith. I later showed Corey the fecalith up close, but he said he didn't want it After the appendectomy, we had three more lap choles to do. JB, BB, and I started on the first one, but immediately ran into trouble. For whatever reason, this was the worst gallbladder we had ever seen, almost completely covered with fat and adhesions and its parts difficult to distinguish. There were times where we had "bleeders" where BB accidentally nicked vessels by mistake, and then they had to scramble like hell with the stapler to try to isolate the vessel and stop the bleeding. I had to hold the camera, but since I still had a cold and was not out of the woods from the fever just yet, I sometimes lost focus and tilted the camera the wrong way. "Uh oh, she's quitting on us," said JB, who knew it was my last day. The longer the surgery got, the shorter tempers grew, and at one point JB told me, "You fail!" when the view went awry, even though I knew I was holding the camera straight and it was BB jostling the fat that messed up the view of the abdomen. We started surgery at 3:40 pm, and we didn't get out until around 7:30 pm. Imagine that, nearly 4 hrs on a gallbladder. In that time, our attending was able to do the other two (uncomplicated) lap choles, then come back and watch us finish.

When I got out of surgery, I went to the call room and checked my voicemail. Several birthday messages were heard, but instead of making me happy, I felt upset. Being on call by myself in a huge county hospital was not the way I envisioned spending my 25th birthday. Still, I sucked it up and went back downstairs in time to eat and see a patient who had a hip abscess/cellulitis, quite a combo. Just as we were prepared to drain it, RB and I got called to a Level 1 trauma. Another GSW patient, this time through the right chest; he was awake but frantic, but his biggest problem was a collapsed right lung. BB put in a chest tube while Manisha (4th year) and I held his legs down. At one point he tried to kick out at us and I said, "Sir, relax, please!" At this, JB laughed and said, "He's not going to relax just because you said please." *sigh* Good point. In the next bed, another patient who'd been unconscious from a seizure suddenly woke up and began thrashing about; it took several paramedics to hold him down. *sigh* Craziness in the ER. When things calmed down a bit, I helped incise and drain (I&D) the patient's hip abscess with guidance (and backseat slicing) from RB. My cuts were too shallow, and I couldn't quite squeeze out all the pus like RB did, but now I have an idea of what to do.

Luckily for me, JB let me go around 11:00 pm (but only after I asked him). So I got to spend some quality time at home before the day ended. *smiles* Happy Birthday to me.