This morning I started off at Tele East as usual and saw a patient who was hospitalized for pericardial window surgery to help her breathe better (she had metastatic lung cancer). When I talked to her, she griped about how she couldn't stop coughing, and I said it was probably due to her many years of smoking. Wrong thing to say. She gave me a dirty look and said that had nothing to do with it. She also demanded to go home b/c she needed to take care of her children. BR saw her shortly after I did, and when he left the room (I heard her arguing with him), he said, "I don't think she likes me right now." After we left Tele East, I went to Tower 6 and found RB, who sent me down one floor to 5. There I ran into the Surgery D team (my team is Surgery B) and saw Dr. P from ob-gyn. The last time I saw her she was 35 weeks pregnant; today I asked about her baby and she said he's doing very well. After seeing the patients on 5 (including the girl with the hand fractures), I went to meet the rest of the team at the cafeteria and ran into Dr. D, my 2nd year ob-gyn resident. I asked her who was on green team this month (Garrett and one of the Kathys) and when she saw that my resident was JB, she said, "Oh, he's good!" Glad to hear it; I'm going into surgery with him tomorrow.
I will never understand why the surgery clinic starts letting patients into the rooms at 7:30 a.m. when the team doesn't even arrive at the clinic until 8:45. I saw a patient who had that 7:30 appointment b/c he was scheduled to have a hernia repair that was cancelled just before he was about to be put under b/c he had an episode of acute pancreatitis a few weeks prior. His hernia was huge (10 cm diameter), causing him lots of pain and discomfort, and he asked if he could get surgery done ASAP. I presented his case to JB, and he scheduled the surgery for ten days from now. Another patient was a friendly AA man who needed a colonoscopy to determine the site of a GI bleed (he was severely anemic and had dark tarry stools), but because I couldn't get ahold of JB or BB in time (he had to leave to take his wife to work), he went ahead and left the clinic. I told JB about him anyway, and commented that he was on a liver transplant list for liver dz. "Liver failure?! Did he have ascites?" asked JB. If he did, it wasn't very obvious, but he did have gynecomastia. "Well, there you go!" said JB. A third patient I saw had severe left flank pain from a hernia repair that apparently didn't work, and a fourth had an inguinal hernia (what's with all the hernias?!) Sometime around 12:30, all the residents except JB went to a mandatory meeting. We still had five patients left so I was freaking out a little, but JB made my job easier by telling me to remove the staples and sutures from one patient while he sees the others.
My patient was an amputee (he lost his leg to gangrene) with a long row of stitches along the stump of his knee. I originally asked him to lay his stump on a stool, but there was a good deal of scar tissue overlying the stitches, so when I pulled those out, sometimes he'd yell (though he was nice about it), and if that happened I'd take a break from the so-called torture. Later RB came in to see how I was doing (I was still pulling sutures out after JB saw all the patients), and helped me remove some of the more difficult sutures. This time he held the patient's stump in his hand while removing the stitches, and this time there was no pain at all. The patient and I were both surprised; we concluded that the difference in pain was probably due to the way his knee was placed (flexed vs extended). The staple removal went without a hitch, and after the patient left it was 1:40 pm. I still hadn't eaten lunch (sneaked a granola bar between patients so I wasn't too hungry), so RB told me to get some fajitas from the surgery conference room. JB was there too, so I got some one-on-one face time with him. He said I've been doing well so far (showing up on time, writing a decent number of notes), and said that there are many ways people approach surgeries. BB, he said, was still inexperienced in many procedures and a bit on the shy side, while BR has to be held back with a leash/rein because he loves operating so much. I wonder what kind of surgeon I would be. After going through the schedule we decided that I'll get my non-call weekends off. Works well with me =) I really think I have Dr. K to thank for showing me and Anita how to write decent notes back in ob-gyn; it's paying off.
The afternoon was spent at the HCW Breast Clinic (JB didn't have to go; he called it the perks of being a chief) seeing patients with breast cancer or breast masses. There I ran into another familiar face: Dr. G, the ob intern from my ob-gyn rotation. Just like that, I've seen almost everyone from the old Green team except Dr. C (the chief) and Dr. B (the 2nd year FP). There were too many people at the clinic (only 4 exam rooms), so BB gladly took his leave and left 3 interns and a med student to see the patients. I accompanied RB to rooms as a chaperone but also got 2 patients of my own. Their cases were exactly the same: follow-up on two young women who each had benign fibroadenomas removed. Fortunately that meant I wouldn't take up too much of the staff attending's time; we were in and out of the room in a matter of minutes (to his credit, BR finished seeing his patients before me, but let me present first b/c he knew my cases were shorter). RB saw one patient who wanted to remove both breasts (she was diagnosed with Stage 2 cancer) and wouldn't be talked out of it; the attending was in there with her for a good 30 minutes at least. *sigh* Well, BB and BR have tomorrow off; so it'll be RB and me doing rounds at first, and then I can go to surgery with JB. That means I'll have to eat a nice big breakfast so that I don't get hungry in mid-surgery *sigh, getting fat*
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