This morning in TeleEast I asked JB how I was doing on my rotation and if there was any way I could improve. JB said that I was doing a good job in the hospital (arriving on time, writing progress notes, seeing patients in the clinic), but knowledge-wise, I needed to brush up on that on my own.
We had general surgery clinic in the morning and vascular clinic in the afternoon. In one morning, we scheduled 3 left inguinal hernia repairs for the same day; talk about nuts. For the first time, we were able to see all the morning patients before noon. Lunch was free since there was a drug rep in the clinic; good stuff, too. Vascular clinic is hard b/c most times patients have no idea why they are there (usually sent by their PCPs). One guy talked about chest pain and shortness of breath, but he was really scheduled for follow-up on his carotid arteries. There was one interesting case: a 40 year old man presented at the clinic two months ago for endocarditis brought about by a tooth abscess, and by accident, the cardiologists realized that his aortic valve was malformed (congenital defect) and practically non-existent. He got an aortic valve replacement, and now he's doing so much better (before he was always tired, dyspneic), almost like he's got his life back. He was also thankful to Dr. A (vascular surgeon) for making his scar look nice, almost decent, instead of looking like a zipper down his chest. I passed the word to Dr. A =)
At the end of the day I reminded JB that I have lecture tomorrow, and he was disappointed b/c he'd hoped to show me an endocardectomy tomorrow (hey, I wanted to see that procedure, too, so the disappointment went both ways). "What are you going to learn in lecture that's better than what you learn in the OR?" he asked. One of the nurses said, "We had this same argument last week" and said that one of the residents wanted to keep my classmates around to help out in clinic b/c he was working alone, but they had to attend lecture b/c it was required. When it comes down to it, students have to attend lecture. I'd rather be in the OR, too, anyway.
Tuesday, January 15, 2008
Monday, January 14, 2008
General Surgery: Sunday Call
Whew, thank goodness I got Saturday off; I really needed the break. Sunday morning started out the usual; we rounded on patients, then went to the ER to see any traumas that needed to be seen. One of the first guys who came in had a stab wound beneath his ribs; BR probed it with a cotton swab and found it to be about 4 cm deep. CT didn't show any peritoneal penetration, but it couldn't be ruled out so arrangements for an exploratory laparoscopy were soon underway. BB would be doing the exp lap since JB was out of town (he didn't come back until 4:00 pm).
Then a fresh trauma was called in: victim with GSW to the head, ETA 9 minutes. This sounded like a case we saw last week, so we all gowned up and got ready. When the paramedics brought the patient in, however, I was caught off guard when I saw that it was a young female in her twenties. There was blood all through her hair and her left eye looked completely swollen. The police had the story: apparently the girl's boyfriend shot her through the eye in a fit of rage before turning the gun on himself (and did the job properly) By the time she got to the ER, she had PEA (pulseless electrical activity) from all the blood lost; we couldn't palpate a pulse anywhere. Sometimes after CPR we'd feel little blips of pulse, but it was rarely followed by another one. Her hands and feet were pale and cold (all the remaining blood had gone to the internal organs), and a blood transfusion did nothing to improve her volume. A doppler was used to find her heart, and while her heart was visibly twitching, the attending (who also happened to be Corey's preceptor) pointed out that her heart muscles themselves were not contracting. Time of death, 13:51. *sigh* This was a sad case, even worse when she was rolled over and I saw that the sheets and the backboard she was riding on were completely soaked with her blood. I had to put her clothes in a paper bag to accompany her body to the ME's office and hold the backboard while the nurses scrubbed it down. Later I found tiny specks of blood on my sleeve, but it was nothing a wet paper towel couldn't take care of. Still, it was unnerving.
Corey was waiting outside when I came out (he didn't see the trauma), so I filled him in on what was going on. He said he was going to see the exp lap on the stab patient with his attending, so I took that to mean I wouldn't be able to watch. While BB went to surgery, I followed BR and RB to McDonalds for lunch and then ate in the Commons (lounge) b/c the guys wanted to watch football. There was a Cowboys vs Giants game later in the afternoon, and my interns were hoping no traumas would come in so they could watch the game. Sadly, that was not to be. RB had to put a central line in a preeclampic patient in L&D (never thought I'd have to see the inside of that place again), but after 3-4 tries he couldn't do it (the girl had a bad case of generalized edema; poor girl was in a lot of discomfort) so I paged BR to come help him out. To our surprise, JB came with him (he finally made it back to town). BR couldn't get the line in either, but JB got it in easily. Later he (nicely) reprimanded me for contaminating the sterile field by putting a syringe down on the blue sheet; I don't even remember if I apologized =(
The guys managed to catch a play or two of the Cowboys game (the OB residents were watching it in an empty room) before we had to go back down to the ER. More MVCs rolled in, and one patient (a nurse, it turns out) was flown to the ER after she got drunk and fell off a scaffolding. She kept yelling that there was nothing wrong with her and threatening to pull out her IVs; BR had to go in and get her to cool down. I then went to see a patient who had an unsuccessful I&D on an abscess on her butt; apparently whoever did it told her to leave the wound packing inside the wound for a week, instead of changing it twice a day, and the stuff was oozing pus. Really gross. It really hurt, too; she wanted to hit RB after he tried to peel the scab off to see how deep the incision was. At one point the Short Stay nurses tackled RB and tried to get him to see a patient who'd been waiting for about 8 hrs, so I was sent to talk to him before the ER attending handed me another chart. This man had a huge swelling around a hernia incision site that was non tender to palpation (rule out abscess?); JB later stuck a syringe in there and drew out blood. It was a huge hematoma. By this time the football game was over and both doctors and nurses were griping about how they couldn't watch the game and how it sucked the Cowboys lost.
I followed BB and JB on rounds, and in the ICU, JB asked me what the point of a Swan-Ganz catheter was. I forgot (I just remembered one prof's story about "floating a swan"), and I proceeded to get pimped on the different types of shock, CVP, PCWP, preload, afterload, etc. Some I knew, others I didn't. "You got to know all these well for medicine," said JB. "All right, that's enough midnight teaching." Whew. JB and BB retired to their room around midnight so I did the same (even though BR suggested I watch RB drain the "butt pus" I was exhausted) Because I don't have a trauma pager, I felt bad about sleeping through the night, so I set my alarm for 2 a.m. My timing couldn't have been more perfect; a patient was brought in after he slit his own throat 2-3 times (he owed someone money and needed a way out). BR said that he was originally going to wake me but let me sleep in, so it's a good thing I woke myself up. There was a police chaperone not far away as RB and BR cleaned the patient's neck and prepared to sew him up. They did the deep stitches while I did some of the surface sutures. There was also a burning smell in the ER b/c the nurses burned a bag of popcorn. At 4:30 a.m. we all went back to the lounge. I slept until 6:15, but the two interns barely had a chance to lie down before getting paged again. The morning went by in a blur but finally at 10:40 we were free to leave.
Then a fresh trauma was called in: victim with GSW to the head, ETA 9 minutes. This sounded like a case we saw last week, so we all gowned up and got ready. When the paramedics brought the patient in, however, I was caught off guard when I saw that it was a young female in her twenties. There was blood all through her hair and her left eye looked completely swollen. The police had the story: apparently the girl's boyfriend shot her through the eye in a fit of rage before turning the gun on himself (and did the job properly) By the time she got to the ER, she had PEA (pulseless electrical activity) from all the blood lost; we couldn't palpate a pulse anywhere. Sometimes after CPR we'd feel little blips of pulse, but it was rarely followed by another one. Her hands and feet were pale and cold (all the remaining blood had gone to the internal organs), and a blood transfusion did nothing to improve her volume. A doppler was used to find her heart, and while her heart was visibly twitching, the attending (who also happened to be Corey's preceptor) pointed out that her heart muscles themselves were not contracting. Time of death, 13:51. *sigh* This was a sad case, even worse when she was rolled over and I saw that the sheets and the backboard she was riding on were completely soaked with her blood. I had to put her clothes in a paper bag to accompany her body to the ME's office and hold the backboard while the nurses scrubbed it down. Later I found tiny specks of blood on my sleeve, but it was nothing a wet paper towel couldn't take care of. Still, it was unnerving.
Corey was waiting outside when I came out (he didn't see the trauma), so I filled him in on what was going on. He said he was going to see the exp lap on the stab patient with his attending, so I took that to mean I wouldn't be able to watch. While BB went to surgery, I followed BR and RB to McDonalds for lunch and then ate in the Commons (lounge) b/c the guys wanted to watch football. There was a Cowboys vs Giants game later in the afternoon, and my interns were hoping no traumas would come in so they could watch the game. Sadly, that was not to be. RB had to put a central line in a preeclampic patient in L&D (never thought I'd have to see the inside of that place again), but after 3-4 tries he couldn't do it (the girl had a bad case of generalized edema; poor girl was in a lot of discomfort) so I paged BR to come help him out. To our surprise, JB came with him (he finally made it back to town). BR couldn't get the line in either, but JB got it in easily. Later he (nicely) reprimanded me for contaminating the sterile field by putting a syringe down on the blue sheet; I don't even remember if I apologized =(
The guys managed to catch a play or two of the Cowboys game (the OB residents were watching it in an empty room) before we had to go back down to the ER. More MVCs rolled in, and one patient (a nurse, it turns out) was flown to the ER after she got drunk and fell off a scaffolding. She kept yelling that there was nothing wrong with her and threatening to pull out her IVs; BR had to go in and get her to cool down. I then went to see a patient who had an unsuccessful I&D on an abscess on her butt; apparently whoever did it told her to leave the wound packing inside the wound for a week, instead of changing it twice a day, and the stuff was oozing pus. Really gross. It really hurt, too; she wanted to hit RB after he tried to peel the scab off to see how deep the incision was. At one point the Short Stay nurses tackled RB and tried to get him to see a patient who'd been waiting for about 8 hrs, so I was sent to talk to him before the ER attending handed me another chart. This man had a huge swelling around a hernia incision site that was non tender to palpation (rule out abscess?); JB later stuck a syringe in there and drew out blood. It was a huge hematoma. By this time the football game was over and both doctors and nurses were griping about how they couldn't watch the game and how it sucked the Cowboys lost.
I followed BB and JB on rounds, and in the ICU, JB asked me what the point of a Swan-Ganz catheter was. I forgot (I just remembered one prof's story about "floating a swan"), and I proceeded to get pimped on the different types of shock, CVP, PCWP, preload, afterload, etc. Some I knew, others I didn't. "You got to know all these well for medicine," said JB. "All right, that's enough midnight teaching." Whew. JB and BB retired to their room around midnight so I did the same (even though BR suggested I watch RB drain the "butt pus" I was exhausted) Because I don't have a trauma pager, I felt bad about sleeping through the night, so I set my alarm for 2 a.m. My timing couldn't have been more perfect; a patient was brought in after he slit his own throat 2-3 times (he owed someone money and needed a way out). BR said that he was originally going to wake me but let me sleep in, so it's a good thing I woke myself up. There was a police chaperone not far away as RB and BR cleaned the patient's neck and prepared to sew him up. They did the deep stitches while I did some of the surface sutures. There was also a burning smell in the ER b/c the nurses burned a bag of popcorn. At 4:30 a.m. we all went back to the lounge. I slept until 6:15, but the two interns barely had a chance to lie down before getting paged again. The morning went by in a blur but finally at 10:40 we were free to leave.
Friday, January 11, 2008
General Surgery: Shortstaffed at the Clinic
JB had to fly out of town yesterday because his dad was ill, so it was just BB, BR, RB, and me today. Normally on Clinic Days, we try to finish rounding by 8:00 a.m., grab breakfast at the cafeteria, and then go to clinic. I left RB on the 5th floor (where I had to recall some OB Spanish to interview a patient recovering from appendicitis) to get breakfast at 8:15, but no one else was there. So I went to the clinic at 8:30, but still, no one was there. But... there were five patients in rooms waiting to be seen, with the first room labeled 7:50! I've always hated making patients wait, so I paged RB asking if I can go ahead and start seeing patients. He got the OK from BB (now the most senior member of our team), so I went to work. The first two were lap chole followups (very straightforward), but the third was a man who needed an ileostomy reversed, and that required a physician's signature on the consent form. Fortunately by the time I finished talking to him the rest of the gang had arrived, and that made my job slightly easier.
Even still, RB was assigned to work with the neurosurgeon today, leaving BR, BB, and me to handle the general surgery cases. I never saw so many patients in one setting on my own as I did today. I had several lap chole follow-ups and also had to schedule new cases. One was an HIV+ man with rectal warts; when I presented to BR, the first question he asked was if he was HIV +. "One guy came to the ER once and asked how he got rectal warts," said BR. "Want to know what the attending told him? 'Buttf***ing.' " That's bluntness for you. What struck me as funny was that he chose to schedule his surgery for Valentine's Day, hardly romantic. The saddest case was one of our last patients, a middle-aged man with Stage IV adenocarcinoma of the lung whose vocal cords have become paralyzed. He needed a PEG tube inserted b/c he can no longer swallow and needs a trache to breathe. Any communication had to be written by hand on a notepad, and he wrote a lot about how his trache gets plugged up by mucus and his entire chest and abdominal area hurt from coughing and choking so much. It took a while for BB to assure him that the PEG will do wonders for his nutrition (the man was pretty emaciated) and pain control, since he can no longer swallow pain pills. The last case was a lipoma removal, but by the time we left the clinic, it was almost 3:00 pm.
I'm so glad I have tomorrow off...
Even still, RB was assigned to work with the neurosurgeon today, leaving BR, BB, and me to handle the general surgery cases. I never saw so many patients in one setting on my own as I did today. I had several lap chole follow-ups and also had to schedule new cases. One was an HIV+ man with rectal warts; when I presented to BR, the first question he asked was if he was HIV +. "One guy came to the ER once and asked how he got rectal warts," said BR. "Want to know what the attending told him? 'Buttf***ing.' " That's bluntness for you. What struck me as funny was that he chose to schedule his surgery for Valentine's Day, hardly romantic. The saddest case was one of our last patients, a middle-aged man with Stage IV adenocarcinoma of the lung whose vocal cords have become paralyzed. He needed a PEG tube inserted b/c he can no longer swallow and needs a trache to breathe. Any communication had to be written by hand on a notepad, and he wrote a lot about how his trache gets plugged up by mucus and his entire chest and abdominal area hurt from coughing and choking so much. It took a while for BB to assure him that the PEG will do wonders for his nutrition (the man was pretty emaciated) and pain control, since he can no longer swallow pain pills. The last case was a lipoma removal, but by the time we left the clinic, it was almost 3:00 pm.
I'm so glad I have tomorrow off...
Thursday, January 10, 2008
General Surgery: Wednesday Call
Yesterday morning around 4:00 a.m. I got a voicemail from Corey (I'd heard the phone ringing but ignored it, dismissing it as a wrong number initially) saying that lecture had been postponed from 7 a.m. to 9 a.m. b/c our prof Dr. B had do perform surgery at 7 a.m. That's all fine and good except I (and the others, I'm sure) was annoyed at being awakened so early. Later Corey explained that the surgery office had called to wake him up and ask him to call everyone to let them know the situation. We have a "call tree" in which everyone calls 2 other people in case something arises, and Corey's name is at the top of the tree. Of course, the two people he was supposed to call never answered their phones, so he just called everyone on the list. Got to give him props for that one.
Because lecture time was shortened, Dr. B just talked about fluids (which I've never been good at). I made sure to eat a huge lunch before reporting to the OR, where JB and BB were in the process of removing a sebaceous cyst from a man's neck. There was a nursing student from OU watching the surgery, too; JB later said she was our attending's girlfriend's daughter (it's all about connections) I was wearing my own royal blue scrubs (got tired of the JPS ones), but that made people mistake me as a nurse (JPS nurses wear royal blue), so JB told me to at least tuck my scrub top in. "Nurses have pockets so they need to keep their shirts untucked, but you can't do that," he said. This isn't the first time that JB has tried to set me apart from nurses; one time I photocopied a prescription to save the nurses some time and he said my brain was made for better things than that. I jokingly told the student nurse (already forgot her name) that sebaceous cysts don't just look like cheese, they smell like it, too. She laughed, but maybe it was a weak laugh. Wanting to familiarize myself with the case, I went to read the patient's chart. Suddenly there was a loud THUD! and a rolling cart crashed into the cart that the chart was on. I looked up and found that the other student was passed out cold on the floor; when she fell she'd sent the cart rolling in my direction. Both the attending and the scrub tech immediately rushed to her side to make sure she was all right, but JB and BB stayed where they were (they were sterile) The scrub tech had to scrub in again because he got contaminated when he went ot check on the student. Later we wondered what had made her pass out. Someone suggested the sight of blood (not likely), and another nurse said maybe her knees were locked. Someone else joked that it was because the nurse went to OU ("Those Oklahoma people...) RB did attend OU for med school so he was slightly annoyed when I related the story to him later. The patient also had little clustered masses on his head, so my residents essentially cut out a chunk of his scalp for biopsy. And the way the scalp sample was cut, it was slightly mouse-shaped; you could make out the pointed nose, and there was a round whorl of hair that could easily pass for an ear. JB got excited and said it was things like this that made surgery fun, even going so far as to give it a thread tail when one of the nurses said it lacked a tail. When the surgery was over, the patient send out a spray of urine when the catheter was removed, and one of the nurses went ducking for cover. "It was coming right at me," she said. That was a close one then.
The second surgery after that was a diagnostic colonoscopy for a woman complaining of rectal pain and bleeding; she couldn't even tolerate a DRE in the clinic. The PCP she saw called it "hemorrhoids). So we put her to sleep, but one took at her perianal area made everyone groan/scream. It looked, in JB's words, as though someone took a shotgun to her anus; there was no sphincter, just an ulcerating hole, and within that hole was a rock-like mass. Looked like cancer to everyone present. The colonoscopy itself was unremarkable, so it hasn't spread beyond that region yet. Later JB went to tell the patient's daughter-in-law the diagnosis, and the daughter groaned. "I knew it," she said, saying that her mother-in-law was the type of person who smoked and drank all the time and never went to see the doctor until things were too late. It didn't help that the daughter-in-law was 35 weeks pregnant and can't take care of both a baby and the patient at the same time; they'll have to think of something. I saw Ilona near the OR; she got to intubate a patient today during an OB procedure. "You got to intubate?" I asked. JB (who was Ilona's resident also) spoke up, "She's interested in anesthesiology."
All surgeries were done by 4:00 pm, so I went to find the ICU to see what I could help the others with. Sometime later there was a STAT trauma call to the ER: GSW victim, CPR in progress. "Do you know the survival rate of patients who receive CPR outside of a hospital?" asked JB. No, I didn't. "1%." That low?! Anyways, we all rushed to the ER, and while there were already tons of people in the room, I got suited up anyway, just in case. They brought the man in, and everyone immediately tried to improve his volume. He had about 2-3 IOs put in; RB did one and said it felt really cool. Next JB opened his chest along the side to give him open chest CPR, at one point putting spatula-like chargers into the chest to give him a defib shock. "Shocking!" someone called, but it did nothing. To my surprise, no one tried again. "That's it," said JB. "Time, 16:48." There were several young nurses gathered around the body, so JB pointed out the lung, omentum, and other organs through the chest incision (I was shoved too far back to see anything). As I got closer and saw the lung (speckled black from years of smoking), I touched it and was surprised by how cool it already felt. The man's limbs, too, were white and already cool. Because this was a crime scene (he pulled a gun on a cop who then shot him), his clothes were collected and his hands were covered with bags for evidence before he was placed in a body bag to be taken to the ME's office. RB had to write a report on him, and he asked me if the patient's feet were pale. Yeah, they were.
After that trauma, RB sent me to look at an HIV+ patient's perianal abscess. The patient was pleasant enough, but I was reminded of his HIV status when his nurse came in wearing a mask and gloves. Even though we know that HIV is bloodborne, when you see someone protecting themselves like that, sometimes you can't help but worry. I saw my patient at 6:00 pm, but it was a good 3 hrs before RB could follow up on him. My gastric cancer patient was wanting to go home so RB needed to talk to her family, and then he had to talk to another patient's family (about 6 family members) so we kept getting behind schedule. RB confirmed the HIV patient had an abscess and after presenting to JB (who came out of an elective vascular surgery and was ready for bed), RB and I got a 10:00 pm dinner at McDonalds (cafeteria was closed and my money was in the call room) We then went to drain the abscess, but all that came out was blood, no pus. After we finished with his wound, it was around 11:30 and surprisingly, for the moment, we were done. RB and BR hung out in the lounge watching football while I went to the call room to sleep. I woke up around 4:00 a.m. and checked the pager (no pages) before sleeping again until 5:30. When I went to the lounge, RB and BR were sleeping exactly where I'd left them. I wondered at first if they got no pages all night, but that wasn't the case. They still had a few consults, but luckily no traumas.
I rounded on a few patients before going to the family clinic for "Christmas" and ran into my residents en route to do an endoscopy/colonoscopy. This was a routine procedure, no polyps seen. After that, we rounded with the attending on call, Dr. T (whose girlfriend's daughter passed out in the OR) before getting dismissed around 10:00 a.m this morning. All in all, not too bad. At least I got some sleep. And tomorrow is a whole day of General Surgery clinic. *sigh* That's going to be tiring.
Because lecture time was shortened, Dr. B just talked about fluids (which I've never been good at). I made sure to eat a huge lunch before reporting to the OR, where JB and BB were in the process of removing a sebaceous cyst from a man's neck. There was a nursing student from OU watching the surgery, too; JB later said she was our attending's girlfriend's daughter (it's all about connections) I was wearing my own royal blue scrubs (got tired of the JPS ones), but that made people mistake me as a nurse (JPS nurses wear royal blue), so JB told me to at least tuck my scrub top in. "Nurses have pockets so they need to keep their shirts untucked, but you can't do that," he said. This isn't the first time that JB has tried to set me apart from nurses; one time I photocopied a prescription to save the nurses some time and he said my brain was made for better things than that. I jokingly told the student nurse (already forgot her name) that sebaceous cysts don't just look like cheese, they smell like it, too. She laughed, but maybe it was a weak laugh. Wanting to familiarize myself with the case, I went to read the patient's chart. Suddenly there was a loud THUD! and a rolling cart crashed into the cart that the chart was on. I looked up and found that the other student was passed out cold on the floor; when she fell she'd sent the cart rolling in my direction. Both the attending and the scrub tech immediately rushed to her side to make sure she was all right, but JB and BB stayed where they were (they were sterile) The scrub tech had to scrub in again because he got contaminated when he went ot check on the student. Later we wondered what had made her pass out. Someone suggested the sight of blood (not likely), and another nurse said maybe her knees were locked. Someone else joked that it was because the nurse went to OU ("Those Oklahoma people...) RB did attend OU for med school so he was slightly annoyed when I related the story to him later. The patient also had little clustered masses on his head, so my residents essentially cut out a chunk of his scalp for biopsy. And the way the scalp sample was cut, it was slightly mouse-shaped; you could make out the pointed nose, and there was a round whorl of hair that could easily pass for an ear. JB got excited and said it was things like this that made surgery fun, even going so far as to give it a thread tail when one of the nurses said it lacked a tail. When the surgery was over, the patient send out a spray of urine when the catheter was removed, and one of the nurses went ducking for cover. "It was coming right at me," she said. That was a close one then.
The second surgery after that was a diagnostic colonoscopy for a woman complaining of rectal pain and bleeding; she couldn't even tolerate a DRE in the clinic. The PCP she saw called it "hemorrhoids). So we put her to sleep, but one took at her perianal area made everyone groan/scream. It looked, in JB's words, as though someone took a shotgun to her anus; there was no sphincter, just an ulcerating hole, and within that hole was a rock-like mass. Looked like cancer to everyone present. The colonoscopy itself was unremarkable, so it hasn't spread beyond that region yet. Later JB went to tell the patient's daughter-in-law the diagnosis, and the daughter groaned. "I knew it," she said, saying that her mother-in-law was the type of person who smoked and drank all the time and never went to see the doctor until things were too late. It didn't help that the daughter-in-law was 35 weeks pregnant and can't take care of both a baby and the patient at the same time; they'll have to think of something. I saw Ilona near the OR; she got to intubate a patient today during an OB procedure. "You got to intubate?" I asked. JB (who was Ilona's resident also) spoke up, "She's interested in anesthesiology."
All surgeries were done by 4:00 pm, so I went to find the ICU to see what I could help the others with. Sometime later there was a STAT trauma call to the ER: GSW victim, CPR in progress. "Do you know the survival rate of patients who receive CPR outside of a hospital?" asked JB. No, I didn't. "1%." That low?! Anyways, we all rushed to the ER, and while there were already tons of people in the room, I got suited up anyway, just in case. They brought the man in, and everyone immediately tried to improve his volume. He had about 2-3 IOs put in; RB did one and said it felt really cool. Next JB opened his chest along the side to give him open chest CPR, at one point putting spatula-like chargers into the chest to give him a defib shock. "Shocking!" someone called, but it did nothing. To my surprise, no one tried again. "That's it," said JB. "Time, 16:48." There were several young nurses gathered around the body, so JB pointed out the lung, omentum, and other organs through the chest incision (I was shoved too far back to see anything). As I got closer and saw the lung (speckled black from years of smoking), I touched it and was surprised by how cool it already felt. The man's limbs, too, were white and already cool. Because this was a crime scene (he pulled a gun on a cop who then shot him), his clothes were collected and his hands were covered with bags for evidence before he was placed in a body bag to be taken to the ME's office. RB had to write a report on him, and he asked me if the patient's feet were pale. Yeah, they were.
After that trauma, RB sent me to look at an HIV+ patient's perianal abscess. The patient was pleasant enough, but I was reminded of his HIV status when his nurse came in wearing a mask and gloves. Even though we know that HIV is bloodborne, when you see someone protecting themselves like that, sometimes you can't help but worry. I saw my patient at 6:00 pm, but it was a good 3 hrs before RB could follow up on him. My gastric cancer patient was wanting to go home so RB needed to talk to her family, and then he had to talk to another patient's family (about 6 family members) so we kept getting behind schedule. RB confirmed the HIV patient had an abscess and after presenting to JB (who came out of an elective vascular surgery and was ready for bed), RB and I got a 10:00 pm dinner at McDonalds (cafeteria was closed and my money was in the call room) We then went to drain the abscess, but all that came out was blood, no pus. After we finished with his wound, it was around 11:30 and surprisingly, for the moment, we were done. RB and BR hung out in the lounge watching football while I went to the call room to sleep. I woke up around 4:00 a.m. and checked the pager (no pages) before sleeping again until 5:30. When I went to the lounge, RB and BR were sleeping exactly where I'd left them. I wondered at first if they got no pages all night, but that wasn't the case. They still had a few consults, but luckily no traumas.
I rounded on a few patients before going to the family clinic for "Christmas" and ran into my residents en route to do an endoscopy/colonoscopy. This was a routine procedure, no polyps seen. After that, we rounded with the attending on call, Dr. T (whose girlfriend's daughter passed out in the OR) before getting dismissed around 10:00 a.m this morning. All in all, not too bad. At least I got some sleep. And tomorrow is a whole day of General Surgery clinic. *sigh* That's going to be tiring.
Tuesday, January 8, 2008
General Surgery: PEGs
Today was a pre-call day (and JB had 2-3 surgeries scheduled), so after rounding on patients I went to the OR to see if the surgeries had begun yet. As it turned out, JB couldn't do his first surgery (VATS, video-assisted thoracostomy) until the vascular surgeon, Dr. A, put in a pacemaker on another patient first. So I hung out in the call room and then followed RB on rounds for a while before the two of us went to the OR and found the patient being prepped for surgery. Then RB left to take care of floor patients while JB and I scrubbed in.
The patient, SP, was an African man who had a leak in his left lung secondary to bleb formation(s) that landed him at JPS with pneumothorax. Our goal: enter the chest laparoscopically, find that bleb, and help SP breathe better. SP had smoked for years and a good portion of his lung was actually stuck to the ceiling of the chest; those adhesions were removed with relative ease. It was interesting watching the lung inflate and deflate with each breath after the adhesions were removed and the lung was no longer stuck. JB then filled the chest cavity with saline to find the bleb ("Look for bubbles with exhalation") Sure enough, we saw what could easily pass as a bubbling geyser on the medial side of the lung, but the bleb was nowhere in sight. It didn't help that the saline was mixing with blood, making visibility even worse. Dr. A came in and couldn't find the bleb either, and with an exasperated sigh he said that they might have to operate by opening the rib cage instead of just working with the laparoscope. Then JB was called away to fill out consents and paperwork on the cancer patient we saw yesterday (whose surgery was after this one), and Dr. A immediately flushed the chest with saline to see if he could find the elusive bleb. My job was to hold the camera, and suddenly, there it was. The bleb looked like a long "proboscis-like" piece of flesh (Dr. A's words, not mine) with a round tear in the tissue, and Dr. A handed me a laparoscopic stapler and told me to cut it out. "Come on, let's get this done before [JB] gets back," he said. "He'll be sorry he missed this one." Under Dr. A's instructions, I snipped the bleb in half, just in time as JB reentered the ER. "Sorry, we're all done! Your med student saw the bleb and took action, I couldn't stop her," said Dr. A. JB didn't bat an eye, just replied, "That's good, I've been trying to get her to talk for a week." At any rate, JB finished up by capturing the bleb with laparoscopic forceps and pulling it out. Fortunately that was the only bleb, and SP emerged from surgery with no complications.
Immediately after we finished the surgery, we went next door where the other patient was waiting. She needed a MediPort put into her chest (for chemo treatments) as well as a PEG feeding tube (radiation treatment to larynx muscles makes swallowing difficult, so she'll need a PEG tube throughout her treatment). PEG is short for The doctor sticks an endoscope down the throat to the stomach, then wires a thread into the stomach through a stomach incision. The endoscope attaches to the wire and pulls it through the esophagus up to the mouth, where the PEG tube is sewn on and then transferred via wire back to the stomach. It's a fairly interesting surgery, and it was cool watching the peristalsis in the small bowel. We also found a small polyp in the woman's stomach (possible mets?) and biopsied it; we also saw an ugly white patch on her throat that had to be her cancer. The port insertion was uncomplicated also, except when the central line went up the internal jugular instead of to the IVC (confirmed by on-site X-ray).
By this time it was very well past noon and I was getting fairly hungry, but JB immediately went to ICU where he was scheduled to do another PEG and tracheostomy on an ICU patient. Somewhere around 2:00 I couldn't take it anymore and told JB I was going to the bathroom. That was partly true; I also ran back to the call room and gulped down a NutriGrain bar so that I wouldn't feel so hungry. I followed JB from around 9:30 to 4:00, and I never saw him eat anything. Don't surgeons ever get hungry? I understand the need to get through as many patients as possible, but surely people need to take time to eat also? Of course, certain people will say that all I think about is food, but I'm used to eating at regular intervals. That has never happened in surgery; I have to carry food with me and eat at opportune times.
The ICU procedure was a waste of my time b/c JB was training one of the FP residents to do a PEG. He kept getting paged by the OR for another procedure, and at one point I asked what to do. Dr. K (who was watching the procedure) looked a bit exasperated and told me to go outside and return the page to see what was going on. *sigh* Some things never change; even back in obgyn Dr. K thought I was too timid for my own good. Since I was reduced to watching, I got bored and nearly fell asleep on my feet. After that we returned to the OR and I watched as JB taught the FP resident how to put in an IVC filter, but after that...another PEG and tracheostomy. At 4:00, after he finished the IVC, I asked if I could take off early. (Nothing else for me to do, after all). Fortunately JB let me go.
I've had three regular patients in Tele East. One was a man with a spinal contusion; another was a man who, along with his wife, got hurt when an 18-wheeler hit their car. His wife was in ICU until today, and now she's been moved into his room. He's happy that now he can just look across the room and see her now. My third patient was a 28-year-old woman who had a Roux-en-Y gastric bypass after she was diagnosed with gastric cancer (big shock right here, since she's so young). She'd been making a lot of progress (eating solid foods, graduating from a feeding tube to no tube at all), but today she fell ill with severe LUQ pain. And now radiology says that more than half of her abdominal lymph nodes test positive for cancer. =( It's just so sad.
Another call day awaits me tomorrow =( Fortunately (sort of) I have lecture in the morning, which will be a break from the OR. My feet are killing me after standing for so long, I hate to think what tomorrow will be like. And of course, I need to load up on snacks.
The patient, SP, was an African man who had a leak in his left lung secondary to bleb formation(s) that landed him at JPS with pneumothorax. Our goal: enter the chest laparoscopically, find that bleb, and help SP breathe better. SP had smoked for years and a good portion of his lung was actually stuck to the ceiling of the chest; those adhesions were removed with relative ease. It was interesting watching the lung inflate and deflate with each breath after the adhesions were removed and the lung was no longer stuck. JB then filled the chest cavity with saline to find the bleb ("Look for bubbles with exhalation") Sure enough, we saw what could easily pass as a bubbling geyser on the medial side of the lung, but the bleb was nowhere in sight. It didn't help that the saline was mixing with blood, making visibility even worse. Dr. A came in and couldn't find the bleb either, and with an exasperated sigh he said that they might have to operate by opening the rib cage instead of just working with the laparoscope. Then JB was called away to fill out consents and paperwork on the cancer patient we saw yesterday (whose surgery was after this one), and Dr. A immediately flushed the chest with saline to see if he could find the elusive bleb. My job was to hold the camera, and suddenly, there it was. The bleb looked like a long "proboscis-like" piece of flesh (Dr. A's words, not mine) with a round tear in the tissue, and Dr. A handed me a laparoscopic stapler and told me to cut it out. "Come on, let's get this done before [JB] gets back," he said. "He'll be sorry he missed this one." Under Dr. A's instructions, I snipped the bleb in half, just in time as JB reentered the ER. "Sorry, we're all done! Your med student saw the bleb and took action, I couldn't stop her," said Dr. A. JB didn't bat an eye, just replied, "That's good, I've been trying to get her to talk for a week." At any rate, JB finished up by capturing the bleb with laparoscopic forceps and pulling it out. Fortunately that was the only bleb, and SP emerged from surgery with no complications.
Immediately after we finished the surgery, we went next door where the other patient was waiting. She needed a MediPort put into her chest (for chemo treatments) as well as a PEG feeding tube (radiation treatment to larynx muscles makes swallowing difficult, so she'll need a PEG tube throughout her treatment). PEG is short for The doctor sticks an endoscope down the throat to the stomach, then wires a thread into the stomach through a stomach incision. The endoscope attaches to the wire and pulls it through the esophagus up to the mouth, where the PEG tube is sewn on and then transferred via wire back to the stomach. It's a fairly interesting surgery, and it was cool watching the peristalsis in the small bowel. We also found a small polyp in the woman's stomach (possible mets?) and biopsied it; we also saw an ugly white patch on her throat that had to be her cancer. The port insertion was uncomplicated also, except when the central line went up the internal jugular instead of to the IVC (confirmed by on-site X-ray).
By this time it was very well past noon and I was getting fairly hungry, but JB immediately went to ICU where he was scheduled to do another PEG and tracheostomy on an ICU patient. Somewhere around 2:00 I couldn't take it anymore and told JB I was going to the bathroom. That was partly true; I also ran back to the call room and gulped down a NutriGrain bar so that I wouldn't feel so hungry. I followed JB from around 9:30 to 4:00, and I never saw him eat anything. Don't surgeons ever get hungry? I understand the need to get through as many patients as possible, but surely people need to take time to eat also? Of course, certain people will say that all I think about is food, but I'm used to eating at regular intervals. That has never happened in surgery; I have to carry food with me and eat at opportune times.
The ICU procedure was a waste of my time b/c JB was training one of the FP residents to do a PEG. He kept getting paged by the OR for another procedure, and at one point I asked what to do. Dr. K (who was watching the procedure) looked a bit exasperated and told me to go outside and return the page to see what was going on. *sigh* Some things never change; even back in obgyn Dr. K thought I was too timid for my own good. Since I was reduced to watching, I got bored and nearly fell asleep on my feet. After that we returned to the OR and I watched as JB taught the FP resident how to put in an IVC filter, but after that...another PEG and tracheostomy. At 4:00, after he finished the IVC, I asked if I could take off early. (Nothing else for me to do, after all). Fortunately JB let me go.
I've had three regular patients in Tele East. One was a man with a spinal contusion; another was a man who, along with his wife, got hurt when an 18-wheeler hit their car. His wife was in ICU until today, and now she's been moved into his room. He's happy that now he can just look across the room and see her now. My third patient was a 28-year-old woman who had a Roux-en-Y gastric bypass after she was diagnosed with gastric cancer (big shock right here, since she's so young). She'd been making a lot of progress (eating solid foods, graduating from a feeding tube to no tube at all), but today she fell ill with severe LUQ pain. And now radiology says that more than half of her abdominal lymph nodes test positive for cancer. =( It's just so sad.
Another call day awaits me tomorrow =( Fortunately (sort of) I have lecture in the morning, which will be a break from the OR. My feet are killing me after standing for so long, I hate to think what tomorrow will be like. And of course, I need to load up on snacks.
Monday, January 7, 2008
General Surgery: Hernias, Staples, Stitches, and Fibroadenomas
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*
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*
Sunday, January 6, 2008
General Surgery: Saturday Call
*This entry encompasses a 26 hr day spent at JPS starting yesterday*
On weekends, call doesn't start until 9 a.m., so from 9-12:30 we rounded on patients. Somewhere in that time I stopped briefly by the lounge to page one of my interns (with a four-man team, it's way too easy to get separated) and saw David H and Dina there; the two of them were on call for medicine. Their medicine resident warned me to expect lots of trauma cases to come in today. I asked why, and he said, "It's a Saturday, and the weather's nice." Great...
After rounding on patients during weekend call (I have three patients on Telemetry), the job of the trauma team (the surgical team on call) is to see trauma cases in the ER or do surgical procedures around the hospital. First I stayed in the ER with RB. There were too many MVCs (motor vehicle collisions) to count. One man was hit from the right by another driver (who didn't make it). A 21-year-old guy (who looked an awful lot like Corey so I did a double take when I saw him) got pinned by the dashboard when his friend accidentally drove off the road and crashed into some trees (car was totalled). A Harley Davidson biker in his 60s got pushed over by a combination of gravel and wind and broke 8 right ribs and tore the glenoid region of his shoulder; the ortho resident offered to take his case, which was a surprise since ortho, according to RB, usually doesn't take action until the trauma team pushes them to do it. A woman who wasn't wearing a seatbelt got a HUGE bruise on her knee and couldn't dorsiflex her foot afterwards; we all wondered what was going on with that.
After a while ER got a little boring (my job was to do H&Ps on patients and give them a physical) so I went to find BR (he was removing a bullet from a John Doe who got shot 5 times and I wanted to watch). When the bullet was extracted, we saw bits of clothing fiber attached to it; obviously it came from John Doe's shirt after he got shot. BR had to keep the bullet (located in a specimen cup) until FWPD contacted him, but they never did, and he has to keep that bullet with him at all times until they do. It'll be interesting to see if he still has that bullet tomorrow. Afterwards, we went to do a central line on a homeless guy who got hit by a car while he was crossing the street while intoxicated (yet the woman who hit him got off free and he got reprimanded for being drunk). He needed a CL b/c he had bacteremia, and b/c he rolled over in bed a lot, arm IVs kept getting ripped off. When BR went to talk to him, he kept talking about how he felt he should be compensated for all the suffering he's endured and kept asking us over and over for more pain meds. Apparently one Lortab every few hours wasn't doing it for him, and he asked for morphine. He even asked BR to call the nurse to the room and tell him to give the patient stronger Lortab. Some profanities were spoken, but BR ignored it and did a successful CL. He came close to losing his temper on the patient after the 20th time he asked for more drugs ("Don't ask me that again!") and said that if the patient wasn't being such a little b**** he would have let me do the CL. Later we inserted a chest tube on a stroke victim in the ICU who kept fighting the procedure; a student nurse had to hold him down. There, I met Thomas, the ICU respiratory therapist, who encouraged me to ask him any questions I had about patients breathing problems. That came in helpful this morning, when one patient had a pleural rub and I didn't know what sound that was.
After that, I went to a room where JB and BB were doing a PEG/tracheostomy (I still don't know what PEG is) with the attending on call, Dr. G. Dr. G asked me if I've ever done a "bronch" (bronchoscopy), I said no, and he offered to teach me. Basically, a bronchoscope is a very expensive little toy ($25,000) that looks like a larger version of the Wii nunchuck. There is a button to move the tip of the scope up or down, and you center the view of the scope by rotating your hand. You also have to keep the end of the scope straight at all times if possible; excessive bending would only destroy the fiberoptic nerves in the scope. I enjoyed it until JB started pimping me on what part of the lung I was in. Making my first big blunder of the night (my brain and mouth don't match up) I asked if I was in the esophagus b/c the word "trachea" didn't come to mind in time. Great, nice one. Then I was asked the distinctive names of each bronchus in the right lung, which I did not remember from anatomy. *sigh* Later JB told me that he wanted me to help the interns do procedures when I'm in the ER (i.e. suturing, Foley catheters, etc) I had a perfect chance to do a Foley when paramedics brought in an unconscious guy who'd been choked (it was Level 1 so BB and JB were awakened and paged from the call room), but someone beat me to it. And as for suturing, the Corey look-a-like had bitten a hole through his lip during the impact, requiring 3 layers of suturing, and the medicine intern doing her ENT rotation had to do it even though she said she didn't trust her suturing skills. JB let me watch a CT scan on a 2 wk post partum Jane Doe who had been found lying in a ditch, and the ICU team (with Dr. K from obgyn) was there, too. Dr. K was hoping to hand one of his patients (who had an abscess) to the surgical team, but JB burst his bubble by saying it was nothing ICU wouldn't handle by themselves.
As Dina's resident predicted (I saw her a few times around midnight in the ER), the traumas didn't stop coming in. One lady got pushed over and landed on her head (possible subarachnoid hemorrhage) and she could not stop throwing up stuff that looked like egg drop soup (I checked on her during rounds this morning and she felt much better). Another motorcycle victim came in and required debridement on many of his wounds (this was compared to the other biker who had relatively little external damage). RB, BR, and I didn't officially eat dinner until midnight (I made it that far by taking quick trips to the call room and eating oranges and granola bars I'd brought from home) My interns don't really care what I do, but they didn't want me to stand around doing nothing either. At 2:30 a.m., there was a lull in the ER and RB told me to get some sleep. Easier said than done; I tossed and turned in the call room for an hour before getting some semi-sleep. Knowing that we start rounding at 6:00 a.m., I set my alarm for 5:30 and met with my team back in ER. Then I saw BB down there (he's the 2nd year) and BR told me that after I'd left, four traumas arrived in a matter of minutes. I felt bad that the interns weren't able to sleep at all (I'd given RB my pager number but he was too busy to page me), and I felt very useless for a good part of the morning in the ER.
Around 7:00 a.m. I started rounding on my telemetry patients as well as two patients we'd admitted into the ER. I went to check on John Doe but JB and Dr. G came in so my visit there was for nothing (JB was rounding on patients and wrote notes on the ones he saw). I returned to the ER to see RB interview a 17-year-old who was in a MVC (seeing a pattern here?) and lost almost all the skin on the back of her left hand. I wondered where all her blood had come from, and when RB uncovered her hand, you could see torn tendons and flesh. She wanted to see her wound, too, and to her credit she didn't pass out or scream when she saw how bad it was (it was fractured, too). Her right hand had a fracture in the most distal part of her middle finger so that was immobilized pending an ortho consult. Not long afterwards, a middle-aged woman was brought into the next bed, combatative and screaming. She kept begging the doctors not to stick her, asking what they were doing to keep her alive, and screaming, "Father! Jesus, help me!" After doing my psych rotation, I was fairly sure her mental status was altered, and told the teenage girl with the broken hands not to let the screaming bother her. "Can you tell [the screaming patient] that there's nothing to be scared about?" she asked. I was very impressed with her maturity and thoughtfulness considering how she was injured, too, and I told her that while I could try, the way the woman is now, it'd be hard to get through to her.
Afterwards I lost RB and ended up paging BR asking me where to go next. He told me that JB had already gone home for the day and that I could leave to. Dr. K came by just as I was confirming that I could leave, and he said, "Go home. Tell them I said you could." Nice try, Dr. K, but you're not my resident anymore =) He also commented that ICU had more admissions last night than they could handle, saying that his team worked harder than ours (friendly rivalry between ICU and trauma). I don't doubt it. After I finally got home, I went to sleep for about 3 hours. Both feet are killing me (my Klogs are failing me), and I can't even imagine how tired the interns had to be. And it all starts again tomorrow.
On weekends, call doesn't start until 9 a.m., so from 9-12:30 we rounded on patients. Somewhere in that time I stopped briefly by the lounge to page one of my interns (with a four-man team, it's way too easy to get separated) and saw David H and Dina there; the two of them were on call for medicine. Their medicine resident warned me to expect lots of trauma cases to come in today. I asked why, and he said, "It's a Saturday, and the weather's nice." Great...
After rounding on patients during weekend call (I have three patients on Telemetry), the job of the trauma team (the surgical team on call) is to see trauma cases in the ER or do surgical procedures around the hospital. First I stayed in the ER with RB. There were too many MVCs (motor vehicle collisions) to count. One man was hit from the right by another driver (who didn't make it). A 21-year-old guy (who looked an awful lot like Corey so I did a double take when I saw him) got pinned by the dashboard when his friend accidentally drove off the road and crashed into some trees (car was totalled). A Harley Davidson biker in his 60s got pushed over by a combination of gravel and wind and broke 8 right ribs and tore the glenoid region of his shoulder; the ortho resident offered to take his case, which was a surprise since ortho, according to RB, usually doesn't take action until the trauma team pushes them to do it. A woman who wasn't wearing a seatbelt got a HUGE bruise on her knee and couldn't dorsiflex her foot afterwards; we all wondered what was going on with that.
After a while ER got a little boring (my job was to do H&Ps on patients and give them a physical) so I went to find BR (he was removing a bullet from a John Doe who got shot 5 times and I wanted to watch). When the bullet was extracted, we saw bits of clothing fiber attached to it; obviously it came from John Doe's shirt after he got shot. BR had to keep the bullet (located in a specimen cup) until FWPD contacted him, but they never did, and he has to keep that bullet with him at all times until they do. It'll be interesting to see if he still has that bullet tomorrow. Afterwards, we went to do a central line on a homeless guy who got hit by a car while he was crossing the street while intoxicated (yet the woman who hit him got off free and he got reprimanded for being drunk). He needed a CL b/c he had bacteremia, and b/c he rolled over in bed a lot, arm IVs kept getting ripped off. When BR went to talk to him, he kept talking about how he felt he should be compensated for all the suffering he's endured and kept asking us over and over for more pain meds. Apparently one Lortab every few hours wasn't doing it for him, and he asked for morphine. He even asked BR to call the nurse to the room and tell him to give the patient stronger Lortab. Some profanities were spoken, but BR ignored it and did a successful CL. He came close to losing his temper on the patient after the 20th time he asked for more drugs ("Don't ask me that again!") and said that if the patient wasn't being such a little b**** he would have let me do the CL. Later we inserted a chest tube on a stroke victim in the ICU who kept fighting the procedure; a student nurse had to hold him down. There, I met Thomas, the ICU respiratory therapist, who encouraged me to ask him any questions I had about patients breathing problems. That came in helpful this morning, when one patient had a pleural rub and I didn't know what sound that was.
After that, I went to a room where JB and BB were doing a PEG/tracheostomy (I still don't know what PEG is) with the attending on call, Dr. G. Dr. G asked me if I've ever done a "bronch" (bronchoscopy), I said no, and he offered to teach me. Basically, a bronchoscope is a very expensive little toy ($25,000) that looks like a larger version of the Wii nunchuck. There is a button to move the tip of the scope up or down, and you center the view of the scope by rotating your hand. You also have to keep the end of the scope straight at all times if possible; excessive bending would only destroy the fiberoptic nerves in the scope. I enjoyed it until JB started pimping me on what part of the lung I was in. Making my first big blunder of the night (my brain and mouth don't match up) I asked if I was in the esophagus b/c the word "trachea" didn't come to mind in time. Great, nice one. Then I was asked the distinctive names of each bronchus in the right lung, which I did not remember from anatomy. *sigh* Later JB told me that he wanted me to help the interns do procedures when I'm in the ER (i.e. suturing, Foley catheters, etc) I had a perfect chance to do a Foley when paramedics brought in an unconscious guy who'd been choked (it was Level 1 so BB and JB were awakened and paged from the call room), but someone beat me to it. And as for suturing, the Corey look-a-like had bitten a hole through his lip during the impact, requiring 3 layers of suturing, and the medicine intern doing her ENT rotation had to do it even though she said she didn't trust her suturing skills. JB let me watch a CT scan on a 2 wk post partum Jane Doe who had been found lying in a ditch, and the ICU team (with Dr. K from obgyn) was there, too. Dr. K was hoping to hand one of his patients (who had an abscess) to the surgical team, but JB burst his bubble by saying it was nothing ICU wouldn't handle by themselves.
As Dina's resident predicted (I saw her a few times around midnight in the ER), the traumas didn't stop coming in. One lady got pushed over and landed on her head (possible subarachnoid hemorrhage) and she could not stop throwing up stuff that looked like egg drop soup (I checked on her during rounds this morning and she felt much better). Another motorcycle victim came in and required debridement on many of his wounds (this was compared to the other biker who had relatively little external damage). RB, BR, and I didn't officially eat dinner until midnight (I made it that far by taking quick trips to the call room and eating oranges and granola bars I'd brought from home) My interns don't really care what I do, but they didn't want me to stand around doing nothing either. At 2:30 a.m., there was a lull in the ER and RB told me to get some sleep. Easier said than done; I tossed and turned in the call room for an hour before getting some semi-sleep. Knowing that we start rounding at 6:00 a.m., I set my alarm for 5:30 and met with my team back in ER. Then I saw BB down there (he's the 2nd year) and BR told me that after I'd left, four traumas arrived in a matter of minutes. I felt bad that the interns weren't able to sleep at all (I'd given RB my pager number but he was too busy to page me), and I felt very useless for a good part of the morning in the ER.
Around 7:00 a.m. I started rounding on my telemetry patients as well as two patients we'd admitted into the ER. I went to check on John Doe but JB and Dr. G came in so my visit there was for nothing (JB was rounding on patients and wrote notes on the ones he saw). I returned to the ER to see RB interview a 17-year-old who was in a MVC (seeing a pattern here?) and lost almost all the skin on the back of her left hand. I wondered where all her blood had come from, and when RB uncovered her hand, you could see torn tendons and flesh. She wanted to see her wound, too, and to her credit she didn't pass out or scream when she saw how bad it was (it was fractured, too). Her right hand had a fracture in the most distal part of her middle finger so that was immobilized pending an ortho consult. Not long afterwards, a middle-aged woman was brought into the next bed, combatative and screaming. She kept begging the doctors not to stick her, asking what they were doing to keep her alive, and screaming, "Father! Jesus, help me!" After doing my psych rotation, I was fairly sure her mental status was altered, and told the teenage girl with the broken hands not to let the screaming bother her. "Can you tell [the screaming patient] that there's nothing to be scared about?" she asked. I was very impressed with her maturity and thoughtfulness considering how she was injured, too, and I told her that while I could try, the way the woman is now, it'd be hard to get through to her.
Afterwards I lost RB and ended up paging BR asking me where to go next. He told me that JB had already gone home for the day and that I could leave to. Dr. K came by just as I was confirming that I could leave, and he said, "Go home. Tell them I said you could." Nice try, Dr. K, but you're not my resident anymore =) He also commented that ICU had more admissions last night than they could handle, saying that his team worked harder than ours (friendly rivalry between ICU and trauma). I don't doubt it. After I finally got home, I went to sleep for about 3 hours. Both feet are killing me (my Klogs are failing me), and I can't even imagine how tired the interns had to be. And it all starts again tomorrow.
Friday, January 4, 2008
General Surgery: The Fem-Fem Bypass
This morning I went to JPS at 6:30 a.m. to help BR see some patients before going to lecture. I saw three patients in Telemetry East before BR caught up to me. I asked him which patients hadn't been seen yet, and he said, "All of them." Apparently while I'd been looking up patient data and talking to them, he'd been chatting with other doctors at the nurses' station! *sigh* Lecture was wasted on me; I couldn't stop yawning in class (at one point I dozed off). It made no sense for me to be so tired since I wasn't even on call last night (Amar was, and he stayed awake pretty well). I treated myself to a long lunch break and a green tea latte before driving back to JPS (only Dustin and I went back; Amar was post-call and Phuong got the afternoon off). I found BB in the OR and he let me scrub in with him for surgery. The assigned procedure was an axillary-femoral bypass/femoral-femoral bypass, which involved inserting a graft that ran from the axillary artery to the femoral artery (yes, it would run along the entire length of the body), and then inserting another graft that connected the two femoral arteries by running above the pubic bone. This sounded intimidating, but word was passed down from Dr. A (the other vascular surgeon) that he hoped to only do the fem-fem bypass. That would decrease the total surgery time by an hour or two, which sounded good to everyone.
The patient, an overweight woman, had her entire body painted with an iodine substitute, but even after we were all scrubbed in and ready to go, we had to wait nearly 45 minutes for Dr. A to arrive b/c he was doing an angiogram. This was BB's first time doing such a procedure (he's a 2nd year resident) so he wasn't even allowed to make the first cut. That honor went to Dr. A. The first thing to do was find the femoral pulse, which was hard because the woman had both occluded arteries and excess body fat, not a good combination. At one point Dr. A asked the anesthesiologist how much the woman weighed, and he replied, "100 kg." To this, Dr. A said, "She does not weigh just 100 kg." Dr. A and BB had to make incisions at least 2 inches deep in order to reach the arteries, and Dr. A had to keep using a Doppler to find the pulse. In this manner, it took up to 1 hr alone to find the arteries (which were "small" compared to her body weight).
Once the arteries were found, Dr. A made a slit up the left femoral artery and removed a white plaque that was lining the artery. Even still, he said the occlusion was not too bad; it was less than 90% so blood still flowed through. Then he sewed a Gortex graft (looks like a long white tube) to the left femoral artery, made a tunnel above the pubic bone with his fingrs, looped the graft to the opposite side, made a slit in the other artery, and sewed the other end of the graft there. Then the incisions were sewn and stapled (I only got to do the stapling; this reminded me of my OB days). The surgery took about 3 hrs to complete, and that was just for the fem-fem bypass alone. And after seeing how heavy the patient was, Dr. A said that he probably would have had lots of trouble doing an axillo-femoral bypass since there was so much tissue to work with, and we were all grateful that all the patient needed was a fem-fem to restore her pedal pulses. BB let me put my fingers on the graft to feel the blood pulsing through it; pretty cool. I was fairly sore and hungry by the end of the surgery, but BB had been NPO all day (and the surgery ended at 6 pm) so I didn't complain.
Tomorrow I'm on call =/ We'll see how it goes.
The patient, an overweight woman, had her entire body painted with an iodine substitute, but even after we were all scrubbed in and ready to go, we had to wait nearly 45 minutes for Dr. A to arrive b/c he was doing an angiogram. This was BB's first time doing such a procedure (he's a 2nd year resident) so he wasn't even allowed to make the first cut. That honor went to Dr. A. The first thing to do was find the femoral pulse, which was hard because the woman had both occluded arteries and excess body fat, not a good combination. At one point Dr. A asked the anesthesiologist how much the woman weighed, and he replied, "100 kg." To this, Dr. A said, "She does not weigh just 100 kg." Dr. A and BB had to make incisions at least 2 inches deep in order to reach the arteries, and Dr. A had to keep using a Doppler to find the pulse. In this manner, it took up to 1 hr alone to find the arteries (which were "small" compared to her body weight).
Once the arteries were found, Dr. A made a slit up the left femoral artery and removed a white plaque that was lining the artery. Even still, he said the occlusion was not too bad; it was less than 90% so blood still flowed through. Then he sewed a Gortex graft (looks like a long white tube) to the left femoral artery, made a tunnel above the pubic bone with his fingrs, looped the graft to the opposite side, made a slit in the other artery, and sewed the other end of the graft there. Then the incisions were sewn and stapled (I only got to do the stapling; this reminded me of my OB days). The surgery took about 3 hrs to complete, and that was just for the fem-fem bypass alone. And after seeing how heavy the patient was, Dr. A said that he probably would have had lots of trouble doing an axillo-femoral bypass since there was so much tissue to work with, and we were all grateful that all the patient needed was a fem-fem to restore her pedal pulses. BB let me put my fingers on the graft to feel the blood pulsing through it; pretty cool. I was fairly sore and hungry by the end of the surgery, but BB had been NPO all day (and the surgery ended at 6 pm) so I didn't complain.
Tomorrow I'm on call =/ We'll see how it goes.
Thursday, January 3, 2008
General Surgery: Clinic
This morning after a trauma conference (where we talked about the death of a patient after a MVA in which her spine was broken at C4; one of the attendings said that if he had such a fracture death would be preferable since you can't breathe on your own if anything above C5 is damaged) I met the rest of my team. Funnily enough, there are B's in all their names: JB, the chief; BB, the 2nd year; BR, the gen surgery intern, and NB, the ortho intern. And I'm the only female of the bunch (actually, there was only one other female aside from me at the conference; surgery really does have a shortage of women) So needless to say, I often feel awkward with my team.
Today clinic started at around 7:45, but we didn't even make it to the clinic until 8:30. I also got very lost in the clinic area (heck, I lost the team after they left the conference b/c they were walking so fast) because it's shaped like an infinity symbol, and the halls are so narrow it's easy to get lost. In the morning, we saw general surgery cases; in the afternoon, we saw vascular surgery cases. At first it was just me, JB, and BB, so it took us a long time to get through the patients. Once NB and BR returned from rounds, however, things moved a lot more quickly. One patient I saw had all the finding of cholecystitis except she was young and had a clean ultrasound; she was also under lots of stress so JB attributed her symptoms to GERD and psychosomatic stuff. Another guy got shot through the suprapubic region and had to wear a colostomy bag b/c of rectum injury; now he's hoping to get it taken out. I got to see the colostomy bag; the "feces" inside it still had lots of liquid so it didn't look too gross. We didn't leave for lunch until 1:25, and by 2:00 it was back to the clinic.
Vascular cases are tougher b/c it's hard to gauge exactly whether the patients need surgery or not (and sometimes the patients themselves don't know what to do). One lady came asking if she was in danger of dying b/c ER doctors had told her that she had an aneurysm in her RCA; in reality, she'd undergone thrombectomies in both common carotids so both of her carotids have a wider diameter than usual. Another man had to get a clot removed from his fem pop bypass, and the wound had become infected. It was now healing by second intentions, and while it looked a bit nasty the drainage was clear (not pus-filled). The vascular surgeon, Dr. S, was present, and he looked young. At first I thought he was a resident =P Tomorrow we have class, but when JB said to remember to stop by tomorrow after classes, I said, "Well class doesn't start until 9:00 so I can come earlier." JB looked impressed and said most of my classmates wouldn't share that sort of information in order to sleep in, and of my willingness to come in early he said, "That's what we like to hear." So am I an idiot for working more hours than necessary?
*sigh* Today was exhausting, and I didn't even do any surgery. I'll probably get to see and scrub in on a few cases tomorrow, but seeing how we didn't have scrub clinic, I expect I'll make an idiot of myself tomorrow. =/
Today clinic started at around 7:45, but we didn't even make it to the clinic until 8:30. I also got very lost in the clinic area (heck, I lost the team after they left the conference b/c they were walking so fast) because it's shaped like an infinity symbol, and the halls are so narrow it's easy to get lost. In the morning, we saw general surgery cases; in the afternoon, we saw vascular surgery cases. At first it was just me, JB, and BB, so it took us a long time to get through the patients. Once NB and BR returned from rounds, however, things moved a lot more quickly. One patient I saw had all the finding of cholecystitis except she was young and had a clean ultrasound; she was also under lots of stress so JB attributed her symptoms to GERD and psychosomatic stuff. Another guy got shot through the suprapubic region and had to wear a colostomy bag b/c of rectum injury; now he's hoping to get it taken out. I got to see the colostomy bag; the "feces" inside it still had lots of liquid so it didn't look too gross. We didn't leave for lunch until 1:25, and by 2:00 it was back to the clinic.
Vascular cases are tougher b/c it's hard to gauge exactly whether the patients need surgery or not (and sometimes the patients themselves don't know what to do). One lady came asking if she was in danger of dying b/c ER doctors had told her that she had an aneurysm in her RCA; in reality, she'd undergone thrombectomies in both common carotids so both of her carotids have a wider diameter than usual. Another man had to get a clot removed from his fem pop bypass, and the wound had become infected. It was now healing by second intentions, and while it looked a bit nasty the drainage was clear (not pus-filled). The vascular surgeon, Dr. S, was present, and he looked young. At first I thought he was a resident =P Tomorrow we have class, but when JB said to remember to stop by tomorrow after classes, I said, "Well class doesn't start until 9:00 so I can come earlier." JB looked impressed and said most of my classmates wouldn't share that sort of information in order to sleep in, and of my willingness to come in early he said, "That's what we like to hear." So am I an idiot for working more hours than necessary?
*sigh* Today was exhausting, and I didn't even do any surgery. I'll probably get to see and scrub in on a few cases tomorrow, but seeing how we didn't have scrub clinic, I expect I'll make an idiot of myself tomorrow. =/
Wednesday, January 2, 2008
General Surgery: Day One
This morning we surgery people had to report to the 5th floor of the PCC for orientation at 7:00 a.m. before going to our respective hospitals for our first day of work. Amar, Dustin N, Phuong, and I were starting out with 4 weeks of general surgery at JPS, and we were joined by Annie and Lauren O for 2 weeks of ortho, also at JPS. There, we picked up our badges (same one I used for obgyn), parking decals (the parking lot smelled an awful lot like fecal matter), and scrubs. I don't like these scrubs; they're so new they chafe my skin. After that, the four of us went to the call room and took turns calling our surgical teams to let them know we've arrived. I was assigned to team B, which for some reason has seven residents this month, and was called to the ER to follow a 4th year resident and an ortho intern, Drs "Burberry" and "Bell," or B&B. (I'll just call them JB and NB). Dr. JB seems like a laid-back, sarcastic (self-proclaimed), and overall cool chief resident; he made it clear from the start that surgery would be a lot of fun. A lot of nurses seem to like him b/c he' s fairly good looking, but sorry ladies, he's married with 3 kids. ;) His wife went to med school with him, but never went to residency in favor of being a stay-at-home mom; I thought that was interesting.
According to Dr. JB, my job as a med student is to help Dr. NB (intern) as much as possible except when there are surgeries to observe and assist in. This meant...progress notes. After seeing a new notes I had a general idea of what Dr. NB wanted (it wasn't too different from the OB post-op notes), so I felt fairly comfortable writing notes on my own in little time. Dr. NB was post-call so he yawned a lot as he wrote his notes (luckily for me my team was post-call today so I don't have call until Saturday). I rounded with him until about 1:30 and then we met Dr. JB for lunch in the cafeteria. After lunch, Dr. NB went home to sleep while Dr. JB rounded on all the others. I think I can get a workout at JPS just from trying to keep up with Dr. JB; the man walks fast. He didn't always explain where we were going so I often had no clue where we were. Along the way, I saw several classmates doing their medicine rotations (Dina) and psych rotations (Justin) as well =) Then I ran into Dr. K (from obgyn) in the ICU; he and another resident were taking care of two fourth years. We exchanged hellos.
Most of the patients I saw today were in motor vehicle accidents, so I saw several broken femurs and broken arms. One fifteen-year-old girl had sustained brain damage in her car crash and was in a semi-conscious vegetative state when I saw her; it was really sad. In non-MVA related cases, one lady had gastric cancer and had a Roux-en-Y gastric bypass after her stomach was removed. Another man got shot 5 times (I'd like to know where that happened so I can stay away from there) by an unknown assailant. All in all, very interesting cases. Tomorrow morning I have to attend a trauma conference at 7:00 a.m., so I asked Dr. JB what time I should show up tomorrow. His reply: "Set aside enough time to see at least half the patients." Okay, but what time? Then I asked where I should meet him and the other residents; again, he didn't give me a specific location. I'm more used to the structure of OB so this was very different for me. My plan: arrive at 6:00 a.m., start on the top floors, and work my way down.
My one gripe with surgery so far: I'll be on call for my birthday =(
According to Dr. JB, my job as a med student is to help Dr. NB (intern) as much as possible except when there are surgeries to observe and assist in. This meant...progress notes. After seeing a new notes I had a general idea of what Dr. NB wanted (it wasn't too different from the OB post-op notes), so I felt fairly comfortable writing notes on my own in little time. Dr. NB was post-call so he yawned a lot as he wrote his notes (luckily for me my team was post-call today so I don't have call until Saturday). I rounded with him until about 1:30 and then we met Dr. JB for lunch in the cafeteria. After lunch, Dr. NB went home to sleep while Dr. JB rounded on all the others. I think I can get a workout at JPS just from trying to keep up with Dr. JB; the man walks fast. He didn't always explain where we were going so I often had no clue where we were. Along the way, I saw several classmates doing their medicine rotations (Dina) and psych rotations (Justin) as well =) Then I ran into Dr. K (from obgyn) in the ICU; he and another resident were taking care of two fourth years. We exchanged hellos.
Most of the patients I saw today were in motor vehicle accidents, so I saw several broken femurs and broken arms. One fifteen-year-old girl had sustained brain damage in her car crash and was in a semi-conscious vegetative state when I saw her; it was really sad. In non-MVA related cases, one lady had gastric cancer and had a Roux-en-Y gastric bypass after her stomach was removed. Another man got shot 5 times (I'd like to know where that happened so I can stay away from there) by an unknown assailant. All in all, very interesting cases. Tomorrow morning I have to attend a trauma conference at 7:00 a.m., so I asked Dr. JB what time I should show up tomorrow. His reply: "Set aside enough time to see at least half the patients." Okay, but what time? Then I asked where I should meet him and the other residents; again, he didn't give me a specific location. I'm more used to the structure of OB so this was very different for me. My plan: arrive at 6:00 a.m., start on the top floors, and work my way down.
My one gripe with surgery so far: I'll be on call for my birthday =(
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