ENT: Another Septoplasty

The title speaks for itself; I only had one surgery to see this morning, and it was a septoplasty/polypectomy that was observation only. Then there was a 3 hr break to study and eat lunch before urology lecture. Dr. R seemed pretty cool; at one point during his powerpoint presentation he showed us a man with what looked like a tree branch shoved up his groin; one leg was completely purple and mottled. Needless to say there were several gasps over that picture. Then there was a picture of a body covered by a blanket except for a single hump in the middle. Guess what that was? Yup, a priapism. "I took that picture myself," said Dr. R. LOL.

On a side note, as far as eating healthy and exercising goes, I've really let myself go this year. =/

ENT: Cardiothoracic Lecture

Man...thank goodness Ben sent me a link to some surgery practice questions yesterday that Jennifer had sent out ages ago. Two of those questions appeared on today's quiz, without which I would have done very bad (case in point: I still failed the quiz). Dr. Y's questions were pretty hard. Then Dr. P came to lecture and he gave us the exact same CIL/quiz questions that we did in Cardio 2 to see how much we remembered about vascular disease. Back in 2nd year, I think I got 1/5 correct, and this year I fared no better. Sure, it wasn't for a grade, but I was still disappointed that my way of processing information hasn't improved. *sigh* Gotta study my vascular stuff.

Jacob was post-call, and he had a rough night. Valentine's Day was not good to Surgery B; there were so many traumas and deaths that he didn't get a minute of sleep last night. Natacha's on call tonight, and she asked Jacob if his team took care of all the cases so that she could get an easy night. That was just like back in ob-gyn when the day team would count on the night team to deliver lots of babies so they'd have an easier day. Jacob also told us that he knows what he wants to specialize in now (psychiatry), and we were all happy for him. I wish I knew with absolute certainty what I want to specialize in...

ENT: Valentine's Day

The only thing that even remotely hinted of today being Valentine's Day was when Dr. B (surgeon) came by and passed out long-stem roses to everyone he crossed paths with. I was in the room with a patient so I didn't get a rose. Ah well. It was still a pretty good day. I had lunch with Ben and I got a mint dark chocolate Ghiradelli bar waiting to be eaten, so in a way I treated myself to something nice =) Poor Jacob is on call tonight though; I remember scheduling a patient to have rectal warts removed on Valentine's Day and thinking that was a crappy surgery to do on Valentine's Day (even if it was by his choice). I still say nothing gets worse than spending your birthday on call though. No surgery for me tomorrow; I have lecture from 8-12.

Speaking of surgeries, there were originally 5 scheduled for tomorrow but 3 of them got cancelled b/c Sandy (the nurse) just got a call this morning from AmeriGroup (Medicaid) saying that they weren't going to pay for the surgeries. She was on the phone all morning trying to straighten things out, but in the end she had to call those three people and tell them that they can't have surgery tomorrow. That's got to suck for them.

ENT: Neck mass and Ortho Lecture

Because today's lecture (ortho) was scheduled for 4 pm, I was able to go to the surgical hospital and meet Dr. P and Kalan for two surgeries. The first one, a nasal polypectomy/sinus surgery, was observation only. Man, I knew the nose was extremely vascular, but I couldn't believe the amount of blood that was suctioned out of those nostrils after he removed the (extremely numerous and huge) polyps. And to think, this was the patient's fourth polypectomy. Those things just don't know when to stop growing, apparently. The second surgery was a neck mass excision, and I got to scrub in. The mass was soft, about the size of a golf ball, most likely an epidermal inclusion cyst, according to Dr. P. The atmosphere in the surgery was extremely laid back. Mix 102.9 was playing on the radio, and the CRNA said he felt old when I said I first heard Alanis Morissette when I was in junior high. Then he was shocked when I didn't recognize Hootie and the Blowfish (I knew of them, but I recognize songs by their tune more than their title or artist), but I redeemed myself by identifying Madonna as the artist of "Vogue." There was also talk of politics; since Obama finally has a lead over Hillary, Dr. P commented that Hillary needs to win over 2 big states if she wants a chance, and that Obama may be the biggest figurehead in politics since MLK. I asked what Bill Clinton would be called if Hillary were to be elected. "Vice president," Dr. P replied, and said that the White House needed someone who hasn't already been in the White House in the last 20 years. At the end of the surgery, Dr. P let me sew the neck incision up with a running locking stitch. The first few were ok, but somewhere in the middle I messed up before correcting myself, so overall the stitches look like what "a drunk spider would have made." Still, they did the job, and since the stitches were covered by Sterry strips anyway, no one can see my not-so-great handiwork.

It was past noon by the time we finished surgery, so Dr. P treated Kalan and me to lunch at a Mexican restaurant called La Familia. There, we chatted about various things ranging from good restaurants in town to the various places Dr. P has traveled to (Napa Valley, Italy, the Alps, to name a few) and recommends that we visit someday. Geography-wise, he's really knowledgable; he's traveled all over the state and recognized Don Emelia's when I mentioned it had good mojitos. "The best mojitos I had were in Athens," he said. Wow, who knew? After lunch, I went to school and napped on the couches (fell asleep in the middle of reading) before lecture.

The lecturer was Dr. H (one of the three dreaded ortho docs), and when he entered the room he was wearing a funky-looking hat with a feather sticking up. He later said that it was a "flirting hat" worn on Valentine's Day in the Czech republic (a former student had given it to him since he likes collecting hats). Although he was nice overall, he still didn't hesitate to pick on people, me included (he said that my mouth made the shape of a zero when I was yawning). His former students all refused to sit in the front row for fear of getting picked on, but he still snagged a few people to be his guinea pigs in demonstrations. At one point he asked us what we all wanted to be. Most of us were undecided, but Corey said he wanted to do neurosurgery so he got teased a bit by Dr. H for that (he thought neurosurg was for weirdos). After class, when we were leaving the building, he said I gave him a lot of trouble b/c I looked so serious and didn't smile in the first few jokes he made (I'm very slow on the uptake), but eventually he got through to me and made me laugh. We also got our grades back for our first few quizzes, and my grades SUCK! Is there a possibility I'll fail surgery b/c of lousy quiz grades? Please let there be a curve...

ENT: Day One

I reported for my first day of ENT at 8:30 a.m ("late" compared to most surgical clinics) for a briefing on what goes on at the clinic before patients began arriving at 9:00 a.m. Aside from me, there's also a 4th year named Kalan working in the ENT clinic; we talked a little today about the residency application process. All in all there weren't many patients today. I did have one lady who had a ton of health issues (frequent nosebleeds, hearing problems, sleep apnea) and she kept Dr. P and me in the room for an hour combined because she had so many questions and was very adamant about taking as little medicine as possible (she's into homeopathic remedies). Afterwards Dr. P proclaimed the woman was crazy and asked Sandy, his LVN, to knock on the door the next time he gets sucked into a room for so long. Because of her, other patients had to wait. *sigh* I'm still learning the ropes.

From Ortho to ENT

Today we had an ENT lecture, and Dr. P (the ENT prof) gave us what was possibly the easiest quiz ever. I read some BRS Subspecialty Surgery (compliments of JB, who gave me some of his old review books) to prepare for the quiz, and it did help, but what really helped was Dr. P walking around the room looking at our answers while we wrote. To Jedd, he said, "You're thinking too hard" regarding a question about the most common cause of hearing loss in kids. He said nothing when he saw my quiz, but said, "Good" when he saw Elizabeth's quiz (and we later found we had the same answers). Aside from ENT info, he also taught us a few life lessons about maintaining a private practice (i.e. be careful of the contracts you sign) and how to avoid getting sued. After lecture I introduced myself to him and told him I'd be working with him next week. He told me that there are no surgeries scheduled for Monday so I can show up on Tuesday. WOOHOO! Three-day weekend!

The peds and obgyn people were taking their shelf today, so I saw several familiar faces. One surprising face was John M, one of the Corpus people; he came up here to see Lori and friends. Later I also ran into Aaron B outside the library and asked him how he was doing. He said he was taking 6 months off b/c he was burnt out after the boards; looks like he'll be graduating with the class of 2010. Still, I'm glad to see he's doing well.

Ortho: Last Day

This final day of ortho was fairly uneventful. There were four surgeries this morning: a labral tear repair, a carpal tunnel release, a menisectomy, and an ankle ORIF (open reduction internal fixation). This was my first ORIF so I was very interested in seeing it. The flu seems to be spreading throughout the clinic; the other ortho doc in the clinic had to leave yesterday after his surgeries b/c he had a fever, and the nurses commented that his face got greener with each surgery. The bad part: he got the flu despite getting a flu shot. Seems like the vaccine companies made a faulty batch this year =( Not cool. I can't afford to get the flu now, so I hope I wasn't exposed to the other doctor long enough to get sick. All in all, ortho wasn't too bad. If I were at JPS or at the other doctors' clinic, I would have had to work a lot harder. And now...onward to ENT.

Ortho: Closed Doors

I'll be the first to admit that unless my brain is totally fogged up (like this week, when I got the lecture dates mixed up), I'm a stickler for punctuality. It bothers me when there are patients lined up to be seen and the doctor disappears for minutes on end, even if it's beyond his/her control. Dr. JD is actually pretty good about seeing his patients on time; if they come to the back room at 3:00, he'll usually see them by 3:10. Today, for some reason, there were more interruptions that usual. There's an unspoken rule in the clinic that when Dr. JD goes to his office and shuts the door, no one is to bother him unless it's very very important. After the first five or ten minutes, however, the medical assistants and the PA start worrying because the patients are waiting and there's no telling when he'll come out to see them. The PA knocked and entered the room at one point to find Dr. JD on the phone, and he was quickly shooed out. Another time I could hear one of the managers arguing about something (again, I don't know what it's about) but with her voice loud and clear we all knew not to go inside. Then M, one of the MAs, got flustered when a bunch of patients needed to get X-rayed all at once, and she started closing the doors harder than usual so that every now and then we heard a loud "SLAM!" The PA was not pleased and said that was unprofessional behavior (M has only been here a few weeks or months). On top of that, the other orthopod in the clinic had a bad case of flu but still came in to see patients. He warned us to stay away from him because he might get us sick. I've already been sick this year; I don't want anything else. My flu shot hasn't worked at all; I keep getting different cold viruses instead.

Ortho: Young people

This morning we had four scheduled surgeries. The first was yet another rotator cuff repair, followed by a cubital tunnel release. This incision was made in the elbow, and from far away I asked what structures I was looking at. That led Dr. JD to pimp me on what nerve ran behind the medial epicondyle (ulnar nerve) as well as the distribution of the ulnar nerve throughout the hand. Because I got pimped on carpal tunnel last week, I'd brushed up on my hand anatomy and was able to answer the questions correctly. Dr. JD then asked me if I knew the surgery schedule beforehand, and I honestly replied no. I did say that I read up on carpal and cubital tunnel last week, though (to avoid another humiliating pimp session; I had enough of those with JB) After that was another carpal tunnel release followed by a labral repair that turned out to be more complicated than we thought. As a result, we didn't get out until about 1:00 pm (past lunchtime). A drug rep brought fajitas from Jason's Deli and there was still some left over; I also helped myself to some strawberry shortcake. That stuff is good; to think, I didn't even know what strawberry shortcake was until I went to Corpus.

One interesting thing about today was that a good chunk of the patients were teenage boys, mostly with broken collarbones, arms, and ankles. The ones with knee and ankle problems were usually hurt while playing basketball or some other sport; makes me glad I never got into sports as a kid (the worst injury I can think of in orchestra is a bleeding callus). Dr. JD used to wrestle when he was young and told us how he yelled at his son for 20 minutes this past weekend after his son lost a wrestling match. "And he listened, too," he said. The nurses just shook their heads at him for being an overinvolved dad. One 20-year-old TCU student actually had a piece of bone break off his knee and lodge in the space between the femur and the tibia (OCD, osteochondritis dissecans). For a young guy like this, the best option could be to use his own bone to repair the hole, or else use a cadaver graft. =( Who knew twisting a knee while playing basketball would cause so much damage? I thought twisting my ankle and wearing a brace for 2 months was bad enough; I'd hate to undergo ortho surgery.

Ortho: The Pathological Fracture

This morning I went to the hospital to scrub in on what was supposed to be a rotator cuff repair, but turned into something completely different entirely. The patient had developed abscesses in her shoulder about two weeks ago so there was an open wound there, and she said that three days ago she heard a "pop" and her arm hurt so much she couldn't move or lift it. She asked if the infection had caused it, and Dr. JD said he'd check it out. I got to help hold her arm (she was morbidly obese so her arm itself weighed anywhere from 10-20 lbs), but when Dr. JD tried to move it around to see how her shoulder was moving, nothing happened at the glenohumeral region. "Something's wrong," he said, and as he flexed her arm some more, it bent funny somewhere in the middle of her humerus. "Something's really wrong. She's got a fracture in there somewhere." He called for the X-ray tech to come and began feeling along her humerus to see if he could palpate the break. "The bone's soft," he said, and the way he said it gave the impression it wasn't supposed to be like that. Her rotator cuff was torn and he tried to repair it by sewing muscle to bone, but the bone was so weak that the sutures came right out. The X-ray tech finally came, and after a great deal of maneuvering around the operating table we saw it: a mid-humeral oblique fracture. "Well, now we know why her arm was hurting," said Dr. JD. "That's a pathological fracture." Bone and tissue samples were obtained for culture and biopsy, and the wound was closed with a vertical mattress stitch while the patient's arm was put in a sling. I asked what could have caused it, and Dr. JD said most likely her previous infection, but at this point we can't rule out cancer, so she's going to see a bone specialist for follow-up. *sigh* Dr. JD used the term "chronic osteo" often and I hope he means osteomyelitis and not osteosarcoma. The other surgery was yet another medial meniscus repair. I wish I could tell the menisci from each other but I'm not that good.