Saturday, January 21, 2006
Below is a post copied from the Official school post. In more person news, I was lucky enough to get off of work at a reasonable hour for ML's birthday and took her to her favorite Italian restaurant here. Huh, not too much other personal stuff to tell you. Maybe that's because I'm only awake for about 1.5 hours after I get home.
Lemonade anyone? I have the lemons.
With a few “awake” minutes on my day off this week, I thought I’d attempt a post. Things have been chugging along in surgery with lots of hernia repairs and thyroidectomies. It’s Thursday afternoon and I’m helping prep a patient for repair of her incisional hernia. That’s a hernia that occurs at the site of a prior surgical procedure. In this case it was a prior hernia repair. The attending and the resident are discussing the planned procedure and the resident, curious about an alternative method, brings it up. The discussion goes back and fourth for a few moments when, out of the blue (to me), the resident was excused from the procedure and all I hear is, “I don’t want to argue with you about this, I’ll just do the operation with Elliott.” The resident did apologize and tried to explain that it was not his intention to be argumentative, but it was apparently too late.
Before I move on, I want to make very clear that I really like the interns, residents and staff I’ve been working with. They have high expectations from us, but they also acknowledge our efforts and do an excellent job maintaining our moral. I have found all of the attendings to be pleasant: even this one.
Something happened in the conversation that caused it to turn from an intellectual discussion (at least that is how I perceived it) to an argument. I suppose it is important to note that the patient was already “asleep” under anesthesia and thus not aware of the conversation. I think that would have more clearly been inappropriate.
So, there I was with the attending and her telling me: “I want you to cut along the line I drew. Actually, do you see the scar along her abdomen?”
“Yes.”
“I want you to cut along that.”
“Okay, how deep?”
“Just cut through the skin.”
And so I cut.
“Now take the bovie and cut down to the Scarpa’s fascia while I hold the skin apart.”
“Which button should I use?” (There are two, one to cut and one to coagulate, but I was not sure which was which at that moment.)“Yellow.”
I got ready to cut.
“Stand up!”
I was hunching over the patient, apparently. (As opposed to passing out.)
I found that I had to remind myself to breath, but it was NOT happening naturally. When I used to play basketball I often thought there were intense times on the court I’d hold my breath but I could not really tell. This time, I could hear it! Or, rather, not hear it.
Once I started breathing, things went pretty well. The senior resident did arrive and scrub in not too much later which was pretty good because the procedure became very complicated just before he arrived. Bowel had adhered to the wall of the abdomen and it was difficult to delineate between the two. Fortunate-for-me, I did not cut any bowel.
This was not the first time I used the bovie (which is a device akin to an instant soldering iron that will cut and cauterize the tissue at the same time (or coagulate a vessel depending on which button you push as you may have gathered from above)). I used one when I was helping perform a vulvectomy during my Gynecology-Oncology month. (If you don’t know what a vulvectomy is, you’re a happier person, but it’s not as bad as one might think.) However, this was a little more intense.
The worse part, which I knew was going to come at some point, was when the attending and the senior started discussing what had happened earlier and she asked me what I thought had transpired. (I think I stopped breathing again when she asked.) I paused for a moment:
“Can I be honest?”
Looking back, I don’t know what I asked that, but I did. The worst part was that no one answered. But, I decided to take the high road anyway.
“I thought you two were having an intellectual discussion, not an argument.” Which is really how it sounded to me and what it would have been considered in any other scientific venue. (Lesson learned: medicine is not science. It is trying to be more scientific these days, but it is not science.)
The next few minutes or so were spent musing over how politically-correct I was.
For completeness, the resident that was involved with all of this did apologize and try to explain that he was not trying to argue with her, but it was too late at that point.
Lemonade anyone? I have the lemons.
With a few “awake” minutes on my day off this week, I thought I’d attempt a post. Things have been chugging along in surgery with lots of hernia repairs and thyroidectomies. It’s Thursday afternoon and I’m helping prep a patient for repair of her incisional hernia. That’s a hernia that occurs at the site of a prior surgical procedure. In this case it was a prior hernia repair. The attending and the resident are discussing the planned procedure and the resident, curious about an alternative method, brings it up. The discussion goes back and fourth for a few moments when, out of the blue (to me), the resident was excused from the procedure and all I hear is, “I don’t want to argue with you about this, I’ll just do the operation with Elliott.” The resident did apologize and tried to explain that it was not his intention to be argumentative, but it was apparently too late.
Before I move on, I want to make very clear that I really like the interns, residents and staff I’ve been working with. They have high expectations from us, but they also acknowledge our efforts and do an excellent job maintaining our moral. I have found all of the attendings to be pleasant: even this one.
Something happened in the conversation that caused it to turn from an intellectual discussion (at least that is how I perceived it) to an argument. I suppose it is important to note that the patient was already “asleep” under anesthesia and thus not aware of the conversation. I think that would have more clearly been inappropriate.
So, there I was with the attending and her telling me: “I want you to cut along the line I drew. Actually, do you see the scar along her abdomen?”
“Yes.”
“I want you to cut along that.”
“Okay, how deep?”
“Just cut through the skin.”
And so I cut.
“Now take the bovie and cut down to the Scarpa’s fascia while I hold the skin apart.”
“Which button should I use?” (There are two, one to cut and one to coagulate, but I was not sure which was which at that moment.)“Yellow.”
I got ready to cut.
“Stand up!”
I was hunching over the patient, apparently. (As opposed to passing out.)
I found that I had to remind myself to breath, but it was NOT happening naturally. When I used to play basketball I often thought there were intense times on the court I’d hold my breath but I could not really tell. This time, I could hear it! Or, rather, not hear it.
Once I started breathing, things went pretty well. The senior resident did arrive and scrub in not too much later which was pretty good because the procedure became very complicated just before he arrived. Bowel had adhered to the wall of the abdomen and it was difficult to delineate between the two. Fortunate-for-me, I did not cut any bowel.
This was not the first time I used the bovie (which is a device akin to an instant soldering iron that will cut and cauterize the tissue at the same time (or coagulate a vessel depending on which button you push as you may have gathered from above)). I used one when I was helping perform a vulvectomy during my Gynecology-Oncology month. (If you don’t know what a vulvectomy is, you’re a happier person, but it’s not as bad as one might think.) However, this was a little more intense.
The worse part, which I knew was going to come at some point, was when the attending and the senior started discussing what had happened earlier and she asked me what I thought had transpired. (I think I stopped breathing again when she asked.) I paused for a moment:
“Can I be honest?”
Looking back, I don’t know what I asked that, but I did. The worst part was that no one answered. But, I decided to take the high road anyway.
“I thought you two were having an intellectual discussion, not an argument.” Which is really how it sounded to me and what it would have been considered in any other scientific venue. (Lesson learned: medicine is not science. It is trying to be more scientific these days, but it is not science.)
The next few minutes or so were spent musing over how politically-correct I was.
For completeness, the resident that was involved with all of this did apologize and try to explain that he was not trying to argue with her, but it was too late at that point.
Tuesday, January 17, 2006
I'm hip deep in surgery now. Things are going pretty well except for sleeping. In fact, I need to go learn about thyroidectomy and get myself to sleep. Good thing it does not take much intellect to hold a retractor! I have been fortunate enough to get to sew on a few people, but I actually was doing considerably more when I was on my GYN-ONC service. Oh well, sewing something is better than doing nothing. Well, except when you go to look at the healing incision and the half you sewed is bleeding--if only a little.
Monday, January 16, 2006
We have MLK day off and I was off Sunday, yeah! First week of surgery is over and I am still pretty worn out. In fact, I had call with the emergency service team on Friday. Had a great time learning all sorts of stuff with the intern and, around 10p when he ran out of stuff to talk about and he had some studying to do, he handed me a paper to read and laughed. He could tell when I started how tired I was already and behind in my sleep. He sent me to the call room to sleep. Did some stuff on-line and fell asleep around 11a. Got up around 4:30a on Sat to see what was up and they had just admitted a new patient. They weren't going to page me initially because it was not that interesting, but he had become interesting and they were about to page me. The poor guy had a laproscopic removal of his gall bladder due to stones. After they sent him home, he started leaking biliary fluid out of his sutures! They put in a drain and sent him back home never checking to find the stone that had already passed into the duct. It caused back pressure and blew-out the stump where the gall bladder once lived. After all of that, I rounded with my team and was done by around 9:30a. I thought I'd stay awake the whole day, but I ended up napping for a few hours.
ML's birthday is coming up and I asked her if she wanted anything special. She wanted a chocolate cake with chocolate icing. Never having made one before, I said, okay! I'll do it! We used the recipe from the Hershey's cocoa powered for the cake and a different one for chocolate glaze. Who would have thought I could bake a cake from scratch? Well, I figured I could, but I never have before. That's right! With all of my cooking experience, I have never made a dessert. Why? you say? Well, it's because I have little ability to control my sweet tooth, so I just don't tempt it. I thought this would be a good exception. I did make a mess, which I just cleaned on my day off, but it came out pretty good and exactly what she wanted! I should added that I made the cake after Nordic Trak'ing for an hour, which I am about to go do again. Here are some pictures:
Here you can see the TWO, yes, TWO layers as the cool on the cooling racks! They are upside down so it is difficult to appreciate that they did not fall. But, you can see how they were removed from the 9 inch round pans unscathed!
Here is the Chocolate glaze as it warms in my self-made double boiler. Yes, I knew to use a double boiler!
Here you see the cake as I liked it to look. ML decided that she wanted the glaze all the way down the side of the cake and I let her do it, but this was a much nicer picture. Note the squiggle on top. YUMMY!
ML's birthday is coming up and I asked her if she wanted anything special. She wanted a chocolate cake with chocolate icing. Never having made one before, I said, okay! I'll do it! We used the recipe from the Hershey's cocoa powered for the cake and a different one for chocolate glaze. Who would have thought I could bake a cake from scratch? Well, I figured I could, but I never have before. That's right! With all of my cooking experience, I have never made a dessert. Why? you say? Well, it's because I have little ability to control my sweet tooth, so I just don't tempt it. I thought this would be a good exception. I did make a mess, which I just cleaned on my day off, but it came out pretty good and exactly what she wanted! I should added that I made the cake after Nordic Trak'ing for an hour, which I am about to go do again. Here are some pictures:
Here you can see the TWO, yes, TWO layers as the cool on the cooling racks! They are upside down so it is difficult to appreciate that they did not fall. But, you can see how they were removed from the 9 inch round pans unscathed!
Here is the Chocolate glaze as it warms in my self-made double boiler. Yes, I knew to use a double boiler!
Here you see the cake as I liked it to look. ML decided that she wanted the glaze all the way down the side of the cake and I let her do it, but this was a much nicer picture. Note the squiggle on top. YUMMY!
Tuesday, January 10, 2006
I started my surgery rotation yesterday with a day full of lectures. Today will be the same, however, I had a mountain of reading to do yesterday so I only got about 5.5hr of sleep. It will be a challenge to see if I can stay away for lectures from 9a till 4p. In the same breath the lead doctor said, "you do not have clinical duties on lectures days, but you should go to morning rounds and go back after lecture to help your team out." Obviously there is a disconnect on what it meant by clinical duties. I'm starting on the general endocrine surgery service and I really have no idea what that means. I suppose I'll find out later today. (In case you could not tell, I got up a little early today so I have a little free time on my hands. I won't make that mistake again.)
In four weeks I'll switch to the transplant service for the second half of my rotation. It's supposed to be a super hard service because the procedures take a really long time (as you might imagine) but, I may get to ride in the Michigan helicopter!
They've started taking posts for the official web site. Oddly, they have not told US where the site is published (AKA the URL). I made an introductory post, but nothing new.
In four weeks I'll switch to the transplant service for the second half of my rotation. It's supposed to be a super hard service because the procedures take a really long time (as you might imagine) but, I may get to ride in the Michigan helicopter!
They've started taking posts for the official web site. Oddly, they have not told US where the site is published (AKA the URL). I made an introductory post, but nothing new.
