getting closer...

It's been quite some time since I've shared my experiences, and I have a lot to tell, especially from OB/GYN. But I felt the need for a quick update because I had a moment where I felt really good about what I'm doing here.

For pediatrics, we have 2 days on call in the pediatric ER, though I wish we had a week of that, and 1 less week of something else. I love the ER of course, and I didn't care if I was taking care of adults or kids- it's the environment, the variety, and the pace that makes me happiest.

The second kid I saw in the ED was 12 with abdominal pain and vomiting. After hearing his story and examining him, I thought... oh my God, this kid has cholecystitis... at 12. I walked out of the room and said to the attending, "How likely is it that a 12 year-old has acute cholecystitis?" He said not likely. After his exam, he was not impressed by the possibility, but he agreed that I could order an ultrasound.

Ultrasound findings: gallstones, gallbladder sludge, thickened gallbladder wall- consistent with acute cholecystitis.

The attending was surprised and impressed. He said, "You created a differential, had a high suspicion, ordered the appropriate testing, and confirmed your diagnosis. Good job." In med school, praise does not come higher than that :)

Little things like that make me breathe a little easier.

Quick update:

I have now stitched up wounds myself 3 times! Without becoming ill! I've turned a corner and I feel like I don't have anything to worry about anymore. Also, not passing out during a foot amputation was a great feeling!

what a week...

Surgery truly started this week. I scrubbed in for the first time on the removal of a clot from a common femoral artery (kind of quick and low-key. I did get to feel a femoral pulse... by actually touching the femoral artery!). Next was a "total thyroidectomy and modified radical neck dissection" that lasted almost 7 hours. I then discovered that my expensive "doctor shoes" are not all that comfortable for standing so long... I have since switched to sneakers and crocs with more success.

I'm doing my best to seem interested and show that I'm reading and learning, so I hope I can overcome my personality and be assertive. The doctor that I normally follow was not working the day of the neck surgery, so I approached the doc doing it and asked if I could come in because it sounded cool. Hopefully I get bonus points for doing that instead of just sitting around and reading. Plus, I got to feel a thyroid tumor and a breathing trachea!

(Side note, I'm doing great with incisions and blood and stitches! I guess I didn't have to worry about being the person who passes out in the OR.)

I had my first on-call experience this week too. I was called out of dinner around 6 for a surgical consult for a guy with pancreatitis, and then nothing again for the whole night. Borrrring. Though I suppose most people would have been grateful for that. But this turned out to be a benefit because at 6am, someone came in with a huge cecal volvulus that needed to be cut out asap.

It looked like that ^ on x-ray (not actual patient). Basically, this is a part of the colon that twists on itself (probably congenital in this lady) and obstructs the intestine.

One of the residents told me that it was against the rules for me to stay any longer since I'd been at the hospital 24+ hours, but I slept as much there as I would have if I went home! So I decided to hover in the OR near the patient and wait for the surgeon, who happened to be the doctor I am working with anyway. When he got there, I explained the situation, at which point he said the resident was ridiculous and that I could certainly stay for what would be a cool surgery. And a cool surgery it was! (The colon was HUGE and practically popped out of the abdomen when we opened it up.) So that was my first 30 hour hospital shift. 

I'm actually really liking surgery... this needs to stop. hahaha

Surgery: It Begins.

Today was orientation to the surgery clerkship. I can feel the DISorientation coming on, however- everything seems confusing. The hospital clearly doesn't revolve around med students (though we pay enough...), so I'll have to jump in and figure it out.

I am looking forward to easing into this since I was lucky to get anesthesia elective for the first 2 weeks. I guess this means I'll get to practice NOT passing out in an OR, and hopefully intubate a ton of patients. Then maybe I can challenge the paramedic exam and get another job on the side! haha

I felt really dumb today because Grey's Anatomy and ER have had me thinking that OR's were dark with only some lights on the field. I got to peek into a bunch of OR's today and they are so bright!

I also got to see the DaVinci robot

and I learned how to scrub! In learning how to scrub, I found out that I'm allergic to the scrubbing soap stuff. We used it in the ER at Chilton, but I guess I never actually got it on my skin. It got all red and itchy. Aaand while I'm at it, add a latex sensitivity. I'll have to have yellow arms from scrubbing with betadine. It was kind of fun putting on all the sterile surgical stuff though. Maybe this won't be so bad after all...

on why i cannot do internal medicine

Medicine has kept me very busy lately- I thought the lack of sleep was reserved for surgery...

I've experienced a fair amount of loss here. I feel like I always get assigned the patients who are dying. Maybe the residents sensed some kind of extra compassion in me that they hoped I would impart- I'd like to think so anyway. Some of my patients have died before, but not in front of me. They usually go home first. Yesterday, I went in to see my patient and he was clearly nearing the end of his life. I said hello to the family and asked them if they needed anything, and then went about my day. About 4 hours later, I found out that he had died. I was definitely bummed for the rest of the day. I saw him every single day (excluding some weekends) for nearly a month. We were friends. I'm at least comforted by the fact that I know he liked seeing me every morning and he helped me learn.

I don't want to lose emotion as a doctor. I think it's an asset. But if I continue to feel like I'm losing a friend, I won't be able to function as a good doctor anymore. Emergency medicine sounds better and better every day- patients die, and it'll be sad. But relationships aren't made in a single visit. Right? I guess I'll find out...

{Rest in peace, my friend}

geeking out!

I saw the coolest x-ray today! (I mean, I'm sure there are cooler x-rays out there, but this is by far the most interesting from a patient I've actually taken care of.) I wish I had a picture... maybe I'll try on Monday.

The patient is an elderly man who looks very malnourished (skin and bones!). He lives alone and had fallen, and now has a painful hip that he can't move. The resident with me also noticed a hernia, but the patient wasn't too cool with us looking down there... Usually there's a report on the computer with the radiologist's impression of the x-ray, but it was missing for this patient. We opened it up on the computer and BAM! We all just gasped and stared for a second. First, most of his colon was in his scrotum (huge hernia!), and the entire head of his femur had broken off and the remaining bone was pulled upward- so if his leg hadn't been bent, we would have noticed it was shorter. Can someone say 'orthopedic surgery consult'? ...and probably GI too. The crazy thing about this patient is that he's got no medical history, zero medications, and hasn't seen a doctor in over 20 years. Oh, and he has no teeth so his speech is extremely incoherent.

Only week 1 and already some pretty interesting stuff. Looking forward to more...

Abbrevs

I think I win for typing this with my intern in a sign-off note today:

88 Y/O PT WITH PMH OF DM, HTN, HLD, BPH, CAD, COPD P/W POSSIBLE SYNCOPE/HIGH BS.

Abbreviations FTW.