Only one week left!

i'm ready to be done. surgery was cool and a great experience to get me started this year, but i'm eager to try something else. i worked a few cases on friday w/ an OBGYN and he was very compassionate to his patients, extremely skilled and graceful and i was impressed...i really hope my experience in OB (starting oct 8) is a good one, because i could see myself really enjoying that discipline. studying this weekend for my exam coming up next week. somehow these hours + my being lazy and all haven't been very agreeable to studying, so i'm quite behind. but i shouldn't whine...one of my friends also in surgery now recently changed to the hospital's trauma team and has to start rounds at 4:30am!! and doesn't finish until 5pm or so. mad-ness. i would be so grouchy all the time, i'd just start kicking random people in the shins as they passed me in the halls.

i have to add something. one of the cases w/ the OBGYN i did was a dilation and curettage- where the cervical os is dilated and then all the tissue is sucked out into a container. an early abortion, basically. but it wasn't a fetus, it was a "blighted ovum" which means that the egg is released w/o a nucleus (so no mother's DNA) and gets fertilized by sperm and so only has the father's set of DNA growing in it. some placenta will start to grow and the pregnancy test will be + and the symptoms of pregnancy will manifest, but there's no baby. so this lady went in for her routine check up at about 8-10 weeks and there was no fetal heart beat and then no image on ultrasound. very heartbreaking and difficult to explain the biological mishap to a grieving family. but again, the MD was amazing. fortunately, it's a very rare, freak thing and doesn't decrease her chances of having further viable children. still pretty sad, though. a lot of trauma and disappointment. so incredibly many things can go wrong with fetus development and labor, it truly is a miracle when everything goes well and you get a perfect baby out of the deal.

Worn out on Wednesday

sleepy today. not sleeping well lately. on call tonight instead of tomorrow as tomorrow night is the season opener of "the office" and "my name is earl" and that seriously trumps someone's urgent need to get their appendix taken out or something. today was a good day. saw an interesting bowel resection w/ a rectal (up the butt) GI staple anastomosis. it was probably pretty obvious in my eyes that i was thinking, "you're going to do WHAT now?" when they explained it to me. but it was pretty cool, though a less than comfy recovery for the patient, no doubt.

Totally Twitterbrained on a Tuesday

i could write a "totally dumb" moment any day you ask me, but i thought since i started this theme this week, i'd make it today. so about 3pm today i was feeling like on the list of dull crayons in the box or blunted tools in the shed i was falling smack between paris hilton and anna nicole smith (may she rest in big blond peace).

the one lousy question i was asked on a thoracic case was, "where do the pulmonary veins empty out?" and i friggin' know cardiopulm anatomy and what did my stupid self say in my panic to say SOMETHING, "ummm...the subclavian vein." geez God. it's the left atrium, of COURSE it's the left atrium. grrrr. the subclavian doesn't even go the right direction for what he was asking and has nothing to do w/ the bloody lungs! stupid, stupid, stupid. i wanted to throw myself out of the window. but then i might get maimed and couldn't use my body to make money in a pinch when this PA thing doesn't work out and so would then HAVE to depend on my rapier wit. hell.

anyway. got to see 2 thoracic cases today and then a vascular case. so it was a cool day. i just need to learn to think before i squeak out an answer.

Meditative on a Monday

so i was reminded of something really important i need to reflect on by one of my all time favorite people in the world- how does my experience stack up to TV versions of the OR?

(side note: this favorite person of mine recently moved to a very cold, icy place in the far north and is writing the great american novel about her new life among the Inuit people and is also (in her spare time) being the lone voice of news (and hope!) for a rural fishing outpost all while wrestling brown bears and mining for coal...and oil...and gold...and riding whales and then burning their fat for fuel and using their umm....eyelashes for...er... ink.. i might tend to exaggerate her accomplishments and live her adventure vicariously through her and she most certainly exaggerates mine and lives my medical career experiences through me. she says she wants a boob job when i graduate and God save her, if she trusts me to potentially maim her for life, i say it's the least i can do. anyway....)

so she was musing today about how cool it would be if my experience was like that of gray's anatomy's interns' experiences. in that image, i would be getting shuffled into linen closets for romps with my attendings, i might fall in love with a patient and thusly cause his death, perhaps help my gimpy wounded hero/lover with intricate vascular surgeries as he recovers from neuro damage, maybe even fall madly in love with a married gay troll and lose all of my mental power and dialogue to the cause of winning him back....hmmm....

it is amusing to me how everyone looks so fresh and clean and wide awake on that show and in reality we're all without makeup, often covered in blood/feces, wearing masks and hair nets and shoe covers, and tired as hell. i don't feel much romance in the air, i tell you what. the only drama is work related from what i've seen, and there has yet to be a bomb or river boat collision. attendings are old married men none of whom can really be described as "Mc-anything appealing."

sorry to piss on your parade, if the plotlines on gray's made your life worth living or something, but i'm relieved to find my experience has been wholly w/o drama, sexual harassment, or manic muffin baking.

but this is still my first rotation, there's still time.

Slacker on a Sunday

i had a meeting on campus last week w/ all my classmates and our clinical rotations coordinators where we all shared our experiences thus far and got some updates/info from the professors. it was great to see everyone, but i'm realizing what a total slacker i am (scofflaw, if you will). some of my peers are working daily 12-16 hr days and THEN coming home and studying, giving presentations to their site preceptors, working weekends, etc. one even left our lecture friday afternoon and went back to the hospital to work. nuts. i've been practicing my sutures at home and occasionally reviewing anatomy, preparing a little bit for my upcoming surgical exam, but not a whole lot. i'm just tired (lazy) all the time and want to sleep (lie around and drink wine). i'm starting to wonder if my lack of motivation/fatigue perhaps means i have caught mononucleosis or that, the most dreaded of all human pathological parasitic infections, pregnancy.

i don't actually think i'm ill or prego. i'm just trying to find excuses for why they're studying circles around me and i'm trying to squirm out of the small bit of guilt i have that i'm not doing more work.

but i'm really enjoying not having to be in the books all the time- i am taking full advantage of it, for the record. my husband and close friend and i went to a national amusement park this weekend and rode all the new, scary coasters. funnel cake + french fries + elephant ears + caramel apples + spinny rides + heat stroke= a great day of fun. i am endlessly amused by what we humans do for entertainment. besides wearing tube tops and tight shorts w/ the words "cutie pie" written in sparkley letters across the butt, we also find it amusing to wait in line for several hours to be dropped from 100' just to get that WHOOOOOAAA feeling in our stomachs.

you know how babies/toddlers can be entertained for hours at a time by "dropping" them a few inches or supporting their heads and tilting them back toward the floor? these rides are basically giant mechanical simulations of that feeling. if we adults had giant huge parents who could throw us in the air and catch us or safely tilt us backwards like when we were kids, we wouldn't need these thrill rides. apparently the only fear we're born w/ is the fear of falling, so we're just trying to make our hearts pitter patter over something very basic and instinctive. that's all we're going for.

that being said, the rides were AWESOME and i totally thought i was going to die, but didn't. one ride you are strapped in (barely) in a (teeny tiny) harness and go way up to the top of the hugest height imaginable where i'm pretty sure i saw China in the distance and my husband and friend are like, "oh, isn't that sunset beautiful, gosh, it's so neat to be able to see across the whole park like this, blah, blah, reds and oranges, blah, blah" and i think that's about when i passed out. i went into a zen-like meditation on how my life had been a full one and i was prepared to meet my personal lord and savior Jesus Christ and that falling off a carny ride isn't THAT bad a way to go and that at least i'm with people i love....and then we were safely on the ground and i was like, "you wanna go again?"

hope everyone had great weekends....

Feminine wiles, oh what the hell....

so it's been a good week so far. i've gotten to do a lot of things i haven't seen yet, and my suturing is improving mightily. i am still breaching sterile field all the time, dagnammit, but even my awareness of DON'T PUT YOUR HAND THERE seems to be getting better. everyone is just so nice and supportive. while they threaten to throw sharp instruments at me when i do stupid stuff, no one has actually done it (or not that i've noticed, anyway).

so today i did 2 total hips in a row w/ the same surgeon. the first time, he told me to use the "bent" retractor....so i used it and didn't think about it again. the second surgery he asked me to tell him what kind of retractor i should ask for and i said loudly and proudly to the scrub nurse, "i would like a bent retractor, please." they all started laughing and staring at me. apparently the "bent retractor" is actually a Bennett retractor and is pretty common and something i probably should have known. so from then on he laughingly referred to it as the "bent retractor" and i just laughed it off. he then said that sometimes it's ok for women to be more whimsical and not always serious and just for the smallest of moments i was grateful for my feminine wiles and ability to charm my way out of sticky situations without being seen as a total boob...(every pun intended), and as long as he wasn't yelling at me, i was ok w/ the fact that he's probably sitting around the doctors lounge right now telling of this young female student with her bent retractor. but to be honest, there was a large part of me that just wanted to tell him to get.....you get the picture.

sleepy. several 12-13 hr days this week and i'm on call tomorrow night. sleepy and sleepy.

i've been hiding some embarrassing moments from you, bloggies.

some things i have yet to admit but feel i must at this time:

1. i have now TWICE grabbed a sterile drape instead of a gown out of the cupboard in the surgical suite and opened that and tried to find arm holes. the first time i wanted to melt into the floor, i was so embarrassed. the second time i just made a toga joke and kept going. i'm such an ass. they're probably each worth more than any item in my wardrobe and i am personally driving up the health care costs in America.

2. i have now TWICE lost items off of my person and had to be notified to find them at the main OR desk. one: a notebook with (THANK YOU GOD) no patient identifying info on it, but apparently distinct enough scrawl that someone in the department recognized it as mine. i just use it for notes to myself on what surgeries i need to prepare for the next day and questions i couldn't answer when asked, so want to do some reading on. (something like, "for tomorrow-look up what the "neck" is and figure out what it does for the human body. i think it has something to do with drinking or breathing or something." or " tomorrow you will be in on a nephrectomy (removal of the kidney)- find out what they do with it when they're done with it! is there really a special heaven for body parts like Dr. Smith said? i have a theory that they bronze it and give it to the patient on a key chain." ) not at all embarrassing to think that someone found and read all that i wrote.

and two: my PDA. i actually left it in the bathroom. it cost something like $400 w/ all the fancy medical programs (dictionary, drug reference, medical formula calculators, diagnostics and symptoms tool, etc, etc) and i left it in the bathroom. good lawd. but to be fair, it kind of deserved it. it's my son-of-a-whore-supposed-to-be-doing-all-the-work-for-me-and- leaving-me-hangin' palm device that freezes often, doesn't have info i'm looking for, and sticks out about 6 inches off my hip in its holster and knocks stuff off walls all the time. i think i might be leaving it in my locker from now on. the old paper kind of drug references work just as well and make me look studious when using at the nurse's station instead of like i'm texting friends on my phone or checking on the most recent celeb rehab scandals (which i totally am).

ok. i feel better. glad i got those things off my chest. and if you're wondering, playing dead did NOT work and i DID do yard work today...but my family did much more than i did and the yard looks gorgeous. it's about 600% nicer than it was when we started. we had become the rosanne conner house on the street complete w/ chicken wire and metal trash cans barring off corners of our yard and our only foliage was weeds that had won. pitiful. but now it looks organized, planned, and very un weed-like. thanks to my husband's wonderful family, we are no longer actively bringing property value in our neighborhood down. tra-la.

And we're half way done.

it's friday night and i'm drinking cheap champagne and listening to my family play nintendo wii in the family room while i attempt to focus on school work (while drinking... i know, i know) and failing miserably and subsequently writing the longest sentence to have graced the "pages" of modern "publication." i had a good week. i saw some really neat cardio, ortho, obstetric, and GI surgeries and am getting more and more competent. when rounding on pre and post op patients on the floor, i've been doing ok. i think i'm a total spazzy mcspazzatron and that i'm only getting 3% of the questions they ask correctly and only occasionally listening out of the correct side of the stethoscope, but apparently i'm fooling them good, because they've given me much praise. and my mid-rotation evaluation was really positive, so i'm flattered and happy and maybe will calm down a wee little bit. probably not.

i've been asked a few times if i'm interested in surgery as a career and the answer is still- it's really neat, and this is a great group of PA's, but i have NO IDEA. i want to leave my mind open to all disciplines, as i have many more to experience and i want to find the setting i'm most comfortable in and in which i can have the most impact. so we'll see. i like the working w/ my hands part of surgery, but it's a whole lot less detailed medicine and patient consultation time than other disciplines. and i'm a total sucker for patients who need a little lovin'. today i held the hand of a scared teenager w/o her parents and it felt great. i know, i'm such a softie. i felt like there should be a gruff, beer-bellied aging surgeon somewhere in the corner saying, "there's no CRYING in surgery!" anyway...

tired and satisfied at the end of week 3. next week i do some office visits w/ surgeons and have a day of class at some point, so it will kind of be an abbreviated surgery week for me.

sleepy...oh so sleepy. doing yard work this weekend but might play dead to get out of it. do you think that will work? i'll let you know if it does.

Seriously cool and oh, geez.

seriously cool: got to hold a heart today during a bypass surgery. amazing. so efficient and they make it look so matter-of-fact. but they stop the heart and lungs for over 30 minutes, sew pieces of vein from the leg to bad (crunchy atherosclerotic plaque-filled) coronary arteries (bypassing the plaque section), and then start heart/lungs back up and sew 'em up, shock the heart, and all is well. insane and incredible. so freaking cool.

oh, geez: the cardiothoracic surgeon i was working w/ was kind of drilling me about myself/my life the whole time during the procedure (because these open heart surgeries are so old hat to them that more interesting than savings lives is harassing the FNG at her most terrified moment) and by the end he'd concluded that i am a paul-mccartney hating vegetarian hippy comedian. paul mccartney hating because we were listening to the most recent album and it (kind of sucks) wasn't my thing and vegetarian because while he was reading me the riot act on potential heart risky behaviors i divulged that i eat healthy and mostly vegetarian. but i never claim to be a true vegetarian- i'm a pescovegetarian (figure that one out). hippy just because of the way i am. and comedian- i told him (oh, geez) that once upon a time millions of years ago i had done improv comedy (why did i say that? why? why?), so he asked me to do my "routine" for him. ummmm.....improv. so under immense pressure and against my better judgment i told him an off-colored joke to kind of test the waters. and then he told a much raunchier one and we were off and running. it was fun. but i was HOLDING A HUMAN HEART, so my hands were shaking and i was kind of all a twitter the rest of the day.

note to self: no matter how much you want to impress a surgeon, never admit to a history as any kind of performer or you will be asked to on the spot give evidence to your claim. i am a quick learner, though, since when he asked if i sang, i said absolutely not. i was not about to be the student everyone remembers with the story, "it was a normal afternoon in the cardiovascular OR when all of a sudden we heard a shrill voice echo through the halls, TOMORROW, TOMORROW, I LOVE YA, TOMORROW....and that was the last time we allowed PA students in this hospital"

Seeing God in the sterility of the OR. Who'd a thunk?

i just have to share this. i had a patient the other day who has been through more suffering and trauma in one lifetime than seems possible. early in childhood this patient was badly marred in an accident and so has lived into adult life with some debilitating and disfiguring effects and now 6 months ago was the victim of a random violent crime. the patient survived this attack against all odds and has been through something like 8 surgeries to repair and reconstruct what was harmed. not all of the procedures have gone well. it has been a painful and brutal process. we saw the patient for the latest surgery, one to clean up all the infection left behind, and when i visited the pre-op room, i found a cheerful, hopeful and funny patient ready to buckle down and face this next challenge. it was surprising and endearing, considering the history, to say the least.

but the thing that really hurt my heart was after the surgery, while we were getting ready to head to recovery and when waking up from the sedation, the patient kept saying to all of us, "God bless you." to the nurses, the MD, the PA's, me, "God bless you. Thank you, thank you so much." i could hardly breath. how could someone who has been drop-kicked by the universe so many times over be so gracious and loving and giving? amazing. it certainly made me curse myself for whining about the occasional stress or the flu. i want that attitude, that spirit and faith. that courage. all i could think to say was, "God bless YOU." and i believe that He does.

Heading into my 3rd week...

so this last week i started working on the floor seeing post-op patients in the morning, and then was in the OR in the afternoons. most surgical pts who aren't out-patient (where they leave straight from the recovery room the same day of their surgery- this is most common, and occurs surprisingly w/ even fairly invasive procedures) only stay a day or two post-op to recover and be monitored/managed. but some stay on forever while placement is sought or they develop more complications (emboli/thrombosis, infections, etc). this hospital has pretty good ratings for nosocomial infections (those that are developed while patient is in the hospital, thought to be spread patient to patient), but it still happens, so with this in mind, i am really encouraging those little old ladies who love the attention and companionship of being in the hospital, to get out as soon as they are able physically.

i have rounded on a few patients on my own, done my exam, asked my questions and written progress notes (subjective account from patient, objective vitals/lab values/exam results, assessment and plan) and i've done ok. i ask a lot of questions of my preceptor and have them look over my shoulder at all that i'm doing. but i've gotten good feedback. i'm also trying to learn staff members' names on the floors so that they will like me and help me when i need it. i made a room full of social workers and nurse case managers laugh the other day when one asked me if i was the PA on a certain patient and i replied that i'm just the student and there is about a 4% chance i can answer her question accurately. needless to say, they all seemed to enjoy that, but did NOT go ahead and ask me the question. perhaps i'm on to something...

it's neat to see the process from beginning to end. i'm obviously not in the surgeon's clinic when they're making the diagnosis and plan to take the pt to surgery, but i do see patients pre-op and get a feeling for how they came to need surgery and what their history involves, and then see them through the operation, and then see them post-op and how they feel/look, what kind of function has returned, etc. most of the patients i've seen are abdominal surgeries- so post-op you're asking a lot of "have you passed any gas yet?" type questions, which is interesting when the patient is hard of hearing so you have to shout it, or a non-english speaker, so you have to mime it for them. GI surgery commonly causes an ileus-paralysis of the intestinal peristalsis (normal squeeze/grind that pushes food down the way it needs to go) and so the patients are obstructed for a few days. they get very bloated and uncomfortable and what can't go down, may come up. so passing flatus (a delicate word that is latin for "big juicy fart") is a good sign that things are starting to move.

on the floor i've been able to do a few procedures, too...like taking sutures out and removing a jugular IV line, etc. pretty cool. all simple stuff, but again, super exciting to me to actually be doing hands-on work on real live patients.

toodles....

There's a sad sort of ringing from the clock in the hall...

it's amazing how much better my mood is when i only have to work 9 hrs in a day instead of 12. once my coffee has dipped below therapeutic levels in the afternoons, i start to whine inside my head a bit until it looks like i might be on the home stretch to getting to leave. when i got home tonight, i found that it had been a banner day at home, too. over labor day weekend we installed a doggie door for my crazy fool dog, so she is not trapped in a crate for 10-12 hrs at a time or a-crappin' on the floor if left to her own devices in the house. today she proved that she has officially and completely (tra-la-la) learned how to use the door independent of our begging/yelling/threatening/bribing, so that's one less worry. she was trouping around the backyard when my husband got home- scaring squirrels senseless and lying in her favorite spot on the cement porch (on the ground, immediately next to her fluffy expensive bed).

the last few days have been good. it varies a lot between surgeons and PA's in what they will allow me to do. today i was w/ a mercurial jekyl/hyde type MD everyone's a little afraid of, so i mostly watched and pretended to laugh at (the least offensive of) his dumb jokes. old hackneyed homophobic one-liners are apparently hee-larious if you're a surgeon. eck.

i guess i'm making notes on how i will and won't be as a practitioner. 1) WILL: When consulting w/ my patients pre-op, draw the intended anatomy on my scrubs to show the patient exactly where the incision will be and how the surgery will work, 2) WON'T: Make off-color jokes or gossip about co-workers while operating (especially when the patient is only under mild sedation and may be able to piece together the whole conversation). 3) WILL: Encourage loud rockin' music to be played when i'm in the OR, even if it means that my semi-conscious patient will wake up w/ an insatiable urge to mosh as soon as they can walk/hop. 4) WON'T: Fall for it when my patients are trying to get drugs out of me when their MD already told them "no" in no uncertain terms. i will be strong and vigilant and....what's that? oh you REALLY hurt? i will be strong and vigi....ok, maybe just one... (just kidding)

hope all is well with you all out there in the inter-world.

First week down.

surgery rotation: 1 week down, 5 to go. i still feel rather dumb, rather useless, and rather helpless, but i have a good attitude (can't you tell?). like the puppy who keeps coming back when he's kicked just because he doesn't know where else to go- i'm smiling and saying, "oh thank you for correcting me on that point- i was wondering how it was possible i had gone a whole 7 minutes without being wrong." they're letting me do more and more and i'm actually eager to try some things on my own. the surgeons haven't been the stereotypical ass-clowns that we hear about, but rather informative, friendly and generous. everyone in the room knows it's their job to stroke their egos, of course, but that's kind of true for all MD's, as far as i've seen in my professional and academic experience.

i have been involved in some really neat things now. all my preceptors keep apologizing that all i'm getting is "boring" general surgery stuff, but to me, since it's all new, i'm fascinated by it all. the things they can do w/ a camera are astounding (laparoscopic). they are actually throwing stitches internally only guided by the images they're able to see on the monitor over the table. unbelievable. i held a gall bladder w/ the clamps all laparoscopically and i couldn't believe how hard it was to manipulate them like that, and these geniuses are sewing in there! incredible.

so while i don't want to go under the knife myself since i now know how the tissue is twisted, bent, drilled through, burnt, and manipulated to accomplish what is needed during a procedure, i am feeling very pro-medicine right now and in awe of all we can do for people. for comfort, for diagnosis, for prevention, and then of course, for cosmetics. i haven't seen any tummy tucks or boob jobs yet (i will), but i did get to close an areola (the pepperoni under the nipple) where they had taken out a fatty lump directly under a nipple (gynecomastia). pretty cool. the little smiley faced scar on that patient's boob is because of me. alright.

anyway....my classmates all seem to be doing really well on their rotations. they're scattered in different disciplines and so we're all seeing/doing very different things, but for the most part experiences have been good. some are feeling out of their realm like i am, and some have crappy, angry, bitter preceptors, which sucks, but so far everyone is afloat. have i mentioned how much i love my people yet? these classmates of mine have quickly over the last year become some of my favorite people and i love how much support we provide each other. just a quick shout out to them.

more soon....