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....