Wednesday, October 29, 2008

What??

so i worked with one of the chief administrator doctors today, who also happens to be one of the "butt boys" and we did a, well you know, fairly unpleasant and compromising case together (as these butt cases tend to go)...but he was SO nice. he kept saying things like, "you're all doing a great job." and "anyone need a break? is your hand getting tired?" i almost dropped the instrument i was holding when he asked that. i couldn't even believe it. it's like he missed the memo. or somehow opted out of the "Navigating the OR as King Rat: A Surgeon's Guide to Intimidating the Peons" class at Man's Best University. every once in a while you run into a doc who totally doesn't fit the mold. and that's this guy.

so it was a pretty good day.

and...even as i wrote "What??" as a title to this post, i couldn't help but laugh. my second cousin, who is 5 now, is absolutely hilarious. and last Christmas every time she opened a present she would loudly state "WHAT? who gave this to me?" her tone was more like an inquisition or a demand than a genuine interest in her benefactor. like she was opening a bomb or a plastic baggy of dog poo- "who would have the gall to give this to me?" was her tone. so now every time my husband or i say "what?" we start laughing.

anyway...

that's all for now. ta.

Tuesday, October 28, 2008

Cry if I Want to, Cry if I Want to....

so my 28th birthday has come and gone. or is going. i still have more celebrating to do later this week w/ my family. and i went out to dinner w/ friends tonight after enjoying a glass of wine and opening an awesome present from my husband.

but i had kind of a meh day. i saw a really neat 5 hr case, but since there were 3 doctors on it, i was just sort of hanging out at the end of the table trying not to fall asleep or get contaminated. and then, sewing up the patient at the end...my ONE JOB...didn't go very well. so not well, in fact, that i had to call in reinforcement to help me finish it. so i was embarrassed and felt dumb. and somehow my little pings of "am i AGED now?" coupled w/ today's inadequacies at work meant that i felt like an old failure. like, 'wasn't i supposed to be settled into a career at 28 instead of being the young, inexperienced pup?' but one of my friends at dinner wisely pointed out that 28 is kind of the starting age for most folks in medicine...so true that.

...but still....why am i not awesome faster?

i think this will just be how it is for a while. some great, fat head days and some really icky, humbling days. gargh.

Tuesday, October 21, 2008

Blue Skies, Birds Laughing, Babies Singing...

i'm in a magical tra-la unicorn land. i've had a great work week.

on wednesday, i scrubbed with a really intense surgeon who is known for his temper tantrums and for kicking people out of the OR if he doesn't like them and never allowing them back. some PA's haven't seen his cases in years, because they are on 'the list.' but i'd also heard that he was a really good surgeon and outside of the OR, a really nice guy. so i was pretty nervous doing my first cases with him. especially because he does vascular surgery, which is really precise and difficult and life or deathy. we were doing endarterectomies. (big word- means cleaning plaque out of arteries) on carotid and femoral arteries....huge, important vessels that sort of mean life or death to brain and limbs. (to be fair, they have a little help from other vessels).

so just to see these cases was wildly cool. to be able to HELP on them, was amazing. you're definitely the second surgeon on these. they really require you instead of just use you cuz you're there (the way it feels on some other types of cases). it's pretty neat. and i'm aware the whole time of how incredible it is that we have clamped the freakin' carotid artery so that we could spend an hour needling around in there. wild. AND TO TOP IT ALL OFF...they keep the patient awake for these cases! (say what?) they gave her an epidural shot for pain control to the neck and some light sedation to keep her calm, but they actually require the patient to hold a squeaky ball (like a dog toy) in her hand and instruct her to squeeze it once in a while to make sure she hasn't stroked out or anything.

¡increíble!

so, it was really cool. and although i didn't know what i was doing, i did ok. and my medical knowledge that he pimped me on was only mildly sub par. and i made him laugh. and we shared a taste in movies. so it was pretty fun.

and then the next day, miracles of miracles, a fellow PA told me that he had said good things about me. like that i would be "excellent" some day. WOOOOOOOO HOOOOOO!!

so i've been floating around since then.

and today i spent much of the day in the emergency room (no, not to get my fat head drained)...admitting new surgical patients and practicing some actual medicine. which is another thing that i recently was bitching about...(to my poor family, much to their chagrin). i was worried that i'd lose all the medicine i learned over the last few years, choosing surgery. but today i got a chance to see what the rest of my life will be like once i've gotten competent in the OR. oy vey, so much to learn! and, i got to love up on a patient w/o the ability to speak. give her some answers and hope she wasn't getting from anyone else. and God, that's good.

but tomorrow is another day...and i'm once again working with the MDITW. so we'll see how awesome and sunshiny i'm feeling tomorrow.

but then it's the weekend! so whatever. :)

Sunday, October 19, 2008

SAVE THE BOOBS!! HELP SAVE SECOND BASE!!

now that i have your attention.

that is actually a breast cancer awareness slogan that i have on a t-shirt. it also says "big and small, we support them all."

you can't talk to any female who has not been effected by breast cancer. if you don't have a personal experience, you probably have a relative or a friend who has faced breast cancer (or at the very least, you are aware of celebrity gossip- survivors like olivia newton john, christina applegate, and sheryl crow). there's a lot of awareness (and pink paraphernalia) out there, this being breast cancer awareness month.

and this is good. breast cancer is the most common cancer in women and the second most deadly cancer in women (behind lung cancer). we continue to make great strides in diagnosis and treatment. (for your info: current recommendations say that from age 20 on, monthly home breast exams and yearly (or at least every 3 yr) clinical breast exams are important in early detection. and after age 40, annual mammograms in addition to those screenings already mentioned). treatment is less invasive than it used to be, and is tailored to each patient depending on the tumor size, involved lymph nodes, pathology of the tumor, genetics, etc. mastectomy with chemo/radiation is often times still the most effective combo.

we do a lot of mastectomies at the hospital. i'm scheduled to do a few tomorrow. as you can imagine, they are often very emotional for the patient. even with the progress that we're making with breast cancer treatment, it's a terrifying process and losing your breasts can often be synonymous with feelings of losing your dignity and femininity. again, hopefully with the public interest, there's now somewhat less dread and hopelessness associated with a diagnosis of breast cancer, but it is still an awful ordeal.

mastectomies and reconstructive surgery is really interesting from a surgical perspective. often times, if the patient knows they'll want to go with prosthesis eventually, they'll put retainers in at the time to start stretching the muscle slowly to allow for the eventual implant. the patient will go in periodically to the plastic surgeon to have more gel inserted to make the retainer bigger until it's of satisfactory size and the tissue is healed and all radiation is done and everything...

the plastic surgeons i work with are artists. the natural shape of breasts is kind of an obsession with them. they're goal is to make the implants fit the patient's figure, have both breasts look equal and have them settle gracefully. one MD explained to me that if you inflate the balloon into a perfect circle (both top and bottom full and round), you end up with very artificial looking jugs like this. once the actual implants are in and the tissue is healed, the last step is nipple tattooing. the patient picks their shade and the doc re-creates a nipple and areola by injecting ink into it to create a nice, natural look. (and no, no one has requested paisley or bright orange areolas. i already asked).

this is not just a disease for women. although it happens a lot less often in men, breast tissue is breast tissue, so men are not safe either and if having symptoms (pain, nipple leakage/bleeding, lumps and bumps, swollen lymph nodes), need to be examined.

there's a lot more information out there, and please, please research it or post me a question and i'll find answers for you. some good places to start are emedicine breast cancer article and the american cancer society.

Monday, October 13, 2008

October is a Wonderland of Joy and Joyness

october is half way over already, but it's objectively the best month of the year. not only is it my anniversary and birthday and halloween and national vegetarian month, but also....

*last week was national PA week, so we got pizza and cake everyday at MBH
*and it's breast cancer awareness month- and i bought a new pink stethescope (because it's AWESOME!) in honor of survivors of breast cancer
*and clergy appreciation month
*and eat country ham month
*and cookie month.
*and sarcastic month (whatever)

and important days include...

*tomorrow, oct 14th- 'national dessert day' and grover's birthday
*oct 18th- 'alaska day' (wear cute glasses and sound canadian!) and sweetest's day
*oct 20th- 'brandied fruit day' (oh, yes)
*oct 24th- 'national bologna day'
*oct 25th- 'punk for a day day'
*oct 26th- 'mother-in-law day'
*oct 31- juliette gordon low's birthday (erected the girl scouts, 1912)

Sunday, October 12, 2008

Candy-Coated Contraception

hot dang. we just survived the tornado that is 9 adults and 2 children under the age of 7 in a 900 square foot house for a weekend. i would have been such a whiner had i lived in the days of tenement housing.

but we had a great time and the weather was phenomenal. we all dressed in costumes for the halloween festival we went to, and it was so nice, we didn't have to bundle up too much.

over the weekend we ate our weight in sugary delights. multiple crates of cookies and cream puffs and cupcakes and candies and caramel corn that my grandma made and brought (she's famous for all things diabetic-coma inducing). plus, my family is really sneaky about using sweet jello dishes as side dishes with meals so that you can still have dessert afterward. PLUS, at the festival they passed out lots of candy and chips and cookies and stuff.

so my teeth are cavitatng (word?) as we speak and i'm in kind of glucose shock right now.

but. the house. is quiet. tra. la.

the relatives who were here were all women. most of my family is composed of the fairer sex. so when aunts, grandma, cousins, and 2nd cousins get together- we're a loud, rowdy, estrogen-y bunch. and they're all wonderful. everyone pitches in to help make and serve the food, clean up afterwards, etc. this is an annual thing we do, but this is the first year w/ little kids.

and these kids are sweet and loving and delightful. but also totally exhausting. i think they had a good time. we got them all dressed up in their costumes for saturday night and the little one was a vampire. she had this little bodice dress w/ long flowy sleeves....which was really cool until i took her to the public restroom at the festival and when she came out she announced to me (and the restroom at large), "i dropped both my sleeves in the toilet." she was pretty matter of fact about it, and once i'd established that it was into a toilet of #1 and NOT #2, we just rolled 'em up and kept on truckin'. :)

they made us laugh all weekend with their antics. but by the end of the weekend ("she got a quarter and it's supposed to be my quarter!" "can i have another cupcake? i've only had 3!" "DID YOU FEED YOUR GUM TO THE DOG??") all cousins of reproductive age were brainstorming ways to reinforce the barricades they use around their uteruses.

Thursday, October 9, 2008

Hands and The Hippies They're Attached To

i've alluded/eluded/ihategrammar to this in previous posts-- that hands are a huge part of my life. first of all...and, brace yourselves because i'm about to go down a rabbit hole here and hope you don't take this to mean that i think i'm a voodoo priestess or anything...BUT... i've been told all my life that i have a very 'healing' or 'energizing' touch. exhibit A: friends, family, patients, (strangers, when i'm feeling especially cheeky) have always voiced that they've found a lot of comfort from my hand holding and touch. exhibit B: whenever we did the 'pass the energy ball' team building game in theater classes (i cannot believe how much embarrassing dirt you people have on me, seriously), i always seemed to 'shock' the person next to me w/ whatever flow was coming through my hand to theirs. exhibit C: my even hippier-than-me friend once read our energies or chakras or colors or something. it was a long time ago, so i don't remember it very clearly, other than that it was cool and that the descriptions of our matching colors based on our personality profiles were pretty accurate...and that my energy source was based in my hands and that i was a healer.

(i did not express that well, and if said friend is reading this post, by all means, chip in to make sense out of my jibber jabber).

so, anyway...as i entered a career in surgery, i was aware that my hands might have some 'divine power' in them. and in my career previously and so far as a PA, i have used them to hold, rub, pat and generally provide comfort and love. so i'm hoping that once my skills are up to snuff, i will pass healing power through them into surgery.

in surgery, my hands are used for everything. to hold, tie, pinch, grasp, sew, stop bleeding, insert lines and catheters, cut, burn, provide tension ...everything. their not having palsy has been a plus this week as i've been on a few very picky, tricky vascular cases- working on aortic aneurisms and vascular grafts, etc.

and today, with the MEANEST DOCTOR IN THE WORLD (MDITW), my hands were blessings as they didn't shake too terribly as he withered my fragile self esteem and yelled at me for not being able to predict his next move and simultaneously evacuate smoke and retract and provide visuals. my hands also did not punch him in the neck, for the record, when he expressed that it annoyed him that i lean my head to the side when trying to see better by just bellowing to me "HEAD!!" or "STAND UP STRAIGHT!!" (last week i was feeling like i'm getting paid too much to do what i do..not so much today).

and lastly, my hands have been quite sick this last few months. i have terrible eczema and they've been painfully dry and broken...so much so that the 10 times a day i wash them makes me practically weep as all the tiny wounds get scrubbed. so i've been dealing with that. better now, with topical and oral steroids, but still thick scarred tissue and a few big red marks. not much fun. and these hands are my money maker now, so i have to look out for them.

i'm also more careful than i used to me when chopping vegetables at home, etc.

so that's my story on my upper appendages.

i've had quite a day, so i'm off to drink myself into a mild stupor while i cook for my relatives visiting this weekend. tra-la.

Friday, October 3, 2008

My BFF. Forever.

so last week at work went pretty well. i'm getting more comfortable w/ the other PA's, MD's, and other staff, and them with me. and i'm even making some friends, i think. i got invited to one PA's wedding already. and at lunch the other day, they were all asking my opinion on things and laughing at my jokes and stuff. tra-la! so either the boss told them to take pity on me, or they genuinely like me. :) i brought back fudge from my weekend away, so if they're on the fence about me, hopefully chocolaty goodness will tip them in my favor.

my surgical skills are coming around, too. things that used to be really perplexing to me are coming more naturally now. step by step. and most days seem to fly by and i really enjoy myself. since i get there by 6:30am, it always seems like "it's already noon?" and then the day's practically over. and each week it's like, "it's already wednesday?" so these are good signs. i've been in jobs where 30 minutes can feel like a lifetime, so i'm loving this.

and this weekend was magical. to celebrate our 6th anniversary, my husband and i escaped up north to my parents' beautiful cabin on a river in the woods. it's completely peaceful and slow, quiet and still up there. the sky is so wide open you can see the milky way foggy line and all the constellations. we even saw a shooting star. there's just a whole lot of lovely nothing up there. this time of year is perfect- it was crisp and cool, but very pleasant. and the leaves are already changing colors in bursts.

we got up there friday night and built a fire and shared some wine, then fell into a sleep coma. i never sleep harder than i do when i'm there- maybe it's the fresh air or something (carbon monoxide leak?), but i am so well rested after a weekend there. saturday, my marathon runner went for a 12 mile run while i took a bath (that's right, that's how we roll), then we went to a little artsy town nearby and did some shopping. we had really good intentions to get Christmas shopping started, but instead ended up getting ourselves a bunch of awesome things we totally didn't need ($12 pickles, for example). and fudge. which, as far as i'm concerned, is, in fact, a necessity for life. then we ate dinner at a swanky restaurant in the area- i had a fried eel sushi roll (weird but good), pumpkin bisque, and a mixed greens harvest salad, and he had a southwest caesar salad and a mushroom and white truffle pasta dish. we also really enjoyed the pinot noir split we had (steele carneros 2006) and a pear pastry w/ hazlenut ice cream and cranberry and caramel sauce on the side. delicious. then saturday night- more wine, more fire, and more coma. this morning, we lazily got around to getting up and leaving.

so we had a great time. but we always really enjoy our time together. we never lack for things to talk about. and we laugh all the time. we talked a lot about our past (we've been together for about 11 years) and our future (how many more years we think we'll be able to stand each other). :)

i can't imagine a more amazing person to share my life with. he's by best friend, my support, my hope, my sanity. and i'm so totally grateful for him.

(but..shhh..don't tell him. i don't want him to get a fat head).