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....