It’s week 3. And
Today is an OR day. Last week, my friend, Branden, and I got in trouble for doing something that we were told to do by someone else. So, we decided last week that we were both going to scrub in for all of the operations that this Dr. was involved in. It’s interesting, because there’s a comfort level that has started to sink in. I feel comfortable in the Pre-op area and in the OR. The Pre-op nurses love me now. I came in today and there were hugs and smiles. I’ve noticed that Surgeons, Residents, and students hardly ever look at people as they walk by… and they VERY rarely smile. Me on the otherhand… sorry… can’t help it… that’s just the way I am… So I walk through the pre-op area hi-fiving, giving hugs and tapping arms. It’s just who I am.
Branden and I start off by visiting our patients. He’s a bit of a social butterfly, too, so we have kept each other sane. We go into rooms to talk to the patient before their operation and we have a funny little routine that we start going into. You know stuff like, we’re medical students, don’t worry, we won’t be doing anything, it’s pretty funny.
One of the rooms we’re in, the mother introduces her daughter to us by saying, “and this is my beautiful, unmarried daughter.” It was pretty hilarious… I think she was saying this more to our intern who is this tall supermodel looking dude. But it was still pretty funny.
We didn’t see anything super cool or anything in any of these surgeries. But the best part of being a student is that we get to see the patient after they have woken up. And it’s great to be a friendly face that the patient gets to see after waking up. And we get to reassure them that everything went well. It’s a great job.
In the afternoon, we have one of our attending sessions. I start off on FIRE. I get the first 8 or 10 questions right, while everyone else ends up missing them. I feel great. But of course… that’s when we all start just getting everything wrong. It’s pretty funny to see how quickly we end up looking like a bunch of idiots. Still. I feel really good about how much I learn from this session.
So, every morning, when I get to the hospital, the first thing I have to do is get a list of the patients that we have on our service. After that, the 4 medical students split up the patients and go find their vital signs and their ins and outs. Ins and outs are exactly that. We have to calculate how much has gone in to their system and how much has come out. It helps us keep track of their overall recovery.
We then wait for our Chief to come in and we start “rounding.” Rounds is where we go around from room to room and discuss the patient in that room in terms of what’s going on with them, how they are doing, and what our plan with that patient is. As a medical student, we have to be ready to talk about the patient that we have been assigned. We are expected to know the patient better then anyone else on the team. That’s because we don’t have as many total patients, so we have the chance to spend more time with them. So far, all of my patients have been going home within 2-3 days of my picking them up. I would love to think that this had something to do with me, but I’m not so naïve.
So mostly, I spend morning rounds going ahead and trying to help out by removing dressings so that everyone can take a look at the patient’s wound and then I re-bandage. It’s not glamorous… but I like it, because I get a chance to actually talk to the patients while I’m in there. Most of our patients are pretty sick. They have some major abdominal surgeries. I don’t think I’ll ever get used to how awful their abdomens look. I’ve seen wounds where you can see intestines making re-connections to the skin, so it looks like you have these rectums that are forming on the skin. It’s incredibly bizarre.
Two of my favorite patients to talk to in the morning are Mr. JC and Mr. WW. Mr. JC has been in the hospital for over 100 days. I feel so bad for him. He’s a really sweet man. He’s a bit under-educated. But he’s so nice and kind in the way that he talks to you. His wound is awful looking. It has gotten much better over the past 2 weeks… but every time I pull his dressing back, I cringe a little bit.
Mr. W.W. has also been in the hospital a long time. He’s 72 years old and had to have his vocal cords removed because of cancer of the esophagus. Whenever we get to him in the ICU, he’s always staring out of the window. He’s such a dignified and sweet old man. His eyes have a kindness to them. And I feel so bad for him, knowing that he can’t talk. This morning, when I see him staring outside, I go up to the window side and I hold his hand and I tell him, “Sir, it is really hot outside. I about sweat through my shirt just walking out of the door today.” He gave me a smile and squeezed my hand back.
Tuesdays are Clinic days. The first 2 weeks, I had NO idea what the heck we were doing and what we were supposed to do. But things are different now. I have a confidence now. I have a swagger. I buy the nurses chocolate. I look for patient names that I know.
It’s pretty cool. I see about 5 patients this morning, which is a huge step up from my average of 1-2. There are 2 stories that I find particularly interesting. One of the ladies, Ms NJ is a 76 year old grandmother who had a nasty form of cancer 15 years ago. She had one of her breasts removed and has made a complete recovery and was just in for a checkup. It was so cool to see her story. Ms MJ is a 42 year old woman who had the same nasty form of cancer. Only she had ovarian cancer first. Then she had both breasts removed. And she was coming in for a check up to see if we could take out her med-port. Only, there was a problem. She had a new lump in her arm pit. And she just wanted to make sure it was okay. When we examined it, the docs told her they wanted to test it, but afterwards they both told me that they thought the way it felt was very suspicious for cancer. It’s so hard to understand why one person gets completely better and one doesn’t. When I was on the Peds Onc floor, I remember a T-shirt that one of the kids with cancer used to wear. It said, “Cancer sucks.” Man is that ever true.
On the way back from lunch, we cut through the waiting room and I see Ms. DW. Ms. DW is the patient that I got to actually cut on the previous week. I really like her, because she’s such a pistol. Imagine, Laverne from Scrubs. She’s so hilarious. And her family LOVES me. I knew Ms. DW was coming in for her check up. So it was great to see her. Later on that afternoon, I get to be the one that evaluates her and it’s pretty cool to have that kind of continuity.
The only crappy thing about the day is another lame afternoon of waiting for afternoon rounds. The past 2 days haven’t been too bad EXCEPT for afternoon rounds. Because at the end of the day we always seem to end up waiting around for 2-3 hours for afternoon rounds to start. Afternoon rounds are PAINFULLY boring. Because unlike the morning, there really isn’t anything that they want us to do. So we just follow around and do nothing. And when they’re running late, they don’t really feel like teaching, so you just hear them chatting away about patients and you get nothing out of it.
Still it’s a good day overall. And the past 2 days have been good.
It’s Wednesday morning. And I have a couple of good moments during rounds. Mr. JC’s wound is looking better. And my Chief actually makes a comment to me, “I think that since you started doing his dressing changes, his wound has really been getting better." This made my day. It’s a small thing to some… but it meant a lot to me. I don’t know how much of this had to do with what I actually did. I think that if anyone had been doing his dressing changes regularly, he probably would have done better. But I don't really care… it felt good to hear it.
When I go to see Mr. WW in the ICU, I go in while the team is still discussing his plan. I give him the weather report and a smile. And I am happy to be able to bring a smile out of him.
My surgeries today aren’t all that exciting. This is intentional, because I realize that I have had the chance to do a lot more than the others in my group. So I want to give them a chance to see and do some stuff. We are supposed to have an afternoon session with one of our attendings, and so she pages me. I call her and she tells me that she only wants to meet with anyone who is NOT in the OR. Well, I tell her that I am the only one NOT in the OR. So she says she’ll grill me by myself then. I tell her that sounds excellent and I head out. She buys me coffee and then starts asking me about my background, because she knows I’m older. It’s a little weird, because it almost feels like a med school interview. Then all of a sudden she jumps into talking about our surgery oral exams. The way these things work is they give you a clinical scenario and we have to ask the right questions and tell them what we would do. It’s pretty intense, but I actually do pretty well.
Afterwards, we have another painful session of wait for afternoon rounds and then actually do afternoon rounds. It’s nuts because the past few days I’m not getting home until after 7, but there’s NO REASON for this. This is the sucky part of being a 3rd year student. Oh well.
I get a special treat in the morning. Mr. WW actually sees me before we get to the room and he smiles at me and waves. I kind of tear up, because I feel so good about befriending this kind, gentle man who is so incredibly sick. I give him the weather report and he smiles back. I can only imagine how frustrated he must be not being able to talk anymore.
After rounds, the Residents and Chiefs have grand rounds, which is a big lecture. Only, this week, we were told that we didn’t have to be there. So we get to sneak off and have breakfast! I already had breakfast at
We then have a session with one of our attendings, and it’s really quite interesting. We discuss all of the possible causes of rectal bleeding. I’m sure it sounds funny to someone who is not in the medical profession. But this has the potential for some seriously awful consequences.
Afterwards, I get ready to go into the OR, while the other folks in my group go to clinic. Just a little bit before I go into the OR, I get paged by Branden. I call him and it turns out that our Chief came down and saw them in clinic and got pissed. He started yelling at them and asking them why they weren’t in the OR. This is the reality of being a Med Student on Surgery. You just never know when things are going to snap and someone is going to yell at you through no wrong doing on your end. I am grateful to have been in Pre-op when this all happened. The actual surgery is uneventful. Although, our attending wanted to know why we had everyone up in the OR.
Thursday afternoons are lecture sessions. They are pretty much as boring as you could possibly get. I spend most of this time dozing off…
I hate afternoon rounds. I figured by the time we were done, they would be done. But of course not. When we get there, afternoon rounds have yet to start. Ugh. Once we do, we witness our chief get into a screaming session with one of the ICU nurses. This is the 2nd time we’ve seen him get into a screaming session like this. Honestly, surgeons just aren’t that nice to people. It’s so weird, because they seem normal most of the time, and just seem to snap. Their patience levels are pretty much non-existent.
We start off the morning with a surprise. Mr. WW has been moved to a different ICU. I’m not sure why he was moved. But his new room does not have a window. He looks miserable. I go up to him and he has tears in his eyes. I feel awful. This is the crappy part of medicine. Not being able to do something for someone you really care about. I don't know what's going on with him...
I have an interesting day of surgery planned. I am only supposed to go into one surgery and it’s with the head of the entire surgery department. It’s a liver resection for Mr. JA. He’s 42 years old and had colon cancer 2 years ago with tumor having spread to his liver as well. Now he has tumor in his liver again. I go to meet him and his wife, and it turns out his wife is Korean. The minute I start speaking to her in Korean she starts falling all over herself and is bowing repeatedly. I reassure her that his surgeon is exceptional. And she seems comforted knowing that there’s a Korean person in the OR with her husband. The surgery itself is pretty cool. I put in his foley catheter and it’s funny, because even though I’ve done a ton of them, I still have to put up with hearing all of this crap from other people that want to tell me how to do it differently. I think this is the thing that annoys me the most about surgery. There are about a million ways to do the same thing, but everyone can’t just accept that. Instead, they have to pick at you for doing it wrong. Even though in reality, it’s not that it’s really WRONG. It’s just that it’s different. Jerks.
I get asked a few questions here and there. I miss some. I get most. It’s pretty cool. They use this device that heats water up to 100 deg Celsius. Then drops the water on the edge of an electric blade. This cuts away at the liver, while at the same time sealing off any potential bleeding or oozing. It’s pretty amazing.
When it gets time to just sew him back up, the head of surgery leaves and it's just the Oncology Fellow, the intern, and me. So the Fellow throws in the first stitch, shows me how to do them, and lets me close half the incision. It's about 5 inches of stitching and it's really really cool! Plus, it's really really fun. And when I'm done, the fellow looks at it and asks if I had ever done these before. I tell him no, and he says, "Don't get a big head." I'm guessing this means I did well. I feel pretty freakin' great.
The afternoon is pretty uneventful. Once again… a lot of waiting around and doing nothing at times. I hate this part of the surgery rotation more than anything else. It’s so hard to stay awake when you’re not doing anything.
I’m on Night Call on Sunday night, so I have to go in for rounds on Saturday morning. The head of all of surgery is rounding with us, so everyone is a little nervous. He’s a really quiet, soft-spoken man, but it’s so obvious that he is NOT someone to mess with. It is so clear that he does NOT mess around. He asks questions that seem so basic, but ridiculously impossible to know. But I figure out right away that he doesn’t care about us as medical students. He is more interested in getting to know the interns. So, we spend our time running ahead of each room and getting everything ready for him. It’s exhausting.
When we see the lady from the thyroid surgery, she smiles at me, and says, "There you are." She tells me how warm and comforting my hand was and thanks me for being there for her. It's so funny. I did absolutely nothing to actually remove the tumor from her neck... but I'm the one she remembers... it just goes to show how meaningful it is when we take the time to be human with each other...When we get to Mr. WW, he looks miserable. I go up to him and he mouths to me that he can’t breathe. I look at his monitor and everything looks normal. I can’t really tell what the doctors think about his breathing. They are discussing it, but I don’t know what their thinking is. But I feel awful for him, because he obviously feels uncomfortable. And I leave there feeling very unhappy.
Thankfully, I’m done by
With Rounds being over, I leave for NoVa. I had decided to go up to NoVa for a quick overnight stay, because I just felt like I needed to get recharge a little bit. Plus, I knew that my friend Pastor Rich was in town and I was hoping I had a chance to see him. I got a chance to eat lunch with him, my parents, and my friend, HyeJin. I also got to go Bible Study that night with some of the College kids. It was great to feel normal.
So my 3rd week of surgery is done. I’m excited for my time on Surg Onc to be done. I am really tired. But I feel much more comfortable with my surroundings. And I really feel like I’m learning a lot. The time seems like it’s moving quickly, which is a good thing.
