Surgery Week 7 & 8

Surgery Week 7

Monday, September 10, 2007

Here I am. It’s my last surgical rotation. I am on the Cardiothoracic Service at the VA hospital. The VA hospital is a hospital that is set up for Veterans of the military. I am looking forward to Cardiothoracic, because I am told that the hours are better & the people are nice! Wow! What a fascinating idea, huh?

I don’t have to be in until 6:45. Which means I don’t have to wake up until 5 a.m. It feels positively heavenly to sleep in an extra hour. It takes me a little longer to get ready, because I am going to be on call tonight, so I’m going to be at the VA for about 30 hours. I need to make sure I have enough food and stuff.

I get to the Surgical Intensive Care Unit (SICU) a little bit late, because I have an awful time finding where I’m supposed to park & how to get there. As I walk in, one of my classmates is standing there & says really loud in front of all of the residents and other students, “You’re late.” I say, “I know,” and just keep walking until I find my intern. I am not pleased. It’s bad enough that I’m late, I hate that she just yelled it out for all to hear.

I meet up with my intern & he’s totally cool. We talk a little bit & we start rounds. I meet our attending who is incredibly cool. He’s a Hungarian doctor who has been practicing for quite some time. He knows a ton about Korea & the world in general, and he has some great stories. I’m already happy to be on this service.

I find the VA to be a very different kind of hospital. Things are a little slower. Things are a little sloppier. I go to get scrubs so that I can go into the OR. I find that the VA uses Purple scrubs. That’s right. Purple scrubs. And we’re talking SERIOUSLY purple… as in Grimace or Barney. I feel ridiculous.

Also with Cardiothoracic at the VA, there is usually only 1 operation a day! How great is that! Unfortunately… all of our operations are basically 5-7 hrs long. Ugh. Our first and only surgery today is an Aortic Valve repair with a coronary artery bypass graft (CABG pronounced like “cabbage”). The first part of the operation is when someone has a bad heart valve & so we put in an artificial valve in its place. The second part of the operation involves the blood supply to the heart. The heart is responsible for delivering blood to the rest of the body. But it also needs blood for itself. So it has several small arteries that shoot blood to the different parts of the heart.

When people have a heart attack, what is happening is one of these arteries gets clogged & so that part of the heart does not get the blood that it needs… so that part of the heart stops working, which is why heart attacks are so dangerous. Sometimes we can figure out that one of these heart arteries (coronary arteries) are starting to get clogged and are in danger of being completely clogged off. If it’s just one of these arteries that gets that way, we’ll usually put something in it to keep it open called a stent. If it’s more than one of these coronary arteries, we do a CABG. To do a CABG, you take a long piece of vein from the leg, cut it into pieces & sew it into the heart so that it carries blood around the area of the clot. It’s a really cool operation & it’s done all the time.

The nurses in the OR are really really really nice. I really like everyone there.

The surgery starts off with them getting the vein. It’s pretty cool. But the real excitement comes when they open his chest. It’s amazing. They cut the skin down to where you’re almost at the bone. Then they use a hand-held saw to cut down the middle of the chest plate. They use their hands to pull the 2 sides apart & there it is. The heart & the lungs. Un-freakin-believable.

They let me put my hands in and feel the heart and the aorta. They let me see the messed up valve. They start pimping me on aortic valve disease. I do alright. They pimp me on how to treat a heart attack. I do alright. They connect the heart to a gigantic heart bypass machine. VERY COOL. Then with the heart basically empty, they go put in a new valve, they connect the veins. When they are done, it looks like this crazy Frankenstein heart. It is SO FREAKING COOL. Then they fill the heart back up to do the last bit of reconnecting. When they poke a small hole in the aorta, blood comes squirting out. And no one even so much as flinches.

When they are done sewing everything together, the heart isn’t quite beating in the right rhythm. The patient is having a rhythm problem called ventricular fibrillation (v-fib). It is often described as looking like “a bag of worms.” That is EXACTLY what it looks like. I’ve seen it on tv before. I’m seeing it less than 1 foot away from me right now. They take out the internal paddles and they shock the heart. Things are cool once again.

To close the chest back up, they use these huge wires that are connected to a needle & basically tie the chest back up with the wires. Then they sew in 3 layers of thick stitches followed by a layer of thin stitches. And when they’re done… you just have this small red line going down the center of their chest. You would never guess that just 20 minutes ago, his chest was wide open & you could see his heart & lungs.

By the time I get out of the operation, it’s 4 p.m. and I have yet to eat. This is life on surgery. You never get to eat when you’re supposed to.

And my feet hurt like CRAP. I made a mistake and wore dress socks today. I decide today that I am never wearing dress socks again for the duration of my M3 year. I am only wearing black athletic Under Armour ankle socks. It’s the only thing that keeps my feet from feeling like they are going to explode.

I normally would be able to go home at this point. But I am on call tonight. I find the intern I am on call with & he tells me to just hang out in the student call room until 7.

On my way back to the student call room, I run into some students, & I laugh & say something about how that student had yelled out that I was late. They tell me that before I got there, my intern had actually said I was late. Then that student had told my intern and everyone else that he was getting by far the best medical student in our class. She told everyone that I had all of this clinical experience from before and that I knew everything and that he was going to have the best experience with me. Wow. Funny how mad we get at people when we don’t even really know the whole story, huh?

My intern for the night is kind of interesting. When I talk with him, I get the sense that he’s really scared. And I would be, too. He’s the ONLY “surgeon” in the hospital for every single surgical patient that night. And I say “surgeon” because he’s not really a full-fledged surgeon. He’s been a doctor for exactly 3 months. There are other doctors that he can call to come in… but he has to take care of everyone until then.

Before I got to the VA, everyone told me that I would get to sleep all night on call. But I quickly abandon any idea of sleep, because I figure he’s going to need as much help as he can get. We start off quick. He has a bunch of people that needs blood drawn. So I do it. I haven’t drawn blood in a while, but I’ve probably done about 1000 blood draws in my life… with half of those blood draws on pediatric patients. But after drawing blood from little kids & babies, I am stunned at the size of these people’s veins. I could probably get a garden hose through some of their veins. The intern is amazed that I’m doing so well. But please. If you can get an IV in a 1 month old, you can draw blood from a 50 year old.

After I do some random errands for him, it turns out we have a guy in the ER there who probably is going to need his appendix taken out. So I have to go into the Operating Room with him. I draw blood on him & then I go to make sure everything is set. I am going to be operating with my old chief from Surgical Oncology. I pretty much hate this guys, but for a brief second, I get kind of excited, because I think I might get a shot at doing a lot of stuff.

But it’s not to be. He’s in a pissy mood. And he ends up screwing up a bunch of stuff during the operation. He starts trying to blame me for stuff. He wants me to hold something in place that is halfway across the body. When I do this, my head can’t help but be in his way. He yells at me to move my head. I look at him like, are you kidding? But the attending basically tells him to calm the hell down and leave me alone. I am so glad when we’re done.

After the appendectomy, I find my intern. It’s so obvious he’s scared, because he asks me to go around and just make sure everyone is breathing… literally… he asks me to walk from room to room and just check to see if they are actually breathing. It’s a ridiculous request. But I jump to my feet and go do it anyway. The guy’s scared. This is the best thing I can do for him. When I’m done, it’s 1 a.m. and he thanks me for everything I’ve done and tells me to go sleep.

Sleep is difficult. The bed sags so much in the middle that it’s like sleeping on a hammock. Which would be fine… except I sleep on my stomach, which if I tried to do here, would bend me backward.

When I get up in the morning, I feel pretty much cooked. All I can think about is going home and sleeping.

After rounds, my intern lets me go home around 9. Sleep is good.

Tuesday, September 11, 2007

After I wake up from my nap, I have a great afternoon of running errands.

Then I spend my evening talking with a fellow Christian sister that needed to talk through some stuff. It’s interesting, because I find that a lot of times when I am talking with others who need to talk… I end up offering advice in the way of sharing my own experiences as examples… and as I do so… I find that I end up gaining so much from the experience. In this particular case, it makes me realize again, just how much I have to be thankful for and just how much God has done for me along the way. It also makes me realize how negligent I have been in maintaining my own spiritual walk.

It’s a good day.

Wednesday, September 12, 2007

It’s another CABG! This time, they get the vein out of the leg using some tubes inserted into a small cut they make in the leg.

Once again, I get to see the heart and lungs.

On Monday, one of the nurses had told me about some of his favorite questions. One of those favorite questions involves understanding how 2 drugs (heparin & protamine) work. So on Tuesday night, I had studied heparin & protamine.

My attending asks me about heparin. I nail the question. He doesn’t ask me any other medical questions after that. Instead, we just chat. It’s a great feeling.

I get to go home by 4. Woo Hoo!

Thursday, September 13, 2007

We have Grand Rounds in the morning. It’s pretty boring. You see, every Thursday morning, we have to listen to a series of lectures. They tend to be fairly boring. At the VA, we watch the lectures at MCV via closed circuit TV. They serve breakfast, too! As we sit there, most of the room is empty. The students are all on one side and we are trying to read and study. We whisper to each other some, but it’s a lay low kind of situation. The Chief is there with the interns and residents. They are talking about all of the patients and stuff. One of the students is whispering a little louder than the others. The Chief asks, “What’s his name?” We don’t know who he’s talking about at first. So the Chief says, “He needs to shut up.” Seriously. Is that necessary? I can’t remember the last time anyone who was sober used the expression “shut up” in a serious way. What a freakin’ jerk. I don’t know why this guy is even a doctor.

Afterwards, I go to the OR for a lobectomy. This is where we have a patient who has cancer in the upper part of his right lung. So we are taking that part of his lung out. It’s pretty cool, because instead of opening his chest down the middle, we are opening him up inbetween 2 ribs from the side. As they are doing this, they call me over to their side to hold the lung out of the way so that they can staple off the arteries & veins. It’s pretty amazing. The lung in my hand feels like this gigantic squishy water filled sponge. It blows my mind to think that I am getting the chance to do stuff like this. They also have to remove part of the airway that this part of the lung is connected do. When they are done, they pull the piece of lung out and it’s like, Ta-daahh! I’m staring at this upper lobe of the lung in complete awe. It’s so cool! Then they begin to sew the airway parts back together so that they are reconnected. They let me get a good look inside to see what it looks like before & then let me see halfway through so that I can see the 2 parts of this tube coming together. I really love the surgeons on this surface, because they are so good about trying to show me everything.

I have to leave before they finish, because I have afternoon lectures. But this might be my favorite operation to have watched by far. I think mostly because I really got to see what they were doing and I got to help.

Friday, September 14, 2007

We have no surgeries today. So there is really nothing to do. I help out my intern a little bit. But basically, he sends me home at 1 p.m. I’m grinning from ear to ear.

Saturday, September 15, 2007

I got some bad news last night.

One of the kids I used to work with on the Peds Oncology Floor passed away. His name was Peter Choo. He had been fighting Neuroblastoma (cancer of nerve cells) for over 7 years. He was 13 when he died.

Peter was an amazing kid. Even though he was 13, he looked like he was 7, because of all of the chemotherapy and radiation he had had in his life. But he was smart and wise beyond anything you could ever imagine.

For his Make-A-Wish… Peter asked for a visit with Pope John Paul II. Unbelievable. And after initially saying that they didn’t think it was going to happen they did it.

Peter was an unbelievable food connoisseur. He ate every kind of nasty sushi & sashimi you could imagine. He loved oysters. My running joke with him was that when I first had him as a patient, I told him that when I left work I was going to get him an oyster. And then from that day forward, everytime he saw me, he would ask me where his oyster was & I would come up with a ridiculous story about how I went to get the oyster and something happened. My excuses got more and more preposterous everyday & it made him laugh.

Peter was an amazing chef. I’m not talking like making spaghetti or mac-n-cheese. Peter had me completely enthralled as he told me about how he made a Turducken for Thanksgiving. This is a chicken stuffed in a duck stuffed in a turkey. Most people order Turduckens. Peter made one on his own. Peter & I would talk about our favorite cooking shows. We both agreed that Rachel Ray was a lame cook. We both loved Iron Chef Japan & hated Iron Chef America. We were both HUGE fans of Top Chef & since the hospital didn’t get Bravo TV, I would tell him about each episode.

In the last year or so, Peter fell in love with tropical fish. Again… we’re not talking about goldfish or some tetras. This kid had a full-blown tropical environment. He knew what fishes he needed to put together to ensure an ideal ecosystem. He knew what fishes tended to be more aggressive… which were bad for corals… He had a 20 gallon tank. He showed me YouTube videos of his fish. My favorite fish moment came when he was in the hospital & he had to poop. He was in the middle of showing me and a nurse one of his videos & telling us about his fish. Well, his dad put him on a bedside toilet & the nurse & I were going to give him some privacy. Peter got on the toilet, pulled his laptop over and then started talking about his fish. It was so freakin’ cute watching this kid sitting on the toilet, while talking about his tangs & blue dories.

But my absolute favorite moment with Peter came one early morning. See Peter’s Korean, but I don’t think his family realized that I was Korean, too. They definitely didn’t realize that I SPOKE Korean. So one morning I came in because Peter had accidentally wet his bed, and his Dad wanted me to stay with him while he went and got stuff for the bed. Peter was half asleep, sitting up in bed. And I asked him in Korean, “Did you sleep okay?” Peter, still half asleep, nodded yes. I asked him in Korean, “Did you have any pain?” Peter, again, still half asleep, shook his head no. Then I touched his cheek with my hand and brought his head to my chest for a hug. I don’t know that I have the words to describe how special it is to share a quiet, whispered conversation with a kid in the early morning hours. When the world is quiet, and all you can hear is the hushed sound of each other’s voices. And feeling so much love for this amazing little man just welling in your heart and eyes. But even more special… was being able to share that moment in a language that was spoken to me as a child as well.

I’m going to miss Peter. I miss him already. I am so heartbroken that he had to deal with this awful disease. I am happy that he is no longer suffering. I am happy to know that he is at peace.

Thank you Peter Choo. For allowing me to be your friend.

Sunday, September 16, 2007

I go in for Rounds in the morning. We have a patient in the ICU named Mr. EC that had a CABG done about 4 weeks ago. He never woke up from the surgery. And he’s been having all kinds of medical issues since then. He’s 85 years old and the doctor who’s with us today is talking about discussing with the family whether or not we are going to continue keeping him alive. It’s a pretty sad situation, because I wonder why we even operated on him to begin with. At 85 years old, this is a pretty intense operation. I hope for a good outcome for him… I just don’t know what that outcome would be.

Surgery Week 8

Monday, September 17, 2007

It’s my last week of surgery! I can’t wait for this to be over. I am starting to get physically very worn down. I’m tired of all of the standing I have had to do. My feet and back hurt so much it’s not even funny. I hate that I almost never get to eat lunch. I hate that my body has gotten used to not eating for 10 hours at a time. But it’s almost done!

We start with Rounds. And we go to see Mr. EC. We have a different doctor with us today… and we bring up the discussion that we had on Sunday. How the surgeon on Sunday had talked with the family about removing life support. The surgeon today hears this and wonders why we are having this conversation. He feels that even though he’s pretty sick, he’s not in any actual organ failure. This just has all of the makings of an uncomfortable head on collision.

After rounds, we have… another CABG. How can this be so humdrum to me so soon? Sheesh. Our CABG patient is an interesting man. Mr. JZ was in the hospital, but asked if he could go home for the weekend before his operation. Why did he ask for this? So that he could watch the Virginia Tech game. Sheesh. They were just playing Ohio for crying out loud. He’s an interesting man. He lost his leg in the Vietnam War & he also has a ton of scars on his stomach from the grenade that tore through him. I’m in awe of what this man has been through.

His CABG goes well. And I’m very glad.

After the operation, we go upstairs to the Medical ICU to do a consult on a patient. The patient’s heart had stopped last week & so the team upstairs had started CPR. Well, the patient also has a history of osteporosis, so his bones are fairly brittle & between the different members of the team, they broke a bunch of ribs to the point where he has something called a flail chest. This is where a huge section of ribs has broken off & is not like a little island of broken ribs. The problem is these broken ribs are pointy & they can nick and cut things. This has happened to him and he now has blood in his chest cavity that is squishing his lung and collapsing it. He needs to have a chest tube placed. A chest tube is exactly that. It’s a tube placed in your chest. It is supposed to suck out air or fluid. Whatever it is that’s causing your lung to collapse.

I get excited, because I’m hoping my intern will let me do it! As soon as we get out of the room, he says I should do it. I get really excited! We go to talk to one of the attendings. He wants a CT scan to be done first. My intern & I look at each other, because we know what this means. A CT scan won’t get done for a while. I’m not going to get to do it. Oh well.

So instead, I have to settle for going home at 4:30. Not bad.

Tuesday, September 18, 2007

I go in for Rounds & we have an interesting situation. The 2 surgeons that had kind of disagreed about discontinuing life support on Mr. EC are both in during Rounds. They agree to talk to the family together. When we are done with Rounds, the surgeons go to talk to the family. After much discussion, the surgeons come back. The family has decided that as soon as the rest of the family arrives, they are going to remove life support. The surgeons put in an order for a large amount of morphine to ensure that the patient doesn’t feel any pain and to be given just before they take him off of life support.

It’s pretty intense. I am surprised by how matter of fact this seems to be to everyone. I understand that death happens all of the time. But in this case, we are taking a person off of machines that are keeping him alive… and we are giving him a significant amount of medication that is going to hurry up the process of dying. I’m a bit conflicted. I’m not quite sure what to think about this. On the one hand, he is 85. He has no real chance at a meaningful recovery. Even if he gets through his sepsis, the best possible outcome for him is going to involve continuous nursing home care. But I don’t know how I feel about the fact that we operated on him to begin with. And that we were going to accelerate the death process.

I don’t really get to figure this out, because I have to go into the OR for another CABG. This time, I get to help open the chest up. After the attending is done with the saw, I help pull the chest open & then I help him as he works on the arteries. I am having a blast… but then a second surgeon comes in and I have to step away & let him help. Poop.

But I DO get to some stitches! They have to take the vein out of the leg by opening up his leg from his ankle area all the way up to his groin. So they let me do about 5 inches of sutures. The Physician’s Assistant tries to be a big shot & tries to show me a way to do it that he thinks is great. It’s not a great way to do it. It’s awkward & kind of dumb to be honest with you, because it uses really poor mechanics. He can’t figure out why I’m having so much trouble with it… but when his back is turned, I just start doing them the way I was taught by the Surg Onc surgeons. When he comes back, he goes, “Wow! That’s Great! Where did you learn to do that?” I laugh and I tell him I’ve only done this twice, but I got to watch it done this way on Surg Onc. He leaves me alone. When I’m done, I look up and down the leg. My area of stitches is so obvious, because it is perfectly even & it is not leaking at all. I am very happy with the job I did.

I go back up to the heart & they have me hold the heart for them while they sew the veins to them. The operation has gotten to be same old same old. But holding a human heart is just as exciting as it was the first time I did it. His operation goes well.

When I come out of the operating room, Mr. EC is gone. His bed is gone. The room is empty.

I get sent home at 4.

Wednesday, September 19, 2007

It’s Wednesday. It’s my last day of operating. I am tired from doing 2 CABG’s in a row. The exhaustion of surgery has accumulated & now I feel like a 90 year old man trying to walk on beat up feet. But I’m also giddy, because I know this will be my last day in the OR.

We are doing… drum roll please… another CABG. It goes very smoothly. I don’t end up doing much. And at 12:30, the attending jokes about the fact that all I saw was CABG’s. He asks me if I am going to be in the afternoon surgery. The afternoon surgery is a pacemaker removal. It’s supposed to be a 30 minute operation. But my intern had already told me I could leave after the CABG. So I tell him that I won’t be in it. So he tells me to then go at least talk to the patient before I leave, because he has an interesting story.

I go to speak to Mr. IG. Mr. IG is 24 years old and originally from Puerto Rico. When he was 22, he started getting really short of breath all of the time and he was always tired. When he went to the hospital in Puerto Rico, they discovered he had Idiopathic Dilated Cardiomyopathy. This is a disease where your heart chambers start getting really big & the heart muscles just aren’t working very well anymore. So you’re not getting the blood that you need anywhere. The thing is it’s idiopathic, which means that no one knows why it happens. They brought him to MCV where they put him on an artificial heart. He had the artificial heart for about 5 months, before he got a heart transplant. We talked about what it was like to have the artificial heart. And we talked about how cool it was to have had 3 hearts. He had his own diseased heart, he had an artificial heart, and now he has a great brand new heart. It’s a cool story. I love hearing it.

And then… I go home… at 1 p.m. It feels freakin’ great. But the downside… is that I have to study for my Surgery Shelf Exam, which is the written exam for all 2 months of surgery. It’s a National Exam, so it’s not necessarily based on what I got to see here. I also have my Oral Exam in the afternoon.

I try to study… but it’s hard. I’m tired. And I just want to sleep.

Thursday, September 20, 2007

My written exam is brutal. I’m laughing because it’s so hard. But it’s done.

My oral exam… I crush. They are supposed to ask 4 questions. They only ask 3 because I clearly know my stuff.

And that’s it. I am done.

I can’t believe it’s been 2 months. I can’t believe I’m done with surgery. It was a hard 2 months. I saw a lot of cool stuff. I learned a lot. I feel smarter than I have ever felt in my life. I know that if I got through surgery, I can get through anything.

I am so thankful for God carrying me through, because I know beyond a shadow of a doubt that there is no way that I got through this on my own.

I’ve seen a lot of good things. I’ve seen a lot of bad things. But most importantly… I am getting a better and better sense of the kind of doctor I want to be.

Surgery Week 5 & 6

Surgery Week 5

Monday, August 27, 2007

Today, is my first day on my new surgical service, the Transplant team. Everyone who heard that I was doing Transplant surgery asked me, “WHY???? What did you do to get stuck with that???” Apparently, Transplant surgery has a reputation for being extremely tough. But I’m lucky, today. There is NOTHING going on. For the most part, all I do is sit in the team room and try to read, while meeting everyone.

One thing I did get to do was go on a consult on a lady with an infected AV graft. You see, patients who have constant kidney problems have to go on dialysis. Dialysis involves taking your blood, filtering it, and giving it back to you. This is what your kidneys do all the time.

So in order to make this work easier, a lot of times, they will do a surgical procedure where they connect an artery in your arm with a vein in your arm. This is called an AV Fistula. If you have to use some artificial tubing to connect them, it’s called an AV Graft.

We were called to check this lady’s graft to see if this lady’s graft needed to come out, because she was showing signs of endocarditis (infection of the heart… usually the valves).

Afterwards, I met one of our attendings and our Chief talked about the case with the lady. She is a bad surgical risk, and it looks like a dangerous thing to do. All of a sudden, the attending looked at me and pimped me by asking what are the causes of endocarditis… I was COMPLETELY shocked, because I was under the impression that attendings didn’t really talk to students on this service. But I blurted out, “IV Drug Use, Rheumatic Fever, and Lupus.” Ding Ding Ding! He said, correct… and then also told me about some unusual causes like colon cancer for some reason…

At 5:30, my chief told me to go home. He told me that it was okay to wear scrubs all day on days that we’re not in clinic and that I had 3 kidney transplant procedures the next day!

It was… a great day!

Tuesday, August 28, 2007

Rounds are SO much easier and efficient on Transplant. It’s amazing how well everything works.

Overnight, we had a patient who got a kidney and pancreas transplant. The donor was a young teenage girl who was riding on the back of a truck and the truck hit a bump and she got thrown off the back and hit her head. Lesson learned… don’t ride on the back of a truck.

The other kidney is going to a Ms. LM this afternoon.

But before that transplant, we are taking the kidney from a middle aged son, Mr. EC Jr and transplanting it in his dad, Mr. EC Sr.

I watch the kidney removal, watch the kidney get prepped to be implanted, and then go to watch the kidney get put in.

It’s a really really long process. The attending for the 2^nd case is the head of transplant surgery. He’s pretty intense and scary. He asks me a whole bunch of questions about myself… including whether I was religious… and what religion I was… I obviously answered these questions honestly and openly, but I couldn’t help but wonder… where the heck is this going? Very weird. He asked me a lot of questions about my life story and how I came to med school and what I was interested in doing. I think he thought I had a pretty interesting life story.

It was hard to see a lot for both of these operations… but it was really exciting cool to see the kidney get implanted and go from being whitish gray… to a pretty pink. And then getting to feel the blood as it flows through the artery was really amazing.

Right after that, I scrubbed in to see Ms. LM get her kidney. This time, it was brought in on a special machine that kept preservative and blood flow running through it. It was pretty amazing. I got to watch it taken out of the machine, and prepped. And then… when they had opened up the space in Ms. LM and they were ready for the kidney… I finally got my moment…

Perhaps, I should explain… when I used to work in the ER, I was working a night shift… and around 4 a.m., they called me to the front and asked me to transport a lady in a wheelchair to a room upstairs. As I took her admission packet, I looked down and saw that she was here to get a heart and lung transplant. So I started talking to her about it. And when I dropped her off… I remembered feeling so privileged to be the person that got to take this woman up to get a new lease on life. And as I left the room, I shook her hand and said, “Good luck with your transplant today, ma’am… and congratulations.”

I walked back down that morning feeling so incredibly happy about my job and being so thankful to God for giving me a chance to walk with people in this way.

So back to Transplant surgery… when I assigned myself to Transplant surgery… I was a little reluctant, because it was known for being kind of tough… but the one thing that convinced me to take the hit… was the prospect of possibly being able to deliver the organs for someone getting a transplant… whether it be taking a cooler to the helicopter people… or bringing in a cooler to the OR.

But in the OR, now… I looked up as my attending said to me, “Dr. Lee… would you like to bring us the kidney?”

I said, yes, sir… and walked over to the table and picked up the basin filled with ice and saline solution and the kidney… and carried it over. The Scrub Nurse laughed and said, “Don’t drop it.” Right. Like that thought wasn’t SCREAMING through my head about a million times. And I felt this rush of joy and happiness run through my body as I brought the Kidney to the table… and getting the opportunity to play a small role in giving Ms. LM a brand new quality of life. Everything else after that was a bit of a blur. I got to see the kidney pink up. I got to feel the blood flowing through the vessels. I got to see urine coming through the tubes.

All of that was great. But the most important thing… is that I was able to have the one moment that I was hoping for more than anything.

All in all… I spent 10 hours straight in the OR… with just a chewy granola bar for lunch… My back, feet, calves, and shoulders were KILLING me… I struggled at times JUST to stay awake… they sent me home as soon as the surgeries were done…

Wednesday, August 29, 2007

After 10 straight hours of surgery, I wake up this morning feeling like someone beat me with a baseball bat. Walking in to the hospital, all I can think about is when I get to sit down.

Rounds are a little painful just because I’m so tired… but it’s really satisfying to see that all 3 of our kidney patients are doing well.

After rounds, we have some down time. I am very grateful for it.

Later in the morning, we get a call for a surgical consult on a former transplant patient with a large abscess on the back of his neck. I go to the clinic with the fellow… it’s pretty gross… and the patient has less than desirable personal hygiene…

It looks like he is going to get taken into the OR to get it drained.

That afternoon, we go to clinic. I don’t actually get to do anything… but we see some interesting stuff. One of our patients got an AV Fistula done a while ago and I get to feel and hear it. It’s amazing what these things feel and sound like! Listening to it is like hearing a whirring and whooshing of an ultrasound machine. It’s amazing.

It’s a fairly uneventful day. And quite frankly… I really needed it.

Thursday, August 30, 2007

Thursday mornings, we have Grand Rounds. Grand Rounds is a lecture with all of the residents, interns, and students. It’s usually on a topic that has very little to do with the students. Today’s session is on the hospital’s disaster plan. On our way in, I run in to my old Chief. He’s sitting down and he looks at me and he says out loud to no one in particular, “I miss Kevin.” I laugh and say, sorry. I’m thinking, ha ha ha ha ha!

One of the residents that I was on call with sees me and says, “Hey, are you on call this weekend with me?” When I tell her no, she gets disappointed. It’s cool to know that as a medical student, I am becoming someone that others want to work with. As lost as I feel most of the time, it’s good to know that I am not coming across too terribly confused.

When we get back to the floor, I see Mr. EC Jr walking down the hallway very gingerly. He was the one who donated his kidney to his Dad. He was trying to find his way to his Dad’s room and didn’t know where he was. So I lead him there. And when he walks in, his Dad looks up. And EC Jr says, “Hey pop.” Sr says “Hey. You hurtin’ much son?” And Jr says, “Naah.” And he sits down and the two of them just tap each other’s shoulders. And sit quietly. It’s a simple scene… one that you’d probably see a million times… except for the fact that one son gave his Dad an incredible gift that would dramatically change his Dad’s quality of life. How incredibly cool.

That afternoon, we have D&C (Deaths & Complications). We talk about Mr. WW. It sucks. They talk about this man’s passing and the complications that led to it. It’s so… I don’t know… I don’t have the words to adequately describe it. All I kept thinking was that… this discussion just did not do this man justice.

Friday, August 31, 2007

Today is a pretty busy OR day. My first case is a parathyroidectomy. This is a pretty complicated procedure. And I’m in with a pretty intense doctor. I get asked some questions by my chief before I go in… and I do well. I get asked some questions by the attending… I miss the first one… but then I recover and do pretty well… The operation is pretty tricky. And some stuff goes very badly. And this attending throws these really intense, stressful temper tantrums every time he doesn’t get exactly what he wants. He has me holding retractors for him, and he gets mad at one point and positions my hand a certain way and says, “THIS is how you hold this.” About 5 minutes later, he gets upset because he can’t find what he’s looking for. He looks at my hands and says, “Why are you holding it like that? Hold it like THIS.” Keep in mind… I haven’t MOVED since he positioned me. About 10 minutes later, he gets frustrated and yells at some other folks… then looks at my hands and says, “I told you to hold it like THIS.” Again… I haven’t moved since he positioned me. What a delightful man.

At various times during this operation, I contemplate WHY I am even doing this. I have elaborate fantasies of me just dropping the retractors and walking out of the OR. I picture myself walking down the hill, getting in my car, and driving home to Fairfax. I imagine other things I can be doing for a living… ALL of them involving waking up at 9 or 10 a.m.

Of course… after thinking about all of this… I also remember all of the ways that God brought me to Medical School. And I laugh. He got me through everything up until now… he’ll get me through this.

After 5 hours of this painful cycle of him yelling and throwing temper tantrums, I am exhausted… and all I want to do is drink a gallon of water and eat a gigantic bowl of food. I don’t care what kind… any kind.

I have just enough time to inhale 2 chewy granola bars and then I have to go back into the OR… with the same Doctor. It’s another painful case. The patient is getting a graft removed from her arm. She is at high risk for anesthesia, so instead of putting her to sleep, they do a nerve block on her so that she will not feel any pain. She is also NOT supposed to be able to move her arm… but the docs that did the nerve block didn’t do a good enough job… and even though she can’t feel her arm, she is still moving it. This causes a LOT of stress during the operation. And the disturbing thing is that the Attending is in such a foul mood that he’s YELLING at her to stop moving. It’s really nasty and stressful in there. He’s yelling at an 86 year old woman. I understand how stressful it is for her to be moving her arm… but it’s so unnecessary to be this way.

After 2 hours of this crap, we’re finally done. When I get upstairs, I find out that one of our patients, Mr. DD, who was admitted that morning is looking like he has a serious problem with his liver transplant. He had gotten his transplant 3 weeks ago. And now part of the transplant is leaking in a very bad way. He gets rushed to the OR. In the OR, they discover that one of his arteries is completely blocked. So it caused part of his liver to die off. It’s really stressful in there, because nothing is going right. There are 2 attendings and a fellow that are scrubbed in. I’m over by the wall watching. There is a lot of yelling. I decide it might be best to leave.

Upstairs, we sit in the war room and we talk about the mess of the situation. About an hour passes and the attendings come in. He needs a new liver. The thing is… we actually had a liver that was supposed to go to another patient later that day. So now what do we do? Do we give the new liver to Mr. DD? Or do we give the liver to the person who was supposed to get it? The thing is… it’s not entirely up to us… because there are rules that control these situations. Our attendings put in a formal request to find a way to give the new liver to Mr. DD.

I leave that night not knowing what’s going to happen.

It’s labor day weekend… and I actually have 3 days off. I am going home to NoVa to get some serious sleep and some good food.

My first week of transplant was a weird ride. There was a lot of cool stuff… but some moments when I was absolutely miserable.

Saturday, September 1, 2007

I drove up to NoVa in the morning.

It’s funny how much you get used to living a ridiculous life. Being at home, I couldn’t get over how weird it was being back to a normal life. I didn’t realize how tired I was. I didn’t realize how drained I was. I didn’t realize how much I didn’t want to go back.

It’s good to be home.

Sunday, September 2, 2007

I sleep like a rock and then wake up to go to church. It’s great to see everyone. When I was teaching Sunday School, I would walk through the church in the mornings and get hugged by about a thousand kids ranging from 4 to 20. I miss that. I see one of my favorite girls who jumps up into my arms and kisses me on the cheek. She says she's not letting go until I die. I think everyone needs to hear that from time time.

I also get to spend time with one of the high school kids that I didn’t get to see all summer. We sat down and had time to talk. I realized as I was talking to her that this is where God needed me to be… and she needed to hear what I had to say.

I spend the evening starting to feel relaxed… I spend the evening just talking with my Mom. I don’t want to go back. But I know I can get through the rest of surgery. I just have 4 more days of Transplant Surgery… and then I have Cardiothoracic at the Veterans Hospital. Cardiothoracic is supposed to be very laid back.

So I know that if I can just get through 4 days of Transplant Surgery, I’ll be okay. I’m driving back to Richmond on Monday morning to finish this out.

I think I’m ready.

Surgery Week 6

Tuesday, September 4, 2007

I go back to the hospital feeling well-rested!

I find out that the liver went to Mr. DD and the original person was sent home. I’m told everything went well. And he actually looks great. I still can’t get used to how a patient can be so sick, have their insides opened up… and then later on… look perfectly okay. It’s so weird.

One of our patients who got a Kidney and Pancreas Transplant, Mr. LS is doing so well. He’s mentally not all together. This happens when people get sick. He was so out of it that his nurse walked and found him trying to drink from his own surgical drain. Oh God.

Today is a semi-busy OR day. We have a Kidney Harvest and Transplant today. This particular situation is interesting. This is a “Variance” Donation. “Variance Donation” works like this. Suppose someone wants to donate a kidney to a relative. But they are not a good match. Well that person can instead, donate to the Transplant List anonymously. If they do this, then their relative goes to the top of the list for the next available matching kidney.

Our lady today is doing this… not for a relative… but for a friend… that she met on the internet… Hmmm… a little weird…

She also wants pictures taken of as much stuff as possible… She says she wants to use the pictures to encourage people to donate their kidneys. I wonder if they did a proper Psych evaluation on her…

I watch both the harvest and then the transplant. The attending for the transplant is the scary one. But he actually isn’t too bad today.

Afterwards, I go to watch them put together an AV Fistula. It’s so cool to see them sewing a gigantic vein to an artery.

At the end of the day, I have been on my feet in the OR for 10 hours again. I am so freakin’ tired. Once again, all I get for lunch is 5 minutes with some nutri-grain bars. It’s funny because you get hungry and lightheaded for about an hour… and then after that you’re just too hungry to be hungry.

Still… seeing a kidney turn pink after it’s been implanted? UNBELIEVABLY cool.

Wednesday, September 5, 2007

I am starting to find my groove. I am getting faster at getting stuff done. I’m getting better at being helpful. It’s a great feeling to no longer just feel like extra baggage.

It’s not a SUPER busy day in the OR, but there’s enough to keep me busy.

One of our patients is an 8 month old baby who got a liver transplant at 2 months old. He actually got part of his Mother’s liver. His name is THM. He was born with a disease that causes his blood and liver to hold on to too much iron. It’s usually fatal in babies. He had been doing okay after his transplant, but now he keeps having this weird cycle of developing fevers and watching his Red Blood Cell Count drop. They can’t seem to figure out what’s going on with him, so today, we are doing 3 things. We are putting in a Central Line because they have been having a TOUGH time starting IV’s on him. We’re then doing a liver biopsy and a bone marrow biopsy.

He’s such a cute baby and I feel so bad for him as he lies there unaware of what’s going to happen to him. When they knock him out so that they can intubate him, it is really disturbing to see his limbs just go completely flaccid. Intubation is when they a patient gets a tube put down their throat and just above their lungs so that they can be kept breathing while at the same time knocked completely out. I’ve never seen a kid go from being awake to being intubated before. It’s a little hard to get used to.

The Central Line gets put in. The liver biopsy goes well. It’s time for his bone marrow biopsy. I have sent off many kids to GET a bone marrow biopsy done. I never knew that THIS is how it gets done. It is incredibly BRUTAL to look at. A gigantic needle that looks more like a pointed stake is pushed with a TON of force into the patients hip bone area. Then they use this handle on top to just screw the needle deeper and deeper until they get a good section of bone marrow. It looks UNBELIEVABLY painful.

While we are in the OR, I find out that we have a kidney transplant scheduled for that afternoon. It’s for a nice grandmother named Ms. MH. When I meet her, she spends some time telling me how excited she is to get this kidney. It turns out that because her kidney has been giving her difficulty, she has been on fluid restriction. This means she can only drink so much liquid a day. She tells me the one thing she is looking forward to the most is that she will be able to drink as much as she wants. I am really happy that she is getting a kidney.

Her operation takes 5 hours. I can’t believe how painful it is to just stand. The operation goes well though.

I limp home at the end of the day. I can’t wait to sleep.

Thursday, September 6, 2007

A really uneventful day.

A lot of classes.

Blah.

I think I get MORE tired when I’m not doing anything.

Friday, September 7, 2007

I’m a little excited about today. First off… it’s my last day of Transplant Surgery! Woo Hoo! Second off… I’m going to get to see my first laparascopic operation! That’s when they stick these cameras into the belly and use special instruments to do what needs to get done. It’s cool because it makes it easier for the person to recover.

I am going to see a person’s gall bladder get taken out, followed by a liver biopsy (sampling of the tissue for testing), and an RFA. An RFA is where a special probe is inserted into an area and high frequency radio waves are transmitted in order to kill cancer cells.

My Chief pimps me before we start, but I nail the questions without any problem. The surgery itself is pretty cool. And it’s with one of the nicer attendings. When the surgery is done, the attending leaves and it’s just me and my Chief. There are about 5 incisions to suture up. My Chief lets me suture up 2 of them. They look great. I know it. He knows it. He’s impressed. It feels GREAT to be able to do some stuff.

The next surgery is an AV Graft. My Chief and I start off without the attending. He lets me Bovie, which is the electrical scalpel. It’s so freakin’ cool. And unlike LAST time, my lenses aren’t fogged up and I can see without any problem. It feels great to finally get to do some stuff.

There were 2 kidney transplants that were done overnight. The kidneys came from a person who had Hepatitis C and they are going to 2 patients with Hepatitis C. One of the recipients also has HIV. Here’s the problem though. Neither of them is producing any urine. This is a HUGE problem.

On top of that, 1 patient is having trouble getting rid of their Potassium, which is potentially damaging to the heart.

The other patient is getting dialysis since she is unable to urinate. During dialysis she develops terrible pain and numbness in her right hand. She doesn’t have a pulse in her right hand and when we get an ultrasound, we see that 1 of the 2 main arteries that supply the hand is completely blocked. The other one is almost completely blocked. Normally we would give her blood thinners. But the problem is… she JUST got a kidney transplant. She can’t get blood thinners. No one seems to know what we’re going to do. As it gets to the end of the day, I am feeling very glad that this is my last day of transplant. I get the feeling that things are going to get bad.

When they decide to send me home, they tell me that I did a good job on the service. It feels great to get the compliment… but even better just to know that I’m done… and I survived.

Transplant Surgery wasn’t necessarily as bad as Surg Onc. There was one attending that was incredibly intense. But everyone else was really nice and fun to work with. The surgeries were REALLY long. I’ve learned that I can go a long time without peeing, drinking, or eating. I’ve learned that it just might be possible for a person to sleep standing up. I’ve learned that the simple act of standing is BRUTAL on your feet and back.

All of this is going through my head as I head home… and I realize that I was a little anxious when I was in NoVa for Labor Day weekend. I was afraid that I was going to be in more uncomfortable situations with my attendings. I was afraid of how I was going to handle the long surgeries. But everything went well this week. That’s when it hit me… getting through this week as well as I did... wasn't an accident... someone was praying for me this week. And I knew who it was.

I called home and I thanked my Mom. She asked me how I knew. I told her I just did. I thank her and my Dad. And I tell them that I love them.

It was a good week.

Sunday, September 9, 2007

I’m on call today. When I get there, I find out that one of my friends who was on at night is still down there in the middle of a call. I go to relieve her and find out that she wants to hang out and suture the patient up, because she’s never had the chance to do so. As she gets ready, she suddenly realizes… she doesn’t know what she’s doing. And the residents are busy doing some other stuff. So I decide to talk her through it. And it’s so cool, because I realize how much I’ve learned. Both she and the residents comment on how good a teacher I am. It’s a cool moment.

We get a call that comes in later that day. It’s a guy who was in a car accident and was unconscious and not breathing and didn’t have a heartbeat. One of the other guys on call decides to take it. So I stand back and watch. There’s a nursing student there as well. When the guy is brought in, they are doing CPR on him. I stand back and watch with the nursing student and this nurse that comes in from another floor. I explain to her everything they are doing and why. They ask me a bunch of questions and I sit there and explain why we don’t do certain things, what kinds of injuries you worry about in these situations. It’s really cool. I can’t believe how much I know at this point. Then the nurse looks down at my ID and says… “wait a minute… you’re just a student!” And I say, yes, ma’am. And she asks me how I know all of this… and I tell her I just do… and that I used to work in an ER before. She asks me if I’m going into Emergency Medicine… I tell her I’m not… and she can’t believe it.

The guy didn’t make it. But in a situation like this… they almost never do. When a person is in a trauma and their heart and lungs stop without any obvious injuries on the surface… it’s never good. When they used the handheld ultrasound on him, he basically had a ton of blood just filling his chest cavity and abdomen. He never had a chance.

That’s the only call of the day really. So we spend the rest of the day just studying. It’s a great and relaxing way to transition out of Transplant. I can’t believe it’s been 6 weeks since I started! Where does the time go?

My next rotation is Cardiothoracic at the VA. I’ve heard this is a cool rotation. And that the people are really laid back. I’m really looking forward to a laid back rotation.

Surgery Week 4

Sunday, August 19, 2007

I’m on call tonight. That means I have to stay at the hospital from 7 p.m. until the next morning… and then continue to work through the hospital day. It’s a long night. We keep getting trauma calls that we have to go down to. There doesn’t end up being a lot to do with each trauma that comes in, but we all have to report to each one anyway. I get about 2 hrs of sleep. And then it’s time to go to work…

Monday, August 20, 2007

It’s 5:30 a.m. and I’m getting ready for rounds. I feel kind of nauseous because I’m so sleepy. I slept about 2 hrs total, but not in a row. It’s amazing what happens to your brain when it’s sleep deprived. We start rounds and my Chief is in a bad mood. Rounds are even more disorganized than normal. I get to see Mr. JC and do his dressing. And I’m so happy to see how good it looks. I look forward to seeing Mr. WW because I want to know how he’s feeling, but we don’t go to see him today… which is a bit odd.

Rounds are over and it’s time for the OR. I’m only supposed to be in 2 surgeries today. But my first case is with a pretty intense doctor. I’m a little worried, because I don’t know how I’ll do. The surgery is the removal of a benign lump in the breast, which is weird, because we don’t usually remove lumps from the breast unless there’s something wrong with it. There wasn’t a lot of information about this surgery in any of the records, so I didn’t really understand why we were doing it. So of course, when we start, he asks me why are we doing this surgery today. And I’m honest with him, by saying, I know we’re removing a lump from her breast that’s benign, but I don’t really understand why. So he asks me how I would go about evaluating a person who came in with a breast lump. I go through the entire workup I would do and what tests I would do. In the end, I come back to the same conclusion… I’m not really sure why we’re doing this. So he asks me, “So am I an idiot? Am I completely wrong for doing this?” I tell him, “ I don’t think so, sir… but I don’t know why.” And he laughs and tells me that my answers were completely right… the only reason we’re doing it, is because she wanted it out. I almost laugh out loud with relief, but I just keep it to myself. The funny thing is, when we take out this lipoma, which is just a fancy word for fatty tumor, it actually looks… kind of pretty. Strange thing to say, don’t you think? I mean it’s smooth, perfectly encapsulated… pinkish with swirls… it looks very very pretty… Strange how mother nature works… things that are harmless look really good when you take them out… cancer just LOOKS really bad when you take it out.

But during the surgery, the doctor and my chief are talking… and I find out why we didn’t see Mr. WW today… He passed away over the weekend. I feel my heart sink right there in the OR. I’ve seen a lot of death in my life. I’m not naïve. I know Mr. WW had a really bad prognosis. I just feel awful knowing that I was part of the team that was taking care of him and yet we couldn’t figure out what was wrong with him in time to help him. I remember that on Saturday, he was complaining about not being able to breathe. Well… it turns out… he died of respiratory failure… And that just makes me sick. When I find out the details of how he passed, I feel even worse. And I don’t care to share them. Even as I write this down, I feel my eyes well up and my heart hurt just knowing that I couldn’t help him. Even worse… I’m angry that no one on the surgical team was willing to sit down and talk to us about it. I’m angry that no one decided to help us to come to terms with his passing.

We have an attending session in the afternoon. Once again, it’s an intense session where we get asked questions as we talk about mechanical ventilators. This is NORMALLY tough even under normal conditions… being sleep deprived makes it about a million times worse. I can’t even think.

When we’re done, we figure they already had afternoon rounds and we’ll be able to go home. But no. Of course not. We have to freakin’ hang around and wait for rounds to start… then we start rounding and we serve absolutely ZERO purpose. Then all of a sudden our chief just disappears. So we have to go back to the break room and wait. At 7 freakin’ p.m. we finally leave. I go home and pretty much just go straight to sleep.

Tuesday, August 21, 2007

I wake up at 4 a.m. feeling like someone beat the crap out of me. I’m so glad that we aren’t in the OR today, because I think I would fall asleep standing up if all I were doing were standing there.

During rounds, I still can’t get over Mr. WW.

Today is conference. Conference is usually when the interns and residents get asked a bunch of questions. But for some reason today, we, the students, get asked questions. They start talking about PET scans, and they ask us if we even know what a PET scan is. I tell them yes, and they look at me, and say, oh really? Well what is it then? I totally nail the answer. The response I get is, “that’s exactly right.” It’s absolutely stupid that this should make me happy… but it does.

After conference, we have clinic. I brought M & M’s for the nurses today. They are very pleased with me. During afternoon clinic, I see Ms. DW waiting in the lobby. I go out to say hello. She’s the patient that I got to do the incision on. I love seeing her, because she’s a cool lady and because she is the first and probably only patient that I ever got to do an incision on. I actually take her drain out for her today. Of course, I have everyone hovering over me as if I’m an idiot. You just have to tolerate it. But I feel cool doing it.

Towards the end of afternoon clinic, I had a really amazing experience. I was about to see a patient, when one of the surgeons stopped me and told me she had a job for me. It was weird, because there were other med students around, but for some reason, she came to me. She said she wanted me to go upstairs to the Pediatric floor to do a surgical consult. Now, here’s the thing. A surgical consult is when a surgeon is called in to evaluate a patient to see if they need and/or can tolerate surgery. This is not a job that is given to medical students. It’s usually given to an intern. I am incredibly honored. She gives me the name of the patient, and I recognize the name as a surgery that I was in on before. We took out a lymph node from his armpit to evaluate him for cancer. I actually got to sew up his surgical incision. When I tell the surgeon, that I was in on his surgery, she gets excited and says, “Great! That’s even better!” So at least I know that she didn’t give this job to me for that reason, seeing as how she forgot that I was in on it. I have no idea how to go about doing this special job… but I wasn’t about to pass it off to anyone.

When I get upstairs to the Peds floor, I find that CH isn’t there. He’s at Radiology getting fit for a special mask for future treatments. I don’t know what I should do. I sit there feeling kind of unsure of myself… when I notice on the board… the name of a very special patient I used to work with. Her name is SD. I used to work with her when I volunteered at the Peds Onc Clinic. She has bone cancer and I first started working with her when she lost her leg. She wasn’t very talkative back then and I didn’t blame her. This beautiful girl had every right to be upset that she had to lose her leg. This was probably the first kid with cancer that brought me to tears just by looking at her. She became my most special patient here at MCV. Whenever she was admitted to the hospital, I would go visit her. I’d mostly just play cards or sit with her while she watched movies. We didn’t talk much, but we had a good rapport. We always looked at each other behind people’s backs and rolled our eyes at how goofy people could be. It was cool. I was with her on her last day of hospital chemo. I was so happy for her.

Well, sometime after that, she relapsed. I wasn’t part of the hospital system, so I couldn’t really go visit her. And I felt awful not knowing what was going on with her. So seeing her name on the board was an absolute Godsend. So I went in to see her. And we had a great chat. She was so much more talkative than when we knew each other before. It turns out she’s relapsed a 2^nd time. I know what this means. I know that her chance for survival isn’t good. And I understand that this is probably part of the reason our paths crossed again. I know that this is one of the things that God has called me to do. I know that I connect with kids that are terminal in a way that is unique. And I know that God brought us together again so that I can walk with her during this particular part of her journey.

When I was done chatting with her, I came outside… and CH was back. Coincidence? Yeah, right.

When I went in to see CH, my heart sank. When I saw him 2 weeks ago, you could easily see and feel swollen lymph nodes all over him. Now, the swelling around his neck was so bad that his neck looked like a bullfrog. This is not a good thing. For his lymph nodes to grow that much in such a short period of time does not predict good things. I did the consult and wrote down as efficient yet thorough note as I could. When I present it to my senior resident, he tells me he’s impressed.

I didn’t leave the hospital until 7 again that night… but somehow, I felt good about the day.

Wednesday, August 22, 2007

Rounds are getting worse and worse. I hate them. The only bright spot to the day is when I got change Mr. JC’s dressing. He is reading a children’s story bible. I ask him what story he’s reading and he says, the story of how Jesus fed the many. I smile and say, “5 fishes and 2 loaves, sir. 5 fishes and 2 loaves.” He laughs and asks if I’m a Christian. I tell him, “Yes, sir. I absolutely am.” And I tell him that my favorite story in the Bible is the story of Joseph. I find it for him and watch as he starts reading with that look of wonder that only children get. And I think how much God must love that despite all of his suffering, Mr. JC still has the faith and innocence of a young child. I think of all of those people out there that are better educated… and I laugh at the wisdom Mr. JC has in comparison.

It’s an OR day. I’m not in many surgeries today. My first surgery is a tumor excision from the leg with the head of surgery. When I go in to talk to my patient, I see someone from anesthesia trying to start an IV on her. For some reason she looks familiar, and I realize that I had seen her around the hospital up at INOVA Fairfax. I ask her if she used to work there and it turns out she did. She was a nurse up there and she’s in Nurse Anesthesiology school now. It seems like a small thing… but at this school… it’s always nice to meet another Korean! Whenever I get a free moment that day, we chat about Korean food and NoVa. Anyway…

The surgery itself is pretty cool because we actually take part of the inner thigh muscle with it. And as they cut the section of muscle away with the electric scalpel, the muscle twitches… keep in mind, this makes perfect sense, because the electric cautery is passing electricity through the tissue. But it still looks cool.

When we’re done, I have to keep an eye out for CH who is my next surgery. I did the consult on CH, and basically he’s just getting a special line put in that will allow him to get chemo without getting stuck all of the time. But this morning, his blood isn’t clotting right, so he can’t get operated on until they give him a transfusion. So I bounce back and forth between looking at the computer, going to the Peds floor, paging the interns with update, and checking the OR schedule. Over the course of the day, I probably walk about 15 miles going back and forth. During one of the times I’m upstairs, I see SD again on the Peds floor. We exchange email addresses and I’m so happy that we are reconnected.

At 3 p.m. I finally get CH ready to go to the OR. When we get to Pre-op, his Mom says she’s glad I’m going to be in the OR with him. Of course, that’s when I get paged. We’re having teaching rounds. I ask the surgeon what I should do. She tells me I need to go to teaching rounds. I’m so upset, I can’t even explain. I spent the whole day trying to get this kid in for his operation. And his Mom tells me she’s glad I’m going to be in the OR. And now I can’t go in. When I get to teaching rounds… I find out… big surprise… that we have to wait. An hour passes and I am getting bitter. When all of a sudden… I find out that teaching rounds are canceled… and we’re just doing regular rounds. I get so mad I think I’m going to punch something. My friends try to cheer me up, but I’m upset.

To make matters worse, Mr. JC has been sent home. As we stand in his empty room, my chief laughs and says that when someone has been in the hospital for this long, when they finally go home, they are usually back within 48 hours or they die. And he laughs. At this point, I am inconsolably angry. We’re in the hallway as my chief goes to a different room and I start talking to my friends about how this is why I hate surgery as a profession. The callousness that forms about anyone other than themselves. I’m all but shaking, I’m so pissed. When we get to the Pre-op/Post-op area to Round on some post-operative patients from the day, I decide I’m not going to round anymore. I go out to the waiting room where I know CH’s Mom is probably waiting for his operation to be over. And we sit and talk for a bit. It’s a great conversation and I know that she needed it. Of course this is how God’s plan always unfolds, right? I wanted to be in the OR. But obviously, I was more needed in the waiting room with his Mom. And my anger and outrage were what put me there rather than just rounding as normal.

But of course, all of this great perspective doesn’t come until a while afterwards. I leave the hospital at 7 still seething mad.

Thursday, August 23, 2007

When I get to the hospital, we have a little time. I’m sitting at the nurses’ station and I ask the night secretary for something. I know it’s kind of a pain in the butt and I feel bad, so I ask, “Ha ha… are you going to miss us when we’re gone?” And she says, yes. I ask her if she’s serious and she says, “You all are one of the nicest crews we’ve ever had come through here.” It’s such an unexpected compliment. It makes me momentarily, very happy.

But then we have to Round. And Rounds – suck.

But after Rounds… we get 2 hours for breakfast with no residents around!

I had a brilliant idea right before I went to sleep and my conversation with the night secretary confirms it. So before I eat, I get cards for the nurses at the clinic, the nurses on the floor, and the staff of surg onc and make sure we all sign it.

After breakfast, we have our last attending session and it’s pretty cool, because we get to talk about whatever we want.

Afterwards, when we go to clinic and give them their card, they tell us that we’re the first group that has ever gotten them a thank you card. How ridiculous is that? I can’t believe that as much as these nurses teach us, not one student ever thought to get them a card. It just shows you why people don’t like med students.

I see an interesting patient at clinic. He has cancer under his thumbnail. It’s one of those things I never really knew about before I started this rotation. And just the fact that I understood it without him having to tell me anything more made me realize how much I have learned in this past month.

The afternoon is pretty much a waste of time. It’s our classroom sessions. They are BRUTALLY difficult to stay awake for.

We have rounds afterwards. I hate rounds. We get out of the hospital at 6:30.

Friday, August 24, 2007

It’s our LAST day of Surg Onc! I’m doing everything I can to make sure we don’t get in trouble.

Rounds are AWFUL.

But I do my best by running ahead and making sure the bedside chart is ready. My chief is in a foul mood… but everyone else has an early surgery today… so I have to stay with him the whole time… when we’re done, I tell him I’m going to go change and go to the OR. He says okay… and then… he says, “Thanks for running ahead and making sure rounds ran smoother.” I was FLOORED. To actually get compliments!

In pre-op, I find out that my chief is going to be in my first surgery with me. So when our patient gets there, I page him. When he sees me… he thanks me for paging him! I’m wondering if he’s hurt or if he’s drunk or something. And I realize… he actually is going to miss us…

Surgery is brutal. The operation is pretty simple… but the attending surgeon is yelling and screaming at the chief for almost the entire operation. The attending asks me a few questions, but I nail everything he asks me. When the attending leaves and it’s just me and my chief closing up, we have a pretty decent conversation. My chief thinks I should consider doing something more than just Peds. It’s a pretty big compliment I think.

After that case is done, my last case is a hernia repair on a patient that I examined my first week on Surg Onc. It’s supposed to start at 11:45, but the surgeon is held up in another surgery. So we have to wait until she’s done. We don’t go into the OR until 1:30. And the surgery ends up being kind of complicated. She actually starts having some blood pressure and heart issues during the surgery itself. It’s funny because we have these sterile drapes that divide us from anesthesiology. And it’s like there are 2 totally different worlds sitting there with that patient. Our side has part of the patient open and that area is all you see, whether it be an abdomen, breast, or arm. The other side has just the head and a WHOLE bunch of machines and tubes that are controlling her heart, lungs, and her fluids. So we’re just sitting there, calmly doing our operation, when all of a sudden, about 8 doctors and nurse anesthesists come in to the room by the head of the table. We actually have to stop the operation for a little bit, until they can get everything under control.

We don’t finish until 5:30. I almost pass out from hunger and tiredness. I think it’s an appropriate way to finish the rotation.

When I go back to the floor, I find the other students just sitting around and waiting for rounds. Everyone else on General surgery is done and home. We have to wait of course. It sucks. Our chief comes in at 6 and says, we can go. Our friend, Katie says, “Oh, but we wanted so much to round.” After a split second of terror on our end, our chief starts laughing! As soon as we hit the stairwell, our fists are pumping, I fall to my knees.

I can’t believe we survived our month of Surg Onc. It was a brutal experience in many ways. But I learned so much. I feel so much smarter than I did when I started. I still have another month of surgery left… but nothing will be as hard as this past month has been. So glad it’s over.

Friday night, I go out to Liver Rounds, which is a gathering of students from all 4 years at a local bar. It’s so funny because first years are so happy and excited and… yes… clueless. I am happy to see many of my 2^nd year friends… but it’s hard for them to really understand what I’ve just gone through… I’m annoyed at any of the 3^rd years that do NOT have surgery… because I know that no matter what THEY may think or say, those of us on surgery had it so much worse than they did…

I am only really happy to see my fellow surgery students… We survived a month of ridiculous hours and much aggravation.

But as happy as I am and as much as I want to celebrate… I’m pooped by 9 p.m. PLUS, I’m on call the next day. So I’m home by 9:15… asleep by 9:30. What a party animal I am.

Saturday, August 25, 2007

It’s 7 a.m. and I am officially on trauma call.

Basically when you’re on call, you’re MAIN responsibility is to respond anytime a trauma comes into the ER. A trauma is when someone is hurt in an accident or attack of some sort that may involve potentially life-threatening or permanently disabling injury.

It’s a busy day. My first call involves a guy that got hit by a car while he was on his motorcycle.

My second call is a guy that got beaten up and thrown down the stairs.

I get a moment to chill out and I decide to go see CH, the kid that I worked on getting into the OR on Wednesday. He’s doing well. He looks great. And we chat for a little bit about little league baseball.

On the way back, I decide to check on my last surgery patient. She’s still in the ICU and she’s sleeping or unconscious. I figure it’s best to just leave her be.

I think about visiting one of our old patients, Mr. AB in a different ICU… but he’s on contact precautions, which means I would have to put on some protective gear just to go in to see him. I decide against it… and instead choose to have coffee. As I’m in the cafeteria, putting my coffee together, I see Mr. AB’s family walk in. And they immediately come to talk to me. How bizarre is that??? We chat for a while and they are able to vent to me about how frustrated they are and how difficult things have been. All I can do is tell them I wish there was something more we could do. But I also tell them that in my estimation… he’s due for a good week. I tell them that he’s had some crappy weeks… and it’s about time he had a good one. They brighten up when I say this… and I feel a little better. I can’t help but be amazed at how these work… There I was… feeling the pull to go in there… and in the end… it worked out better that I had a chance to talk to the family instead.

After coffee, the calls come in again.

I go down for a call and as I’m waiting for it to arrive, we get this guy that walks in off of the street. He got stabbed in the neck 3 times. As we’re working on him, we get a guy that comes in after running a marathon. He finished the race and on his way home, he passes out or something and runs his car into the siderails on I-95.

I get a quick break after these calls, when I get paged again. I get down there and I find out we’ve got a gunshot victim coming in. Well it turns out there are 2 of them. The first guy comes in and they figure out that he’s very much dead. They declare him dead within 1 minute.

We start working on the next guy and he’s still awake, but very much woozy and out of it. They have a big thing of gauze on his groin area and they tell me to hold pressure on it to try to stop the bleeding. The thing is… he’s in really bad shape. And as I’m sitting there holding pressure, they have to crack open his chest. Keep in mind, I can NOT move, because if I let go, he’s likely to bleed all over the place. So I’m just sitting there watching as they cut through skin, muscle, and fascia, and then spread the ribs apart. And there it is… his heart and his lungs moving all around for me to see. It is UNBELIEVABLE.

They get to work and they end up having to shock his heart using internal paddles. I can’t believe that I am actually seeing this just 2 feet away from me as I’m holding gauze over his groin.

They end up getting his heart back under control and the next thing I know we’re moving him to the OR. When we get to the OR, there are so many people involved that I don’t even scrub in. I just try to help out and then just watch. They are trying frantically to stop him from bleeding out. It is crazy to see what I am seeing. While we are there, another trauma call comes through. So the intern and the resident leave, and they tell me to scrub in with the trauma attending and the chief. I’m sitting there holding retractors and watching the heart and lung moving around. I cannot describe how amazing it is to see the human heart and lungs working from the inside.

But no matter what they do, they cannot get his heart and lungs to work on their own. And they have to declare him dead. Once they do, they let me put my hands in and do cardiac massage, so that I can feel what a human heart really feels like. I am in awe. I can’t believe that this man’s tragic circumstances are providing me a window of education that I couldn’t possible get otherwise. I am so humbled by the incredible privilege of being able to be a part of this journey. As we close him up and I feel his skin get colder and colder, I realize how suddenly death can overtake us. I realize how quickly life can end. Just 1 hour ago, this man was awake. Just 2 hours ago, this man was alive. And now, I was trying to help the surgeon sew his chest back together so that his loved ones wouldn’t have to see him like this. I don’t have the words to put all of this into perspective. Not without sounding trite.

When we finish up, I realize that the legs of my scrubs are covered in his blood. I go to change and am happy to see that it is 7:15. I am done for the day.

My last week of my surgical oncology month was certainly out of the ordinary. I can’t believe a month has gone by… but I am also very glad… I am tired. I am in severe sleep deficit. I am finding mail in the kitchen. I am finding books in the refrigerator. I am having trouble remembering if I did things I’m supposed to. I don’t remember what day it is most of the time. And I have a hard time remembering what life was like before surgery. I can’t sit for more than 30 minutes without getting sleepy.

But I’m halfway done with surgery. And I know I have learned a TON.

But more importantly… I still have a smile on my face… because I know this is where I’m supposed to be… even if surgery isn’t what I want to do… every day I see something that I know will make me a better doctor… and every day I get a chance to interact with a patient in a way that I know is helping them.

And when you look at it from that perspective… sleep is a small sacrifice to have to make.

I still wish I could get more of it though…