Surgery Week 2

Week 2 Monday
4:00 a.m. ugh. I hate the feeling of getting up this early.

It wasn’t a very busy day. So, I actually had some time to talk to one of my patients. It’s so strange, because you sit there and you know all of this stuff about your patient in terms of their disease and what you are trying to do for them. But you never really appreciate the emotional toll this whole process is taking on them. As I was listening to his story, I could feel the frustration that he has been experiencing. Before he came to our hospital, his care seems to have been very badly mismanaged. And as time has progressed, you could tell that he has been getting more and more aggravated. His wife left the room to go cry after a while, and for the first time in a long time, I felt tears welling up in my eyes while listening to a patient’s story.

I think my time with him helped bring me back to where I needed to be mentally. You get so caught up about worrying about trying to figure out what you’re doing and what you’re supposed to be learning and where you’re supposed to be. Sometimes it’s easy to forget that we are privileged enough to be able to momentarily walk with a person on a journey through incredible physical and emotional difficulty.

Later that afternoon, we had an afternoon session with one of our attending physicians. One of the nice things about being on the Surgical Oncology service is that we have a lot of sessions where we sit down with a doctor and just talk through some cases. This one lasted 2 ½ hours and was amazing. It’s so cool to get to see how an experienced physician thinks through a complicated case. I have been surprised at how much medicine surgeons need to know. It’s not just about cutting. You really have to understand the way disease works.

I went to check on the patient that we operated on Saturday night. He was surprisingly okay. I can’t believe the body’s ability to survive.

It looked like it wasn’t going to be too bad of a day, but then all hell broke loose. We got these emergency consults in the ER and we had a patient that was critically ill in the ICU. It was nuts. I didn’t get out of the hospital until 8. That’s the thing. Things can turn on you in a split second.

Week 2 Tuesday
Today was a clinic day. I don’t know what happened, but I guess they decided they were taking it too easy on the medical students. I was allowed to go see a patient by myself and I came outside to fill out the chart. When I came out, my Chief and one of the attendings were waiting right there and before I could do anything, they called me over and told me to present. I wasn’t at all ready. But what choice did I have. So I just started talking as confidently and quickly as possible. Of course I was told what was wrong with my presentation, but it was over quick and secretly I think they were okay with me. I got to take out the patient’s staples and all was cool. That afternoon, was kind of nuts, because we had 2 critically ill patients. I didn’t get home until 8.

Week 2 Wednesday
Rounds are interesting. We really do walk around the hospital and talk about patients almost as if they aren’t there. It’s kind of surreal. We have this one patient in the ICU who is in his 70’s. He can’t talk because he has a tracheostomy which is a tube that has been placed through a hole cut into his throat. He seems like such a nice man and he never fusses. I saw him staring outside as we were working on his dressing. So I smiled and told him how hot it was outside. I held his hand for a bit and smiled at him and he smiled back.

I scrubbed in on a mastectomy today. This is a surgery where you remove a breast because a patient has breast cancer. The patient was a really scrappy feisty lady who was grumpy and tired, but who had a funny sense of humor. Before we went into surgery, I met with her and her family. Her daughters all told me that I was in charge of keeping an eye on everyone in the OR. They seemed to feel good knowing I was going to be there.

The surgery itself was really cool. I got pimped an awful lot. Pimping is where the doctors constantly ask you questions to see if you know your stuff. I did really well. A lot better than I thought I was going to. And as my reward, the doctors let me do part of the operation. It wasn’t a LOT of stuff, but they let me make an incision and they let me use this electrical cutting device called a “bovey.” Up until that point, I was mostly just holding skin up with these clamps or pulling back with these retractors. To get to cut was an UNBELIEVABLY cool experience. Terrifying, but really cool. The worst part was my mask was all fogged up and I could only see through this one tiny clear area. I had a hard time seeing perfectly, but I wasn’t about to say anything. How many times do you get to do this stuff???

I also went to go check on her later and her family was very happy to see me. It was very satisfying.

We had another session with an attending. I didn’t like this one as much. The attending we worked with was kind of full of himself and I didn’t get too much out of it.

We had a little stretch of the afternoon where we were able to sit down and study. It was GREAT. We mostly did imitations of doctors and told stories and laughed about the brutality of our experience thus far. I didn’t get out of there until 7.

Week 2, Thursday
4 freakin’ a.m. I’m so tired I can’t even begin to explain.

We had Grand Rounds, where everyone sits through a boring lecture and then we had an attending session. I was so sleepy I thought I was actually going to fall asleep. To be honest, I kind of sort of almost did fall asleep, but I hid it well. The crazy thing is that the attending would ask me questions and as he did I was still able to answer them despite being dead sleepy. Afterwards, we went to clinic and it was a total waste of time. We then went to some afternoon instructional sessions. These were once again, a waste of time. We then had D & C. D & C stands for Death and Complications, where the Chief Resident of each department gets up and talks about the surgeries that happened that week and then talks about any deaths or complications that occurred during the process. It is BRUTAL, because the attending physicians start grilling the docs about what they did and why. I felt so uncomfortable.

Right after D & C, one of the attendings came up to us and asked us about our time line for the day. It turned out that when we went to clinic, we really should have been in the OR with him… even though our Chief had told us that we needed to be in clinic. We kind of got grilled, and there were people around to hear it. It was pretty uncomfortable and very unpleasant. It sucks because it’s not like we were trying to avoid doing anything. But that’s the problem with surgery. A lot of times, you can’t win and you’re just going to have to take a little abuse. There are just a lot of egos and a lot of harsh teaching styles. I feel very fortunate to have had the experiences I have had in my life, such as boot camp and stuff, because it has really helped me to just roll with this stuff. But still… it sucked.

I got home at 8.

Week 2, Friday
I am SO tired. But I have to get my act together. I am in a complicated surgery today. It’s called a parathyroidectomy. It involves cutting into the throat and removing a small little node. The thing is though, there are a lot of really really really important structures in the throat and there are things that you DEFINITELY don’t want to touch. It was cool,because I actually did okay with getting pimped. Then, once they removed the node, they sent me to the pathology lab, where I got to watch it analyzed and looked through the microscope with the pathologist. It was such a simple thing, but it was so freakin’ cool to look at this specimen that I had just seen taken out of a patient.

The next surgery of the day was a lymph node removal on an 18 year old. I felt bed for this kid, because he had these gigantic ping pong ball sized lymph nodes at all of these different locations of his body. It was so obvious to the touch. It was a quick operation, and the attending left kind of early, so it was just me and my Chief. He decided to pimp the hell out of me while we were closing up, but I nailed every question that came my way. So he let me close. He showed me how to do some special sutures that are just under the skin and I closed up. It was pretty freakin’ cool.

Immediately after we were done, we got to experience the greatest downside to surgery. We got called to meet with our team back on the floor. Once we got there, we got a call to meet one of the attendings back in the Radiology room. So, we went there and the crappy thing is they had absolutely NOTHING to tell us or teach us. We just stood there while they had this whole conversation going amongst themselves. We couldn’t really see what they were doing, and no one was interested in explaining any of this crap to us. It was such a waste of time. I think that’s the thing that is the most annoying about being an M3. You get dragged to a lot of stuff that makes absolutely no sense to you and that no one wants to explain to you at times. And you have to appear interested otherwise you get blasted for not showing an interest. After 2 hours of this crap, we finally get released to our interns who immediately send us to go eat. It was now 3 p.m. Keep in mind… I ate breakfast at 4:30 a.m. Ugh.

Before I left the hospital, I went to check on the patient from my first night of call. He had a 4 1/2 hour operation and when I saw him on Monday, he was doing okay. But when I went in to see him on this day, he was not doing well. And I found out that he had a tear in his colon and he had been leaking into his abdominal cavity. Ironically, when I was a kid, a similar thing happened to me when my appendix ruptured. But in his case, it was probably something that happened during surgery. I was sad to see that he wasn't doing well.

Week 2, Saturday
I’m on call. Being on call is so weird, because you never know where you’re supposed to be. Within 2 minutes of getting there, I get paged for a trauma. I go downstairs and get set up. As soon as the trauma gets there, I do my part. When it was time to put the foley catheter in (tube into your pee pee hole), I offered to do it. The resident said, don’t worry about it, because it needed to be done quickly. She then stopped for a second and turned around and said, can you do it quickly? I’ve been pretty good about not being cocky about doing stuff, but I couldn’t resist this time… so I smiled and said, “I can be quick.” So she let me do it, and I had that foley done in less than a minute. Her eyes got kind of big and she said, “wow… you are quick.” I didn’t tell her that I had done about 100 of them when I used to work in the ER. Ironically… the first day of surgery we were supposed to have foley training… foley training got cancelled. So I’m probably the only one on our service that actually knows how to do this.

Afterwards I helped stabilize c-spine (the neck area) of a patient who had this HUGE cut on his head. He basically took off his scalp. As they were trying to sew it back together, his scalp was basically flapping back and forth and you could see about 50% of his skull. It was a big bloody mess.

After THAT, I got called to the OR, where I was supposed to help with what they thought was going to be a LONG surgery. It was a woman who was in the hospital with LOTS of complications from a gastric bypass surgery. For any of you who are even remotely thinking of gastric bypass surgery or know someone who is… please… DON’T. There are SO many complications and so many bad things happen with these complications. It is NOT a good thing to do. I volunteered to put in the foley, which everyone thought was going to be tough for me, because it was a female. But again… after 100 foleys… some of them on patients with prostate issues… it gets to be second nature. I got it in pretty quickly and I think everyone was pretty surprised. The funny thing… the surgery wasn’t actually a surgery. The attending came in and explained what he wanted us to do. He just wanted the dressings for her OPEN wound to be re-done in a way that would be better for wound care… and he needed it done in a sterile environment like the OR to minimize infection risk. So, after 5 minutes of dressing the wound… we were done. It took 30 minutes just for the doctors to get ready to go into the OR.

Then after that… a crazy thing happened… my pager stopped going off… and I got to eat… and I got to go to the call room and sit down… and I spent the entire afternoon just reading… ahhhhh….. I fell asleep for a little bit… and then I went home at 7. A perfect day. And a perfect way to end an 80 hour work week. Ugh...

So I’m halfway done with my first month of surgery. I can’t get over how tired I am all of the time. It’s really aggravating at times. And it’s really cool at times. When I run into people I know, they all ask me, “How is it?” And I don’t really know how to answer them. I feel lost a lot. I never know when I’m going to do something that’s going to piss off someone above me… but I still find myself smiling most of the day… and I laugh at some of the craziness around me. I guess I’m reminded that you can’t really control what goes on around you… but you can always choose how you’re going to deal with it.

2 weeks down, 4 more to go.