Surgery Week 7
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
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
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
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
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.
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.
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!
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.
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
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.
1 comment:
yay, ur done!!! congrats!
Post a Comment