yesterday was a blast. finally. showed up for 5:30am rounds and saw 6 all new residents on our surgery service (it happens at the end of every month, this changing of the guard, so to speak). after all the introductions, etc, i sized up the situation in my head....2 OR's, 2 attendings, 6 residents...and me. lucky number 7. yeah. basically there would be nothing for me to do for the rest of the day but stand around and watch everyone else do something. superfun.
so at morning meeting, when the vascular surgeons asked for help in their clinic, i rapidly jumped ship. which is probably PRECISELY why i would not be very good at this military stuff. following orders is not so much my thing.
i went and watched a hernia repair (running tally this week: 8) in the OR to pass the time before clinic started. i chit chatted with the rep who was there to show us all the new mesh samples he had, which was moderately interesting. it's made of polypro and goretex. just like a raincoat for your intestines.
then i went to vascular surgery clinic for the rest of the day. and i learned more from them in one day than i have in the last 2 weeks combined. it was amazing. having great surgeons double as phenomenal teachers and just plain good human beings made all the difference in the world. for whoever else rotates through here, put it on your must-do list. plus, there's a PA who works in their office who helped me immensely with all my charting and who drew me into the secret club of vascular surgery. i was totally eating it up. and....loving it. who knew?
none of the patients i saw were under 70, the oldest was 94. a few were doing well enough to be discharged from our service, which was wholly satisfying to know that even geriatric patients with a laundry list of problems can get better and do just fine. but the best part was again, listening to their stories, which they are not shy to tell. probably because they think i'm too young to know any better. and they all tell time in reference to war and who was president at the time, which i find fascinating.
i got schooled by one gentleman who let me know just what he thought of obama and his "re-cycling" attempt. so i had to bite that one. he explained that at the end of WW II (which incidentally started on his 10th birthday, how dare they!) the only person that could solve the depression/recession thing was eisenhower. the eisenhower interstate saved us, and now obama thinks he can just re-cyle that idea and save us all again, but it won't work...obama ain't no eisenhower. and that's how we sort of left it...and as i went to walk out of the room he told me "i always wanted to be a history teacher..." well, man...it was your lucky day.
madigan army medical center is a very large teaching hospital. thusly, there is seemingly a lot of time set aside for students to learn in ways other than hands on opportunities....which i am not convinced is the way to go, but whatever. as it turns out, ebm DOES exist in the real world. or at least in the army. crap.
so thursdays are "academic" days...so in between rounds there are all sorts of exciting meetings to attend. first up, intern lecture and morning report. no biggie cause that's pretty much every day. then we got a break and a chance to catch up on paperwork followed by tumor board. not terribly exciting except for the ginormous teratoma we discussed... this one had no teeth, which was a little disappointing. marissa would've been totally crushed.
then we did the crux of thursday meetings....the "mandatory fun" bit. which i'd heard about. which i thought was sort of a joke, but it wasn't. and lisa's scraped and bruised legs, ranti's nearly blown orbit, erin's hamstring pull, and everyone else's grass stained scrubs tell the true tale behind the steam that is blown off when the entire surgical staff gets together to play a game of full contact ultimate soccer. nothing like full on ego's, testosterone galore, ranger-danger tactics, screaming, and army style competition to have to suddenly have to negotiate...while running as fast as you can trying to prove something to someone even if you don't have a clue... not unlike being in the OR, minus the kicking of the ball bit. it was no-holds barred and brutal, to tell the truth. i was a little bit shocked at the lack of apologies and glad when it was over since it was rapidly becoming not fun. at all. on the bright side, it was a gorgeous day to be outside, and now i know who i NEVER want to deal with again. ever. on any level.
and then back inside for the m & m (morbidity and mortality) conference. i wonder how well it would go over next time if i brought a bag of m & m's to that meeting? anyway...basically just reviewed all the screwing up that was done in the past week, and who died as a result of it. not that any blaming was done, (ahem) but to live and learn and never make that mistake again. today i learned that if over 75% of your liver is a cancerous tumor, then surgery is NOT a good option for you.
but the total highlight of my day was getting to eat lunch for REAL for the first time (not just shoving down a pb and j in 3 minutes in the locker room inbetween cases)...in the dining hall and all. at high noon. when it's packed. but the treat in all the chaos of this event was getting to share a table with an old timer who told me the most fabulous stories of his youth. like what it was like to grow up on a farm in minnesota in the 30's and 40's and being a farmer's son, getting relegated to fly the crop duster at the tender age of 14, and crashing it at the age of 15. (sorry dad, crashed the plane...) puttered around in high school, never graduated...(more on that later) and saw all his friends going off to korea, so he thought he'd give the army a go...but he had flat feet and they wouldn't take him. so he walked dejectedly out of the recruiter's office, not wanting to be the only one left behind when his buddies went to war...and ran into the air force recruiter who said, sure! we'll take you. and just like that, he was shipped to mississipi to attend fighter pilot school. which is where he met his wife of 56 years. they used to go out on dates to a bar down there where they would listen to a certain elvis presley play (live)...and they would sadly shake their heads and think that poor kid, he'll NEVER make it. we got a good laugh out of that one.
and the rest of lunch just sort of melted away as i sat chit chatting with this gentleman, i never did get his name. he was a fighter pilot in korea and vietnam, flew everything the air force had, he said. and then he blinked and his 20 years was up and they told him it was time to retire. in the 20 years he'd been in, he and his family moved 21 times. but they kept coming back to mc chord afb (just north of ft. lewis) and liked it, so they stuck around. when he got out of the military, he found himself unsure of what to do. it was the early 70's and boeing had just laid off thousands. the job market wasn't looking so good. he wanted to be home with his family and not fly anymore. so with the GI bill he went back to community college where, incidentally, he got in because they asked if he had been to high school and he said yes. they didn't ask him if he had graduated. we got another good laugh out of that one. so he became an accountant. a year later the bank he was working for asked if he knew anything about computers. and they sent him back to school to become a programmer. and that was that.
now he's retired for good. he and his wife had 5 kids, all but 1 military as well, including a west point grad who is now just retiring from the military as a colonel. he joked he wasn't sure if he should call him "son" or "sir"....and there was even more laughing.
then we talked for a while about something that was clearly on his mind, the idea of where people of our generation (gen X, gen Y, call us what you will) feel like they have no duty to their country anymore. that there is no great call for civil service and he just couldn't seem to wrap his head around the thought that we just take everything for granted. that we are too self involved to consider country before anything else, or have any sense of national pride. that we are too selfish to commit time to national security and well being, and that we are to petty and wrapped in our anti-reality personal technology gadgets to care. ouch. for a moment i wished i wasn't a civilian. and i've been thinking on it every since.
he was accompanying his wife for cataract surgery this afternoon, and all of a sudden got teary about leaving her alone up in the opthamology office and excused himself to go be with her. damned if i didn't get all teary too.
who had the most amazing name that i can never repeat, but for fun let's call him juan pelletier...just so you can imagine with me the pure definition of melting pot lineage...
which is what i was doing for the first minute or so of his appointment (what kind of parents give their kid a name like that?) while sort of vaguely asking questions and listening to him speak with a portugese accent he had recently cultivated after living in the azores for years....
and then i snapped back to reality as it became apparant that this was going to be a pre-op visit, not a run of the mill meet and greet/establish care, etc. which was something i wasn't quite prepared for...but then, nothing i've done in the past 2 weeks has been, so there is this sort of comforting feeling to that particular brand of panic i get now.
anyway achalasia. scheduled him for an esophagram (how proud todd would be!) and went to precept. wherein the problems really started for me. for you, let's just say you're all welcome for the heads up. i'll be widely available for thanking at the next PPS.
achalasia. and not just your run of the mill achalasia, the good kind. the kind that's caused by parasites picked up in south america while you're say...hanging out in chile. that's right, the chagus kind. the kind that you have to order a lab that no one has heard of to confirm. the kind that there may be no treatment for and may expand your esophagus to the size of an inflated tube sock. the old school kind with stripes. the kind that you'll need surgery for regardless of the outcome.
that's my favorite line here so far... "well, you have xyz. we can open you up and fix it if you want. there's no guarantee the surgery will work, or that you'll feel any better afterwards but you need to decide if you can live with xyz or not. when you can't live with it anymore, give us a call back."
on the bright side of today, if the chagus wasn't enough, i saw like 4 hernias of all shapes and sizes IN A ROW. i'm a hernia magnet, apparantly. and if i ever screw up a hernia presentation again, then shame on me. but there is definitely something to be said for reducing them. that feeling when they get sucked right back inside the abdominal wall is something else. i'm on a mission now to keep a running count for the rest of my time here since i need something to poke fun of.
is that apparently the boys hair would never be combed or trimmed, nor would their fingernails or toenails be cut. and on closer inspection of all i've missed this last week, it appears that the bathrooms would never be cleaned.
so unless i want dishivelled dreadlocked kids who live in bathroom squalor with freak show, ripley's believe it or not nails....then i guess they really do need to come along for the ride. poor kids. what kind of alternative is this, really??
to everyone's great relief, you should know that ben is quite capable of taking care of everything else... in fact, he is a stellar house husband regardless of whatever else i write...and is the finest maker of vodka tonics i've ever known. which he just handed me.
i love this man. depite his keratin phobia and toilet aversion. i'll keep him.
shipped out to ft. lewis sunday morning with my classmate erin, en route to the unknown. figured out how to get on base, made the great tour (it's ginormous) and stopped off at madigan army medical center (also huge) to get a feel for the place. mt. rainier sits almost right on top of the base, so it's quite a treat to have such an astounding view when the mt is out.
and then monday am, day one- the fun really began. got our security passes, spent an hour or so doing gobs of paperwork, then reported to our respective clinics where we'll be assigned for the next 6 weeks. lisa and i to surgery, erin to inpatient, and kristy to family med. met my preceptor, a super nice guy, and in turn was presented to the remaining surgeons and residents on staff- also all super nice guys (not one girl so far)....and then a short tour. followed by..."well, i can't give you the rest of the tour without you being in proper attire, so go change into scrubs and meet me out here...." which was then followed by us being allowed to float in and out of all the OR's for the rest of the afternoon. casually just passing through and watching cases till our hearts were content. i didn't know you could do that...but as i'm learning, the military doesn't play by the standard way that civilian medicine is practiced. and i like it. a lot. you are generally free to do what you want when you want. it's pretty refreshing to have your own healthcare system to work in without all the crappy restrictions you would normally have. i get the appeal.
day 2- rounding with the chief resident i was assigned to at 5:45am, seeing the pts who were in the OR yesterday afternoon. this part i loved. nice to put body parts and internal organs together with a face. and the elderly guy who they had taken out a pancreatic tumor on was so grateful and wanted to shake the hand of the soldier who had "saved" him. the surgeons were pretty touched. i was pretty touched. for as much as i might want to believe the army is lame, there is this overwhelming sense of family there. that they're all in it together, which can be pretty comforting. the rest of the day was spent in computer training. blegh.
day 3- and possibly the pinnacle of my surgical career this go around....i got to be the first assist on 4 cases. somewhat minor cases, but still fascinating to me. all the residents and most of the surgeons had gone to a conference, so it was just me and my attending. we did an umbilical hernia repair, an accessory breast removal, a lipoma removal, and a pilonidal cyst with sinus tract removal...the last one being the most interesting. i got to cut, retract and suture. it was the coolest thing EVER. i might have sliced through some vessels on the lipoma removal...some good squirters for sure....but knowing how to fix that problem once you create it is also pretty important. so, now i know. my attending was super patient, very informative, and overall a fantastic teacher. the only criticism i have for him is that he walks too fast and i was literally running behind him all day. the CRNA was also super nice, pointing me in the right direction a few times, and sending me hints over the drape. i'm hoping to buddy up to her next week and see if she won't let me work on some airway stuff. the OR nurses were mostly cool...but that is a distinct benefit of being at madigan...the place is just crawling with students, so it's easy to fit in and not get too chastized. we saw a few pts in clinic in between cases, pulled out some drains, assessed some old scars...and then called it a day since there was nothing else to do.
and now...they've sent me home for the long weekend....4 whole days to play with my boys is pretty much a dream come true, mostly cause i know it won't happen again soon....AND super extra bonus...it's supposed to be beautiful, warm and sunny for that whole time.
i'm looking forward to next week, with a more regular schedule, and getting to know who's on my team a little bit better...and getting to know my way around better. i swear i walked in circles yesterday for a good portion of the time i was left on my own to figure out where to go. they tell me i can't get lost because everything is built in a circle pattern....but yeeeah....will have to work on that. in the meantime, have set about to healing my aching feet, blissing out sleeping in my own bed, and having the luxury of eating real food whenever i want to. ahhhh.....
