this is it. i can now leave happy from my surgical rotation. today was the crowning glory of achievement, the holy grail of any rotation.
no, i did not perform any great feat of surgical brilliance...although this week i did get to drain a seroma and clean out gobs of pus and blood from a decent sized wound and pull all sorts of tubes out of people, and follow up with 2 patients who i've seen start to finish in their surgical process...which was sort of exciting....as well as watch someone's heart beating...and then stop beating...then start beating again inside their open chest. that was truly stunning. the logistics that go into open heart surgery are beyond amazing. and another reason why i would not want to be in anesthesia. but it is a sight to behold. and if you get really bored, it's a fun game to count all the tubes and wires. not that i would know.
84.
kidding! boredom and open heart surgery just don't go hand in hand. it's simply not possible.
no, no, no....with complete and total disregard to any sort of legal stipulations, i will continue the story started above. the reason why i can leave totally fulfilled from this rotation is that a certain patient named betty crocker came into the clinic today to discuss gastric bypass surgery.
not a whole lot to write about this week. no real favorite patients or anything outstanding. maybe i'm just overtired and can't think straight right now. i did get to pull a chest tube, watch a central line placement and put in a bunch of foleys if that counts for anything. lots of cancer this week. lots. it's so fascinating to me to have a 3-D disease process that you can see and feel. and maybe a little bit gross.
moved in with kristy this week in her fifth wheel which is pretty awesome. like camping, only in a moveable 1 bedroom apartment. it's super nice. all the amenities. went for a nice bike ride. enjoyed karaoke nite at the RV park, although planning on making it there in person next week rather than hearing it from a distance...from the sounds of it it'll be a good show. maybe i'll even get back on the photobug boat and take some pictures next week. it just occured to me that i haven't pushed the trigger once since i've been here. huh.
as a p.s. to the last post, i had one decent encounter this week involving the zero bullshit army style history and physical taking: when interviewing a guy who was following up for a surgical trauma visit (think partial colectomy due to a MVA rollover, training maneuver gone horribly wrong), the preceptor comes in after i presented to him that the patient is still having diarrhea post-op. so the preceptor opens the door, greets the guy like old friends and dives right in. not even a blink inbetween.
"so buddy, i hear you've still got the shits. how bad is it? i mean, are you shitting your brains out, because if so this is definitely something we need to deal with cause you're deploying in like 2 months, right?"
"yes sir. still shitting my brains out, sir."
and there i was, stuck in between in a state of mild amusement and candid surprise. strangely pleasant surprise. i just so badly want to talk to all of my patients this way for the rest of my life.
that feeling was still with me after receiving a text from my sister in law today that my neice and nephew totally ROCKED their swim meet. so proud. but a little perplexed when i heard they had won the "breath stroke". cause that's what they call it there lest they upset anyone with the proper wordage. which makes me so, so sad. clearly the swim league organizers in NC need a little militaty intervention. maybe even an invasion. total takeover, even.
apparantly it's nap time until i can come up with something better. apologies. t minus 1 week until i have some sort of life back...in bend! woot!
something i love about the army...enlisted folks are just NOT afraid to tell it like it is. (for some reason, the officers are much more reserved, i'm guessing it's because they get extra pay to tone it down. seriously, you get "bonus pay" for all sorts of silly reasons here.... if you are remotely bilingual, or you can pick your nose with either hand, or are able to procreate profusely, then man, has the army got a GREAT deal for you! it's the financial equivalent of boy scout badges of honor or something.)
diversions notwithstanding,
the army seems particularly good at deprogramming whatever filters a person might have in terms of beating around the bush. meanwhile, politeness filters seem to be installed in their place. it's kinda like being stuck in an heavily guarded area with half of the population of manhattan.... on zoloft. very strange. but funny.
my favorite patient of the week was a young man who came in with a presumptive inguinal hernia, just like the dude before him AND after him... his main issue was pain with erection and ejaculation. (and for those of you in the know, i still can't get the mini marzucco out of my head. i keep having these bad flashbacks. ptsd. yikes. it's like there's a marzucco with a halo on one shoulder telling me to compassionately do the right thing, encourage and support the psychosocial and emotional issues behind this sort of thing....and then there's a peidmonte with a halo on the other shoulder telling me to turf the jamoke to urology already )
so he says, "ma'am....i don't know how to tell you this without just saying it"
"ok, so just say it."
"the hernia doesn't bother me, but when i'm with my girl, it's a problem. i'm not leaving here until i know for sure i can get with her again."
"ok. well, let's check and see if you have a hernia to begin with. have you ever been checked for one before?"
"no ma'am."
so i explained it to him, what to expect, what i am looking for, etc. his eyes kept getting bigger and bigger. he started sweating. and then apologizing. a lot. he was so so so sorry to bother me with this, like it's not my job. it's really hard as a female PA student to astutely reassure someone that poking around their penis is no big deal. especially to this guy, to whom it was the very center of his universe. he reminded me again he was not leaving until we could fix his problem (priorities!), and then made a disclaimer that he was already pretty excited about having me poke around down there.
poor guy. i think he was envisioning a different kind of exam....not the kind he got. he was a little more than surprised.... the bonus of having 3 boys is that i was not. i even brought a whole crew of residents in with me to quell any more of his fears about being left alone to be groped by a student. stage fright can be used to your advantage any old day, really. so simple. hard to be a tough ass when you're nekked and exposed. another thing i love about army folks is that they never hesitate to get nekked when you ask. even the mere hint will send pants and shirts flying. must be another deprogramming issue.
long story short, no hernia. sent him for an ultrasound. no hernia- no surgery, then. DONE.
then he got mad and became a broken record player, partially out of a blown ego, partially out of sheer terror of what else could be wrong.
"ma'am, i am not leaving here until you can fix this."
"i don't know what to tell you, sir. it's a little out of my area of expertise. "
if i had given him some differentials, he probably would have melted into a puddle on the floor and obsessed about them to the point of nausea. referral to urology (for whom i will NOT be volunteering for next week because of this guy). go talk to the penis people, buddy.
"but ma'am....what am i supposed to do with my girl tonite then?"
ummmm....how bout a nice game of backgammon? terminator movie? putt putt? was it bad that i told him he'd just have to get creative? not my job to come up with chaste-like activities. but i'll bet there's an army bonus somewhere out there for it.
today was going swimmingly, i was suturing and assisting all over the place...and then happened to be in the right place at the right time for a case i was interested in watching...and ended up getting roped in...which was great but....much more difficult than i bargained for.
mostly, i find that surgery is not so bad as one might think. i don't really give a second thought to slicing and dicing because all i ever see is what is right in front of me. a square of betadine scrubbed skin surrounded by layers and layers of drapes. you don't see the pt's face or body other than that. there is no crying, no wincing, and if you don't look too close, no hint of sickness.
and then there was today. a 3 year old little boy with cancer. tiny. no hair. very sick. spent a lot of time with him pre-op and just couldn't really shake the big picture. even after he was all draped, i couldn't quite get over it. he was just so little. and so sick. so when the surgeon let me put in the chest tube for this kid's thoracostomy and scope i sort of had my first brief moment of hesitation in the OR. how do pediatric surgeons do it? is their secret just pure just love and sheer hope? comfort in the fact that they are helping these kids get well? what about when you pretty much know for sure the kid you're about to cut into will never be well and you are just going to make him more miserable in the short term? all i could do was blink a few times, kid myself that "THERE'S NO CRYING IN BASEBALL!" or surgery....and get on with it. deal with the problem at hand, worry about the rest later.
but seeing just as much sickness was inside this kid and correlating it to how much sickness was outwardly present was almost too much. nodules all over his lungs. huge chunks taken out to biopsy. solemnly hand delivered to pathology and ID with as much care as possible. pleural fluid drained. lungs stapled up, ribs sewed back together, skin sutured as nicely as i possibly could. my parting gift to this child, in a way.
undraped and back to his whole reality. de-intubated and groggy, but thankfully not yet crying was how i left him in PICU. mom was a mess. i don't think i would have kept it together if he had started crying. sigh. 3 hours of eye stinging from all this confliction. bigger sigh.
one other valuable lesson learned today (besides being able to cross peds off my list of future endeavors) is that the peds OR is always kept toasty warm. add that to inherent nervousness and the freak out factor of having to deal with cutting into sick kids and all you do is sweat profusely. it's a regular sauna in there. which gets old REALLY quick.
perhaps tomorrow will be better. i was offered a spot in the am urology clinic. here's my chance to perform non-stop prostate exams for hours on end- that should take my mind off of today. woot!
started a surgery yesterday afternoon that ended in the wee hours of this am. you know it's bad when the surgeon makes the initial cut, pokes around a bit, sighs and says, "this is going to take all night"...followed an hour later by "oh man, i think i might have just killed her"....
the pt thought she was going in to the OR so someone could fix her small bowel obstruction....which we did, only....there was a 12 x 18 cm piece of mesh completely adhered to her bowel from a previous surgery to repair a couple of hernias after a surgery for endometrial CA....so....yeah. 9 hours of tedious, horrible meticulous clips of adhesions later....there was a solution. and only ONE bowel perforation. amazing.
i left around 9pm because i couldn't feel my feet anymore. but the pt was well in ICU today, considering. fingers remained crossed.
in other slightly more uplifting news, i got to admit a pt today based on my recommendation, not the opposing resident's recommendation. (small victories, people)
this week's hernia count: 10 and counting
oh, and the malnutrition and dehydration diet is going GREAT. blegh.
highlight of today: finally having a patient with a phenomenal sense of humor and who thought he could get a rise out of the little PA student.
pt presents for eval of pilonidal cyst (which by the way, am feeling like an expert on at this point)...so we discuss his pertinent HPI, etc and then we discuss how the physical exam will go, that we'll be poking around his bum, etc... and then i get to the part where i say "ok, let me just go grab my preceptor and we'll take a loo-"... and before i could even get the sentence out, there was a half nekked guy bending over, telling me to take a good look in the tone of voice that told me he was clearly enjoying my reaction.
i mean....what could be better? how's that for being proactive about your own healthcare? if it wasn't for his giggling, i might have gone ahead with the exam. instead, i muttered something about him needing more of an audience for such a great show...and left the room to grab someone, anyone...who wanted in on the action. now that i've seen a few of these, i can't say that i was all that riled up about it, but i feigned enough surprise to keep him happy. oh fun times.
good news for this guy: no pilonidal disease. good news for me: i got a couple of new dirty jokes to add to my repertoire now. totally inappropriate. but funny.
