Monday, October 7, 2013

"BAM! I got your appendix!" Day 1

Well, wasn't expecting that....but then again, who am I kidding.

Wasn't expecting that off the bat
First of five days general surgery.

Call time this morning was 7:25AM. I luckily planned in enough time for wandering around the hospital looking for the right room to show up at. The door was open but the lights were off and I was the only one there....and it was 7:23AM.

So I sat in the dark (it was early and that was comfy) and waited.

A few minutes later, a girl I study with showed up. We sat in the dark and waited. Two more students showed up. We all sat on the side of the room, in the dark, waiting.

Finally, the doctors started rolling in for the morning meeting.

As a medical student, you are at the bottom of the food chain and sit either in the back of the room if it is filled with rows of chairs or on the side if there is a conference table in the middle (Unless you are in a smaller department such as Urology. But even there, you typically sit as far away from the chief as possible).

The morning meeting commenced as though we weren't even there. The chief kept asking his doctors more questions about their patients, their conditions, the circumstances and so on. It was very detailed and I just sat there hoping they could answer all of his questions. The did a good job :)

At some point, he brought up the education. Our names were read and we were given our ward assignments. When they said, 'Hasselhof, Viktoria on ward 6013' he stopped and asked which one of us that was. I just raised my hand and said hello and smiled. Who knows why that happened....
Once everyone was introduced, all the doctors knocked on the table (our substitution for clapping). We suddenly felt awkwardly touched that they cared enough to welcome us with that. But thanks :)

After the morning meeting, the other students and I left the room wondering if we should just head up to the wards or what the deal was. Luckily, doctors approached us, introduced themselves and took us to the wards.

My doctor was a younger looking woman with a friendly smile, Dr.L.
She showed me around the ward. There were 6 patients that needed their blood drawn. A meeting was planned for the students and interns at 10AM and she said it would be great if I could get the drawn blood before that. Easy peasy.

I guess I should add that I am on the private patient ward belonging to the chief of general surgery. This shouldn't make a difference in the quality of care but in reality it does. In the end everyone gets treated... the private patients just experience a more pleasant treatment. The only thing that is relevant for me regarding them being private patients is that I have to see that they are happy.

The first lady I wanted to draw blood from started saying she had bad veins and that she doesn't necessarily prefer a student drawing the blood because she doesn't like the pain from the needle. Student or not...that needle is going to have to penetrate your skin....if its in the hands of a student or the chief. It's not like he can beam your blood into the syringe. But okay...I'm not going to argue and of course "I am looking out for your comfort (blah blah blah) during your stay here so I will let the doctor know she should come by and draw the blood. Have a great day."

The third patient I drew from was a professor of mine. The pressure is kind of on in that situation to get it done right. I was just glad it wasn't my professor of hygiene. Although I draw blood according to protocol, I would have the feeling I did wait a half a second long enough or sprayed a milliliter too little of the disinfectant. I have rarely had issues drawing blood and I was glad it was the same for this time. We even exchanged pleasantries about our respective dogs.

The fifth patient also immediately started telling me how she never really thought students drawing blood was a kosher thing. "They always stuck the needle in and then prodded further and that hurt terribly". I told her that was completely unnecessary if they were drawing blood. Laying an i.v. maybe....but not drawing blood if you find a good vein and know what you are doing. I drew her blood and she was just so thrilled about how that didn't hurt one bit......See.

After getting all the permitted blood drawn, I went to tell Dr.L she would have to do one herself. She was on the phone with the intern (his first day on the ward) standing next to her. He was supposed to go into the OR but his card wasn't activated for entrance to the OR. She asked me if I had been in the OR here. Affirmative. She asked if my card was activated. Affirmative. She sent me into OR 09.

And what about the meeting at 10? She said if I got out early enough I could go but otherwise I already knew everything I needed to know. Because of her statement and it being 9AM I concluded I wouldn't be in the OR for much more than an hour. Wrong.

The first operation, I stood for 4 hours. Not having been prepared for OR work again (aka forgot my fancy antithrombotic socks) I struggled again for a bit there. I have mastered my circulatory system freaking out to the point that I don't have to sit down or pass out but it still is a very uncomfortable feeling. I started sweating a lot (which made my dang glasses slide) and my eyes started being super sensitive to light (as though you cranked up the contrast on a picture). I started breathing like I would during yoga. In and out throw the nose and deep belly breaths (those made my stomach growl due to lack of food). It was amazing how much that breathing technique helped. Chief at some point noticed how bad my forehead was sweating and asked if I was okay. I said I was fine, had he asked me 5 minutes ago my answer may have been different. He stopped operating, put his hands and mine, looked me in the eyes and asked if I was sure. I told him I was positive and that I experience this sensation on every first day in the OR if I haven't been there a while. He was impressed by how well I knew my own body. (Enough electives in surgery fields has taught me to manage.)

After those few minutes I was fine but bored. I've said it before, surgery is an exciting field and fun but if all you do is hold hooks although you are capable of can be very boring. What kept me awake is that fact that I was working with a new team and the radio they turned on half way through the procedure.

The patient had a bile duct tumor that needed to be removed along with the pancreas head. This required cutting up the duodenum as well and reattaching everything. At the very end, after reattaching the loose ends and sewing subcutaneously, I got to help with the intracutaneous stitches.

I was given a 10 minute break to eat and drink something...this ended up being a half a liter of water and 8 almonds. Better than nothing.  

I headed back into OR 09. This operation was supposed to take about an hour. It was just the attending and I operating. We were operating a pilonidal cyst. From the Latin pilus (hair) and nidus (nest) = hair nest. It is often located right above or on the natal cleft of the buttocks. The patient had a reoccurring cyst. We basically cut it out and left a tennis ball sized hole in the top most part of his buttocks. I was contemplating how we might reconstruct the defect but then the Dr. just put gauze on it and started removing the OR what?! He said it would heal like that. Oh ok.

After we were done I headed back up to the ward. No doctor to be found. I started looking through patient files to get acquainted with what the patients were there for. Soon the doctors returned from wherever and we did afternoon rounds.

The intern and I headed to the conference room after that. The afternoon meeting was done at 4pm and we were released.

I was so tired and exhausted from the day and thought I would just fall into bed once I got home. Whilst leaving the hospital though, I saw a man having a epileptic attack outside of the entrance. I (and about 3 other people) ran over to see if we could help. While running the few feet my head started going through things that might need to be done. I was the third person to get there so I let the other two do exactly what I would have done. Immediately someone ran inside and got emergency help. I was surprised at how long it took the emergency team to get there although we were just outside of the hospital. But of course it makes sense, they have to be notified, the gears have to start turning in their heads, they have to run up and get to us. Once they arrived, I left. They can do more than me and there were enough people just standing around watching. That woke me up.

Hopefully I will be able to fall asleep early so that I am good to go with call time at 7AM tomorrow.

Baci, V

P.S. the header of this week is dedicated to Brad S. Even years after first saying it, it still makes me laugh and was fitting for general surgery.

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