Saturday, June 20, 2015

Week 30: "Have you changed a nephrostomy tube before?" "No." "Well, you gon' learn today!"

Well, it's 6:30 on a Sunday morning.....thanks internal clock for not letting me have the experience of sleeping in on a Sunday. I'm awake and not tired but still....there is just something about waking up after 9AM on a Sunday that has a feel of luxury to it. Oh well, early bird know.

This past week flew by again! And once again I have a hard time trying to keep the days apart. So I can't really describes my individual days but rather my individual patients.

I was allowed to suture every case that came in and needed stitches. There was the guy at work that cut the back side of his finger with a saw, the old man that fell and rather deeply cut the side of his hand (it bled so much and his hands were drenched in blood and it looked like he had killed something with is bare hands), the old man that fell and hit his head and had a small wound and then there was the woman suffering from borderline disease who cut herself to relieve pressure.

Suturing in the ER is more fun for me than in the OR. I worked in plastic surgery for a month and learned the importance of aesthetics suturing. We weren't doing aesthetic surgery but rather reconstructive. Of course, if you are operating on a patient that needs reconstructive surgery, you will try really hard to make it look nice....its a big reason for why the operation is being done.  Most other departments don't see the closing of the patient as an aesthetic issue. Often times, patients will have staples placed instead of sutures because it's quicker. I think, if you had to go through a big abdominal operation, your scare isn't your biggest issue but the thing that constantly reminds you that you had to have surgery and might as well look nice. In the ER, the patients are wide awake and usually watching you as you suture (since the local anesthesia had time to work by then). A few do mention that we should try hard to make it look nice (especially when its in the face) but I also have expectations for myself to make it look good. So far, everyone has been really pleased with my work.

On my way up!

I was called up to the privately insured ward twice. Both times to place a line. You never know how a patient is until you meet him/her but I'm always more concerned about how a patient is when I'm on the privately insured ward. The privately insured often have higher expectations and straight up make you feel like you are a servant in a luxury hotel sometimes with the requests they have. I'm just not a fan of that mentality and sometimes have to refrain from commenting. The second day I was called up, it was the first thing I did that day. When I arrived, the nurses just smiled and said the patient was a rather complicated patient. Greeeeeeeeat. Just what I want to hear first thing in the morning and then having to place a line. In the end, this lady wasn't complicated at all. She was frustrated and exhausted. Her operation kept getting rescheduled due to her blood lab values. There is construction happening near her room and she is afraid to have another operation. All those factors together just made her exhausted and frustrated with the whole situation......but she wasn't complicated.

I definitely empathized with her. It bugged me a bit that she was described as complicated by the nurses. I've dealt with complicated patients before with absurd requests and expectations of the whole staff.  I'm sure even this patient rang for the nurses multiple times a day with questions about weather or not her operation is taking place. Keep in mind that the patient is not eating every day because there is a chance she might have her operation just to find out she isn't being operated in the afternoon. Please tell me you wouldn't be frustrated and exhausted if you were in the same situation.

Friday morning, trauma surgery was less than busy in the ER. Oddly enough, the urology department was receiving one patient after another. One of the first ones was a man from England. The nurse sitting at the reception desk just called over to the doctors room to inform me that I had a patient to see due to my English skills.

He was an urological patient which just made it all the much better for me. I stayed with the patient even after the urologist came. Once the urologist found out that I was planning on going into urology, his face lit up and for the next two hours, I was constantly by his side and doing procedures I hadn't done in the whole 16 weeks of my urology rotation. He would just ask me if I had changed a suprapubic catheter or nephrostomy tube before (my answer to both was no) and without further hesitation, I was changing the catheters with the help of his instructions.

Both things really aren't complicated but they were things I hadn't done before and that made it really exciting. We had a patient whos catheter was cut off by the nurse in the nursing home and the end part with the blocking-balloon was still in his bladder! We had to take him to the urology department because our plan was to perform a cystoscopy (looking into the bladder with an endoscope through the penis) and removing the catheter piece. The urologist again asked me if I had done that before and I again answered with no. He said I could do everything once we were in the bladder. This urologist was on a roll! Sadly, the passageway into the bladder was blocked due to a big prostate and adhesions that I didn't actually get to do anything. Nonetheless, the urologist explained how the endoscope worked (which was a question I had had for a while but people were always so stressed in the urology department I was in to take the time and explain it to me). This urologist was under stress too due to being responsible for the ER patients and the outpatient procedures but he made it work. He asked me when I would start working and that I should apply in their department. Very sweet but I had to break it to him that I am attempting to do residency in the States. After a few more things, I returned to my doctor in the ER. It was still rather empty.

That of course changed quickly. The second half of Friday was packed with patients. To top it all off, we also had a polytrauma. While my doctor had to work on the polytrauma, I did as much as I could to finish up the other 7 cases we had. I left an hour later than I had expected. I was so drained by the time I got home. I decided to take a 25 minute nap.....which I then repeated.....and once more. I made myself get up again to finish some errands before eventually dropping back into bed.

I have one week left in trauma surgery. It'll only be a three day week because I'm gone Monday and Tuesday. My doctor repeatedly told me that she was going to miss having me around when I leave for the internal medicine department. I'll miss her too and the work we do together. But I won't be far away considering I'm only two floors above her. So if I end up being bored can most likely find me in the ER suturing up a wound!

Stay healthy!


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