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Friday, 31 July 2009

Water

Today, the family of one of my patients in the ICU finally decided to withdraw care. We found out just after we finished operating on him for the fourth time in the last 10 days--taking out more dead bowel, washing out more blood from his abdomen. He very likely may have died by now, but I was thinking about how the last time he was awake, all he talked about was how much he wanted a drink of water. The first time I met him I had to urgently get his consent to put in a dialysis catheter because his kidneys had failed to the point where his potassium was up in the lethal range. He didn't speak a word of English, and I had to use a speakerphone with an interpreter on the other end, repeating over and over to him that it was very important that we do the procedure. He just kept asking for water, and I had to keep explaining to him that we couldn't let him drink any water because we were going to take him surgery later that day. (Patients aren't allowed to eat or drink anything for at least 8 hours prior to surgery.) Not one hour later, he decompensated and I had to intubate him. And the story goes downhill from there. He never got that drink of water.

Wednesday, 04 March 2009

The "surgeon"

It was great seeing you guys!

We were all at Trader Joe's when someone came up to me and asked, "Are you the surgeon who sewed up my hand?" It was about a month ago that he came to the ED after a homemade bomb experiment went south. Well, I guess I should clarify--he was taking a class in which they were instructed to place liquid nitrogen into 2 liter soda bottles. The bottle exploded in his hand. That laceration took me over an hour to close. It started from the back of the hand and went almost all the way across the palm between the first and second webspace, making it a very awkward angle to work with. It must have been close to one o'clock in the morning when I finished. But it has healed wonderfully and he was really grateful. That's the kind of thing that makes surgery rewarding.

And then we took two steps and saw a five dollar bill on the ground. None of us picked it up. I wonder what happened to it.

Monday, 23 February 2009

Update

I've long contemplated just letting this blog die, but I didn't really want to have my last entry be the first night of residency. So here I am. Obviously, a lot has happened over these last eight months. I've learned a lot, I've had more than enough frustration, triumphs, sadness, etc. to last me a good long while. And yet I'm really still at the beginning of my training. The surprising discovery for me is that the hardest thing for me is not the actual technical aspects of surgery, or even learning how to take care of sick patients, but just getting used to the fact that everything is scrutinized. It's like living in a fishbowl. You don't know who you can trust. Perhaps nobody. Everything you say, do, or even what someone thinks you're thinking, is carefully tucked away in a memory bank somewhere, ready to be brought up again at the quarterly meeting--the so-called Resident Bash. Even personalities gets picked apart. I'm not venting about any particular incident, but the environment is starting to get to me. Don't get me wrong, though. I love operating, and it's such a feeling of accomplishment knowing that I can now do an inguinal hernia repair or a laparascopic cholecystectomy. It's all a learning experience. The good, the bad, and the ugly. Then again, who said a surgical residency was easy?

Wednesday, 25 June 2008

First night

...on call. It also happened to be my very first day of residency. Soo...where to start? It was worse than I imagined, but then again, it could have been much much worse. Thankfully, nobody crashed and burned, no codes to pretend-run to, no shortness of breath/chest pain/massive bleeding out, etc. But in short, it was awful. I felt pulled in so many directions. I must have gotten about 50 pages that night. I covered consults for orthopedics and burns/plastics. I covered all the floor patients for trauma, vascular, ortho, burns/plastics, and elective surgery. I was expected to go to the OR, write post-op orders for cases I never even scrubbed on, all while I had three or more consults sitting in the ED that I hadn't even seen yet. Waiting by the phone, waiting for the chief resident to come by and check on the consult, hunting down supplies (where are med students when you need them?). And I had to pronounce a death. No, I didn't kill him--the family withdrew care. Oh, and I guess I was supposed to be in on the traumas, too. Then there were the calls I got from nurses about patients that weren't even on my list, and believe you me my list was extensive. It didn't matter that I didn't know where the call room was, or the code to the call room. Because I never got to see it. I went home the next morning, after being up for 28 hours. But I got today off! And it was quite awesome.

Friday, 13 June 2008

McDreamy vs. House

There's the age-old question of whether or not surgeons are taller and better-looking than their physician counterparts. Is it really true? Of course someone had to study this...and it was published. Too bad it only applies to males. Here's an excerpt:

How do surgeons become taller and better looking than physicians?
There are several potential explanationsfor the phenotypic changes between surgeons and physicians.Firstly, surgeons spend a lot of time in operating rooms, whichare cleaner, cooler, and have a higher oxygen content than theaverage medical ward, where physicians spend most of their time.Furthermore, surgeons protect (but not always properly) theirfaces with surgical masks, a barrier to facial microtrauma,and perhaps an effective anti-ageing device (which deservesfurther testing). They often wear clog-type shoes, a confoundingfactor that adds 2-3 cm to their perceived height. The incidentalfinding that fewer surgeons are bald might be related to theseenvironmental conditions and to the use of surgical caps.
In contrast, senior physicians are surroundedby fewer people in their habitat (the patient's bedside andthe office), and they therefore have less need to be easilyidentified or spotted by families and nurses in the middle ofa swarm. Physicians tend to hang heavy stethoscopes around theirnecks, which bows their heads forward and reduces their perceivedheight. They also complain of a (clearly abnormal) need to endlesslyupdate their knowledge in accordance with the current evidencebased approach to medicine by reading and studying heaps ofmedical journals; this overload of information further grindsthem down. Although a prospective study found that doctor'swhite coats decrease in weight with increasing seniority, nosignificant difference was found between the mean weight ofphysicians' coats and surgeons' coats (1.4 v 1.5 kg).