My Goodness!

Its been more than a little crazy for me this past week at BigWhig. It seems like every consult that we’ve had on the Trauma team has gone back to the OR. Which is wonderful for me as a student, but I have to feel bad for my residents. Captain B has been especially swamped but she’s handled it with an amazing amount of grace. Though I’ve definitely seen her look at myself, Lurch, and Checkpoint (both third years as well) with a sort of ‘damn I’ve got to give these three some busy work to get them out of my hair’ glaze. This week was money though for me: I got to see a perforated ulcer and ruptured spleen!

Jigsaw

Do you ever have those moments when you feel completely and utterly inept? Like you are an extra puzzle piece that somehow has to fit into the picture? The other day on my Trauma Surgery rotation at BigWhig we had a fairly bad pediatric case. I wasn’t scrubbed in the OR at all, but I was there in the back watching. There must have been twenty people in the room fighting for this little one for hours. Several different surgical subspecialties were involved in this case and you had attendings as well as chief residents scrubbed in. It was a full blown effort on a somewhat hopeless situation. And I just stood in the back and watched. It feels wrong somehow to have been witness to this tragedy on such an intimate level with having no real role in it. I felt like an intruder in the OR and yet I was supposed to be there, I was told to be there. I was supposed to learn something from this situation, gain some nuance on how to be a better doctor, or simple be able to more succinctly describe a situation to a layperson. Maybe I will someday, but now all I have clearly from this case is an image of interosseous lines and rapidly decompensating vitals. I guess I also have just a deep sadness about what happened and I don’t know what to learn from it or do with this piece of the puzzle right now.

Top o' the Morning to You

As part of my surgical rotation at BigWhig Hospital we have an hour a week surgical pathology conference. The conference is located in the basement of the oldest part of the hospital. To get there I have to go through several doors marked ‘do not enter’. It is kind of a creepy trek most especially because, as you enter the final door, you get greeted by prosections of the brain. Not the most pleasant of sights.

However, the instructor more than makes up for the dank surroundings. He’s the quintessential professor portrayed by Hollywood. Dashingly intelligent, somewhat ethereal, white hair, grandfatherly form, and Irish accent (ok, so Hollywood usually gives them a British accent). He’s something from another era entirely. He’s a pathologist, who I believe is as passionate about his specimens as most doctors are about their patients. He forever quotes Robbins and refers to the students as ‘Doctor’ in a slightly cheeky and condescending tone that is adorable. He spends the time with us showing formaldehyde soaked specimens and quizzing us on what they are and the pathophysiology behind the disease. Honestly, it is ridiculously hard and somewhat useless, from a surgical standpoint, to identify a 40 year old specimen as its perfused counterpart in real life. And truthfully, I’ve not gotten much out of these sessions that has helped me in the rotation. But I love them. Each one makes me feel like we’re stepping back in time to a more bookish and slow paced era. And I feel lucky to be taught by this character of a man. He’s definitely an Original and these days I think that’s very hard to find.

The Incredible Edible Egg

I foresee that the people that brought us the above catchy phrase will soon be sitting around in a boardroom attempting to find a way to work the following bit of information into the new jingle.

The Roslin Institute, otherwise famous for bringing Dolly into the world, has given a press release stating that they’ve made anti-cancer chicken eggs. Now, first off, what they’ve done (which is pretty damn cool in and of itself) is found a way to engineer chickens so that they lay eggs which contain medically relevant proteins in their egg whites. This isn't going to cure cancer, but it is exciting! The extremely cool bit is creating these proteins for the price of chicken feed (substantially less than other current methods I assure you). However, I wouldn’t go out and buy chicken commodities anytime soon: it will probably be a long time before these tasty drugs are available in the U.S.

"Our lives begin to end the day we become silent about things that matter."

Martin Luther King Jr. (1929-1968)

Somehow, I believe that this man though no longer present among us lives more richly today than most. While I might argue the necessity of having a day off of work or school to celebrate his birth I will never question the dedication he had to the cause of true equality and freedom.

The Never Ending Pile

You would think with the fact that I’ve been wearing scrubs every day for work, my laundry load wouldn’t be so bad, right? That’s what I thought too, until this morning when I attempted to tackle the issue that I’ve been putting off for the past three weeks (ok, so I would have put it off longer but my supply of fresh necessities was running low). I woke up this morning at 7am (not on purpose! My body was just so used to waking up much earlier on this rotation that 7am seemed like sleeping in till noon) and started working on my mountain. FOUR LOADS later!!! And I’m almost done. Four loads people! I mean I live alone, am only doing laundry for one person, and have been wearing scrubs every day for work. What the heck is up with that? And I really hate laundry. Not to mention the fact that it seems to be laundry day in my building and we're all racing to get one of the three units in our building...Sweet little old ladies can become very cutthroat when they want their sheets washed.

Andreas Vesalius (1514-1564)

This was one Belgian that Galen most certainly wouldn’t have had breakfast with. He was a physician who spent years dissecting human bodies (nice thought that, right?) and proved that Galen’s ancient works on anatomy were based on the dissection (and sometimes vivisection~ fun stuff; especially when performed in front of a crowd) of ….drum roll please….apes. He compiled his findings into the texts De Humani Corporis Fabrica (if your Latin is a bit rusty that would be: On the Workings of the Human Body). This was a seven volume compendium that was based on his dissection of the human body. The volumes were artistically illustrated with a multitude of engravings that posed the corpse in a number of amusing and slightly ridiculous ways. The popularity of these revolutionary texts gave him enough fame that the Holy Roman Emperor Charles V ( He ruled Germany before it was German) appointed him as court physician. Like most men, he left his cushy job to go off on some midlife crisis. But this was the 1500s and instead of grabbing the nearest 20s something blonde secretary and high tailing it to Vegas he went to the Holy Land. Like most midlife crises it ended badly. In 1564, on his way home, his ship sunk off the coast of the island of Zacynthus.

The Cat Lady: Meow

After rounding yesterday morning at the hospital I decided to do some of the random everyday errands that can only be accomplished between 9am and 5pm. These haven't exactly been hours available to me during my surgical rotation. Luckily, the bank and various other places have hours on Saturday. After rumaging around the city for a couple hours I found myself at the local pet shop so that I could pick up food for my poor neglected cat who ran out of cat food a day ago (don't feel too bad for him, he's been subsisting on tuna quite well). After getting the deluxe 50lb bag of cat food and enough toys to clear my conscience for leaving Cat home alone so often I stopped to see the adult cats from the animal shelter at the front of the store. I've been thinking of getting another cat to keep Cat company during the day and I'd rather get an older feline that has less chance of being adopted by others. I was playing with a cute black cat when a very pleasant middle aged woman came up and struck up a conversation with me. I was in my scrubs and Medschool affiliated jacket so it was pretty easy to guess that I'm on surgery right now. Her daughter is a trama surgery fellow somewhere in the South, who apparently loves her job and couldn't imagine doing anything else. This very nice lady went on to say that her very pretty, funny, and wonderful daughter who I apparently 'reminded her of' was wasting her life as a cat lady with three cats, no husband, and an unhealthy number of work hours. I was firmly cautioned that I should find myself a man, go into something 'less demanding' and not get another cat. As funny as the encounter was, it sums up nicely some of my worries about choosing surgery as a specialty: I really don't wan't to end up as the cat lady.

What drugs will not cure, the knife will (Hippocrates)

There is something amazingly satisfying about surgery. Oh, the operations themselves are pretty darn cool, but the happy gut feeling goes beyond that obsession. You see a patient, determine a problem, and fix it. Ok, so sometimes is a heck of a lot more complicated than that, even a lowly Med3 can figure that one out, but the gist of it can be that straightforward. Take today: a very nice well mannered lady came to BigWhig Hospital cursing and screaming at the top of her lungs. Not that I know her well, but I’m fairly confident that this isn’t her normal behavior. She had an acute distended abdomen. It was bloated, could be played like a drum, warm, and just plain wrong looking. Not to mention that she was writhing in pain just from breathing. Added to that the CT scan was just plain ugly. Now, not to long ago (ok the measurement would be more closely related to centuries than decades) this lady would have been toast with jam. Today, she gets some happy meds and is rushed back to the OR~ much to the ire of the surgeon who got rescheduled~ and waddya know: her problem could be fixed! Although, I have to admit that her insides looked almost as knarly as her outsides. She’d had a perforation of a diverticula in the sigmoid colon. Brown alert all the way! But at the end of the surgery, her problem is fixed. Yeah, she’s going to have to get through a fairly tortuous course of post surgical recovery and has a super high infection risk, but still she’s fixed.

Can I please have a sandwhich?

Hard work is undesirable for the underfed.
(Hippocrates)

So, I have to admit it: I've got it pretty easy on my general surgical team. I drew the short (or long depending on how you veiw it) stick and was placed on the Trauma unit for my 4 weeks of nonspecialty work. And other than the fact that there really aren't that many surgeries that don't get transferred to a different unit I've got very little to complain about. Captain B and Flyboy are great, we never really see the attendings, and rounding doesn't take up the whole day. But my one complaint is that food sometimes needs to be scavanged and I get cranky when my stomach rumbles.

A rumor without a leg to stand on will get around some other way.

So today, I realized once again that the Hospital really is like high school. People still talk about who is sleeping with who, the popular girl, the weird guy and the teacher that everyone has a crush on. My Chief, Captain B, and junior resident,FlyBoy, who I really in general think are funny and brilliant people if a little on the sarcastic and bitter side fell into the easy trap this morning of propagating the rumor mill. Which I admit is damn easy to do at 6am. Its also damn easy to do at 8pm when chitchatting to a classmate and spilling your guts because your poor sleep deprived mouth doesn't know when to can it. Ah well, at least there are bigger things to worry about.

Hippocratic Aphorism of the Day

"Life is short, and the Art long"

I think the one thing that third year is really good at making you feel is inadequate. There is so much that you feel that you should know already, be able do do already, be able to explain already, that you spend half the time wanting to curl up in a ball and the other half wanting to cram (ok, so maybe the desire to cram only comes when you're being pimped). Somehow I find this aphorism especially reassuring: I mean the ancients didn't even have to contend with the biochemical process of disease and still they found medicine an overwhelming topic. Of course, they also went around tasting urine, so maybe I shouldn't use them as a gold standard.

When they let the Med3 actually do something...

In the Begining:

So I’ve just started my surgical rotation at BigWig Hospital. And yes, for those who have gone before me, I do realize that this is a terrible time to invent a new way to waste time. However, there is something cathartic about ranting in my own little corner of cyberspace and I’ve already done my required 2 chapters of reading for the evening so drum rolls please:

I have to admit that I’ve enjoyed it more than I expected. I went into medical school with a very nebulous idea of entering primary care. Approximately, 20 weeks of that in various specialties was enough to disillusion me out of that particular fairytale. And surgery is just fun.

The Medical Student's Prayer on General Surgery

God, today can I please not feel like a useless appendage.
Can I not get yelled at by the attending,
for the labs that weren’t ordered by the resident

Can I not get yelled at by the intern,
for the nurse who decided that only nurses can be ‘patient advocates’

Can I not get yelled at by the nurse
for the fact she/he can’t make anyone else’s life hell
as much as she/he can make mine.

Can I get something to eat
before I’ve gone hungry for 12 hours

Can I sleep for at least 4 hours

Can I not get splashed by urine/blood/worse

Oh, and if You could manage it:
Can I not spend 10 hours in the OR with
the surgeon who believes all Med3s
should know how to recite Netter in Greek.

Hall of Medical Quotes

1. Professor: Gene therapy might cause cancer, but its still really cool

2.Medical student : So you're saying that lack of sleep, binge drinking, and high stress are bad for you? Wait, isn't that my life??

3. Doctor to patient: You're 5', 350lbs, your blood sugar is uncontrolled, you refuse to take your meds, and now your upset with me because your joints hurt? Lets be a little more realistic.

4. Dr. House (from FOX's awesome show): Patients lie.

5. Relative A: So I have x, y, and z giving me trouble. What do I have?Relative B: I'm a first year medical student, they're still teaching me how to have social skills.

6. Lecturing Physician Assistant to First year medical students: You need to remember that during those years you went to medical school (4) and through residency (3-7) we were out actually working. So we will know more than you do at the end of your residency.

7. Backrow Medical Student to Lecturing Physician Assistant: Bullshit

8. Uh, what'd you do with the gloves?

9. We estimate that each of you will graduate with 130,000 dollars in debt at best.

10. Genital-Rectal Instructor: Starting in the middle of the penial shaft, gently bring the skin to the base. Then apply a firm, but gentle, pressure to compress the urethral meatus and milk the penis.

11. Me: What the hell have I got myself into!

12. OB/GYN attending: "and is this the babydaddy (one word)?"

13: Surgeon to patient with heart problem: " And if you keep on using cocaine you will die. Oh, and you can be discharged today."

14: Surgical patient three hours later to med3: "Am I being discharged to God?"

15: Doctor to patient: " You have a hole in your aorta from your motor vehical accident. Luckily, its a contained rupture. This is still very serious". Patient to doctor: " So other than this little hole I came out pretty ok. So can you take these wires off and I go home now?"