Eat When You Can, Sleep When You Can, And Don't Poke The Pancreas

After a month of General Surgery my rotation is done.  I had so much fun!  The human body is amazing and I loved being able to observe it up close and hands on everyday.  It's incredible watching a heart beat inside the chest, feeling the aorta pound with blood right under your fingers, poking the ureters and watching them shrink in response, feeling the small intestines telescope in and out of each other.  Everyday I was just in wonder and awe at God's ultimate design.

While fun was had, I have also never worked so hard in my life.  But it actually felt like my work made a difference.  It was great meeting with the patients a few days after their surgery and hearing how much better they felt, how their pain was gone, and how thankful they were.  Surgery was very satisfying, it has instant results.  Sick gallbladder?  I take it out.  Hernia?  I fix it.  Collapsed lung?  I put in a chest tube.  Necrotizing fasciitis?  I cut it out.  There were solutions to all these problems.  I understand that not everything always goes according to plan and the outcome is not always so wonderful.  I was very lucky to never lose a patient during the month which I'm sure helps to glorify my outlook.  But even so I was never sitting back and waiting...surgery is all about doing something which made me feel better, like I was taking action.

My attending is an incredible teacher.  He spent a lot of time with me and showed so much patience.  He treats me like a colleague and has all the staff treat me like a full fledged doctor already.  (It's very exciting to have people address me as 'Doctor' and ask me what I would like done with the patient.)  I consider myself the bottom of the totem pole at the hospital but he says no.  He expects me to play the part of doctor rather than student.  When I offer to gown myself or remove a Foley or change a dressing he tells me to stop.  He reminds me that my job is surgery and I need to stick to my job.  I don't have time to perform these other tasks when there is someone else qualified to do them.  I understand now how surgeons get a bad rep for being stuck up and non-caring about patients.  But that's really not the case at all.  They just don't have the time to do all the things that are required of them.  This is why we have specialists in healthcare.  No one can do it all.  And also, it's the doctor's license and reputation on the line.  No one sues hospital staff these days...when something goes wrong everyone blames the doctor.  So it makes sense that a surgeon gets frustrated when their orders are not followed out to a tee or when time is wasted or when a mistake is made in the OR by support staff.  I will no longer be mad when my own doctor is late for my appointment.  I understand all the things that need to get done behind the scene and how emergencies can just pop up.  Just imagine if you were the emergency.  You wouldn't want your doctor to tell you to wait so they could stay on time with their office visits.  But I'm stepping down from my soap box now...        

Back to my experience in the OR...  One time my attending just walked out of the room towards the end of the surgery and left me to close.  I just stared at his back walking out the door while screaming in my head "NO!  Don't leave me!  I have fooled you all.  I really have no idea what I'm doing."  My panic died down when the scrub nurse looked at me and asked "Doctor, what do you want to close with?"  And I knew.  I knew what sutures to use and what knots to tie.  After finishing my last suture, I looked up to find my attending watching through the observation window.  So he didn't really leave me alone, which was comforting to realize.  I will really miss him.  Not only was he a great attending, he went out of his way to include me in his family outings and take care of me outside of the hospital.  He took me wake boarding on the reservoir, had me over to his house for dinner, and treated me to may lunches and dinners out.  He even drove me home at 4:30 in the morning after an emergency surgery where I almost passed out in the OR.  After a long 16 hour day at the hospital, I got home at 10 pm, finished my assigned reading and went to bed at midnight.  I was awoken by my phone at 1:10 am.  Turns out our patient had turned septic and we had to operate now.  I walked into the OR at 2:00 am not even realizing I hadn't had anything to eat or drink
since 5 pm the evening before.  We were closing the patient up a few hours later when I started to feel really hot and my vision tunneled a little.  According to my attending I turned sheet white.  He had me step back from the table and sit down right there on the floor where I stayed while he finished up.  He then personally got me breakfast and drove me home promising to pick me up later that morning so he could control when I went back to the hospital.  During the ride home he shared with me the golden rule of surgery: eat when you can, sleep when you can, and don't poke the pancreas.  Well, lesson learned.

With the Da Vinci - you can see my vagina
 repair on the screen in the background

On Friday, my last day with my attending, he told me he had a surprise for me as a reward for all my hard work.  He led me into the last OR room down the hall, one I hadn't been in yet.  Inside was the Da Vinci Robot.  This robot can do the work of several doctors at once.  The trocars (little portals used for laparoscopic surgery to get the instruments in the body) are placed in the pt and the robot arms are threaded through them.  The doctor then controls the robot from a station with a viewing window that reflects the camera inside away from the patient.  Everything the doctor does with their hands and wrists the robot does inside the patient.  Foot pedals are also used.  The robot arms can rotate 360 degrees in the patient.  This is the only one in all of Pueblo and only a few doctors are certified to use it.  My attending is in the last bit of his training and will perform his first surgery with it next month.  Well, I was in awe looking at this robot.  He demonstrated all it can do and set up a manikin and then told me it was my turn.  He let me run the 1.7 million dollar robot!  It is really amazing how sensitive it is to my touch and all the things it can do.  I had so much fun.  Anyway, I'm sure you're all tired of me droning on.  Last thing I want to share is a list of the most important things I learned this past month.  Next week, on to orthopedic surgery!              

At the control station of the Da Vinci

Things I've learned during my surgery rotation:
1.  Tie your scrub pants tight - it's tragic when they come loose while running to a trauma
2.  Always have a granola bar in your pocket.  Or two...two is better
3.  Hand lotion is your best friend - my hands have aged years with the 100+ times I wash them everyday
4.  Fruit chapstick under your nose or inside your mask takes care of most smells
5.  Have multiple pens in multiple pockets
6.  There is a fine balance between staying hydrated and having to pee in the middle of a 5 hour surgery
7.  Scrub caps are a great way to hide that you didn't have time to wash your hair
8.  It's amazing how little laundry you have when wearing scrubs everyday
9.  A good pair of shoes makes standing 12+ hours a day possible
10. Sleep and eat when you can, where you can...you never know when you'll be called in for a 2 am surgery      

Adventures in Surgery

Who knows?  Maybe I want to be a surgeon!  I am having so much fun on my surgery rotation!  Pardon me if somethings appear vague from here on out but I am trying to be very aware of HIPAA laws.  My first week with surgery was very intense.  My attending certainly kept me busy.  The very first day he had me as first assist in surgery with him.  Gallbladders, hernia repairs, and small bowel resections filled my day.  My first day was actually the easiest.  My attending never left my side, which was a drastic change the rest of the week went he sent me to accomplish tasks by myself.  I left the hospital at 8pm with two chapters of reading to complete and three surgeries to prepare for in the morning.

The rest of the that first week was crazy!  I logged 95 hours at the hospital.  My days became routine: I would get up around 5 am and get to the hospital by 5:30 to round on 8-12 patients by myself.  Rounding involves looking up all patient info for the past 24 hours.  You check the labs that were run that morning, any imaging or pathology reports that are in.  You check the vitals and the intake and output.  You talk to the nurses to see what kind of night the patient had.  Then you actually see the patient and do your exam.  The exam always includes looking at the incision for signs of infection.  I had one patient accuse me of just admiring my handy work (which I was while checking  for infection).  You answer their questions and tell them you will pass on everything they tell you on to your attending.  Then you get on the computer to right your note about your encounter with the patient.  All this is done with each patient before 8am.  At 8, I would meet up with my attending for our first surgery.  I absolutely love surgery!  Guts are just so cool!  And my attending lets me suture and cut and cauterize and staple.  

In between surgeries you talk to family members and write orders and chart the procedure.  You also run up to the floors to round for a second time with your attending.  He then reviews the notes I hopefully got done that morning and signs off on them.  Then back to the OR for the next surgery.  There are no breaks; I've learned to eat when I can as quick as I can.  My attending is also a machine who doesn't need sleep.  I think he personally enjoys going into a surgery at 9pm.  Then after stumbling out of the hospital at midnight, I go home to fall into bed only to get up 4-5 hours later to do it all over again.  

It's busy, but I wouldn't change it all!  My attending was actually out of town this past week so I worked with other surgeons.  I got to join ortho for a day.  They let me drill into the bone.  It was awesome!  And I spent a day with anesthesiology where I got to intubate patients!  Last night I was on call and got an appendectomy at 9pm.  Well the attending let me start and finish the procedure since we weren't on any time limit.  It was so amazing!  Anyway, I am having a lot of fun and working hard.  I'll try to update you all again soon :)