Perfect Timing 1

Bet you were wondering about Perfect Timing 1 what with Perfect Timing 2. I was on ENT when this wonderful thing happened to me.

Some background. Ahem. My first day on Ortho I happened to toss my OWN scrubs into the bin where the community scrub jackets go; in essence, I threw one pair of my scrubs away, and us students only have 2 pair on our ID cards. Now I was down to one. So when you wear a pair to the med center and come home, there's no way to get a fresh pair for tomorrow. Plus, when you're on Surgery and the laundry services open at 8 and close at 2, you have to leave a bunch of freaked-out-med-student messages when you finally get off after 5 since you've been there since 5 and pray to God that they somehow put another scrub suit onto your card. Somehow, some way. Student Affairs said they couldn't help me.

So when I was on ENT, I took a clinic day with Dr. Wildman, a crazy Jewish surgeon. I wore professional clothes to clinic that day, and my one pair of scrubs was at home. Dr. Wildman gets a page from Plastics and he has to leave clinic and head to the OR straight away. After powerwalking through hallways he says to me "Ok see you in OR 9" and disappears through the men's locker room. He of course is already IN scrubs. So I run to the scrub machine hoping against hope that Laundry Services finally got one of those frantic messages and was able to do something about it...

And lo and behold, who is there but the man who STOCKS the scrub machine! He takes one look at me in my haste, says "Small?" and tosses me a pair. I thanked him so profusely, but he'll never know how perfect his timing was!

Perfect timing 2

So as an MS3 (medical student - 3rd year) on your first rotation, there is only so much you know how to do. Which usually feels like abosultely nothing. Sometimes you are sent to get papers, like a consult or consent form in the ER, and even then you won't know where to find one. So you ask 3 different people who end up sending you from one place to the other and then back to the place you started. And even though you're doing something in 7 minutes that would've taken the resident 30 seconds, they still thank you for your "help."

This happened to me during my crazy on-call night. I had been wondering how on earth I will ever get to the point that my residents are, at which I will know how to do everything that needs to be done to manage even ONE patient. I was thinking this while scouring some cubbies at a nurse's station for the form; then I spied a lone Dove Dark Promise, its royal blue wrapper shimmering in the ED fluorescence. I asked the nurse, "Is someone saving this for a rainy day?" And she said "Looks like it's YOUR rainy day!" So having received the greenlight, I unwrapped it and shoved the sweet dark chocolate into my haven't-eaten-dinner-so-I-should-be-a-hungry-hippo-and-yet-I-am-not-really-hungry face.

You know Dove Promises, right? They come with little sayings on the inside. After finally discovering where they stash the op consent forms, I glanced at the wrapper:

"If they can do it,
You can do it."

How's that for some perfect timing.

What a day

On Wednesday I took call with my Lebanese resident. I usually followed him because he liked teaching me things, quizzing me, and worked on the Pediatric Neurosurg team. Plus he always had tic tacs or gum that he'd hand out to EVERYONE. Me, fellow residents, the nurses we'd talk to, everyone. He must have the biggest gum stash on the planet. And he likes good music. So after he gave me a wicked awesome evaluation, I burned him a shitload of Radiohead B-sides set it an a pack of Eclipse in the on-call room for him yesterday.

Anyway, Wednesday was eventful. I did clinic during the day, saw a 4 month old boy come into the ER with head trauma (his cheeks were all chubbed out above his C-collar), and saw two lumbar punctures (spinal taps) on 2 little kids. My resident said I'd have to do LPs as a pediatrician, so I took careful mental notes. Afterward he always said "I'm sorry" to the little kids. One was a teeny tiny Amish girl with curly blonde hair. She had just finished crying from getting an IV placed. And then she had to get the shot of lidocaine to numb her back, and I think she felt some pressure from the spinal needle anyway, so it was more tears. At one point my resident told the little Amish mom, "ok, here is a point at which she needs to be perfectly still and not cry." Her Mom whispered something in Amish (is it Dutch? A variant of German? I need to do research), and she completely stopped crying and was still. It was amazing. I wonder what she said. We gave her tons of stickers afterwards, and in the morning when we rounded on her with the attending, she was all smiles eating a ham sandwich and chocolate pudding. She was able to go home that day. Plus she didn't have meningitis! =)

Wednesday night was nuts though because after rounds, we'd had a stroke emergency. My resident and I RAN. Literally sprinted through corridors to find the patient on his way into gettin an MRI. After that, 2 more admissions into the ER while the stroke victim underwent emergent angiocatheterization to try to break up his brain clot. At 11 we finally had time to see all the patients in the hospital on our list, so my resident had me check up on 2 of them. Neither of us had eaten dinner. At 12:35 my eyes were getting heavy and my resident ordered me to go home. I accidentally slept through my alarm by an hour, getting 3 hours of sleep instead of 2, and went in the next day to do it again.

It was in all honesty a lot of fun!

=/

So after getting my bearings on the Neurosurgery team last week, they started giving me some patients to preround on in the morning and then present on rounds. Here is a typical day on the Neurosurgery team:
4 AM--wake up at the hour I used to go to bed on weekends
4:45 AM--walk to the med center in the dark listening to Thom Yorke
5 AM--look up my patient's vitals, ins and outs, and lab results over the past 24 hours
5:30 or so--go wake up the patient, do a physical exam, chat
5:50 or so--write up what I found in the chart
6:15--Rounds. Neurosurgery has so many patients that they first tell the Chief Resident what they found, then they go around to the patients with the actual Attending OR go to the operating room after rounds.
This is where I'd "present" my patient info. It takes practice to even know what you're supposed to say and what they want you to say. Our rounds would start off great--lots of patient info. But then as we'd get to the end of the patient list, the chief would start getting antsy and just basically ask if the patient wasn't dead. SO when trying to practice presenting patients that were toward the end of the list, I'd start off with what you're SUPPOSED to say: "Mr. J is post-op day 1. No acute events over night, vital signs normal; max temp 37.2, current temp, 36.9..." and then I'd get the 'ol interruption and the chief would look at the resident REALLY taking care of Mr. J and say, "So is he going home today or what?" Frustrating!

But so when I saw Mr. J for the first time on Tuesday, I couldn't wake him up. Here was a little old man, DNR, who'd had a big brain bleed; and the family wasn't willing to give him a feeding tube. He aspirates most of everything he's given to drink too. He's on "comfort care" which somehow translates to not feeding him. That really pissed me and one of my senior residents off. Anyway, I asked an older med student to help me wake him up. Turns out you have to SHOUT at people and shake them to wake them up so you can examine them. And it's really unnerving; and Mr. J ended up falling asleep before I could examine his lower extremities' function. His exam was unchanged for days, and all the Neurosurgery team was waiting on was Palliative Care placing him in a home. So when he fell asleep before I examined his legs, I just let him sleep.

....

Don't worry, every patient I saw was seen by at least 2 other people within the half hour.

The rest of the day is spent as such:
7:15/7:30--Rounds end, the residents BREAK! And I go to the OR
8:00-4:00--watch/assist with various surgeries. A required Surgery class/lecture always interrupts the most interesting ones, and then I have to scrub out annoyed.
5:00-7:00 afternoon rounds.
7:00-8:00 eat something and VEG OUT.
8:00-9:30 pretend to study but end up just playing on the computer
Go to sleep, do it again!

Quit that!

There are some slightly horrific things that go on during surgery, aside from the gore that you're lookin at. I think it's the scariest when patients stir around while the surgeons are working on their heads, spines, etc. Trust me, it's not uncommon to have someone start to get up. The craziest times are when the patients aren't lying on their backs (supine) but their fronts (prone). Sometimes the patient will just twitch a finger or a hand, and the anesthesiologist corrects for it accordingly, but this one guy who was prone tried to get up and extubate himself (take the tube out of his windpipe that was supposed to be delivering him the anesthesia). Apparently even though Anesthesia is watching these people's every breath and heartbeat, etc, you can't always tell when someone's gonna wake up.

Take Mr. S. I left his lumbar laminectomy for removal of a spinal mass (they cut his spine bones and took a mass from around his spinal cord) for a class, and when I came back the surgery was over. So I helped undrape the patient and stuff. But this guy had been placed in this crazy-style contraption where you first flip him over onto his chest, then strap a butt-pad onto him, bend his legs at the knee so his feet are up in the air, secure them in this metal thing, then rig it all up so that he would be on all 4's if his arms weren't by his sides. So the thing stretches out your back by putting you on your knees. So this guy has a respiratory rate around 4 (usually you're 12-20 breaths per minute), and he's just been undraped, and he WAKES UP. He starts tryin to get his tube out while the Chief and I are frantically attempting to unscrew his feet. The guy even helped move himself onto the awaiting gourney!! When we asked him about it later, he said he had zero recollection of it. And thank goodness!

Another thing I saw that I HATE to the point of queasiness was the way the 2 4th year med students were assessing comatose patients' reactions to pain. It helps you assess how with it they are or not if they haven't been responding to your verbal commands. I mean, a deep sternal rub is one thing, and pushing on nailbeds or pinching the arm another, but they twisted peoples' nipples. Like TA-WISTED them. I couldn't watch. No way am I doin that to someone.

I touched a brain

This week I started Neurosurgery. The team is a good one, although the chief resident is S-C-A-R-Y. Like the Suzer says, "She's a loose cannon." She likes to swear, and tells us "Ya'll need to curse more." She also calls people F-in morons; not to their faces or anything, but she gets frustrated easily. Paradoxically, she's a wonder with patients; and if I had to have neurosurgery, she'd be my pick. She really knows her shit.

On Monday, the first surgery I saw was a craniotomy for removal of a brain tumor. The tumor sits within the sac surrounding the brain, not the brain itself, but it's on the floor of the skull so you have to push the brain out of the way to get to it. So they go in and make an incision in the scalp, peel it down, do all that cauterizing and stuff. Then they drill two large burr holes into the skull, then connect the dots with a small saw. So you remove a "bone flap," or a piece of the skull that you'll pin back in at the end. Then you go thru the first layer of that sac---the dura mater; literally, "tough mother." Seriously! Tack that down and you got a part of the brain just sittin out. The chief said "come here and feel this." They give the patient a drug that pulls some fluid out of the brain cells so that it's more easily retracted. Plus you don't want a swollen brain, cuz your skull is rigid and that would compress the brain---NO GOOD! The brain wasn't like mush or anything, just soft and smooth. They got the tumor out the best they could, but there are lots of big vessels and nerves runnin in the same area. Anyway, the woman came back yesterday to the ER with mental status change---she didn't know her name or the year, but she knew where she was. I'm going in tomorrow to see how she's doing.

But yeah, umn, I touched a brain. And that is weird. And craniotomies are insane.

a sad farewell, ENT...

So Thursday morning I went to the first conference I've ever been to for ENT. They have conference every morning, but for some reason Dave and I had managed to have classes or whatnot every other morning. The conference though had a presentation by the chief resident, let's call him Dr. Bowtie (cuz he likes to wear those). It was on Obstructive Sleep Apnea; and when I looked around, all the resdients were fighting sleep. I thought it perfect.

Dr. Bowtie happens to be a great guy who has stolen my pen. Well, I GAVE him the pen in the morning...something that my fave R2, let's call him Dr. Chill, said was a big no-no. "Why?" I asked. "Because you'll probably never get it back now." To which I said without thinking, and probably crossed some sort of line, "Oh, so it's like when you lend a friend your lighter." I said this as I say most inappropriate things, in passing---like physically in passing. I was rising from the table to go get a napkin when I said it, and when walking away immediately thought "ooo...poor choice?" Because now he thinks I'm an avid smoker or something. Not that that's so major, but it made me think "poor choice" because Dr. Chill, instead of saying something like "oh I know!" or "yeah!" or just laughing, he didn't say anything and gave a sort of awkward smile about it. But really, when you are friends with avid smokers, having a lighter = being everyone's favorite person. But lighters disappear like pens, accidentally-on-purpose thrown into pockets and purses after being used. You gotta fight for the lighter. Besides, you never know when you're going to be stranded somewhere and need to quick make a fire.

Anyway, Thursday came and went with 2 VERY interesting surgeries interrupted by a simulated tutorial. Simulated by a mannequin named "Rocky." Rocky can be programed to do a lot of things; you can feel his pulses, track his blood pressure, hear his inspirations and expirations. Rocky's eyes can even dilate. But his heart-sounds are super-mechanical. The tutorial was of 3 different cases, all having something to do with shock. It was fun cuz it wasn't graded or anything, and 3 classmates and I got to put our heads together. But it was also SUPER frustrating cuz geez we have no clue what we're doing most of the time. This is why it takes so long to become a physician.

While we're naming people, let's review and add:
Residents:
Dr. Bowtie---chief resident; what a great one.
Dr. T---kind of a geek, but an EXCELLENT teacher who just loves to tell the med students stuff. Also a chief resident. The one who took the time to teach the most.
Dr. All-up-in-there---perhaps an R3? She is the most zealous.
Dr. Muffin---another R3. Always super-nice to EVERYONE, regardless of their position in the hierarchy. Will also answer questions without making you feel like you're bugging him.
Dr. Chill---my personal fave. The wise-ass. The most approachable, and we'd have been great friends if we were in the same phase of doctor-life.
Dr. Newbie--the intern! Another female, so she's automatically appreciated.

Attendings:
Dr. Wildman---a crazy Jewish surgeon! He was ALWAYS entertaining, if not very overbearing. He'd say things to the residents like "Dissect it superiorly, tease out the tissue, and WATCH THE NERVE. Don't f$*% it up, boys!" and then take off. Then come back 5 more times, check things out, get all up in there and dangerously close to the sterile field without being scrubbed in, and leave and come back.

Dr. Niceguy---actually was my physician for my laryngeal nodes! Which I think are probably still there...thanks to my still being a vocal-abuser. Oh well. He's still a nice guy.

Dr. Blankface---amazing woman, but she has a seriously deadpan face 98% of the time.

Dr. Napoleon---although 3 of the 4 male attendings are short, he is by far the shortest. Ohhh Dr. Napoleon. He is much appreciated by patients---several told me how amazing he is and how he saved their lives. But he has a very business-like streak, and for example, barked at the Olympus guys who were supposed to be giving a half-hour conference: "Now who scheduled vendors before our conference? You guys have 10 minutes---I'm dead serious. This is important." He made it all sorts of awkward, and wasn't very nice about it, and these Olympus guys were super-nice guys. It happened to be Dr. Napoleon's and all the other docs' faults that the vendors started at 6:50 instead of 6:30, and yet Dr. Napoleon gave them all the shit for it.

And last but not least, Dr. McDreamy---named by a friend who loves Grey's Anatomy. I'd had him as a facilitator for a PBL my first year (which he remembered somehow on Friday and asked me about). I liked him back then too. He's really tall and has a kind of crooked face. I got to work with him in his clinic on Wednesday; this guy's specialty is ears. And for one patient I'd had the time to take more of a history than the resident I was paired with, Dr. All-up-in-there, had. So when she said to Dr. McDreamy "I wonder if she's scheduled to have a hysterectomy," I said, "Oh yes, she is. She was found to have a lot of endometriosis on exploratory laparotomy, and is scheduled to have a hysterectomy soon. She and her husband are already into the adoption process too." And All-up-in-there and McDreamy looked at me with some astonishment. "You asked her more than just about her ear pain?" asked McDreamy. And I was like "well yeah, when I asked if she had other health problems......umn, well I had a longer time in there..." And then later Dr. McDreamy referred to me as a super-star. So looks like their expectations for us wide-eyed 3rd years are pretty low...

So back to Thursday. The surgeries Dave (my partner in crime these past 2 weeks) and I viewed involved laryngoscopes. Both patients we saw on Thursday were in for the same procedure. Now get this. When someone gets a cancer in their pharynx (back of the throat)-larynx (voicebox)-esophagus (food tube!) area, it can cause the tissue to scar. Then you have trouble swallowing. Medicine's ingenious treatment plan---just mechanically stretch it out. And that's what we saw: esophageal dilation. This is gonna sound gross cuz it kinda is. They have these tubes with tapered tips; they come in a series and get bigger and bigger circumferentially. You stick some lube on the tip and slide the tube down the esophagus, and just keep using bigger and bigger ones. Viola---manual muscle stretching!! Ugh. The first patient had scarring from a former cancer that was interfering with his swallowing. The second though had a muscular dystrophy in which her esophageal muscles and upper larynx muscle were all just SQUEEZED TIGHT without relaxation. So they gave her...a Botox injection to the throat!! That was the coolest because the docs used a laryngoscope---a tiny camera placed on a long wire that also has a needle on it! So Dave and I got to watch it all on the video monitor.

The afternoon was clinic with Dr. Blankface. She's surprisingly a pediatric ENT, even with her deadpan face, and actually very very good with kids and parents alike. No-nonsense kind of lady. I went to see some patients for her and when presenting them to her she'd say "So did you ask if the snoring is loud? Did you ask if the child is hard to wake up? How many episodes of pharyngitis in the past year?" To which I'd respond, "All excellent questions!!" and "No, sorry..." It's funny because physicians assume that you know what to ask. And these are super-specialized physicians. But this is how you learn, by f-ing thing up and feeling like a fool, so it's OK. Besides she goes back in and basically asks everything over again, and I watch and learn. I do get to do physical exams alone though, so that is fun---although my exams aren't necessarily reliable because I've seen not-as-many ears and listened to not-so-many hearts and graded tonsil size about 2 times prior. The part that makes me nuts is that I have to write down my findings in the patients' charts, and when they turn out to be crappy and wrong, here the findings are written down and I don't know if they really get corrected...!!!

Which brings us to Friday, the last ENT day. Dave was scheduled to be in the OR in the morning, and me in clinic with Dr. Niceguy. But instead I accompanied Dave to the OR in the morning, because there was only one surgery scheduled for the whole day. Dr. Wildman was the attending surgeon on the case; but Drs. Bowtie, Muffin, and Newbie were all to work on the case, so that's already 4 surgeons, plus Dave scrubbed in on it too. Dr. Newbie was like a glorified med student for most of the case, but then got to do some dissecting. My role was to stand on two lifts (because Drs. Bowtie and Muffin are sooooo tall) and see what I could see. The scenerio: taking out the parotid gland, the big 'ol salivary gland on your cheek by your ear, and all the lymphatic tissue in the neck on a guy who'd had a malignant melanoma on his forehead. The reasoning is that the melanoma spreads through the lymphatic tissue that drains the forehead, which includes tissue within that salivary gland and the neck stuff too. So I was super-jealous of Dave when he got to feel the carotid artery with his fingers and such.

No one informed us of how long this procedure would be---and I was scheduled to be with Dr. Wildman in the afternoon. But because Dave was already scrubbed in and sooo many residents were in the room, and crazy Dr. Wildman kept coming in, scrubbing for like 30 seconds to get all up in the residents' business, then leaving and coming back and doing that like 3 more times, I just watched instead. We hadn't been informed how long the surgery would last. And the longest one I'd been in to date was about 3 hours, so I hadn't bothered to eat anything beforehand. The surgery lasted 7 hours. On your feet just watching for 7 hours. Thankfully, the surgery was cool enough to pay attention most of the time: the facial nerve, the one to all the muscles in your face (so nicely named), comes out near the parotid gland and branches WITHIN it. So the surgeons had to dig out all the gland tissue without hurting the nerve or its branches. A bunch of other nerves and muscles run through the neck too, so they had to be digging those out and identifying things all through there as well. It was all very, very cool to see. Dave and I would geek out, and he kept saying "Better than Anatomy class!" I'll miss his same response every morning to "How are you?"---"I'm all fired up!"

In the end, Dr. Bowtie did end up stealing my pen for good. However, on Friday when I showed up, I could hear him asking the other residents "Where is Katie today?" "Here I am!" And there he presented me with THREE new pens!

ENT was a good time. Dave goes to be run ragged but see awesome things on Cardiothoracic; I wonder what Neurosurgery will be like! I hear LONGEST SURGERIES EVER! Good thing I had some practice in stamina!

Still likin it

So, I DO do (hahahaa doo doo) a lot of watching on this surgery rotation as well. BUT I got to be all up in a hemi-thyroidectomy yesterday, as well as go to one doc's CRAAAAZY zoo of a clinic. He'd throw me in a room with absolutely no background on the person or their disease---so I'd have no idea what questions to ask, and would feel like I just chatted or something. It's amazing how much people assume you know, and both ways---patients will ask me all these questions because hey, I have a white coat on, I must be a doctor. And docs MUST assume I know something if they decide to throw me in there with patients. Umn...

Today was also fun, but in clinic the whole day. Met some very nice people; also had to fly over to the OR with this crazy-man surgeon who got called over to see one of his throat cancer patients being operated on by a different (plastic) surgeon. They were going to take his pectoral muscle and flip it up over the neck or something terribly insane like that. But the guy had such a big tumor and sooo much necrotic tissue and residual tumor that all they can do is sew him back up and irradiate the area. It was really sad; and also kind of gory. It's hard for me to see surgery on peoples' faces. Surgery anywhere else and the face is always covered up, and you can kind of separate yourself from the fact that you're cutting into a live person...well, at least a little bit. But this gentleman's face was what was being worked on, especially around his cheek and his lower lip. And I couldn't stop thinking as they were cutting into it, "Stop! That guy's alive in there!" I mean of course they were going to sew everything back up, but it's just really REALLY weird to see for the first time.

It's good to come home and swap surgery stories with my roomie since we're both on surgery. But as for right this moment, I'm hoping we don't have a tornado over here. Gotta go and study SOMETHING for like the first time ever this week (either that or hit the bar for an hour with friends who have easier rotations...what do you think I should do???)

ENT ROCKS!

Umn, much better start this time around. The ENT residents are super-nice. Plus we were taught in-depth how to do a basic ear, nose, and throat exam---KEY. Putting speculums up peoples' noses is no big thing unless you can't stop giggling like I did with Dave. You can see SO MUCH with a nasal speculum! And yes, the basic idea behind it is the same as a gynecological speculum---also a part of why I couldn't keep it together, aside from the fact that people look funny when you make their nostrils real wide. I have a whole new appreciation for noses. And ears. And throw in throats too.

I even took 2 histories today, did physical exams, and presented some patients. Practice practice practice. The attending AND resident I worked with all day were super-chill and nice! And now for some lessons and fun facts:

--the "tragus" of your ear is the part that's closest to your face---that little lip of cartilage you'd smoosh down over your ear canal if you were plugging your ears up. "Tragus" means "goat"---and it's called that because old men have hair on it and it makes it look like a goat beard. GOAT BEARD!

--HPV strains can give you papillomas on your voicebox. The complications can range from making you have a hoarse voice to obstructing your entire airway with a mass of "warty lesions." They have to be routinely scraped or lasered off. Babies get them if their mothers have genital warts at the time of birth---one of the reasons why these moms usually get C-sections (although there have been cases where the babies get the "recurrent respiratory papillomatosis" anyway). Although how adults contract it is officially unknown, it is "probable" that it is an STD. That's right---oro-genital contact. So just watch yoself. It's pretty rare, but it's a complication I'd never heard of til now...

--I HEARD AN AORTIC STENOSIS MURMUR!!

--Kids are hard to examine. Period. You gotta be super clever; and even then, sometimes you just gotta get mom to hold their faces and arms down and stick that otoscope in their ears. Some kids are SPLENDID; and some burst into screams the second you look at them with a medical tool in your hand.

I was told that I have lovely eardrums today, a fact that surprised me since as a child and a swimmer-teen I'd had so many ear infections. Just another example of how well the body can heal itself!

Tomorrow---the OR, ENT-style. ;)

Ortho days 2 and 3

You probably already heard about Day 2. I probably called you close to tears. You all did an excellent job of consoling me, and I'm grateful.

I spent 4 hours in Ortho clinic being a friggin shadow. I did more as a 2nd year in a clinic than as a 3rd year in that clinic. I tried out taking a patient history and doing a piss-poor physical exam, and was all ready to present it to my attending; then he's already got his hand on the door and I say, "Wait, don't you want to hear about her?" and he says "No, that's ok! I'll get it."

So really, I was a waste of space.

The questions I asked whenever I could catch my resident or attending not making calls, seeing patients, looking over radiographs or dictating seemed sooooo far below these guys' level of knowledge that the answers were pretty short. I was reaching to even think of things to ask that wouldn't sound completely dumb. And at one point when I was basically ditched to stand in the hallway and try to keep it together, I kept thinking "what on earth am I even here for?"

Lunchtime was spent bitching about life to friends in similar situations, then seeing one friend on my way back for another 4 hours of being a shadow and my breaking down to tears. Then it was slightly better, because I decided to just gain whatever I could that day and talk to patients like they were my old friends, since I wasn't really doing anything else. I even answered a phone. Tada!!

Yesterday was MUCH better because we were back in the O.R. I even saw an operation on a guy who I'd seen in the clinic the day before. Totally awesome; well, totally gross. He had a big surgical wound infection that needed reincision, drainage, and irrigation. My poor resident was trying his best not to spray me all over in the face as he irrigated it, but it was kind of hopeless and at least made for a lot of laughing. Except when I thought it kinda got on my bare neck. This stuff was nasty; I really want to know what the results of the culture will be. My resident even taught me vertical mattress suture technique! The time it takes him to throw like 25 stitches I got two done. But it was fun nonetheless. Except when I thought I stuck myself with the needle I was using---thankfully in Ortho the scrub nurses and techs automatically double-glove you, and when the nurse filled the inner glove with water, none came squirting out. Crisis averted, and once again felt stupid.

I also got to see a total knee replacement. Things look so crazy and pretty inside there. Then they're using chisels and hammers and knocking the crap out of it, and shaving it and shaping it all nice with powertools, and getting the right angles down for the prosthesis. So yesterday was much better. However, I am fine with saying bye bye to Ortho. Way over my head. And no testing of my knowledge. And no rounding or prerounding. I gotta learn these things at SOME point! I should've taken call tonight and see what it's like when trauma cases come in, like motor vehicle accidents, but I just don't think I can bring myself to it. I'm going to study instead.

Today we had a 2-hour suture lab with a jerkface from the Plastics team. A Russian guy who kept saying "Comprende?" with his Russian accent; you can imagine how humorous that is. Too bad he was being such a jerkface and talking up how amazing plastic surgeons are. Every time we have suture labs on pig shanks or foam we get better and better. But it's funny to have a suture lab AFTER you've already sutured real people...

Gen and I went on a hunt for compression socks and were not successful; but we did find underpants and bras on sale, plus plates and a salad spinner on a good deal from the Goodwill. Ahhhh shopping---life makes sense again.

Off to study! I've decided to be more proactive for my next 1-weeker, ENT. All the kids who just got off ENT had a good time, so here's to THAT! I can't wait for Medicine or any other rotation that gives me my own patients to follow.

status/post 2 days of Ortho

So the past 2 days have been sort of rough. I was, like every other 3rd year, thrown into situations with very little guidance. You learn to highly appreciate any helping hands (like nurses and scrub techs); they are GOLD. And I love them.

These 2 days have seemed like 5. Yesterday I went to the O.R.---not knowing how exactly to scrub in or wear my surgical mask (I ended up paging a nurse, Kaye, who'd taught us to scrub in and had given us her pager for this exact moment, and she informed me in the nicest way possible, "Oh you need to put the colored part on the outside dear." Oh and I was told I paged from a phone that the CSA's would KILL me if they saw me do it. Of course, I don't know what a CSA is). The first surgery I basically shadowed and couldn't see much. But that's where I met Dale, a nurse who is just the nicest most helpful lady ever. My resident tried to get this scrub tech named Chris to teach me how to scrub in effectively---he literally looked me over, a once-over (made more apparent because all I can see is his eyes with his mask on), and said "Isn't Kaye supposed to teach them first?" And I was like "Oh, she did!" But they teach us stuff and we do it once and then don't do it for over a week and of course forget it. In the end, I had to page Kaye myself. That was around the time I had been ditched by both resident and attending and didn't know how to use the big chart.

Kaye set me up, and from there it was goooood times. She led me back to my resident, Brian, who I still don't know if he hates me or not because third years are basically ignored as a rule. HOWEVER, he is cool in my book because he helped me not only scrub in, but also said "so watch me drill this in, because you're doing the next one." Yep. I drilled a hole into a lady's humerus, then he helped me screw a screw into it! WHAT. Then he had me suture a bit too! That was the BEST part of the day. Especially because John was there. John is a scrub tech who gives me shit for mentioning Pediatrics as a career interest. But the jovial kind of giving-you-shit that makes you feel better because someone has actually talked to you, and it wasn't to say "hold this retractor." Plus he is the most able-to-multitask man I've ever met in my life. Like I backed into the arm of the table AFTER THE ATTENDING SAID "Ok come around but don't back into the arm of the table." Embarassment up the yin yang. "Now you're contaminated!" So John was assisting in the attending's sawing off a femoral head AND regowning and regloving me.

Ok so when you meet people in the O.R., you only see their eyes. Everyone is wearing a mask---sometimes even a big 'ol fancy hood thing that shoots air into it so that you can breathe (I got to wear one of those too. Like the skeleton of a bike helmet plus a drape/hood around it). So when I met Dale and John I only met their friendly blue eyes. John I actually saw and instantly decided that if he was 15 years younger and not married-with-children I'd date him immediately. And Dale I saw in the hallway after about 3 surgeries and I almost didn't know who she was! Of course I stick out like a sore thumb, so I wasn't surprised when John later pulled me aside and into a hug and said "You know I'm just giving you a hard time, right? You do what your heart tells you."

At one point I was pretty low cuz I'd lost both resident and attending. Then I was taught how to page Brian and was free to go. But I forgot to mention that all I'd eaten was a granola bar I stuffed in my mouth at 7 after morning conference, and went til about 3:00 that way. Brian asked if I had any basic questions and I said "yes...do you eat?" And he laughed and said "yeah, I meant to send you for lunch but things got crazy. Just make sure you go next time."

After a mandatory lecture, Day 1 was done. Aside from moaning and wailing with Genevieve. This blog shall have a lag because I desperately need to copy things before this library closes. Sadly, Day 2 was a downer. But here's to Day 3!

Rezee and me (see previous post)

Dead ringer for sure.

sucked in

So the Hobocamp girl (I'd link her if I knew how) sucked me into this myheritage thing. You upload a photo and they tell you what stars you resemble. Ahem.

Emmanuelle Beart 57%---ok, I'm quite flattered by that, even though no clue who she is
Lee Young-ae 54%---yes, I'd LOVE to be Asian. Also, do you see how low I'm scoring on these? I'm not so attractive.
Hilary Duff 51%---DID YOU EVEN LOOK AT ME?!
Jake Gyllenhaal 51%---because I want to MARRY MYSELF OF COURSE! Shit we'd be a brother-sister couple.
Wladyslaw Szpilman 49%---ANOTHER DUDE. Who the F is this guy? Should I be really upset? Too late, already am.
Demi Moore 49%---AGAIN, did you look at me?! No way.
JOHN CUSACK 48%---HAHAHAAA I agree.
Alanis Morissette 48%---I think I look WAY more like her than I look like Hilary Duff.
Emmy Rossum 48%---who?
and last but not least: Bashar al-Assad 48%---so I look just as much like this Arabian man as I do John Cusack. F YOU MYHERITAGE!


Round 2, with this picture:


Kristin Kreuk 72%---TOTALLY FLATTERED
Penelope Cruz 70%---OHMIGOSH WHAT A COMPLIMENT!
Lee Harvey Oswald 68%---OH WOW I'M SO...wait a minute...
Sammi Cheng 67%---yes, I am very Asian
Angelina Jolie 67%---are you kidding me?
Charlize Theron 66%---posing while biting a wrapped pack of smarties. I agree.
Natalie Imbruglia 66%---hmn.
Sofia Coppola 66%---it is all in the family with this one.
Tata Young 64%---how Asian can I be?
Jessica Lange 64%---?

So I kept running my craziest of smiley faces and Ricki Lake is the top pick for me. Agree? I'm most proud of being 50% Rezee Nelweger! Woot!

Umn, play this game, it's really fun!
http://www.myheritage.com/FP/Company/face_recognition.php?s=1&u=g0&lang=EN&restore&category=1

up before sunrise!!

So yesterday around 4:30 I had to say goodbye to a moogie who'd partied with me aaaaall weekend. We had drinkin times, we had Amish times---and really had a ton of fun!! But when I came home through the demon hell ride of a rainstorm and checked out my schedule for Surgery rotation the next day, I found something quite special:

HERSHEY MEDICAL CENTER students
ONSITE: Report as directed, at Orientation. Students rotating in Orthopedic Surgery report at 6AM to C3862, Ortho Conference Room (prior to Orientation on Day 1).

!!!!!!

Frantic emails and phone calls ensued, with no hope of answers of course because now it is Sunday at 6:30 PM, and for some odd reason, faculty don't check their email every hour on the hour like I do!

So last night was me trying to go to bed at 11; then about 15 dreams in a row about being late, then waking up when someone went to the bathroom, another sweet dream about losing all of the hair on the top of my head AND being late because of it, then finally the 5 AM alarm.

Then I did my morning powerwalk of near-tardiness. I prefer to think of it as the brisk stride of near-punctuality, but I know better. What I think happened at 6 AM in the Ortho conference room was something called "Rounds." They are SUPPOSED to talk about each patient in-depth; in Medicine, rounds can last for hours as they debate why the potassium is 0.3 off. But on Ortho, this is what happens instead, and it lasts a total of 1.9 minutes for about 50 patients:
"Smith?" "Fine."
"Houcek?" "She's fine."
"Kane?" "Fine."
"Wisner?" "Off the list."
"Stagg?" "Fine."
"O'Connor?" "Switched Rooms."
"Schneider?" "Fine."
"Pham?" "Crashing."

I was asked what year I was and said "first" instead of "third," but a classmate helped me out. At least I had classmates there and it made me feel better. I understood very little of what was said about the radiographs being presented. I did know the answer to one thing! Lytic lesions on bone make you think FIRST of metastasis. The guy doing the presentation was none other than Shawn Price, which of course made me smile---except that he is an African American man and not my big Irish Eeyore. And all I could think was "God, this guy is sooooo tired." But he did a good job anyway, what with all the rapid-fire orders and questions.

After the presentation of the new cases, a chief resident started saying things like "Ok, I know this is a high-stress situation and we're all going to have disagreements and arguments..." It sounded like it was gonna be REALLY good; but then it was noticed that med students were almost outnumbering residents and we essentially were, nicely, kicked out. I mean, everyone was really nice, not condescendingly even, the whole morning. Our time had just been up.

It's 15 minutes to go to see if I was supposed to even be there this morning; 15 minutes til people shuffle into their offices or listen to their messages. 15 minutes til the bookstore and library open. I got out of rounds and thought well, I should go home and put on some deodorant cuz I definitely forgot that part. And make some tea.

Oh and I already have a crush on a chief resident based on looks alone. =)