outer space

On Wednesday I got to wear a space suit. We finished general surgery stuff in early afternoon. To follow was an orthopedic case that they graciously allowed me to scrub in on so I got a firsthand look at the inside of hip fracture and replacement. Because of the risks associated with cutting and drilling into bone versus soft tissue, we donned helmets that run air into the scrub suit. We were covered with a face shield and then wrapped in a sterile blue gown not to mention a few pairs of gloves. It's quite the outfit. I felt ready to walk on the moon almost. In all my shadowing experiences, I had enjoyed orthopedic surgery the most. After my general surgery rotation, I've started to question that. I guess that's okay. I mean that's what this year is for, getting experience and learning what you like and don't like to help you when you get out there. I'm not sure what I'll go into - right now I'm looking forward to family practice. I'm done with 2 rotations already! 6 more to go! I've successfully moved back home. My room looks like a disaster zone. I need to figure out what to do with my stuff. It's hard to know what you'll need and to get rid of sentimental things from days gone by. I don't enjoy packing or unpacking, despite lots of experience with it. A new adventure starts tomorrow! It's strange after 8 weeks not going back to Dodgeville. I'll miss it.

A marathon day

I put in 11 hours of general surgery today - in the OR, on the floor, in the clinic, documenting, etc. We had another case of something that my preceptor has never seen before in his many years of practice. More excitement for my last week!

It's hard to believe that I'll be done with this rotation and moving on to the next in days. I've grown fond of the people I've been working with. They've even given me a nickname. There are a few others that share my name, there's even a surgical instrument that I share a name with. It'll be hard to leave. There's a lot that I don't know which is a bit scary, but you can't expect to learn everything in 2 months either. It's tough seeing patients that we've been following and knowing I won't see them again and be able to follow up on their care after this week. For completions sake - I'd like to see the resolution. I guess that doesn't always happen in life. 
I'm celebrating the conclusion tomorrow (a bit early) with pizza and treats to share with my OR team simply because it works in the hectic schedule this week better than other days.

In other news, I ran another half marathon on Saturday with some gals I love in a city that is dear to my heart. It was a perfect day for running on a beautiful course. Later we enjoyed the sights and tastes of downtown - visiting the Farmers Market and the art museum before making our way home. Despite a nice laid back weekend following the long run, I still don't feel rested. I'm anxious about finishing well (remembering all that I should, having the stamina to last all day with enthusiasm and interest for every patient). Just a few more days.

I've gotten more suturing experience. One of the techs told me that I have steadier hands than some surgeons she knows. I fail many times, but it's always nice to get positive feedback like that. The same tech was concerned about when my last day was last week because she knew my time was short. She was relieved when I told her I'd be around for the surgeries this week because they are pretty complicated and an extra set of hands scrubbed in is handy.

Llamas doing the limbo...

Something I never expected to see, but did at the Wisconsin State Fair! Llamas and all sorts of animals strutting their stuff.
I had a great weekend - visiting friends, seeing family, eating good food, etc. I probably keep myself too busy - trying to do and see as much as I can. Going between a few of my favorite places in the state (home, Madtown, Milwaukee). When you are faced with people dying from ailments at work, I guess it makes you want to live and experience as much as you can. I wonder where I'll end up. It's funny that even as we age and bodies change - sometimes it seems as if we're all still young at heart - under the impression that we'll live "forever" until some news shocks us into remembering each day is a gift and we all have an expiration date on this life. 

Surgery hasn't been what I expected either. I've seen and done things I didn't think I would at this point in my career. Every day, I never quite know what I will encounter. I try to prepare, but face the unknown. It can be tough not knowing the answer, especially when you have patients that desperately want reassurance. I'm finding it's difficult finding the balance between offering them hope and cheer, but still being realistic about possible less than desirable outcomes.
Hope. Truth. Faith. Life.

Knowledge is power?

There are many days when I just don't know the answer. It's disheartening. I feel like I should, but I lack the experience or discipline studying or brain recall memory or something. Missing neurological signals

As a health care professional, we are expected to know: anatomy, physiology, pharmacology, psychology, gender and cultural aspects impacting care, evidence based practice techniques, associated costs/risks/benefits of treatment and diagnostic options, statistics, medical terminology, cancer recommendation guidelines, how to resuscitate someone, reference ranges and indications of diagnostic tests, how to navigate health care system computer software, how to counsel/teach, how to read imaging studies, how to accurately measure, essentially a little bit of everything!
It's overwhelming. I realize no one person is expected to know everything, that's why we work in a team, but patients look to us expecting us to have a solution a lot of the time.

Crazy stuff

Since I've been on rotations, I've seen a lot of wild cases. Extreme things that my Doctors admit have never seen before or seldom do they deal with such things. I'm not sure that's a good thing, because when something routine comes along I may not actually know what the standard is.  That and while the weird stuff is happening, I don't even know what's going on most of the time. Yesterday was a good example.
A colostomy was created for a patient with significant rectal prolapse. No one wants to go in a bag, but it's actually the best option we had to offer this patient who has many other issues to deal with besides this one. So that was something you don't see everyday. It was followed not long after by an older patient who has been hospitalized for a while following an abdominal surgery. A decision was made to reinvestigate his belly because he hadn't been recovering as expected and may have a small bowel obstruction. Unfortunately, in the process of cutting into his abdomen this time his intestine was injured. The surgeons did what they could to salvage the situation. It's not what we wanted to happen, but that's why they discuss the risks of the procedure before the operation because less than desirable outcomes are a possibility even in the best, most experienced hands. I wasn't there when it happened so I came in on the case - belly fileted open, guts squirming around - and was a bit lost.
Unfortunately, there are some things you just can't fix. It's quite ingenious the solutions that they do come up with though. Now all we can do is wait and see what will happen next. 

In the name of medicine...

Today I stitched up my first awake patient. He had skin cancer that the surgeon sliced out. Then we had to sew him back together.
Everyday seems to have a new learning experience. It's hard to keep up - hence the slight blogging hiatus that I'm trying to catch up from.

Last week, I felt as if I was torturing people in the name of medicine, while they slept.
As one of the MDs said, "you can go home and tell mom that you stabbed someone today." I cut someone open with a scalpel. It was a tiny incision on a laparoscopic procedure - but it was still a sharp knife. Then I poked them with a needle repeatedly in an effort to stitch them shut again. 

I also yanked some poor kid's toenail off. He asked for it. Really - it had been bothering him for a long time. When they say general surgery - they sure mean general! I was not expecting to have to do that. There's definitely a bit of a grossed out feeling that comes with peeling the nail off. Gruesome. Maybe even worse than blood and guts. 

In other news, after those interesting experiences (you'll never guess what I did today...) I went home and enjoyed a nice weekend with family. My uncle who lives on the other side of the country was visiting Wisconsin so we had a mini reunion.

Surviving...

This was a long day. It was particularly stressful because of a big case involving 2 surgeons on a woman with breast cancer. She underwent a bilateral mastectomy with reconstruction. As she said, "not how I wanted to have a boob job." We also saw several other patients for various ailments - some just as threatening to life/well-being.

It was crowded around the operating table with both general and plastic surgeons working simultaneously on the lady from each side. I was in on the action. Because of the amount of work being done, it took a while - probably 3 hours. It didn't quite go as planned - but everything turned out fine in the end. Lymph node biopsies needed to be taken and a port was placed in lieu of chemotherapy treatment. That's 3 hours of standing still -working in a small sterile field, wearing a lead apron for protection from the radiation used from x-ray imaging - trying to focus on everything going on and hopefully learning something during my first ever mastectomy over lunch. By the end I could hardly think straight to be able to tie knots for drain placement. Fortunately the surgeon was nice enough to show me what he wanted. With his tutorial, I managed to get it done. It can be discouraging to watch these professionals who make it look so easy - like second nature - and compare it to my own flustered, clumsy fingers under pressure.

While I know it's necessary to treat the disease and the patient wanted aggressive treatment so she hopefully will not ever have to deal with breast cancer again, the things done in surgery to completely remove tissue seem a little barbaric. Maybe it's something surgeons just get used to. But for me, there's still something a bit surreal about being scrubbed in for an OR case. I stand there and am literally holding living tissue in my hands, watching blood oozing (or squirting) from surgical areas that we are working on. It's amazing.

Working in healthcare makes me pray. When you see cases like this woman lying open and exposed in front of you knowing she is hoping to God this surgery goes well and helps her become a cancer survivor, you want to do the best you can. That only takes you so far and faith comes in. We want a miracle. 

Friday was my first back to campus day since starting rotations. It involved an exam, meetings, paperwork, and a presentation. After a day I just had in surgery, I was glad to have a break, though a bit disgruntled that I missed a whole day of surgical learning opportunities for an unpleasant exam. It was nice to see my classmates again and compare some stories from our experiences so far. I'm also excited about the plane tickets purchased for my next international adventure coming up.

The rest of the weekend was busy with a wedding in Madison Saturday followed by a Brewer game on Sunday. Carpe diem! I have to capitalize on fun when I can to make the stressful student days more bearable. While there wasn't a baseball victory, not much says summer like tailgating in the hot sun.

Quarter of the way done with Rotation 2

Woohoo! I survived another week. Today was another long day, but for Friday the 13th and a black cat crossing my path on the drive to the hospital, it wasn't bad. We went to another small town hospital in the area for the morning to see patients. I did my first dictations. I don't do well talking out loud into a phone speaking med terminology. I was also given some more responsibility to see patients - get their history and do a physical exam, plus I did some assisting in the OR. We performed an inguinal hernia repair on an older gentleman and a hemicolectomy on a women with an unusual colonoscopy. As a student, I'm mostly in charge of retracting, other maneuvers to aid in surgical field visualization, snipping suture ends, and staple closure. It's hard to screw that up. This weekend my preceptor is on call. I have plans bringing me to Madison and Whitewater on Saturday and Sunday. I may stop in when I'm able if something unfolds and he calls. Meanwhile, I'm going to try to rest and recover from a crazy week. Putting in 40+ hours of work and trying to study on top of it is no easy task. It doesn't leave much time for sleeping, working out, eating or anything else that is healthy and normal. 

"Worst day ever"

That's how my preceptor described today. It was insane. I may not have described it in those exact words, but it is one of those days when you wonder, what have I gotten myself into with this medicine business? Yesterday was an interesting experience as well. What is going on? I felt a bit thrown into the wolves this week. It's not over yet.
We were supposed to start doing colonoscopies this morning at 730. However, an emergency C section came in so our procedures were bumped back. It was an inconvenience at first. The emergency turned into a problem severe enough that they called in my preceptor to assist with the operation because the mom was bleeding significantly. I threw on some scrubs and ran into the OR to stand awkwardly as close to the wall in order to stay out of the way, but still try to see and learn. Red liquid on the floor of an OR isn't generally a good sign. It seemed like there was enough blood and gore for a horror flick, but maybe that's just because it was my first time in on something like that. Once they seemed to have things under control, we left to get started on some of our patients who were patiently waiting their turn. After a colonoscopy, the Doc got called back in to the OR because the mom was pulseless despite blood units being dumped in her via IV. She was in trouble. Yet again they regained control of the situation and had to do a more extensive operation that initially planned, but it was nerve wrecking. It's terrible to be stuck unable to do anything useful when serious stuff is going down. By then we were incredibly far behind and had to work overtime to get everyone seen and taken care of as quickly as possible. No margin for rest or extensive teaching times. Another patient needed surgery which was scheduled for the next day. I was winging it - doing what I could on the fly in my limited experience and realm of knowledge.
Eventually we made our way to the office to finish up when we got a call about another surgical case. This was an elderly woman who had significant abdominal pain and related issues - a recipe for disaster. A decision had to be made about the value of an operation at her age with associated risks and quality of life concerns. In the end, it was determined by her family that it is preferable not to have her undergo the stress of the surgical procedure and try to make her as comfortable as possible in her final days. It was a whirlwind of a day. I was thoroughly frazzled by the end. It probably didn't help that I was running around on just my cereal and morning coffee. Never underestimate the value of breakfast!

All day in the OR

Today we had two significant operations. One was a paraesophageal hernia repair. I didn't really know what it was until I looked it up last week, but if you are curious about what a laparoscopic procedure looks like - check out Youtube. That one took a while as it was on a large patient. I spend 2 hours trying to stand still holding the liver out of the way for them to be able to see what they were doing in there. Later, I got to help suture a drain in place and close one of the wounds. I'm moving up in the world and was even praised for the good job I did. Not moving in order to keep things in position is pretty important and requires self-discipline and endurance. I might be sore later. I knew surgery would be taxing, but I wish I could have prepared more for it. I'm still working on getting in shape.
Our first case didn't start on time because we were waiting for our anesthesiologist and it took longer than expected so that meant we continued working through lunch to do the next procedure (subsequently delayed) which was a reversal of a colostomy. During that, I was holding a retractor most of the time and I had the honor of stapling the incision closed and cutting the end ties off a few stitches. Cool stuff. At the end of one of the procedures, we had a minor scare that required a bit of a workup to make sure everything was ok. This is why we have monitors to alert us to potential problems. Part of me was wishing it would be the worst case scenario to see them fix it, but the other part of me was of course hoping that it wasn't a big deal for the patient. In the end it wasn't anything major to worry about. We'll follow up with them down the road. It's great seeing cases from start to finish - getting the whole scope of what is going on and what to do about it.

Tough day

It's Monday for sure. He wasn't kidding about boot camp if today is any indication. I had a day of highs and lows. Today was the first day I didn't get enough of a break to sit and eat lunch. I also realized after most of the day had gone by that I hadn't even gone to the bathroom yet. Probably not a good thing. I snacked on some fruit when I could, but otherwise I was busy seeing patients from 8 until 5. It was a long day, but I learned a lot. A genuine surgical rotation experience I guess.

 I saw somethings I wish I didn't have to deal with - like a new cancer diagnosis from a biopsy last week. It took all that I had not to break down in tears when the patient was crying. On the other hand, I also had the pleasure of more hands on things like removing staples, dealing with laparoscopic instruments, and even suturing during my first appendectomy. Tomorrow we have a couple cases in the OR which should be interesting. I have to move on and keep going taking critiques in stride. *Deep breath*

It's Friday!

I survived my first week. Dr. Asurgeon says to get ready for boot camp next week. I guess this week was just a brief intro and a nice welcome to the hospital/office. Our schedule opened up this afternoon so we went out to lunch. It won't always be like this. I'm excited to go home and enjoy the weekend with my family. My sisters will all be home. Being around them is generally therapeutic - I almost always laugh a lot - that's some good medicine.

New stuff

Today - day 3 of my latest rotation due to the holiday yesterday (despite a couple emergencies I guess I wasn't called) was my first day actually in the OR for surgeries. I witnessed my first gallbladder surgery (a lap chole). There were some interesting looking stones inside that one. Later, I saw a wide excision breast biopsy. That was a new procedure for me.
 I'm trying to make myself useful. With it being my first time in their OR today, the nurse was a bit concerned about me. She kept offering me a chair so that I wouldn't pass out. I told her that so far (in my limited surgical experience - I've been in an OR a handful of times) I haven't had a problem yet. Did I just look dead on my feet? I'm worn out and ready to crash by the end of the day. It's fascinating stuff, but it's hard to keep going. I don't know how people do it every single day and take call on top of it for years on end. They must really love it.

Rotation 2, Day 2

Today was interesting. We didn't see as many patients as yesterday when I felt like we were running from the moment I stepped in the door. They kept asking if I needed a break. I wondered if it meant I looked like a deer in the headlights which is kind of what I felt like trying to take everything in. With the holiday this week the schedule is a bit different than normal I'm told. The surgeon dealt with some hemorrhoids. Not something I would wish on anyone. It looks terribly uncomfortable. We also had a couple consults. One was a woman who came in after a mammogram to schedule a breast biopsy for a lump. Naturally, she's terrified that its the C word. No one likes cancer. It's awful, but this family has had their fair share already. I hope the procedure goes well in the next few days. I'm excited to actually scrub in and get more hands on experience. It's only been a couple days, but I feel like I've been able to see a lot for such a small place.
Tomorrow is a holiday so the office is closed, but one of the surgeons is on call. I asked to be called in - figuring it'd be a good learning opportunity. We'll see what happens. Not sure what else to do besides try to catch up on the upcoming procedures. It's going to be strange not having fireworks near by because of how hot and dry it's been. It may mean getting called in for a burn victim if someone decides to make their own fiery display.

Rotation 2 Day 1

Starting at a new place is scary. I probably worry too much about waking up late, getting lost, forgetting something, and most of all looking like an incompetent fool. As a student in a new program, a lot is riding on me to make a good impression at a practice that has yet to use a PA. The pressure is on. Fortunately, my preceptors seem really cool and flexible. To be perfectly honest that wasn't something I was expecting in surgeons. I didn't know what to expect besides long, demanding hours. I also have about 8 weeks to prove my worth. That's a good while to get the hang of things and hopefully be useful. Right now I feel as if I've been tagging along like a puppy dog - trying to stay out of the way and utterly exhausted at the end. I struggle with being insecure about my limited abilities as a newbie and trying to exude confidence to not freak out the patients. Fake it 'til you make it as they say. Not sure if it works. I want to be myself and yet be everything the preceptors want me to be. Rural Wisconsin is an experience in itself especially after life in larger cities/suburbs for the last several years up until just recently. Besides doing a good job in surgery, I don't want to be a burden staying on the farm either. I have a lot to read up on and my schedule is unpredictable. Wish me luck!