Tired, but Inspired

My first day of gen surgery went well.  Rounding was done at warp speed and I've decided I really don't like wounds or dressing changes. Not so fun.

Also I was assigned a SOAP note for a pt that had been in the hospital for three months. I spent 1.5 hour reviewing his chart yet somehow managed to miss the part about him having a stroke. But my Junior resident had my back and my senior resident was quite understanding about it. Other than than it was just more of the same. Consults for the ER, yadda, yadda. Yet somehow the day lasted from 4am to 7pm. I was so tired and yet I am still not sleeping through the night. But at least I managed 4 hours of sleep before I was wide awake. I guess I can go in early and give myself plenty of time to read mammoth charts. I don't know what else to do at 3am. Other than read. I recommend this middle of the night on-line browsing and inspiration: In Iran, A Brotherhood of Doctors

Up All Night

So, night float is over. Of course my body doesn't know that. So despite the fact that I start general surgery tomorrow and have to be in to write notes at 4am I am wide awake in the middle of the night. Which would be okay except I've only slept for 3 hours so far. Oh, the transitions. This is the part of the job that you really don't prepare for. But despite what it seems, I am really not complaining. Night float for two weeks certainly beats the alternative of being q4 on-call.  Because on-call really means just working for 30+ hours straight. So the night float system is fine with me. I am now quite comfortable doing consults, responding to traumas, writing post-op notes, etc. I don't know if that means I am ready for the real thing, i.e. 6 weeks of gen sx but I'm about to find out.

And without further ado here is a brief recap of nights: what I saw and what I did, when the rest of the world was sleeping.

10 Trauma Consults- pt in the ER and stable but being consulted for C-spine clearance and/or possible sx.  For example if you crash trying to land your hang glider or a wheel falls off your ATV you'll get a full H&P from the surgery team starting with the medical student. And this does include a DRE. Fun all around, right?!?

2 Trauma Alerts- ER pt that requires a trauma team response (medical student, residents and all ER staff). Perhaps you cut a major artery b/c you were drunk and mad and punched your hand through a glass window- this is where you'll end up.

5 Trauma Activations- ER pt is being transferred or walks in off the street in possible critical condition so entire trauma team + Attending responds. (Medical student does the paperwork.) Stab wounds, gunshot wounds and high speed MVAs all end up here.

ER Consults for Surgery/Admission- Abdominal pain that might be surgical. Post-op pts with irretractable pain or a fever. People that do stupid things requiring surgery for removal. These are the bread and butter consults. My most common consult was for gallstones +/- pancreatitis.

OR cases-
3 lap appys (2 x I got to drive the camera)
2 toe amputations
1 perineal abscess I &D
1 open exploration for small bowel obstruction
- suturing is harder than it looks!
- first knots tied = fun (thanks Dr. BF for all the tutorials)
- first opening incision

Not to mention countless hours of TV watched in the resident lounge and a few hours of sleep stolen while waiting for something to happen. All in all nights were an okay way to get my feet wet, now it is time to swim.

Good night!

Transitions and such

Tonight starts the first of my night float section of surgery.  I am not really ready to be done with neurosurgery and I guess the team feels the same about me as I was invited to scrub and assist in a case tomorrow. I hope I am awake enough after being up all night. Can you say coffee? With any luck I'll see a trauma or two and perfect my consults and post-op notes tonight. And then see a cool neurosx case in the AM. Have I mentioned lately how much I love med school and third year?

And, in other news I finally found out my placements for the rest of the year. My schedule looks something like this!

Family Medicine (6 weeks) -CA
Psychiatry core (6 weeks) -NY
Pediatrics core (6 weeks)  -NY
Holiday break 12/19 - 12/30/11
Ob/Gyn core (6 weeks) -NY
Medicine core (12 weeks) -CA

So all in all I am very happy with this. I get to stay at my current hospital for FM and then only move across the USA once. Hopefully I can set up sub-Is and electives on this coast for 4th year.

I am one step closer. Time to work. Have a wonderful night, I'm off to the hospital.