Revelations!

So, I'm only two day into my Family Med* rotation so I'm not sure if that is really enough time to come to any conclusions. But I'm going to anyhow because I have the time to blog and because in just two days time I've come to realize a few things about myself... First a quick comparison, which is probably not fair to either field but its my blog and I'll compare if I want to!

Going from Surgery to Fam Med feels like running a marathon to strolling in the park. Everything moves a whole. lot. slower. Everyone is nice. The attending bakes you homemade chocolate chip cookies (literally), the resident apologizes for not having time to teach and for being so busy. You are asked repeatedly each day if you need to eat and then given ample time to do so. All patients are seen by the attending, every day! It is like an alternate universe. And I'm not sure what to make of it.

All of this is good. And nice. But it kind of bores me. In two days I've only gotten a single patient to myself. I did help another student with her H&P and co-wrote a single note this morning. Plus I got the priviledge (a.k.a. intern too busy so asks me to do it) of updating our team's entire patient census list which was grand total of 6 patients. But back when I was a surgery student I saw 6 patients/ wrote 6 notes in a single morning.

Okay, so my patient. I did his admission H&P on Monday and today I got to present him to the attending and help her with the A/P so he's mine until discharge.  Except that not tomorrow morning because our team switches to night float for two nights so another team covers our patients (I don't know how that makes any sense but that is how it is). Anyhow, maybe by the end of the week I'll have two whole patients. That's the hope anyhow.

Oh, so my discoveries. Well while we were busy waiting for rounds to start, then later munching down chocolate chip cookies, then later at lunch, then later waiting for rounds to resume and then end, I realized that I did not like that attending had to run off to deliver a baby in the middle of my presentation. Or that the 11am weekly lecture was canceled because of the same. I know, it is medicine and things happen. But I think I need a schedule, a plan. I don't get stressed when plans change per se. I'm okay improvising or adjusting but I do like having structure. And surgery had that going for it. Cases were scheduled. When one finished another started. There was some predictability of what days were clinic versus OR versus just rounds.

Family Med is the embodiment of unpredictability. In the next six weeks I never get more than one day off at a time. My schedule changes every week.  Actually it changes ever day or two. As a medical student on a rotation this is not a big deal. But I cannot imagine a life of this. So I guess that means inpatient Family Med is off my list... which is too bad because the people are SO nice. Maybe it is the laid back nature and the I can deal with anything, at any time mentality that makes these people so cool. So I hope that they can be my friends.  But I guess I'm too uptight for their field.  Surgery vs Medicine: It is the classic do versus think. And come to think of it, I've always imagined myself somewhere in the middle. Child Neurology is a middle ground, right?

*Disclaimer, at my hospital the Family Med rotation is all inpatient so it is really more like an IM elective and probably not wholly reflective of FM


** This post is not to slight either Surgery or Family Med. I met some brilliant surgeons that were quite capable of thinking and even treating the whole patient. I learned a lot of medicine from my attendings during surgery. And it is important that we have people who love Family Med and do it all, it is SO needed.  I just don't think I'm one of them.

Three Months Later

Patients seen: 88
Surgeries scrubbed into: 26
Lives lost: 7
Goodbyes said: 1
Hands held: 15

Surgery is over and I don't think I'll miss the ER/traumas or sad stories that bring the patients to the hospital. I'd rather not have to contemplate skin grafts for the women who fell asleep while smoking causing her bed to catch on fire and burn 30% of her body. Neither cup of noodles nor sparklers should never be given to children to children under 7. Gas stoves or BBQs and unsupervised cooking for children- please no. And just in case you didn't know: grandma driving while on amphetamines,  uncovered empty pools without water, holding a boiling pot of beans in your lap = very bad ideas. I use to think hang-gliding sounded like fun, but after seeing the results of landings that didn't quite work out maybe I'll rethink that. I have had my fill of gun shot wounds and stabbings. Pneumothorax, appendicitis, cholelithiasis - check, check, check!

The OR was actually quite fun most of the time. I can see the appeal, and I even liked about half of the surgeons I met. I'm crossing surgery off my list but am so thankful for the long rotation (even if I wasn't always thrilled during it.) I will probably never see brain surgery or even a lap appy again, but I'm so glad I got to experience them.

(Next time I post I'll be on inpatient family med. Stay tuned.)

Don't know what to call this post- surgery is almost over and I'm still happy to be a medical student

Just four more days of 4am note writing and surgery will be over. One more clinic day, one more call... it is winding down. In some ways I am done with surgery and glad that it is (almost) behind me yet it was pleasantly bearable. I like the hospital and the patients, most of the residents are amazing, my attending is great, I think I've learned a lot. I am now comfortable with all types of wounds, I know how to scrub, suture, tie and I can be of some help in the OR. I like clinic and seeing patients post-op. I don't mind consults and I've survived rounds more often that not.

That isn't to say that I want to go into a surgical field or that I've loved everything about these past 11 weeks but all in all, it could have been much worse. We'll see how the oral and written exams go of course but I'm content.

I have a few favorite patients and a bunch of sad stories to tell including some with happy endings, but that will come later. For now I am just trying to reflect, study and get ready for what is next.

My happy/celebrating patients...

Best news ever?
-How about telling a patient (and her family) that she doesn't have breast cancer. The biopsy was negative and the mass is benign. Yes there was a party in the clinic and yes I laughed and celebrated with the patient. And yes, I got to tell her the good news myself.

2ne best news ever?
-One of my first patient's from neurosurgery, a patient that was at one time in a drug induced coma -went home. I thought he was going to die, but despite the complicated surgery, new-onset seizures and hospital acquired pneumonia he somehow got better. Medicine is amazing!

My crying/scared patients...

Waking up from surgery can be scary. I have never had major surgery but I imagine that waking up in an unfamiliar room with what seems like a million people staring at you musts be a little unsettling. Today my patient woke up and she looked scared. I met her last week in clinic when I did her H&P and I had talked to her before the surgery so she knew that I would be present in the OR. She was having an elective surgery and the complication rate is low. She did well during surgery but it was slightly more difficult that anticipated and so her lengthened surgery status earned her an overnight admission. I held her hand as she woke up and her eyes told me she was scared. I went with her to recovery and told her that we would be keeping her overnight for observation. Or maybe the nurse mentioned this to her, but in any case I had to explain it to her. She didn't want to let go of my hand so I offered to stay. For half an hour I stayed by her bed and answered questions about her surgery. I tried to reassure her and I offered the only thing I could think of my time and my self. Eventually I tracked down the attending to come reassure her and I continued to check on her throughout the day. She will be fine. I was told by a resident that I wasn't acting like a surgeon. But you know- I am okay with that.

Being newly diagnosed with cancer. Being alone in the the hospital over a Holiday weekend. Being in pain. These are depressing things. So understandably my patient was minutes from tears when I entered her room this morning. She felt forgotten about. A simple procedure and biopsy of her mass were put on hold over the long weekend. As she talked and cried I offered her a tissue and she said they were bigger and softer the the hospital issued ones. She most likely has terminal cancer (and she knows this) and yet she thanked me for giving her a kleenex and listening to her. As a medical student I don't have much power, I can't make decisions and my knowledge of actual important medical information is tiny. But I can provide kleenex, hold a hand and lend an ear. Maybe these aren't behaviors of surgeons but they sure make me feel like I'm doing something.

Today was one of the most fulfilling days I've had in surgery. I went to the OR but it wasn't what I did in the OR that I am reflecting upon, it is all of the stuff I did beforehand and afterwards. Patients by their very nature are going to be scared, anxious, neglected. Isn't it our job as physicians to notice this and do our best to help them cry, accept and move on? Isn't it our job to comfort them?

Red, White, Blue and Surgery

Happy 4th of July to all! I am actually enjoying gen sx, suprisingly more than I expected, but that doesn't mean I don't appreciate having a three day weekend and especially today off. I'm home in SD with my hubby and have plans to watch the fireworks later. In the meantime I'm enjoying the day. And I have a bit of time to reflect on what has been two weeks of gen sx so far.

I've seen some interesting cases and have enjoyed clinic, consults and pretty much everything in between. The new interns have arrived and the whole hospital is fresh with new faces and lost looking white coats. I actually feel like I have something to offer the team, my intern finds me helpful and it is kind of refreshing.

I have discovered that I like being in the OR. It is fun, which sounds weird to say and I can't seem myself doing the training or putting up with the surgeon types for 5+ years in order to be in the OR but I do see the appeal.

I have confirmed that I don't enjoy the ER. I don't like the pace, the noise or the rawness of everything. And I hate not knowing what is happening with the patient after they see me. I need follow through and the ER doesn't provide that. However I do like the ER docs. Shift work and cool colleagues are definite pros.

I like clinic. I like taking to and examining patients without too much of a time constraint. I like reading the chart, knowing the history and seeing someone who is going to be followed. I love it when I get to see the same patient for 2nd time, either post hospital d/c or follow-up appt, etc.

So to recap. Surgery- I don't like surgeon mentality but the OR is pretty cool. ER- not my cup of tea, but the ER docs are awesome. Clinic- seeing patients makes me happy.

I hope you have a wonderful, festive and safe 4th!

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.

Lost (and Found?)

Since I'm on the "study hall" portion of my surgery core I have a bit of time to roam the hospital and ponder life. And I am studying. I've read/outlined the first 19 chapters of Lawrence's "Essentials of General Surgery" but it doesn't take an entire day to read three chapters so I have some time.

Last week I went to the ladies room and found a very well-loved lost lion in my stall.

I found him propped up, just like this so I have to think that he fell out of a stroller or was dropped and someone hung him here in hopes he would be reclaimed. I checked the restroom later in the day and he was gone so hopefully his owner was happily reunited.

I don't have any patient stories or amazing tidbits of info to share with you (yet) but I'm one week closer to being on a team, writing notes, rounding on patients and all of that fun stuff. In the meantime I'll leave you with this fun fact: the liver has over 2000 metabolic functions. So love your liver, because it loves you! Oh, and good luck to any and all of those "already brave" lost lions (and other well-loved stuffed animals) out there.

-Kudos if you read a rather amazing blog and get the reference!

False Start

So,  I have been orientated. I am at my surgical site and new home for the next three months. But due to new SGU guidelines our 12 weeks of surgery now includes protected study time. Which is great, but guess what? I ended up getting my two weeks of study time upfront and my six weeks of general surgery at the very end until the day before exams. Yippee for me! (NOT.)

So no early morning rounding for me or scrubbing in to watch a case, or any of that. Just sitting in the assigned library or conference room from 8am-4pm. Of course I can take breaks and leave for lunch but it kind of feels just like studying for Step 1. Sure I get to walk around the hospital in my short white coat and attend all the resident and academic lectures but I just don't feel like a third year. I know, my time will come. Pretty soon I'll be wishing I was back in the library with the entire day to read (at least this is what I am telling myself.) I have entertained the idea of just walking into a patient's room and assuming her care like I belong there, no one will call if there are extra notes in her chart, right?  Fine, I suppose I will just stick to pre-reading for surgery. It has been a long day. In a quiet/boring kind of way.

Time for Fun Facts:
-A normal healthy person sighs 9-10 x per hour. This protects the lungs from atelectasis. (Patients undergoing and awakening from anasthesia do not sigh or cough and thus this is a possible complication. I'd never thought of sighing as protective, had you?)

-Licorice consumption can lead to renal potassium loss. (Okay, I think I knew this one, but it is still pretty cool, so be careful what you eat!)

There are more, but I don't want to bore you. I am 90 pages in to Lawrence's "Essentials of General Surgery" and I have to say, I wouldn't be if it were not for this protected study time, so yay!?!

13 days until my neurosurgery rotation, at least I have that to look forward to!

(gulp)

Tomorrow is my first day of third year. I think I am ready but it seems like I can't really be ready because I have no idea what this will be. It feels like the first day of school and the start of first year all over again.

For those of you playing along at home I got my first choice in that I got to stay in California (for now). I was assigned surgery as my first rotation which is 12 weeks long.  And while I am not at a clinical center I am within driving distance of Dr. Boyfriend for weekends, etc. Of course after surgery I will have to most likely move and then move again and again but I don't know what comes next so I really can't worry about it right now. Instead I just have to focus on remembering my anatomy and being the best third year I can be.

The new apartment is set up and unpacked. My fridge and freezer are stocked. I have clean laundry. I guess I'm ready. In the meantime I am enjoying a glass of chilled wine. Cheers to surgery!

Time's Up!

So the torture is over. I have officially been notified that I will start rotations in California at my first choice spot. I still won't get to live in the same city as Dr. Boyfriend but we'll settle for the same state and time zone.

I can't believe it. In just two weeks from today I will be starting my third year rotations with surgery. Which means I need to do some serious anatomy brushing up before then. And find an apartment. Buy a car. Pack and move. Little things really...