When I woke up this morning at 7 it was actually light out. Our dear peds surg residents would have just been completing morning rounds as I was eating breakfast. It's a relief to be done with surgery. Overall I enjoyed it, I really did, I just don't think it's what I'm going to be doing the rest of my life. Love the kids, but I also love having a life.
Much to the disappointment of my dear friend Roopa, I did not, in fact, live out any Grey's Anatomy fantasies during my surgery rotation. People are much to busy to be having sex in the on call room. Plus, I'm engaged...and pretty much everyone else is married. Although some of the attending physicians are handsome in an older, distinguished kind of way, I don't think any long, dreamy looks were exchanged in the OR. At least not that I was aware of. However, you can certainly imagine scenarios that would bring people together...the residents practically live in the hospitals and rarely see their families. And things get intense...very intense...maybe not to the level of a scripted TV show (plus we don't have the moving soundtrack), but stress levels run high. You've got to be willing to cut in order to heal. We did practice drawing blood on each other, but no one suggested we practice trying to take out another student's appendix. Probably a wise move.
Now it's on to OB/GYN. More surgeries and more babies...but from a different perspective. And with slightly better hours?
Wednesday, July 22, 2009
Monday, July 20, 2009
Hero Worship
How do you say thank you to someone who literally saved your life? One of the coolest parts of Peds Surgery has been meeting Dr. Grosfeld, the surgeon who operated on me almost 25 years ago. He's retired now, but he loves to come back and teach so we've been rounding with him once a week. He's a pretty big deal, writing books, meeting with congressmen, just being awesome. I'm glad he was there when I needed him. One of the patients I presented had Type IV jejunal atresia (similar to my duodenal atresia) and as I was describing the surgery she had undergone he suggested that he would have done something different, a tapering enteroplasty instead of a stricuturoplasty. Sure enough the baby had to go back to surgery the next week to get a tapering enteroplasty. Even with highly skilled surgeons, there's experience and then there's EXPERIENCE.
And I think he was happy to meet me...with so many babies who do have questionable long term outcomes, hopefully it's rewarding to meet one who is doing well a quarter century later (damn, I'm getting old). It's been interesting for me to go back to my beginning. I tracked down my medical records and got copies of them off of microfilm. There it is on paper, the beginning of my life. APGARs of 8 and 9. Polyhydramnios, annular pancreas, malrotation. A KUB with the double bubble sign. Textbook. In many ways my surgery was never really a big deal to me, I was out of the hospital after 3 weeks and I don't remember anything. All I had was a scar and the vague knowledge that I owed my life to modern medicine. Now it's more tangible...I can imagine my hospital stay. The daily progress notes, though not computerized, are almost identical to the ones we write today "patient still has high OG output", "continue HAF until feeding". Even the notes from the social worker are similar "Lianna is a very much wanted child", my parents were "appropriately anxious the day of Lianna's surgery" (I always find that comment a little condescending). I also found out they discovered a heart murmur. Who knew? I'm a little sad peds surg is almost over, but the thought of sleeping past 4 am does seem pretty appealing.
And I think he was happy to meet me...with so many babies who do have questionable long term outcomes, hopefully it's rewarding to meet one who is doing well a quarter century later (damn, I'm getting old). It's been interesting for me to go back to my beginning. I tracked down my medical records and got copies of them off of microfilm. There it is on paper, the beginning of my life. APGARs of 8 and 9. Polyhydramnios, annular pancreas, malrotation. A KUB with the double bubble sign. Textbook. In many ways my surgery was never really a big deal to me, I was out of the hospital after 3 weeks and I don't remember anything. All I had was a scar and the vague knowledge that I owed my life to modern medicine. Now it's more tangible...I can imagine my hospital stay. The daily progress notes, though not computerized, are almost identical to the ones we write today "patient still has high OG output", "continue HAF until feeding". Even the notes from the social worker are similar "Lianna is a very much wanted child", my parents were "appropriately anxious the day of Lianna's surgery" (I always find that comment a little condescending). I also found out they discovered a heart murmur. Who knew? I'm a little sad peds surg is almost over, but the thought of sleeping past 4 am does seem pretty appealing.
Saturday, July 18, 2009
Traumatic
After working 19 straight days, I finally have a day off! Actually two! Things may be looking up (though we have our pediatric surgery exam Monday morning). Overall I've had a great time, and nothing too emotionally traumatic has occurred...none of the babies we care for directly have died. However, for some of them the long term prognosis is rather grim. I've certainly toyed with the idea of becoming a neonatologist, I'm really interesting in developmental biology and it's kind of part of my history, but at least from a objective standpoint I've never completely been able to convince myself that saving a 22 week old baby who's going to be on ventilators and intravenous feeds for years and then likely have long term health problems is always the right thing to do. Of course it is if they survive and have a happy life, I'm sure as hell glad no one gave up on me, and we're constantly pushing the limits so I'm sure that soon their survival outlooks will improve greatly.
However, so far the hardest thing I've experienced on this rotation was a Care Conference where a bunch of doctors, nurses and social workers all met together with the parents of a little 4 month old boy I've been following. His twin died at birth, he has microcephally, his liver is already enlarged from being on TPN his whole life, he had fungus growing in his brain for a while, and while he's getting over his repiratory issues his intestines are still no where near functional. Essentially the doctor had to sit there for an hour and explain to the parents their sons long term prognosis best as he could predict. And it was not good. The parents love their little boy so much, but still after 4 months of problems they had to readjust their expectations. I don't know if I could handle those kind of conversations every day.
Compared to that conversation, my over night trauma calls have been nothing. I saw a women with suspected necrotizing fasciitis, but it turned out to just be a boring abscess. In contrast we've been taking care of a 14 year old girl who was bitten by a brown recluse spider and ultimately had to have her leg amputated above the knee. Just yesterday we had two babies come in, one with Necrotizing Enterocolitis Totalis who died before they could ever operate and another baby who was shaken by the boyfriend and is now brain dead. That's hard to deal with. On Trauma call at Methodist we also had a 15 year old come in who had collided with another kid while playing baseball and was bleeding from his spleen. Sounds exciting! Trauma 1! Not totally, he came in fully conscious but kind of pale and ultimately went to Interventional Radiology (a really cool specialty) and they solved his bleeding without ever cutting him open. It sounds horrible to say that I hope people experience some sort of trauma, and I certainly don't really mean it, but it if they have to get in an accident it would have been great if it had happened while I was in the ER! The most traumatic part of trauma calls was staying up all night.
In good news, I got my Board score back and I passed! 246! Yay! Seriously, what a relief. But then I called to tell my parents and they had just found out that the parents and daughter of one of their friends had all died in a horrible car accident. Things can all change so fast.
However, so far the hardest thing I've experienced on this rotation was a Care Conference where a bunch of doctors, nurses and social workers all met together with the parents of a little 4 month old boy I've been following. His twin died at birth, he has microcephally, his liver is already enlarged from being on TPN his whole life, he had fungus growing in his brain for a while, and while he's getting over his repiratory issues his intestines are still no where near functional. Essentially the doctor had to sit there for an hour and explain to the parents their sons long term prognosis best as he could predict. And it was not good. The parents love their little boy so much, but still after 4 months of problems they had to readjust their expectations. I don't know if I could handle those kind of conversations every day.
Compared to that conversation, my over night trauma calls have been nothing. I saw a women with suspected necrotizing fasciitis, but it turned out to just be a boring abscess. In contrast we've been taking care of a 14 year old girl who was bitten by a brown recluse spider and ultimately had to have her leg amputated above the knee. Just yesterday we had two babies come in, one with Necrotizing Enterocolitis Totalis who died before they could ever operate and another baby who was shaken by the boyfriend and is now brain dead. That's hard to deal with. On Trauma call at Methodist we also had a 15 year old come in who had collided with another kid while playing baseball and was bleeding from his spleen. Sounds exciting! Trauma 1! Not totally, he came in fully conscious but kind of pale and ultimately went to Interventional Radiology (a really cool specialty) and they solved his bleeding without ever cutting him open. It sounds horrible to say that I hope people experience some sort of trauma, and I certainly don't really mean it, but it if they have to get in an accident it would have been great if it had happened while I was in the ER! The most traumatic part of trauma calls was staying up all night.
In good news, I got my Board score back and I passed! 246! Yay! Seriously, what a relief. But then I called to tell my parents and they had just found out that the parents and daughter of one of their friends had all died in a horrible car accident. Things can all change so fast.
Tuesday, July 7, 2009
Sustainability
Aside from learning basic clinical skills and how to function in a hospital environment, 3rd year is all about figuring out what you want to do with the rest of your life. As a somewhat eccentric anesthesiologist told us during orientation, you have to find something that is not just immediately interesting to you right now when everything is new and different, but something that you can see yourself doing for the next 40 years. The reason he chose anesthesia is that he enjoys gardening and spending time with his family. That's totally legitimate. A 4th year surgical resident told us that if you can do anything other than surgery and be satisfied, do it.
I think I may fall into that category...while I'm really enjoying pediatric surgery, the different types of cases, the active sense of doing, the definitive fixes, there's LOTS of things I see myself enjoying. And having a life outside of work is definitely one of them. I can do anything for a month (waitress at Cafe Lalo, live in a Mayan village) but when you start talking about years and years of waking up at 3:30 am it becomes a different story. I have so much respect for the residents and fellows who still somehow manage to be pretty nice most of the time, but I don't know if that's the life for me. So what is?
I got to see a laparoscopic Nissen fundoplication yesterday which was pretty cool (except the kid is now retching uncontrollably). Anatomy class (even a whole year of being an anatomy AI) doesn't really prepare you for being in the living, breathing abdomen. I also got to sew up an incision on a kid who received a Portacath! And I think I did a decent job. Other than that I've seen a PEG placement, an abscess drainage, excision of a lymphangioma and a pilomyxoma, another hernia repair and a fun proctoscopy. I guess in surgery you never know what you're going to find...but already none of the med students are super excited about watching a portacath placement...or if we are it's because we might have a chance to cut, sew or inject. And after you've done that hundreds of times then it really might get a little boring and repetitive. As it should, as do most things. That was the anesthesiologist's second point...if most of your job doesn't become second nature and not constantly challenging, you're probably not doing it well. Now I just need to find a specialty that will be interesting for years to come. Or maybe it's the patients that will continue to surprise you and keep things fresh no matter what.
I think I may fall into that category...while I'm really enjoying pediatric surgery, the different types of cases, the active sense of doing, the definitive fixes, there's LOTS of things I see myself enjoying. And having a life outside of work is definitely one of them. I can do anything for a month (waitress at Cafe Lalo, live in a Mayan village) but when you start talking about years and years of waking up at 3:30 am it becomes a different story. I have so much respect for the residents and fellows who still somehow manage to be pretty nice most of the time, but I don't know if that's the life for me. So what is?
I got to see a laparoscopic Nissen fundoplication yesterday which was pretty cool (except the kid is now retching uncontrollably). Anatomy class (even a whole year of being an anatomy AI) doesn't really prepare you for being in the living, breathing abdomen. I also got to sew up an incision on a kid who received a Portacath! And I think I did a decent job. Other than that I've seen a PEG placement, an abscess drainage, excision of a lymphangioma and a pilomyxoma, another hernia repair and a fun proctoscopy. I guess in surgery you never know what you're going to find...but already none of the med students are super excited about watching a portacath placement...or if we are it's because we might have a chance to cut, sew or inject. And after you've done that hundreds of times then it really might get a little boring and repetitive. As it should, as do most things. That was the anesthesiologist's second point...if most of your job doesn't become second nature and not constantly challenging, you're probably not doing it well. Now I just need to find a specialty that will be interesting for years to come. Or maybe it's the patients that will continue to surprise you and keep things fresh no matter what.
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