Getting on Their Level

Today we were in ortho clinic and Dr. Boots was consulting a middle aged man with chronic shoulder pain.

We took his history (frequent disclocations and subluxations, as well as limited range of motion) and then asked him what he did for a living. He was a computer guy, an I.T manager.

Doc Boots explained the problem with his rotator cuff muscles, his glenoid labrum, what surgery he might need, risks, etc. The patient looked slightly overwhelmed and confused. Boots paused...


What I am trying to say is...your shoulder is running Windows 97 my friend. It needs a serious overhaul. 


The patient informed us he was an 'apple man' to which Boots replied, exactly.

I (Heart) Rural Medicine

In the last 48h have included having the opportunity to:

-catch a baby
-cut a piece of glass out of someone's face (and then stitch them up afterward)
-surgically assist with fusing toes, replacing hips, replacing knees
-perform a D&C
-assist with a hysterectomy
-sew up knife wounds
-assess / treat / discharge about 75 emergency patients
-learn how to insert an IUD

Despite the exceedingly damp climate my hands are cracking from so much handwashing, I'm surviving solely on t.v. dinners and instant soups, clean underwear is becoming a scarce commodity, and I've spent every day (except one) in the hospital since my arrival. And I couldn't be happier.

My days are so full and varied, with such fantastic teaching from the docs here. It's hard to sleep at night, completely wired and excited by each day's events. I feel so fortunate to be here. I'm starting to believe that saying about how "there are teaching hospitals and then there are learning hospitals". Say what you will about rural medicine...but my experience is that people working in remote areas have half the egos and double the desire to teach.

I've been spending a lot of my retractor-holding and trying-to-sleep time thinking about the (soon arriving) residency application process. Today I truly felt like a few things have started to crystallize in my mind about what I want to pursue...

As always it is a work in progress, but I think that will have to be a post for another day.

In the meantime, check out my new O.R clogs while I try to get some well deserved sleep.

Yes, yes I did.

Hard Mattress

After a somewhat lengthy orthopedic surgery where I had been holding a foot / leg up off the table, Dr. Boots handed over the suture material and told me to get to work.

Me:

Umm...should I come around to the other side of the table?

Dr. Boots:

No, sweetheart just get to work, this man's got a bloody tourniquet on! We don't have time for dancing around. Put in some mattress sutures. 

(Some of you might scoff at the fact that I haven't mastered the mattress suture. As a potentially aspiring surgeon I maybe should be able to do them in my sleep, however, I spent most of my time in general surgery trying to perfect my sub-cue stitches and hand-tying. Bad medical student, BAD!)

And now I have.

And they were a thing of beauty. All two of them. Damn you arthroscopy and your tiny wounds!

Dr. Boots:

There, that wasn't so bad now. No need for all the shivering and shaking. You know my 17 year old daughter can do mattress sutures, no problem. She taught herself.

(Surgical Drape) Curtain Falls. 

[For the record...my hands were shaking because my forearm muscles were maxed out from assisting...I swear! I should also add, Dr. Boots is amazing and kind of like the slightly-unimpressed-but-fantastic-teacher orthopedic-surgeon-father I never had. Above example illustrates the way we communicate. Me, hopeless rube in ortho...him ortho king. Get it?]

Apparently I Look Like a Drug Dealer

So, I am here in BC doing an orthopedics elective. But really, I am doing an everything elective. I've worked in this hospital before as a nurse and most of the doctors know me. I want to scrub for surgeries, stitch wounds in the ER, catch babies, intubate, whathaveyou. So I need a cell phone, otherwise no one can reach me when wounds / babies / femurs are presenting themselves.

I walked into the 7-eleven and looked for the cheapest phone. $39. Brilliant. I asked the attendant to please fetch me the $39 phone from behind the counter. He looked at me strangely and said, "Er....are you sure you don't want a nicer phone? These ones are only $100". I waffled for a moment but held strong. All I need this for is "baby coming" texts. Status symbol, status schmimbol. Give me the ridiculous one. 

I was quite proud of my new phone so during my next shift I whipped it out to show one of the murses. He burst out laughing, "Dude!! You've got a burner!!"


"Uh...what is a burner?"

"It's a phone that drug dealers use so that their calls can't be traced. They're disposable. Hilarious. You totally will look like a dealer every time you take that phone out."

Now I feel old, and crazy out of touch with slang.

The next day I get a text at the nurses station and I'm trying to thumb my way through a response when one of the other nurses starts pointing and laughing, "NICE BURNER!!!!"

Siiiiiiighhhhhh. Am I the only person that didn't know this term? Apparently if I watched The Wire or CSI I'd be well versed in these matters.

I sent a text to my orthopod to give him my number (since we were on call) saying "Here is my mobile number courtesy of 7-eleven" and the next day in theater he tells me that his wife saw the text and asked him who was sending him messages from a burner.

For the record, he's in his 50's.

It's no iphone 4, it's small, it is ridiculous. I look like a complete rube (and low-life, apparently) when I try to text from it. But you know what? It is almost so lame that it feels cool. In fact, I like that it is ghetto. It feels slightly rebellious and hip to not be showing off what apps I can get on it. I wear rubber boots to work and I own a burner. It is just how I roll these days.

Surgical Pearl: Nutrition

Today the locum pediatric orthopod took me down to the x-ray department to look at some films, on our way out he stopped at their desk and poached some chocolate. He clearly saw my judging questioning gaze (I have firm beliefs that you ought to contribute to the trough you graze from).

"Look, when you're a surgical resident you learn to get calories from any source available. It's an old habit. You find every patient fridge that is stocked with ensure or crackers...this hospital is great because the recovery room fridge has cheese. Cheese will be where you get your fluids from."

Residency: when you begin to see cheese as hydrating nourishment.

Hip Replacements and Baby Catching

This past week was amazing.

Some of the highlights.

I delivered my first baby! Yes. It turns out if you harass the maternity nurses and docs enough they will call you up to catch one. I had witnessed a few during the summer but it wasn't until the day before my birthday that I got to catch my first one (thanks Doc R!) Baby Jessica was 9 lbs 4 oz, slippery, pink, screaming and born with a head of dark curls.

I was so excited in those last few pushes I had to clasp my hands together in order to keep them from inadvertently just reaching in there and taking the babe out or patting the perineum with anticipation. Doc R and I had gone through the steps verbally ahead of time but I hadn't really thought of what I was meant to do once the slippery, heavy, squirming baby was actually in my arms! I think I was giggling and cheering and almost (sorta) tearing up and then thought-- "er...do I put her down or clamp the cord or...ack!" It was a crazy wonderful blur and flurry of activity, Doc R helped me from there, "yes...just set the baby down now", "oh, right".

Yes she did give me permission to post this photo of her.

That afternoon I got to scrub in for a great toe amputation. It actually amazed me at how simple and slick it is to remove a toe. The thing really didn't give up much of a fight at all, just a couple of swipes with the 'ol scalpel and, thunk! It's in the bin. For some reason I just assumed that everything in the body was really anchored down. Meshed together, tightly woven. I suppose that I've always thought that because in order to have survived the sabre toothed tigers, bears, falls, wars, famine, the body must be a very study structure. But as I am seeing more and more in the operating room, it really isn't.

The next day my colleagues kindly let me spend most of the day shift (which was supposed to be spent working in the  emergency department) scrubbed in on several orthopedic surgeries. Ok, let me just say now, I take back EVERYTHING I ever said about orthopedics.

How I could never do it. 

How I could never stand to watch such brutal surgeries. 

Oh how very off the mark I was. 

Let's just say, tendon harvesting for ACL repairs is a thing of beauty. I was actually operating the arthroscope for that one. Hello that is not an easy task. When you are staring at a large screen tv it is difficult to immediately appreciate that moving the scope 1mm actually turns your field of view to a completely different scene. I could feel the sweat running between my shoulder blades and down the backs of my knees, 

just don't screw up

don't lose what he's trying to look at

don't pull the scope out by accident. 

Yeah, I did all three. Considering the fits of rage that I'd seen come from Dr. S I was expecting him to wrap the scope around my neck and throttle me with it. But to my surprise he only called me a 'useless assistant' a couple of times and commented on how much I was slowing him down once! He also yelled pointed out that holding the scope for the first time was no excuse for not doing a good job. I was in bone-chip, bloody, tendon harvesting heaven so it didn't even bother me. He let me pull the finished graph through the hole to where it was anchored. Pretty amazing actually. 

Other thoughts from the day included, 

Wow! the plantar fascia is REALLY thick and white!

I can't believe that a hammer and chisel were just used to crack open that calcaneus! 

Exposed muscle really is a thing of beauty!

I think I might faint from hunger and sleep deprivation soon!

Hey. I didn't say they were deep thoughts. 

There was also a theme party--70's due to the decor in my living room. It was a combined triple birthday party/retirement from nursing for ABB party. 

Things really took off when both Karaoke and Dance Dance Revolution showed up. 

Yes I am wearing a giant peace sign bindi. Thanks for asking.

There was also a beautiful 15km hike one day, some c-sections, entertaining shifts in the emergency department, dinner on a cruise ship, the move into a new (wicked) house, a meteor shower, and possibly a hang-over somewhere in there as well.

Two shifts left as a nurse. So many memories rising to the surface. Almost exactly 7 years to the day that I graduated. 

My Favorite* Orthopod

Today was my last day scrubbing into the O.R before heading back to Ireland.

I've had so much fun this summer getting to assist with the orthopedic surgeon and the general surgeon. Here is a photo from today, Dr. S captured in a rare moment where he wasn't yelling at someone, swearing, making an inflammatory statement, or all of the above at the same time. In all seriousness though, I've learned a ton from this man. He really took a lot of extra time this summer to teach me with every opportunity and it is very much appreciated. Not to mention the fact that he is a KICK ASS surgeon. Too bad he'll probably be retired by the time I need a knee replacement.

Pre-game before a hip replacement. 

*I told him not to be too flattered....he's the only orthopod I know.  :)