Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts

Tuesday, June 10, 2014

Skin to Skin

I meant to come home and write all about it. But of course by the time I got home my stomach was aching with hunger and I had a fridge holding wilted cilantro and questionable soy milk. So I had to make a dazed trip to the grocery store where I found myself staring at the nectarines and asking myself, "Do I really eat nectarines?" which then spiraled into an internal dialogue about the ethics of buying fruit that is shipped from a thousand miles away in order for me to have some variety in my snacks. This always happens when I am tired. I start to question everything I eat and try to convince myself that a diet of entirely chocolate and "Mary's Crackers" will suffice.

So now I am just standing there with my basket containing cheese, kale, and tuna and I am nowhere closer to having a normal dinner, showering, and writing up the day's experiences.

I did my first c-section! Let me qualify that statement. I have done all the 'steps' of a c-section in the past - but never all on one person. Usually the surgeon opens up to the uterus and then I go from there, or I open and they close. Or some other combination of events. But this one was mine from beginning to end, the reward for all my hard work, so I was told. I wanted to write it all down, remember every moment, however, many of the details are already starting to blur.

It was hard work rewarded with hard work. This was her third section which meant that the often easily identifiable tissue planes and regions become scarred down to one giant zone of adhesions. Meticulously dissecting the bladder can still result in injuring it or unknowingly cutting too low on the uterine wall. The tissue is also thinner which can be an issue when it comes to closing up, add in the friable bleeders, distorted anatomy, and the clock that is always ticking down on how long the spinal anesthesia is going to last.

My mentor was walking me through it, keeping the pressure on for time while ensuring I was being cautious yet bold. It's a weird combination. When you cut - CUT! Don't saw away taking little swipes! Go deeper...not THAT deep. 

Being new to all of this I still don't appreciate the different forces needed to cut through skin, fat, and muscle. I don't hold the cautery just right, I can't throw a fast stitch in a bleeder. I don't know when to dissect with my finger versus gauze versus a blunt end of a blade versus a blade. It's an entirely different universe suddenly, peeking out between the sterile blue drapes. I'm navigating with a mask that covers my mouth, connected to a plastic shield over my eyes.

Sweat is dotting the inside of my plastic shield and I can feel it running down my sides. The other surgeon is waiting at the dictation desk and his patient, a hernia repair, is waiting in recovery to come in. We are only a little behind schedule but the scrub nurse reminds me that the next surgery should have already started. The baby is out, I can't remember if it was a girl or boy. I can't even remember the mother's name or face. I would have never believed it if someone would have told me that I would forget the gender of the baby of my first skin to skin cesarean. But I don't. I remember green armytage forceps.

I remember being thrilled, scared, and sweaty. I remember having to change my scrubs immediately after, before going out to recovery. They were soaked from my chest down to my knees, as if someone had thrown a bucket of water at me. I remember being happy and surprised that mum and babe had an absolutely unremarkable course in hospital and that they were discharged two days later.

How could I have done that right?

Tuesday, May 29, 2012

Operation Smile

I walked out of my final short case exam on Friday with a cryptic text from an unknown number simply stating "please call S____". Still buzzing with adrenaline and excitement at being done I dialed the number, worried that something was wrong, perhaps with someone I knew.

"Hello, this is ABB, I received a message to call."


"Yes, hello ABB, are you finished your exams?"

The slight worry ratcheted up one degree.

"Yes..."

"Oh good. Well I can congratulate you on that and something else as well...you've been selected as the recipient of the Operation Smile medical student fellowship!"

[Cue exhilaration and dress wearing suppression of cartwheels on sidewalk].

I think I then said the words delighted and thank you about 17 times. She added that the competition was stiff but they thought that I'd had some amazing life experiences and that the organization wanted to add to that list for me. Which I thought was such a lovely thing to say.

Of course I am honored (and surprised nearly beyond belief) that I was chosen. Being unable to take on international electives or sign up for volunteer work since starting medical school has been difficult, especially after getting a taste for it on my Himalayan expedition in 2008. I've been having to bide my time and just look forward to future opportunities much further down the line. But now, I won't be waiting long at all!

This is such a gift for me, and I am fully aware of the fact that it is the chance of a lifetime. According to their website they receive thousands of inquiries a year from medical students, for only about 20 available positions. I. Can't. Wait.

Still don't know when or where, but will be keeping the blog updated as things unfold. I still can't believe that third year ended on such a high note, especially after the last few months. And so, back to packing boxes. Smiling.

Image from http://www.operationsmile.org/


[Incidentally, you can donate to Operation Smile any time!]


Tuesday, April 3, 2012

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.


Tuesday, February 14, 2012

FIRST CUT!!

Dear Diary,

Today I had the chance to make my first scalpel to skin incision. M.C was very nonchalant about the whole thing. I had set up the tray as per usual (thanks to years of nursing and having to set up many a tray for minor ops) and then he just casually said to me, "okay, so work away there...get a blade for yourself..."

Yeah, I tried to play it cool but I am fairly sure that the eyes-popping-out-of-my-head-with-questioning-stare gave it all away.

He smirked and pretended to have something to do away from the patient while I went about (excitedly) excising my first skin tag.

This was followed by a sebaceous cyst excision and another skin tag removal (of a patient I had seen 1 month ago and booked for the procedure). She said she hadn't felt a thing, and that I was worth every penny that he was paying me. HA! I shall never let M.C live that one down.

I was pleased to learn that I have a steady hand and do indeed get a rather large kick out of cutting people (in the socially acceptable cutting to cure sort of way). I am sure that such a milestone is something you never forget. Course I am happy that this happened in one of my favorite little hospitals, on Valentine's day nonetheless.

Today was a good day.

Sincerely,

ABB




Monday, February 13, 2012

Surgical Field Trip

Headed for the hills today for a surgical assist field trip. M.C took me with him to the wild and wooly west coast for an operating theater day in one of the remote hospitals.

I have Monday's off (from GP) but was more than happy to spring out of bed at 0545h, knowing that I'd have the chance to be first assist and 'camera woman' for all the cases today.

And indeed, it was well worth it. Worked a lot on my sub-cue suturing skills and scope handling. Lots of neck craning and nervous sweat. So. Much. Fun.

I really cannot pretend to be aloof about this whole surgery thing. Pretty soon I'll stop sheepishly mumbling and toeing the floor when people ask me what I want to be when I grow up. Not today, but pretty soon.

Friday, September 30, 2011

Fin

Well my first official hospital rotation has come to a close.

Today was my last day on the surgical team and I found myself staring off into space more than once, feeling genuinely sad. It seems like the last 9 weeks screamed by at break-neck-running-behind-my-consultant-speed. The thought of starting on a new team is a little daunting. I feel as though I just figured out my true place with this team, and that I was starting to habituate to their rhythm.

The apple crumble made big waves, the pan licked clean before the end of 1st tea break. The nurses and porters seemed genuinely shocked that I baked for them and many approached me to say thanks, or "fair play to you" which is the Irish equivalent to something like, "well done" . The porters also pretended to have food poisoning all afternoon (yes, pretended) and one proposed marriage.

When the last stitch was thrown in the belly I didn't know if I should shake M.C's hand in a formal manner, or make some cheeky comment (more my style)...so I just had my chlorhexidine shower (as per MRSA case protocol) and went to the gym.

I was happy to hear nothing but silence when I arrived home. The alarm people had to come and tear everything apart because the thing was completely haywire. I think I am going to start calling the alarm system, Hal, from now on. I was able to un-tape my memory foam pillow and yoga blanket from the wall (dampers) and make dinner without earplugs in, which was a pleasure.

Tomorrow I am going to attempt to review some medicine-y things. Like the heart. And probably the lungs. Look up Na+ levels and try to remember what exactly this condition known as diabetes is, which has come to mean only really really bad leg ulcers in my mind.

And so, I begrudgingly shelved my Surgery at a Glance, Surgical Recall, and my Physical Signs for Clinical Surgery and ordered The Oxford Handbook of Clinical Medicine.

Speaking of clinical surgery...if you haven't watched this TEDtalk by Abraham Verghese, please go make yourself a cup of tea and spend the next 18 minutes watching an extraordinary author and surgeon discuss the lost art of physical assessment. It is another typically awe-inspiring TEDtalk.

It is late so I'll close with a quote by Yeats, cited in Verghese's book, Cutting for Stone, 

The intellect of man is forced to choose
perfection of the life, or of the work, 
And if it take the second must refuse
A heavenly mansion, raging in the dark. 


Sunday, September 25, 2011

Another Charming Trend in Medicine


"IMG" means "International Medical Graduate". As in, anyone who studied medicine outside of Canada and wants to do post-graduate studies in Canada.

Did I mention there are 45 Canadians in my medical class alone?

Dare I delve into how many of those 6.5% matched to something other than internal or family medicine?

Hello, Ireland. Need a doctor?

Thursday, September 22, 2011

Last to Know

So, why is it that no one ever told me about surgical critical care as a specialty? It basically combines all the things that I love: really sick patients, emergency medicine, critical care, and...surgery...!

What? Why was this option never presented to me at career day in high school?

Off the cuff one day M.C told me I should consider trauma surgery (yeah yeah, OMDG I hear you snorting) and I brushed the suggestion aside because I would like to start my career sometime before the age of 45. But I've started looking at some of these different fellowship programs and (Trauma! Surgery! and Critical Care! Oh my!) they sound ahhhh-mazing.  

How seriously bad assed would that be? I can only imagine people who have that training must land in the department completely dressed in black, crashing through ceiling windows, and worming their way under laser sensors to get to their patients, because that is how medical ninjas roll.

I just hope I am married by then because LORD knows no man will have me if that is the career I choose.

Anyway, just reading the program descriptions makes me slightly wide eyed.

The problem is, I could also see myself running a vegetarian aromatherapy clinic where we sit and knit our own yogurt after telemarking to work.

And thus continues the fight within me on choosing a medical specialty. My complete love for living the simple life in the mountains, attending bake sales for the hockey team, and making soup is at odds with the part of me that could live in a crazy wild big city cracking chests in the ED by day and going to the symphony at night.

The only thing that really comforts me is that M.C also said, "I think you'd be good at anything you do". Which is no small thing, coming from someone who you have a great professional respect for.

So I suppose time will tell.

Sunday, September 18, 2011

The Blasket Blast

Last week I was whining to Paddy (our surgical SHO) about the fact that my bike needed a tune up, M.C overheard and kindly offered to get it road worthy for me. From this, the topic of the Blasket Blast road ride came up. It is an organized bike ride that goes around the Dingle Peninsula, along some of the most breath taking scenery that this country has to offer. So M.C asks Paddy and I if we want to enter the event with him as he's going to be participating. In true ABB form, I agree without asking any questions (you know, shoot first, ask questions later). I either didn't hear that it was 150 kms or figured that he was exaggerating.

I forgot all about the discussion until a few days later when M.C informed me that he'd paid my registration. Paddy was out because he was on call and couldn't get anyone to switch (how hard he tried is unknown!) Right, so at that point I started asking for details because the longest road ride I've  done is ~70 km in Prince Rupert TWO SUMMERS AGO. He tells me it is 150 km and 8 days away, that was when I started to get really, really worried. This was compounded the day my roommie met M.C and uttered immediately afterward: you are so screwed! He looks seriously fit. Great. Thanks.

Thus began my week of fretting and bike riding. I did ~80 kms last Sunday, then two 35 km rides during the week. I had no idea what was going to happen but I figured I better give it a lash. 

I did enjoy the carb loading part of the whole thing and took it to the next level...indulging for several days before the ride. You know--popcorn for dinner, hummus and crackers several times a day, granola by the handfuls...and chocolate mousse the night before (there are carbs in chocolate, right?)



A scene from the night before, all the food and water ready. And spare socks. Of course my riding shoes with clips were nowhere to be found so I busted out the sneaks. Awwww yeah.

First coffees, just after the summit of Connor Pass.
So there were two rides, one that was 110 kms and one that was 150 kms. We were doing the latter with about 40 other people, men in tights to be specific. Ok, there was one other woman doing the long ride...at least we think she was...a woman. If you note the biker in the background you'll get an idea of the one-piece spandex jumpsuits and waterproof clip booties that everyone else was wearing. All the long riders were SERIOUSLY decked out. We looked like we'd found our gear at a garage sale the night before, by comparison. Both M.C and I were also the only people wearing running shoes. We got some very disappointed and looks and clucks throughout the day due to our athletic faux pas of epic proportions!



And then there was the flat tire. The guy who stopped to radio the support car with a foot pump informed us that he hadn't gotten a flat in 4000 miles. We were undeterred though our place at the end of the line was definitely secured.




And then we got stuck behind some sheep. As you do, when you're riding the Tour De Irelande.




Some lovely scenes from the day. 

The Blasket Islands.

The above photo shows the Irish version of a 'highway', and how wide a bike rider can expect the shoulders to be. 



First lunches. And a latte from a road-side bus! This was my kind of race. 

 
 At the 95 km mark we decided it was time for ice-cream.


And a photo op of the old ABB and her bike.


Finally! Several hours, 150 kms, 2 pairs of socks, 2 lunches, 3 coffees, 1 ice cream, several rainstorms, and 3 pee breaks later we arrived back at the start. We had a really fun day, actually. I even managed to pull out my last bit of juice on the final summit and trash talked M.C all the way to the top.

And it was GREAT!!

I am so glad I did it. I love it when I surprise myself! Go Team Sneaks!!

Thursday, September 15, 2011

Good News

The best part of my day, hands down, was getting to tell a patient that her CT scan was clear, and that no further cancer had appeared in her abdomen.

As a nurse in the emergency department I often saw the test results before the physicians did. Many patients would ask me directly what the results were but I always had to defer and say that the doctor would be in to speak to them shortly. It was one of the things about nursing that irked me on a regular basis.

Today the chart landed in my hands and I called a bubbly woman in to the office. I asked what her referral was regarding and she informed me that it was for the results of her recent CT scan. She had a history of cancer in her abdomen and as I flipped through the chart trying to find Diagnostics I said a silent prayer hoping things would be normal. Found the report and read it out to her...everything was normal. As I read I could see in my peripheral vision her shoulders relax slightly from a hunch, and heard a breath escape with the movement. The relief on her face was a delight to me.

So much of our practice deals with pathology and telling people bad news that these moments of relief and reassurance, are a treat. I am grateful that I was able to start my career of telling people results with some good news.


Tuesday, September 13, 2011

Tiny Holes and Testicles

So I knew, going in, that medicine wasn't glamorous. But sure, I love it anyway.

M.C has been giving me any opportunities he can to unleash me on patients and attempt my (now feeble after two years of atrophy) suturing skills. I learned a new tie last week and had a chance to suture up some trocar incisions. The piercing gazes of the O.R staff can be enough to make any steady hand tremble and I was kicking myself for not being smoother when he handed the needle driver over to me. It was only a few tiny knots in a couple minute incisions but I could feel the sweat starting to trickle while I worked it out.

Then yesterday he let me attempt hand-tying for the first time. Of course the anesthetist had to come out from behind the drapes to watch the show and the scrub nurse faintly jerked her head every time I made a mistake, but M.C let me persevere until I got it right. I just hoped that my damp scrub top at the end was from my nervousness and not from the hydrocoele fluid that I'd been sprayed with earlier in the procedure. I figured out quite quickly that practicing tying knots with a shoe string around a toilet paper roll is no substitute for scrotum and sutures. Go figure.

And speaking of testicles...I thought I saw plenty of man-bits when I was nursing...but oh no. Of course seeing testicles isn't anything new, but having to figure out what is wrong when someone comes in with a swollen one is something completely different. I find myself sometimes getting caught up in trying to visualize the structures under the skin while I am palpating the problem. I think the last thing you want as a male patient is a woman staring off into space, blank expression, ball in hand. Rolling.

So I am going to try and become a little faster and more methodical with that exam. Like everything else.

Only 2 weeks of surgery left, and then I am off to ponder sodium levels and sliding scales for the next 9 weeks start my general medicine rotation.

Theater tomorrow!

Thursday, September 8, 2011

A Personality For Surgery?

I don't really know what people mean when they say, "oh you've got the personality for surgery". Is that like having a face for radio? Because to me, that is what it sounds like.

When I think of surgeons (apologies in advance to any who might be reading this) I usually envision an ego-maniac who likes to have hissy fits. Someone who is impatient, brusk, irritable, and cold. Granted, in the last while that stereotype has been opposed by many of the all-around-awesome surgeons I've met and worked with. Many of them well rounded, caring, hilarious, sensitive folks...really!

The other night myself and and handful of the junior attendings were out for supper and the registrar (a position equivalent to resident purgatory as far as I can tell) was going on about our astrology signs and when he found out I was a Leo he joked that I was the quintessential Leo. Now he's been around hospitals for a long, long time so I asked him if he thought there were specialties suited to certain Astrology signs (I am grasping at straws here people, I know that) and he laughed and said, "Do you mean, 'what should I go into because I am a Leo?'"

"Er. Yes." All eyes around the table fixed on me. Conversation stopped. Now I was feeling awkward.

"Well, surgery of course. Lots of Leo's gravitate to surgery."

"Why?"

"Because they are bossy and need to always be the center of attention!"

Ah, thank you. Yes. Well I suppose I did ask.

Sunday, August 28, 2011

Trains

My sister informed me in a huffy way that it had been too many days since my last blog post. So, hello again, blog world, and hiya Dust!

The days just seem to be so long and groundhog-esque I start a post and think, "I am boring myself" and I close it. I've been doing that lately with emails as well, I'll spend half an hour writing someone an email and then I just delete it. It's mostly that I feel as though life has become quite one dimensional, it is a good dimension, don't get me wrong. I just fell uncomfortable rambling on to others about it.

It is also the pace of life these days unsettles me, like when you're on a train and think you're not really going that fast until another train passes going in the other direction. Suddenly the force, speed, and momentum is clear and almost frightening.

There have been a few trains going in the opposite direction lately.

I spent a good part of my morning with one of our palliative patients. She is a lovely woman and as she spoke about the impact of her recent diagnosis I made no attempt to hide the tears in my eyes. I used to be quite good at remaining buttoned-down with my reactions to patient's emotions (working in the emergency department gave me a lot of practice). She was just so open and honest with me, held my gaze, and for most of the interview gave me unflinching details of her ordeal. So when she cried, I did too. And I think it was appropriate. I have no idea though.

I also assisted with a below the knee amputation. That was my first limb amputation, having seen a great toe removed before. My normally jovial consultant (M.C) was thin lipped and quiet for most of the lengthy surgery. At one point he simply said, "God I hate doing these procedures." I suppose a surgeon simply cannot get the same satisfaction from amputating a limb, compared to cutting a cancer out, or removing a troublesome gallbladder.

But it wasn't the bone sawing or muscle slicing that I found unnerving. It was how quickly the patient reached for my hand and how tightly he gripped it before the anesthetic whisked him off to sleep. A couple of weeks ago I had met him, a broad burly man, who was gruff and a little abrasive. He wanted the procedure because it was going to improve his quality of life but I felt his reservations as soon as his giant hand engulfed mine.

So today, in an effort to slow things down a little I ventured out to the mountains and hiked in an area known as the Eastern Reeks. The ground involves a lot of bog walking and slippery rock negotiating. The forced concentration and good conversation gave me a much needed break from thoughts about the hospital and school.

An Irish Inukshuk?
I am definitely going to make an effort to get out at least once a week. Especially once my foot is completely healed. Yeah. It is possible that a 6h hike today may not have been what my ankle needed.


A long day outside was definitely what my head needed though. Also, the unwinding pace in a cottage with beer, a fireplace, and hot soup, was perfect.

Thursday, August 18, 2011

Scenes from an Irish Surgical Ward

I went upstairs today to see if I could find my intern, Simon. There he was, filling out yet another cardex of medication orders. The poor guy does such a ridiculous amount of scut it boggles the mind, yet he always has a smile on his broad Burmese face. I am so happy that he's on my team.

We were discussing Mr. Smith's night time sedation as as his current meds aren't doing the trick. The Ward Sister warned that the night nurse would have a fit if he didn't settle again tonight. So as we hammered out some different strategies I leaned back from the nurses station to have a peak in Mr. Smith's room.

And there he is, sitting upright in a big blue padded chair, his tray table in front of him. An open bottle of Guinness is on the table and he's grasping a plastic cup almost empty of it's brown fizzy contents. He gives me a giant dentured grin and I remember how he looked last week, flat out in bed and sucking hard on the 10L non-rebreather mask. I thought he wasn't going to survive the weekend.

"Er.....is he getting...Guinness??"

"Yes, I think they prescribed it for him yesterday." 

So I'd heard that it used to be common practice to prescribe the stout because it was so high in iron and vitamins, but part of me just dismissed that along with so many other back in the olden days stories. Like how my cardiologist grandfather used to round on his patients with a cigarette in hand and the nurses used to smoke at the desk.

But I saw it with my own eyes, today, and hell if Mr. Smith didn't look a lot perkier.

Then while I was taking bloods from another patient a cell phone went off and the ring tone was an Irish jig being played on a fiddle. At that point I wouldn't have been surprised to pull down the bed sheet to see the patient wearing wellingtons and a tweet jacket. Seriously.

I hope when I am practicing in Canada that one day I'll see a patient pouring maple syrup over poutine while a Celine Dion ring tone goes off. Wait, scratch that...a Neil Young ring tone. Otherwise I'll have to give more points to the Irish for being so...(quaintly)...Irish.


Tuesday, August 9, 2011

Me Med Student, Me Watch Things and Do Nothing

Today I went to Middle of Nowhere (MON) Ireland for a rural lumps and bumps clinic. I really enjoy the outings to the country, hanging around the little hospitals, and seeing the old farmers who drive in on their tractors (true story). I had the chance to see a nice variety of patients: from swallowing difficulties to sebaceous cysts, urinary retention to infected toe nails. For me the real fun is with the procedures so I had to sit on my hands all day. Naturally I jumped at doing dressings or applying pressure to the odd excised mole lesion. Hey, that is how I need to get my kicks these days. Sigh. MC actually told me last week to stop making the beds between patients. Old habits die hard, I guess.

My registrar (I.S) and the locum consultant are both Muslims so they are currently fasting for Ramadan. This means that I.S gets up at 0315h to eat and cannot have any food or water until after 2100h. So today when he offered to buy me lunch I had to decline--I was definitely not about to scarf down a giant lunch in front of him after hearing his rumbling stomach all morning. I guiltily ate an orange in the hour long ride back to the hospital instead. It was 1430h after all, and despite the fact that most days it feels like I am fasting at the hospital...I am not obliged to.

Today's clinic reinforced that being a medical student in Ireland is way different than being a medical student in Canada. I suppose the main reason is over here, when one graduates one is allowed to test the waters for a bit longer, in Canada one is thrown into the pool at the deep end.

For example, I was chatting to the surgical intern yesterday at lunch and I asked him what clinical skills he can perform here at the hospital: IV cannulation (though mostly Senior House Officers [SHO's] do that), catheterization, and blood draws. He has never scrubbed in for a single surgery and likely will not have the chance to this year as he is on call for the wards and spends his days doing scut (writing discharge orders, medication charts, ultrasound requisitions, etc.). After an intern year, one becomes an SHO and does a little more, like admit patients, start IV's, mix and administer meds, maybe hold the odd retractor in surgery.

When I told him that medical students do all those things, plus skills like intubation, arterial lines, and suturing he almost choked on his egg roll.

Needless to say medical students here are to be seen and not...well...heard, unless they are being pimped, in which case the responses should be quick and confident sounding.

I know that I chose to sign up for this training but frankly I am a little worried I'll lose the skills I learned as a nurse such as cannulation, catheterization, blood draws, arterial blood gases, and suturing. Never mind the fact that I'll be hopeless at case management, creating care plans, admitting and discharging patients. Hopefully I can cram as much of that type of learning into my Canadian electives over the next two years...

Tomorrow brings a couple of long theater (O.R) cases so I must hit the books and Acland videos. Here's to hoping for light pimping, kind scrub nurses, and no lead aprons.

Sunday, August 7, 2011

Week Two: Objectives

It's now Sunday afternoon and I'm quite smug about the fact that there is a ridiculously tasty pot of chorizo, chickpea, chicken, barley, and veg soup simmering on my stove. It is part of my objectives for the upcoming week which include:

-eating proper food as opposed to scarfing down (in the washroom) warm string cheese that has been sitting in my purse all day
-fruit (yes, that is an objective)
-exercising (ok that might be a bit of a hoop dream)
-keeping a log of what patients and presentations I saw (oh right, that one is a course requirement)
-going to bed earlier (and not watching Parks and Recreation reruns until I am almost comatose)
-actually looking up the answers to one of the 1000 questions I have lingering at the end of the day

I do love surgery. I wish I didn't. Even the tedium of holding a VERY large and awkwardly positioned retractor for hours on end doesn't deter me. I got to see how a stoma is made and how to reconnect loops of bowel following a resection. These are important life skills as far as I am concerned.

I just wish it was the days of olde when surgeons were trained as apprentices because I have lucked out with some great master barbers! Mind you, if I were living back then I'd probably be a serving wench, wet nurse, or prostitute...so...maybe I should count my blessings. 

Thursday, August 4, 2011

Conversation During Clinic: Pimping

My consultant (MC) and I saw around 80 patients today in clinic. And I was in heels. Wow, when I was nursing I really took for granted the privilege of wearing scrubs and runners to work!

Needless to say there wasn't very much talking between patients, but one brief exchange did occur which cracked me up...

MC was trying to describe one of his colleagues to me, when I figured out who it was the conversation went like this...

Me: Oh right, I know the guy you mean. He's the one that pimped me on my first day and I had NO idea who he was!


MC: What did you just say? He what you? 


Me: "Pimped", wait, er...you don't know what pimping is? Didn't you go to Hopkins? Surely they talked about "pimping" there!?

MC: Isn't that like, a pimp, someone who has...you know...

Me: No no no...'getting pimped' means 'getting grilled' in front of patients or other medical students. Like when you ask me what the collateral blood supply is to the rectum. That is pimping. I can't believe you haven't heard that term--especially at Hopkins. Hang on, you were a Fellow so you'd have been the 'pimper' not the 'pimpee'.

MC [grinning madly]: So I was pimping people at Hopkins and didn't know? Wait, is that bad then that I pimp you?


Me: No, it's your job.


MC: Oh, ok, good to know. Pimping. Huh! 

And thus concluded a conversation I never thought I'd have with a consultant surgeon. 

 

Wednesday, August 3, 2011

First Day of Surgery Rotation, Take 2

So the conversation yesterday went something like this:

My Consultant (MC): So, why did you choose this part of Ireland?

Me: Because I miss the great outdoors and as far as I can reckon this is the best part of Ireland for hiking, biking, swimming, surfing, walking, climbing...

MC: My wife is part of this walking group that meets every Tuesday, you should go with them sometime. It'd be a great way to explore the area and find walks* that would never be on a tourist map.

Me: Yeah, that'd be great. I'd definitely like to do that... [In my head adding...in a few weeks when I am settled].

--Fast forward several hours. I am sitting in our video conference on anesthetic assessments and my mobile rings, I am not going to take it and then I see that it is MC calling. YIKES! So I grab it and run out of the conference.--

MC: Ok so my wife is going to be wearing a pink NIKE hat, driving a silver VW. She'll meet you at the Windmill parking lot at 1820h, do you have a pen? here is her number...

And so it was.

I know, I know. It sounds like a ridiculously gunner move but honestly, I thought it was really nice of him to set it up for me and I didn't want to seem like some outdoorsy blowhard who is all talk and no action. Also, was it a test?? I really don't think so, but I thought on my first day I did not want to seem like a flake. So I went.

And it was wonderful. Aside from the ring of geriatrico-hiking-psychos that cornered me at the beginning and created a chorus of 'tut tut's' over my footwear (runners). There were about 10 of them that surrounded me and started chastising me for my poor ankle support, lack of foresight, poor decisions...I offered to hitch a ride back to town when MC's wife piped up in my defense, "But she climbed Carrauntoohill last year in them and was fine!!" They finally dispersed with a collective head-shake and we were off!
 

We went to the peak on hikers right, just above the head of the lady in the foreground

Possibly the clearest night I've seen in Ireland. About 1/2 way up.

All retracting and no play...? NO WAY!
I couldn't take any photos from the top because it was almost dark so we were busy trying to get down as fast as possible. Yes, the sneaks held up and I made it out in one piece despite my "complete lack of ankle support!"


And thus concluded my first day of clinical rotations. Hope I didn't peak too soon!! Heh.


 *When people use the word "walking" here they often mean, "hiking". Turns out.

Tuesday, August 2, 2011

First Day of Surgery Rotation, Take 1

It is 2355h and I walked in the door about 20 mins ago. I've only just finished scrubbing the layers of peat moss and bog water off me (long story) but I thought I ought to give a quick update.

Surgery=AWESOME

I have the privilege of being with a surgeon who is not only talented but nice. He's got a great team and I think I am really going to have a fabulous experience.

Really excited. And happy. And relieved.

Until tomorrow...good night!

Monday, August 1, 2011

Into the Fray

So tonight is the eve of starting clinical placements and my 3rd year of medical school. Just found out I have the wrong shoes for theater (no sneaks or crocs, only clogs with a heel). So I'll be starting off with an inappropriate-footwear-bang!

I've gone through my entire wardrobe trying to find something that is summery-yet-appropriate-and-comfortable-yet-stylish. I do not own anything that fits all of those categories.

I am someone who is always to hot (which is why it is a good thing I came to Ireland over the Caribbean, tomorrow's high: 9 degrees Celsius. No joke). I don't want to be the medical student who looks like she's having a hot-flash tomorrow. Yet somehow the best outfit I could come up with were wool-blend pants and a wool-blend sweater. Nothing else seems right because I want to be as understated as possible tomorrow when I meet my team and Mr. Surgeon. Yes, in Ireland (and the UK, I think) the surgeons are Mr.'s not Dr's. Another odd quirk, like the hot and cold taps.

So, I am nervous and excited. My appetite has been gone for the past few days (which is probably a good thing after fat-camp all summer (a.k.a "studying for the USMLE").

On the upside, the blog fodder will hopefully improve as reading a blog about someone who does nothing but study isn't exactly gripping literature.

Fingers crossed things will go well tomorrow. I've been looking forward to being back in the hospital for so long--I just hope this part of the course will live up to my expectations. I remember so clearly when I was back in pre-req hell and typing up a physics lab, stumbling on Old MD Girl's blog while she was in her clinical rotations. I wished there was some way I could teleport myself to that place in medical school. And now I am here! In my wool suit. Look out world.