Today was my first pre-call shift. The pre-call schedule is relatively chill. We start the morning as usual; getting numbers, pre-rounding, rounding, pass-on. Then our team goes to do the surgeries that are scheduled for the ACS teams, split into either trauma or non-trauma, with note-writing and orders and other various tasks sprinkled through.
On the non-trauma side there was an appendectomy. On the trauma side, we had a pretty gnarly leg wound debridement. I remember seeing the patient in the ED when we were on call just 3 days ago. She came in with super severe leg pain with imaging and labs concerning for a bad infection. I guess they debrided it the text day, and today she was scheduled for us to clean it out again. She had 3 big openings (made by the surgeons) going down the lateral aspect of her right thigh, each at least 6 inches apart, and 1 opening on the upper medial part of her thigh. Each one of these openings communicated with each other.
During the surgery I was able to feel the tense fascia that runs down the lateral leg (aka the fasciae latae) and was able to touch my finger coming in from one of the other openings. We had to clean out any developing clots from old blood that was collecting in there and also look for pockets of pus/ infection.
This poor women, must have been suffering for a long time for it to have gotten as bad as it was before coming in, and the recovery is not going to be easy, with her likely needing to return to the OR before going home.
(2) High-quality sunscreen
(3) The learning opportunities I get every day in the hospital and the residents, fellows, and attending who go out of their way to teach me something even if it means taking a little more time to do a task.
Today we celebrated my aunt’s 60th birthday. Though we aren’t related by blood she has been a part of my life since I was just a wee lad. I’ve always admired her lively energy and her ability to bring joy and laughter with her wherever she goes. She has been through a lot these past few years, enough that would probably extinguish the spark of any other person, yet she remains a beacon of positivity and hope. Thrive on Auntie Rina ❤ I am very thankful to have you in my life.
Two other things I’m thankful for:
(1) Moments of silence that don’t need to be filled.
(2) Relationships that have reached the point of open vulnerability.
It wasn’t too crazy of a call shift thankfully, and I actually got to leave the hospital a tiny bit early because we had teaching that morning, but I am still counting it at the next day because (1) it literally involves the next day and (2) I spend more time in the hospital on my call days than I spent over multiple days on other services.
We had a sub-intern join us on service today. Seemed like a nice guy. He was from Loyola Medical School in Chicago. During some of our downtime there was some discussion about matching into residencies and all that. In our own school, admin has been preparing us to for what 4th year is going to look like. All this has just been making me a bit worried about matching for residency. I’m not sure how competitive of an applicant I am at this point. Definitely want to use these coming month to step up my game for Step 2, no pun intended.
3 things I’m grateful for:
Staff at places who are extraordinarily friendly, like you have no reason to be as smiley and friendly as you are being, but I am here for it.
Old rattley cars that still get the job done.
Banana split Dippin’ Dots only.
Call Day 2/4. Feeling pretty good today, but maybe ’cause we haven’t had to scrub into many cases. Also I’m on non-trauma today so there hasn’t been a lot of fast paced action, but all our surgeries got pushed to the night time. I don’t feel all that tired right now though, but I partially attribute that to these special fridges in the cafeteria that only open after everything else closes with free snacks inside for hospital staff. I would probably gain a lot of weight if I was a surgeon.
3 things I’m thankful for: the opportunity to observe and take part in surgery, my classmates who have all been very supportive and collaborative, free diet coke from the fridge
We put so much emphasis on having answers readily available. When there’s a question we don’t have an answer to, often times the first instinct is to reach for the Google machines in our pockets if the answer doesn’t come to us within the first 30 seconds. This is how we were trained. In school, we are praised (directly or indirectly) for being the first student to raise our hand to scream out an answer. If we get called on to provide an answer and can’t provide one in 10 seconds or less, we are punished with a being shunned (teacher just moves on without being intentionally negative) or worse a disproving look or snarky comment. Our culture rewards outcomes and not processes. We are obsessed with facts and rote memory, leaving little room (and little patience) for recognizing the value of thinking things through.
So many people are convinced they are dumb early on in life simply because they aren’t as quick (or perhaps not as eager) to shout out answers. And that becomes reinforced as they go through life built by a society that rewards quick answers.
What if instead of jumping around from student to student fishing for the right answer, what if we paused for an uncomfortable amount of time and let students mull it over. What if instead of telling kids they are wrong or jumping to praise when they are correct, we said,”Can you talk us through that?” or “Let’s break this down.” I think kids would be a little less scared of learning.
The schedule for ACS for medical students really isn’t all that bad. Sure we spend 28 consecutive hours in the hospital once every 4 days, but we also essentially get to of those days off (granted one is ~supposed~ to be dedicated to sleep, but also there is no good way to fix your sleep schedule in that time). As I’ve said before, the life of the surgery resident really seems terrible among the specialties I’ve seen (except maybe aside from Ob/Gyn), but that’s why they get paid the big bucks, because you are literally trading in your life. I’ve never had more people try to convince me not to go into a specialty as I have in surgery. It seems like your life really has to revolve around medicine, but I think that works for some people (some of whom I have met).
Today I was in the outpatient surgery clinic which was very chill. Definitely different vibes from primary care clinic. I literally felt guilty about asking Review of System questions that weren’t strictly/ directly related to their surgery (even if they were maybe tangentially relevant). It’s just a whole different philosophy from what I came into medicine for.
We made it. It actually wasn’t as terrible as I thought it would be. It’s weird spending a whole 24+ hours in a building that is not your home without stepping outside. Now that I think about it patients in hospitals do that all the time. It must be weird for them as well, but this feels like a different think. It was weird to watch the sun rise and set from the inside of a building, know that time is passing, but also not feelings like time is passing. This morning after I left I was a bit disoriented to exactly when I was. Overall though it was a cool experience. Being on the trauma service we saw some interesting stuff, but nothing too crazy, but definitely stuff that I don’t think I would every see over at the private hospital. Also coincidentally, the 3rd year resident I was working with is a Cottage resident.
Currently on hour 15 of my 24(28) hour acute care surgery trauma call shift. To be honest it’s gone by pretty quickly. We’ve had to scrub in to a couple cases, nothing too crazy, one necrotizing soft tissue infection and accident leg-slicing (the medical term) with a Skill saw. I don’t mind staying up as long as there are things to do and on trauma there has been plenty to do. We have a bit of a lull right now so I’m going to try to get some sleep before all the action starts (hopefully not).
Tomorrow is my first 28-hour call shift and I should probably get to bed. There are a lot of stuff to catch up on that I would like to get done before I sleep. I’ve done some of them (including this), but I’ll complain about it more tomorrow.
Past couple days of my 10 task challenge have been a little rough. Not because the tasks feel hard, but because there have other things going on in my life unrelated to the tasks; spending time with friends and family, driving homes, Thanksgiving stuff. The things about 10 tasks is that it doesn’t leave a lot of room for flexibility, but maybe thats’s more of an issue of the choice of tasks. I think the exercise is still valuable, but I think part of the practice is practicing self-compassion when you fall a little short on the stuff you set out to do.