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.
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
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).
It was my last day on the HBS service and in a few days I start acute care surgery with a 28 hour call shift. I enjoyed my time on this service, but also kinda glad it wasn’t longer than it was. Similarly I’m looking forward to all the interesting things I’m going to see on ACS and the once-in-a-lifetime experiences I will have.
I did not think this was how I was going to spend today. The surgery gods graciously decided to usher me into my late twenties with a literal surprise Whipple procedure. The case started a little later than usual and was supposed to be just a relatively standard liver resection, but after we got in there the disease appeared to be more extensive than we thought and so we had to convert to the Whipple. Thankfully, I feel like it moved pretty quick for a this kind of procedure, only about 8-9 hours (compared to the 10-12 nightmares I’ve heard of). While it was a long time to stand and mostly just watch, it honestly didn’t feel like it was as long as it was in reality. It was fascinating to watch and it’s always cool to see things that you usually only see in textbooks fleshed out. Don’t get me wrong, if I had it my way, I probably would not attend another one, but I’m glad I was able to experience the whole thing at least once. Very thankful for my attending and especially my resident for their patiences and letting me participate. Very thankful to all the nurses and the scrub techs for their patience as well. Sending the patient all the best in their recovery and future treatment.
Anyways I’m tired, more thoughts on this tomorrow maybe.
Being a non-native English speaker undergoing surgery in a predominantly English-speaking hospital must be scary, even more so than any other hospitalization. You are undergoing a major invasive procedure and you can’t even properly communicate with the person who is going to be cutting into you. Even though interpreter services are available, as good as they are I’m sure there are things that get lost in translation or simply omitted, and there is no way for the physician to verify or clarify since there is no way for them to know if a mistranslation occurred. On top of that, working through interpreter services makes a patient encounter take double the time as it is so there is some pressure, even if subconscious, to not be as thorough or comprehensive as one would be in a language concordant interaction.
Today in clinic I was using a Spanish interpreter and on several occasions the interpreter simply left out parts of what I was saying (based on my limited Spanish). I’m not sure if it was for clarity sake, or succinctness, but I think part of the art of medicine is carefully choosing your words and how you relay information to patients.
The solution is simple, physician need to learn the languages of their patients, but that is not super practical. Not sure what the solution, but I just imagine it’s a bit scary having doctors examining your belly and talking about you in front of you without you really understand what is being said.
Sundays in surgery I really feel bad for the residents. At least on the service I’m on, the third year does a 24 hour shift and they are by themselves with no intern or other resident to help them. They will sometimes have at least 1 medical student, but sadly the help that we actually provide is probably minimal. Yet I am impressed by the resolve and attitude of the 3rd years I’ve worked with, that despite the occasional complaints or exasperated sighs, they seem to be keeping it together and able to work with a relatively positive attitude (perhaps relative to what might be expected).
Today felt like a lot of getting to understand bit more about the structure of residency and glimpsing the mind of a seasoned resident in day-to-day action. I’ll do my best to soak up what I can from these last few days on the service.