Category: Medical

It was a long day today. Not only because of hospital/ clinic work but other commitments, but having to get up at 5 am certainly doesn’t help. Rounds started a little earlier today with our new chief resident and then we went to clinic later with the attending (we were late because the schedule we were given was wrong). It was nice to be back in the clinic though. It being a surgery clinic, there were some pretty heavy conversations had. In some ways, it feels wrong for me to be there in these important moments, as a spectator/ medical student. Another part of me feels lucky to be able to be present in those moments. If I did go into surgery, I can see clinic being something I enjoy. Our attending also did a lot of patient education which I thought was nice, especially since the image of surgeons can often be kind of cold and fast paced. But I am very sleepy so that is all for now.

Today was my first weekend shift on surgery. There were no procedures, so today was just rounding on the patients who were already in the hospital or got admitted yesterday. Compared to internal medicine, handoff in surgery seems very inefficient and almost haphazard, but it also feels like there are less issues being tracked, but those issues may be slightly more volatile. The resident I worked with today is supposed to stay at the hospital until tomorrow morning. Part of me is confused as to why. Why does someone have to be on call for 24+ hours. Is it a continuity thing? Based on what I’ve seen, it’s not like being around the first half of the day makes you any better suited to care for a patient overnight than someone coming in fresh who received a strong sign-out. It almost feels like one of those archaic practices that is held on to as a source of pride, like “look at me able to withstand a 28-hour shift.” But also what do I know, I’m literally talking out of my ass. Maybe it is better for physician wellness. Maybe it is better for patient care. I bet there’s gotta be some studies out their pointing one way or the other.

We didn’t have any cases today, so (thankfully) I didn’t have spend any time in the operating room (even though watching surgery is cool, yesterday was just a lot of standing). So it most basically like an internal medicine day, minus the long rounds and comprehensive discussions of pathology. I actually like the residents on our surgery team. The chief is kinda scary, or just very surgeon-y, she can be kinda terse, but also very nice at times and willing to be patient with us and help us learn when there is time.

There was supposed to be a liver transplant today which I was really looking forward to but it got cancelled (perhaps for the best), so we got a chance to sit down with the team a bit more and set expectations and stuff. And we got to go home a little earlier which was quite nice.

It’s only day 3 but I think I already know surgery, as awesome as it, is not going to be for me. The giddy has mostly worn off.

I got to scrub in on 2 liver resections today. Both cases of rectal cancer with metastases to the liver. This procedure is another great example of how kinda straightforward surgery is (again, besides all the technical parts of it); there’s something wrong with part of the liver, let’s just cut that shit right out. And when we cut the liver, I was kinda expecting this clean margins, like you’d get if the thing was made of Play-Doh. Nope it looks janky as heck.

If anything see all of this is, whole organs being chopped up, tissue being burned apart and sewn back together, it’s all a testament to how amazing our bodies (and living things in general are). We can put our body through hell, and yet it find away to put things back together, more or less in the way it’s supposed to, something we often take for granted.

We’re back to the early mornings. Yesterday our intern told my fellow medical student and I to show up at 6:00 AM at the hospital. Turns how it was his first day on the the service and first day working at this hospital as well, so the morning was a bit chaotic. The intern ran off without telling us much, and then the senior resident showed up and was like wtf. She took us to go round which was a very different experience from IM; walking rounds, but very brief visits with the patients. We finished in like 30 mins and then the resident was like ok go scrub into whatever surgeries are going on. And we were like uhhhh.

This was my first time actually working in this hospital and the scrub orientation/ OR tour we had yesterday was for the county hospital. After some running around with my classmate we eventually made it to our respective ORs. I got to go to a Whipple procedure, which I was pretty excited for. It’s basically a big plumbing job (like many surgeries). As technical and difficult and high-risk these procedures are the concepts are kinda basic, just take out what you need and make sure things are connected and stuff doesn’t leak out (obviously this is an oversimplification, you need to know what you are cutting and why).

This particular procedure is supposed to take 8+ hours. I was there for only for 4. It was amazing to watch the surgeons work. I feel like I often think about internal organs as so vital and almost delicate, but watching surgery proves otherwise. Sure the surgeons work with great care and precision, but at the same time things are flopping around, getting pushed and squeezed and cut and stitched and disconnected and reconnected and then later when the patient comes to they are still able to live as a functional human. Wild.

I will say as amazing as it is to watch, just watching does get a bit boring after a while. Though I can imagine actually doing the procedure being less so.

The surgical fellow straight-up told me that if there is something else I enjoy in medicine, do that and to avoid surgery if I can help it. After what I saw today I think that may be good advice. I can’t really imagine doing what these guys do into my 50s and 60s and not being an attending till I’m nearly 40.

Still looking forward to seeing more cool procedures though.

Today was orientation day for surgery. While I don’t think I want to end up in surgery (nor am I probably competitive enough to match even if I wanted to), I am actually pretty excited for all the cool shit I’m about to see during this rotation. I’m going to be on the hepatobiliary service and I am very much hoping I will get to see a transplant. I’m honestly not 100% sure if this service does transplants or if there’s a transplant specific service because I’ve heard conflicting things. Today we had some workshop for practicing IV insertion and surgical knot tying. The practical and hands-on nature of surgery is something that has always appealed to me about surgery, so I’m excited to learn these skills and hopefully be able to use them on actual patients. It’s going to be a rough next 6 weeks, but I don’t know why I’m kind of feeling giddy about it. We’ll see how long that lasts. Stay tuned.

We’re finished. Coming into this rotation I definitely had conflicting feelings. On the one hand I recognize how important psychiatry is and I also really enjoy talking to patients and having the opportunity and privilege to walk next to patients during some of the most vulnerable moments of their lives. On the other hand, I felt like management of a lot of psychiatric illness felt like a crapshoot even with the use of evidence based strategies. You are often reliant not only on individual response to medications, but also personalities or pathology that make adherence sometimes even more difficult than it is with the less-psychiatric population.

I think through this experience I got a lot of really great opportunities to talk to emotionally and mentally fragile (often times due to them being pushed to their edge) or volatile patients, and practice skills in dealing with stressful and delicate situations. I think I learned a lot about management of psychiatry illness and everything that goes into making decisions about patient’s medications. I learned about ways we can try to regain the trust of people who have felt abandoned and/ or betrayed by our healthcare systems and by doctors.

There were a lot of valuable lessons and the are just a few. While I the field of psychiatry is probably not for me, I will definitely try to bring (and likely will have to whether I like it or not) all that I learned to wherever I end up.

It was a true Halloween day on the EDHU today. One of our patients was telling us about how there was an invisible man living in her house. Whispering to her while she mops the floor, lying down in bed next to her, reaching out from the toilet. Truly frightening stuff. To make matters worse in the middle of our interview, one of the blinds, all of which were pulled down, snapped up all of a sudden, and our patient goes, “Did you see him?”

The day also included pitch black vomit and a bone chilling scream.

Anyways, it second to last day of the rotation and while I’m going to miss the people I worked with and talking to the patients, I will not be missing psychiatry all that much as of this moment. That said I won’t rule it all the way out quite yet because there are a lot of part about psychiatry that I do like and I don’t want to throw away the baby the bathwater as they say (do they say that?).

Our healthcare system is so fucked up. The fact that a person’s insurance determines the quality of their care, or whether they even get certain kinds of care made available to them in the first place is fucked up. The fact that physicians have to dance around the greed of insurance companies in order to provide patients what they think is appropriate is fucked up. On multiple occasions we’ve had patients who care was delayed because insurance companies were fighting over who should pay. We’ve had local mental health services say, nope we don’t want to deal with this patient, but them on a bus and send them to LA to establish care there. Sad day.

One thing I have noticed these past few weeks that was especially apparent today is how tenuous our ties to reality and to our lives as we know them can be; how easy it is to lose control. I’ve met a lot of people whose lives have been ruined by substance use, and for all their differences, a lot of the stories are somewhat similar. Alcohol, weed, cocaine, opiates, etc., it all starts as a coping mechanism — a way to relieve whatever kind of mental or spiritual pain they are experiencing (whether they are cognizant of it or not). Control gives way to the illusion of control and to dependence, tolerance, expansion, things that can be harmful to a person. I’ve seen alcohol give way to loss of custody, weed give way to psychosis (hallucinations, delusions, derealization), benzos give way to homelessness, and various other permutations.

On a regular basis in psychiatry you are talking to people during perhaps some of the most vulnerable moments of their lives, which is a scary thing, but also something I find beautiful about psychiatry.