nANIMOv

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.

I got to see a kidney transplant today. Truly one of the most amazing things I’ve seen in medical school so far, maybe after delivery of a human baby. The transplant surgery was everything I imagine when I think of surgery. High precision, high stakes, anatomical engineering. We took a kidney procured from a deceased person off ice, hooked up all the plumbing (artery, vein, ureter) to appropriate, but not identical vessels in the body of a totally different person, in a place that was not originally intended to house a kidney, let the blood of this person flow into it, and all of a sudden this kidney, that was once in a pale stasis, is all of a sudden red with life and a pulse that is in sync with it’s new owner.

Also all the surgeons I worked with today were super nice, and they aren’t even on my service. The 1st year fellow who had the misfortune of having to close the patient with me was very patient in helping me with my suturing, guiding me and letting me take my time instead of rushing me or just taking over.

Also I saw a robotic surgery today (liver resection). The technology is super cool and it was very sci-fi to watch these weird arm things plugged into someone’s belly, manipulating things inside. Also the thing that the surgeons look through allow them to see inside the person abdomen in 3D which was also amazing. But being a bystander to the surgery was pretty boring. Just basically watching organs get manipulated and cut and pinched and burned for the time equivalent of viewing the Return of the King extended edition.

I really like my team right now. This week we got a new chief resident (4th year) and a new senior (3rd year) resident. They are both so nice and so chill, and perhaps most importantly they set clear expectations and act like they want us to learn and be part of the team. I don’t blame the previous ones at all for not really engaging with us. I imagine the life of a surgery resident is super tough and having to deal with medical students is just another thing to manage on top of everything else, but I guess that’s why it means a lot when residents take time to engage with us (and in fairness our prior residents did, it was just harder).

The team around you makes such a difference in your experience. Because I like my team currently, I’m kinda looking forward to going in tomorrow. That is how it was on Internal Medicine. The hours were long and I had to wake up at the wee hours of the morning, but I kinda looked forward to getting to spend time with the team and learn.

Hopefully this keeps up.

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.