Surgery Residency Diary, Mom of 2

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  • #123199
    cardiacrn1cardiacrn1
    Participant

    age: 29 years old in 2 days
    kids: daughter (9) son (7)
    hubby: neurosurgery PGY 1 somewhere in NY
    me: general surgery PGY 1 somewhere in MI
    nationality: subsaharan africa
    interests: abdominal transplant surgery
    world cup team: team brazil:)

    Today my wonderful husband had orientation and I was excited for him but sad at the same time because I know the next three months it will be up to me to travel. He has three straight months on Neurosurgery and I am starting on IM. I am making dinner and just plan on having a great night with him. Tomorrow I will be flying out of NY and going back to MI and who knows when we will be seeing each other. I am sure when I am busy with work and kids, I will be ok and I know that the God who has carried me through in the past will be right by my side. I am blessed to be following my dream and to have a wonderful supportive family and friends. I should be studying for my ACLS recertification but I am instead dilli dalling on the computer. To all those who read my blog, may you be encouraged and I hope to be good about updating.

    ciao

    #123242
    cardiacrn1cardiacrn1
    Participant

    Today is my birthday and I got to celebrate it at my new second home, the hospital. I got my beautifully embroidered white coat, my badge and pager and I am feeling official. It was a good day, and some of the residents from my department came to welcome us and talk, it really put me at ease. As I sat there listening to the ‘orienters’ speaking, I thought, ‘Its my time now and I should go forth and have the best time of my life. Yes it is going to be hard, I am going to work hard, I am going to be exhausted, but I would like to finish the year with little complaining. I chose to do this and I will do it to the very best of my abilities and with a smile. Ok, off to studying ACLS!!

    #123348
    cardiacrn1cardiacrn1
    Participant

    BLS/ACLS….check, EMR training….check, long white coat….check, pager…check, orientation….check, educational license….check.

    Well, tomorrow is July 1st, I am ready to start. IM will be a good transition for me I think. I am starting off being on call tomorrow which is okay, and I have 4 full days off this month. Call is Q5, I hope I can learn as much as I can on this rotation and though I am not a fan of IM I will do my very best and learn. It is so important to take responsibility for one’e own education.

    I believe in God and He has done wonderful things for me in my life. I am blessed to have family that is constantly lifting me up in prayer. When I arrived at orientation last week, I was told that I had no license, I would not be able to start tomorrow. I made some phone calls in our huge health system to find out what happened to my application, no one knew. Somehow it had gotten lost and the last 3 months I have been chilling thinking that all was well. If I had known even in May I would have been ok to apply so I would have my license by July 1st. Anyway, my documents were lost and there was nothing at the state licensing office. I was devastated. That day, thursday, I called the state licensing office and I was told that it would take 6-8 weeks to process my license. I did not know what to do, I was sad, anxious, worried about being behind. What to do??

    I called my parents and my sisters and told them what was going on and I knew they were praying for me, even fasting. After my orientation on Friday, I ran around to get the paperwork signed by whomever needed to get it signed at the hospital and drove to the state licensing office in the capital. When I got there, there was another young lady from our rivalry school who had driven to find out about her license and they told her the review would take at least two weeks for her and there was nothing that they could do, it was crunch time and they were going through the paperwork as fast as they could. I was depressed.

    When it was my turn, the lady was very nice to me and told me it was taking 6-8 weeks, but maybe I would be lucky since I was a D.O because the list was not as long but it would take a miracle for me to have my license by the 1st. Monday afternoon as I sat in hospital orientation I decided to check my email and my residency coordinator had emailed telling me that they could not find my fingerprints. I got out of orientation since it was close to five and I needed to make phone calls before the offices closed. By God’s grace I was able to locate my fingerprints and gave the state licensing office the information to have them transmitted to them. I thought I was on my way to get my license but it was not to be.

    Tuesday early morning before I went into the hospital, I look up my license and it is pending. Ha, what was that all about? I wondered. Anyway, I searched under osteopathic medicine and surgery and I was not there, they had put me under allopathic medicine. I made a series of phone calls and had to stay waiting for assistance for close to half an hour on various occasions. I was so discouraged. They realized their error after they had accused me of filling out the wrong application form and with that the lady said it was their error they would do their best but it would still take a miracle for me to get my license by the July 1st; it would probably be at least another two weeks. This is the first time I cried during all this and my husband i-chatted me at the right time and calmed me down. I realized when I was crying that I was doubting God being able to pull this miracle off. I knew everyone was praying for me and was filled with a comfort that basically allowed me to let it go, I laid my burden at the foot of the cross and went on with my day as usual, not thinking about it even for a moment.

    When I woke up this morning, I decided to search for my license and I was pleasantly surprised to see it. God came through for me right on time and I am just grateful for His love and mercies. I know that He will be with me now as I begin this journey and I am excited to have this opportunity to learn to be a surgeon in this beautiful country so one day I can help my people…

    ciao:)

    #123385
    cardiacrn1cardiacrn1
    Participant

    So Thursday July 1st was the first day for thousands of interns around the country. There are some who started the week before but for most of us that was the day. When I arrived at the hospital, I was excited, anxious to start my day. I put on my white coat and smiled, I felt like a fake…. Was I ready for this?? I didn’t think so. I reminisced on life as a medical student when I had no worries, now I was a ‘doctor.’ I went to the floor where I was to meet my resident. He gave myself and the other intern on our team a quick 5 minute orientation, showed us how to transfer the oncall pager to our pagers and assigned us our three patients each with instructions to meet him in 45 minutes. On the IM service, there are two teams on call every day. The first team which was us on thursday carries the on call pager from 7am till 7pm; the second team carries the pager from 7pm to 7am the next morning. There are two on call pagers one to cover the north tower and one to cover the south tower. I for this month will be covering the North tower.

    The IM program has a very strong didactics program, at 10 we had case studies and at noon we had conference. After that, it was admissions and cross coverage. The pager went off every few minutes and by the time 7pm rolled around, I was ready to be rid of it. The main calls were elevated blood glucose and hypertension.. A few hypotension here and there; and then other simple stuff like can we d/c foley; restraint renewal; patient wants to sign out AMA. This particular hospital has a cap on the number of admissions per team of 12, with no admissions after 4am. We had our 12 admissions by 230ish am and so it was a 6-6 split between the other intern and I.

    I had a 20 year old girl who came in with DKA. SHe had been doing well, her last admission being about 6 months ago, but she was not feeling too good and when she checked her BS her monitor read high. When she came to the ER her BS was almost 900. She is a frequent flyer, she knew when I ordered lantus and food for her that her gap had closed, so she was ready to go home. I went down to the ED, told her all the bad things that can happen when one leaves AMA and told her she was welcome to come back if she experienced any problem and off she signed out… I was devastated for her, here she was, 20 years old, with neuropathy pretty bad, I wondered where she would be in ten years…

    One of my other patient was a 22 year old girl with Stage IV colon cancer. Can you imagine?? I was heart broken for her, so young with so much ahead of her. And then the 40 something year old physician on the kidney transplant list… I started thinking of myself; would I at that point if it was me, unable to work, would I be done paying off my student loans?? If I end up doing transplant surgery I will be out of fellowship at 36, I would not have had much time to practice. So sad. It was busy, but without a doubt, I learnt so much in the 30+ hours I was there. Its one of those hospitals where they throw you in the ocean just far enough for you to be able to see the shore; the waters are deep, there are sharks, and its either sink or swim. Our resident on our team is not very helpful so we have to do everything ourselves, he is basically there to consult with in terms of clinical decisions, “BS is 480 after pt. already got 10 units 3hrs ago, what should I do?” Other than that, there is a time both I and the other intern were slammed with admissions and he did not lift a finger to help. I am not complaining because I think its an opportunity for me to learn how to be effective. I just wish I had gotten a better orientation of what to do and what is expected of me. It was all trial and error. I thank God for my experience as a nurse, it has come in handy.

    At this rate, I will definitely not be compliant with the 80 hr work week. It is so busy, I never got to sleep even for ten minutes… I had a bowl of soup at noon when we had our conference and that was it until 2am. And after that, I did not get to eat until 4pm when I finally got home even though they want you out by 1pm the latest when you are post call. One thing I learnt about self preservation is to take very good care of myself.. Keep high protein bars in my white coat, munch when I can, keep hydrated; it goes a long way. The patients at this hospital are so sick, it is a great place to train. I am confident I will see it all here and I will be excellent at handling really sick patients.

    On a lighter note, note, my hubby who is doing neurosurgery residency somewhere in new york has way better hours than me. They utilize their midlevel providers (NPs, PAs) which gives them better hours and more OR time. He will on average have 2 weekends off (sat,sun) so he will be able to visit me at least twice a month. I on the other hand will have my mandatory 4 24hrs off per month averaged… So today was my first full day off this month and I have 3 more scattered through out, none on the weekend anymore. I just hope I can learn a lot and not just start doing things out of habit and stop thinking. I want to kick ass and if that is what it takes, so be it.

    Hope everyone has a great 4th of july weekend. ciao

    P.S. For the sake of patient privacy, if anyone feels as though I put too much info on a pt. please feel free to pm me and I will correct that…thanks

    #123400
    cardiacrn1cardiacrn1
    Participant

    Today was a good day of learning how to manage electrolyte derangements. I had a patient who has been having massive diarrhea. This morning his potassium was 3.0, I supplemented him and then checked his Mg. As I was running around trying to discharge my very first patient that I discharged on my own (pat on the back), I get a text page from the nurse telling me that the K is 2.3…..My gosh, I was thinking about all the very bad things that can happen with a K + that low. Anyway, I ordered another 40meq IV for my patient and at that time checked his mag.. 1.1.. My goodness, ordered 2 g mgso4 X2 doses and then put in recheck labs for the night. I know the nurse is going to be chasing after those electrolytes tonight. So that said, I am at home now, reading on electrolyte disturbances, how to effectively correct them and walla, I also found out what is causing my patient’s diarrhea. I had gone through all his medications with a fine tooth comb and found nothing of significance, but the learning surgeon in me forgot the most obvious reason: he is s/p subtotal colectomy with a iliorectal anastomosis. That can cause diarrhea!! Anyway, I have to say that I am not a fan of internal medicine but I am learning so I can better serve my patients as a surgeon. Whatever your hand finds to do, do it with all your might, for in the grave, where you are going, there is neither working nor planning nor knowledge nor wisdom. So, as hard as it is after a long hard day at work, it is so important to read. Whether it is my huge schwartz texbook of surgery or an article I print off on up to date or emedicine, its super important. Anyway, I will be calling it a night early today because I am on call tomorrow. Have a great week, and thanks for reading.

    Ciao 🙂

    #123444
    cardiacrn1cardiacrn1
    Participant

    Another interesting night on call in I truly believe one of the busiest hospitals in the world. I am not even kidding. I am sure every intern feels that way. I feel like the learning curve as an intern is super, super steep and man do I feel like the little red engine that could.:) My first night on call I asked my resident what to do about everything I was paged about. My second call even though it was five days later, I was managing everything by myself, walking to the bedside to see the patient if I wasn’t sure and holding my own with the pager and my 5 admits for the night. I made to count how many pages I got between 7pm and 7am, since I had to delete my pager 3 times and was halfway through about 70… Can you imagine?? I was a nurse before but I have to say that some nurses really take advantage of having a resident in house 24/7.. Some of the things they call about at 3 in the morning are ridiculous.. If they had to call an attending, I do not think they would at that time..Yes, it can wait until the primary team comes in the morning, don’t expect me to take care of that when I do not know anything about the patient. Here is one call I did not mind taking, pager goes off; I call back, “This is Dr. so and so, I was paged.” ‘Yes, patient in room 879 has not had a bowel movement in 5days, could you give him something.’ “Your patient is awake at 230? Is he in any distress, any nausea or vomiting?” ‘No, he is sleeping.’ “So how come you decided to call now?” ‘Because I had some down time and while going through the chart saw that he had no bm for 5days.’ “I see, is dulcolax ok,” I asked before putting the order into the computer and answering the next page….

    Earlier around 8pm, I had gotten a text page, the nurse letting me know the vitals on a patient, BP 82/40, HR 34, RR 8. When I called her back, she asked if I wanted a continuous update on the patient. Since the patient was comfort care, I said don’t worry about it, just page me when it is time. This page came around 320. I called my resident because I had never pronounced someone dead before and read my little instructions on ‘how to’. I walked into the room, yes the patient was dead; I did everything by the book. First checked to see if he was responding to my voice, then when there was no response, painful stimuli to the chest, then I checked for a carotid pulse and looked, listened and felt for breathing; then I checked his pupils which were fixed and dilated. Checked for conjuctival and corneal reflexes, and then a gag reflex. There was absolutely no spontaneous activity. Time of death, 0329. The hardest part for me was calling the family to inform them that their loved one had passed away. For me it was easier because they knew he was not doing well, but still it was very difficult because they were so emotional and I knew not how to comfort them.

    I used to be so nervous about managing DKA, I bet by the end of the next week I will be managing it over the phone. I had a patient come in with a blood glucose of 1296, K of 8.4, Na 129… She was in no doubt DKA, after having a DKA patient the last time I was on call, it was a little easier to deal with. She ended up getting 7liters of fluid, she was dry to the bone… Potassium went back into the cell nicely and all was well. Our emergency room is terribly busy. Young guy 30s comes in with horrible abdominal pain, it ends up being pancreatitis. He had xanthomas on his elbows, under his eyes.. Checked triglycerides, 9,678… What are the chances of seeing that??? It was an awesome case, too bad I was too tired to enjoy it, by the time I was done admitting him I had been awake for 25 hrs without even a minute to close my eyes and rest.

    Learning is fun, but tiring. I wish I had more time to read up on my patients when I get home, or time to eat. I get so busy I feel like taking a moment to eat is a waste of time.. I am glad I have the opportunity to learn and it is the truth that the best time to learn, the time you learn the most is when you are on call. You get to see the beginning, how the patient presents and yo get to manage from the get go. Experience really is the best teacher.. I am making an effort to read at least 10 pages of my huge textbook everyday, its hard but I will continue to do my best.. Have a great weekend everyone, thanks for stopping by.:)

    ciao

    #123510
    cardiacrn1cardiacrn1
    Participant

    So today I was off. I got home yesterday around 330pm post call, did a few things at home and by 630pm I was in bed, exhausted. I slept till 340am and it was nice knowing I was off today so I slept till 6am. I went to the hair dresser, got braided, came home took a nap and then started reading. It’s good to read, reenforces.. anyway, I had a patient who came in, 50 something year old with ESRD on hemodialysis. BP was 245/135 and HR 122, his pupils were so constricted I could not even do a fundus exam. When he arrived his mentation was intact, slight headache and nausea; nothing too alarming. First CT was negative but later during the night he became confused, combative, had to be placed in restraints. I spoke to my attending who wanted a repeat CT, consulted ICU which was good coz he needed ICU care. Being a novice I ordered “CT brain stroke protocol” not realizing that an order like that would activate the stroke team….ooooops. My resident shouted at me.. Oh well, I figured no harm was done, my guy got his CT pretty fast:) At least now I know, I am there to learn and so I made a mistake but it did not put the patient’s life at stake. So, will be on call again on Friday, Q5 is not so bad this month. Retiring early today, have a good rest of the week to all.

    ciao:)

    #123696
    cardiacrn1cardiacrn1
    Participant

    So time really flies when you are busy. I am chronically exhausted now. Call comes to quick, I was on call on Wednesday and it was busy. I am on call again tomorrow, this is my last week on internal medicine. My last call, I admitted a 50 somethng year old with Stage IV lung cancer, mets to the brain and left femur. Its so sad, he is in so much pain. He is not ready for hospice yet, still fighting, which makes it so difficult because his blood pressure is 90s at its best and the minute you give him dilaudid, he drops to 70s. I hate to see him in pain (he’s already on 100mcg fentanyl patch, ER morphine 30 Q8hrs), but dropping pressures into the 70s for someone who is full code makes me nervous. He is now getting palliative radiation therapy to his femur, he’s not stable enough for chemo but he is not ready for hospice.. so sad.. My other patient is a 30something year old male status epilepticus, he got valium 10 on the ambulance without resolution, a total of 16mg of ativan in the ED and was loaded with 1gm dilantin.. CT showed a brain abscess.. this guy was shot in the left eye in the late 90s when he was 20 years old and somehow the fracture he had predisposed him to this…….craziness..

    One of my interesting patients is a 30 something year old female with scleroderma, sarcoidosis, severe pulmonary hypertension.. On physical exam she had a very loud P2 and a pansystolic murmur that increased with inspiration. Its so sad, here she is young with her life ahead of her and cant walk to the bathroom without being very short of breath…..So, I had a guy in his early 90s, generally healthy who was put on lasix, HCTZ, lisinopril by his cardiologist two months ago for increased bilateral lower extremity edema. When he went to see his doctor for dizziness, his BP was 80s/40 so he was sent to the ED. The guy when I saw him was dry as a bone. His Cr was 6.1 BUN 87.. THis is one of those success stories that makes you smile all day; we discontinued all his diuretics and ACE-I and put him on IV NS at 150cchr, In 48hrs his Cr was down to 1.2…. It was nice!!

    So this morning I get up at 630, get ready for work and go to the hospital in my jeans and a nice brown top. I was thinking it was going to be a relaxed day, afterall it is sunday. I arrive a little before 8, get my coffee and hear a code blue being called over head. I just about dropped my coffee when I realized it was my patient. I ran up the stairs to the seventh floor and low and behold the on call team was coding my patient. She was in her 90s, but her daughter wanted her to be a full code. Three days ago she stopped eating and I was pushing for family to reconsider her code status as she was deteriorating, but its ok, they wanted everything done for their mother who was almost 100 and we respected their wishes. Today was my first time talking to family about death face to face as a physician. In this case, the daughter was glad that we did everything we could for her mother. It was sad and I cried too, I felt for her; her mother was her best friend. So is life…..

    Its been great learning, I am feeling a little more comfortable, its amazing what three weeks of intern year will do for you, its seems as though I have been doing this for months…So, off to read, I am off on Wednesday and will be going to see my hubby for a day:)

    ciao..until next time my friends.

    #123957
    cardiacrn1cardiacrn1
    Participant

    So, internal medicine is over and I am 1/4 way through my first month on general surgery. One note before moving to surgery, One of the calls on IM, we had a 30 something year old female who came in as a direct admit from her pcp’s office. She had noticed that she was bruising easily and had petechiae all over her body and inside her mouth. Her periods were very heavy last couple of months and she was feeling very run down. No history of recent illness. When her physician checked her CBC her platelets were low….sent her to the hospital, we checked her labs and she had platelets of 2…first thing you do with a patient like that is literally run to the lab and get a peripheral smear to rule out TTP as this can be extremely fatal very quickly. After we all took a deep breath, cleared by peripheral smear, we started her on steroids, ordered more autoimmune labs.. final diagnosis – SLE… of course in a patient like this you want to r/o HIV infection too. That was my life as an intern on IM, one month of residency down and 59 to go.. oh why i love surgery so much I dont understand..

    Surgery is back breaking work. From the time I arrive at 5am until I leave at 6pm or 7 or if on call the next morning at 11 (which is the latest you can leave to be compliant with the ’80 hour work week rule’), I do not get a moment to sit down. The consults keep pilling up. The pager keeps going off. Each night I have been on call so far there is at least one case that needs to go to the operating room. The work is hard, you are working with very different personalities (stereotypical surgical personalities), its exhausting. When I am in the OR though, I remember why I am there. If I did not get the opportunity to be in the OR like a lot of other interns in big residencies, I would be so discouraged. I wish my husband wasnt so far away, they say the first two years of surgical residency are the toughest, I am seeing how that is. I pray that the Lord carry me through these first two years because I know I can not do it on my own. If you believe in God, please send a prayer up for me, I can use all the prayers:)

    My first night on call, I was called down to the ER for a 50 something year old gentleman who came in with abdominal pain and constipation. I went down to see this guy, he was the classical picture of a small bowel obstruction, huge abdomen up to the ceiling, vomiting. CT showed a mass in the cecum and of course small bowel obstruction, and hypodense lesions in the liver suspicious of metastatic disease. Poor guy, never seen a doctor because he does not have insurance..I saw him around 2am, he was ready for the OR by 4am as he was boarded for 7am….I wish I had been on the case but I was post call and it was going to be a long case and I had floor work to finish up.

    The last time on call I had a 50 something year old lady I was called to the ICU for a consult.. she was a heroine, coccaine, alcohol abuser who came in with upper and lower GI bleed. GI scoped her and found multiple huge gastric and duodenum ulcers, they could not stop the bleeding with sclero/epi…I took one look at the lady and knew there was nothing we could do for her. Her children which are good resepectable members of society (both in their twenties have families, jobs, trying to make something out of their lives) were sitting in the room and told me a little about their mother and what a hard life she lived. She was on a propofol drip, versed drip, 400mg Q4hrs of dilantin, Ativan drip and still continued to seize. Albumin was 1.1, you do not want to take someone to the OR with an albumin <2.8 some texts say 3.0....these patient have a very high mortality. She was receiving blood, at this point she did not have active gross blood, slow bleed and hg was 7s and she was getting blood. We would watch and wait until she was stable for OR which we knew she would die before that happened. She coded that night and died. so sad..

    My last consult before we left, 22 yo female with stage IV colorectal cancer with mets to the lungs, liver, and bone. She already had a total colectomy and ileostomy in '07 when she was diagnosed, she had a b/l pneumonia and the ICU team could not wean her off the vent so we were consulted for a tracheostomy and PEG tube..I cried when I saw her, so sad..Here is someone younger than me dying of cancer like this. THis was my second patient in early twenties with stage IV colon cancer in the last 5weeks. She has FAP, most people with FAP have a total colectomy by age 20, she was diagnosed and had mets by age 19 though she went for annual colonoscopies from age of 14...

    I am off today, need to catch up on some discharge summaries and reading. Thanks for reading and have a great week. Hang in there ladies, its temporary, however difficult it might be it will come to pass.

    ciao

    #144875
    cardiacrn1cardiacrn1
    Participant

    I am back!!

    I have been thinking about getting back to blogging. I used to really enjoy it and it was a nice outlet and I enjoyed talking to other moms in medicine. Anyway, so much has happened in the last 3 years. So I was in a categorical residency in general surgery in MI, my husband matched in NY. I thought eh, its just 5 yrs it will go by fast, half way through my intern year I realized it was too difficult for me I wanted to be with my husband. It’s much more difficult for neurosurgery to relocate to I decided to relocate. My program director was amazing and very understanding. So I finished my year, gave up my categorical spot, got a prelim surgery position in a NYC hospital which is all that was available and my program offered me a categorical spot for the next year. So its been a long detour, I basically did my intern year 3 times. Very worth it for me because I am with my family and I can’t see myself doing anything else. My marriage and family will always come before my career. So where am I now? I just started my 3rd year of surgical residency and my husband is now in his 5th year. The plan is still the same, I want to do abdominal transplant surgery, my kids are older, daughter is almost 14 in 3 weeks and baby boy is 11. When I started medical school they were 6 and 3.5. Time does not wait for anyone. Hope to share my journey with you all. Have a great and productive week.

    ciao-

    #144928
    cardiacrn1cardiacrn1
    Participant

    I have been struggling with being a perfectionist. I was always the kind of kid who wrote in pencil so that I could erase if there was a mistake. My handwriting is impeccable and everything has to be just right. I tend to be very thorough and double check and triple check everything. When closing after a case I am teased by the OR staff that I have the best plastic closures; my patients are for the better but I have to learn to let go of perfectionism. I realize that I can not be perfect but unfortunately I don’t know how to get over it. When I make a mistake I beat myself up and it really depresses me.

    Today I was holding the consult phone. When you have the consult phone, you respond to the traumas as well. I went down to an overhead trauma activation and I was the one who went to go and look at X-rays before transporting the patient to CT. I got a call while I was starting to look at the X-rays for an emergency consult for a cold leg on the floor. This is a vascular emergency- if in fact it is a cold leg. I got distracted and did not communicate with the rest of the team that the patient had a right main stem intubation and left the trauma to go and attend this consult. The patient was saturating 100% and doing fine, and got pan scanned, that was when my attending realized that the ET tube needed to be adjusted. I feel terrible, because I am always on top of things and I do not allow myself to make mistakes. It is really hard for me to accept that I am not perfect.

    Anyway, it was a long day. I am on 24 hour call tomorrow. We will see what tomorrow has in store for me. I truly enjoy what I do and even though residency can be difficult at times, I can not imagine myself doing anything else. I have realized that my love for hepatobiliary is getting deeper and deeper. I really enjoy seeing those consults and coming up with a plan for surgery, I get excited. I hate trauma and vascular- though I do love doing AV fistulas and bypasses.

    I am waiting for the OR schedule to come out so I know what cases I am doing tomorrow so I can prepare. There is nothing I hate more than going to the operating room unprepared. I love putting my attendings in a position to teach me. Something I realized early on in my training is that you have to take responsibility of your own education. I have to read as much as I possibly can, there is absolutely no substitute to reading surgical textbooks- as dense as they are. I have to make every effort to be in the OR not only for my assigned cases but to either double scrub in cases I won’t be doing for another year or two or just watch and learn. And as much as I am tired at the end of the day, I have to make time to go to the skills lab for at least 45 minutes 4x/week. Well, thats that.

    Until next time.. Ciao-

    #144988
    cardiacrn1cardiacrn1
    Participant

    19 hours into my call, when I had finally gone up to my call room on the 8th floor to lay down even for a few minutes coz I had been constantly going and my eyes were so tired I was starting to see blinking lights, the trauma team is activated. I spring out of my uncomfortable twin bed with hospital sheets and blackest as well as a dark blue fleece blanket I bought the last time I was at the airport. I slip into my danskos and flip on the light switch and without bothering to straighten my hair, I grab my white coat, trauma shears and a pack of juicy fruit gum(I have a stash on my desk for my call days) and I speed walk to the ED. Mind you, the ED is on the other side of the building on the first floor. Anyway, I get there and the trauma has not arrived yet.
    “What’s coming in?” I ask one of the nurses in the trauma bay.
    “Gunshot wound to the leg,” she says as she gets her IV starter kit together.

    A few minutes later, the EMS roll in with a 20 something year old guy. I quickly look at the patient who is clearly in extremis, (one of those things that you will know it when you see it without someone actually telling you.) Trauma is so simple, I hate being on trauma service or trauma team but it is quite simple. A, B, C..

    I asked the ED resident who was already at the head of the bed to intubate the patient who was minimally responsive, diaphoretic, ashen. His initial blood pressure was 124/90 but he deteriorated very quickly. His blood pressure dropped to 70s, my colleague was placing a left sided chest tube as I placed a right femoral cords. We activated the massive blood transfusion protocol and fired up the rapid transfuser. FAST exam showed fluid in the belly and a cardiac tamponade. BP at this time had dropped to 60. We needed to stabilize the patient and take him to the OR, CT surgery was on the way. My chief did a sono guided pericardiocentisis and BP came up to high 80s, low 90s. We took the patient up to the OR and he got a sternotomy and exlap. He is in the SICU now, I really hope he makes it.

    #145005
    cardiacrn1cardiacrn1
    Participant

    So I truly believe my program is the most chilled out surgery residency. Don’t get me wrong, we are very busy and we work hard. Three area hospitals closed 2 years ago and our ED is extremely busy and we get very sick patients. So the way it is structured, its divided into 4 different teams. A- trauma/peds and covers neurosurgery at night, B- Gen Surg faculty and hepatobiliary C- Vascular, ENT, Breast, Plastics D- Colorectal, Gen Surg private attendings.. Each team has a chief, 4, 3, maybe a 2, and 3 interns as well as 1 or 2 PAs. On call there is a 5, 4- who covers floor consults, PACU, puts out fires on the floors that interns can’t handle, supervises SICU; 3- who covers ED consults, 2 in the ICU, and 3 interns for A, B, C &D. All on call make up the trauma team after 6pm. The 3rd and 4th years alternate holding the floor consult phone on weekdays from 6am-6pm, and also put out fires since most seniors will be in the OR.

    So today I was holding the floor consult phone. I get a call from a medicine resident and the story goes like this…. “I have an 84 year old male who is s/p right hip ORIF after fall beginning of the month and he was at rehab and came in 3 days ago for abdominal pain, constipation and decreased urine output. CT on admission showed fecal impaction. His abdominal pain has been getting worse over the last 2 days and he is very tender on exam. We sent him down for an abdominal X-ray and the radiologist called me to tell me there is a lot of free air under the diaphragm.”

    My response, “ok, whats the name? what room? I will meet you in 2 minutes!”
    I went to see the patient with one of my interns. I laid my hands on him, he had 4 quadrant peritonitis. I asked the nurse to place a second IV and run 2L LR wide open, added flagyl to the zosyn and vanco he had already gotten while my intern was booking the case and I was talking to my attending. The patient was on the OR table within 40 minutes. I went to the OR later when I got a chance and they were finishing up, he had a sigmoid perforation- got an ex-lap, sigmoidectomy, ostomy and mucous fistula. He is in ICU, not on pressers; I think he will do well despite the fact that he had fecal peritonitis and he is not a young man.

    Most hospitals have acute myocardial infarction protocols that aim for a door to balloon time of 30 minutes. I feel like there should be such urgency with true intraabdominal catastrophes; acute surgical abdomens like – pneumoperitoneum secondary to some perforated viscus, AAA rupture or impending rupture, Small bowel obstruction with peritoneal signs, Acute mesenteric ischemia, Gastrointestinal hemorrhage that has failed other forms of therapy, etc.. The aim should be to resuscitate the patient adequately and not delay going to the operating room. Resuscitation is very important because it sets the tone for whats to follow. If the patient is not adequately resuscitated then the anesthesiologist is playing catch up from the get go. Putting in a central line would have taken some time, we got 2 16 gauge AC IVs and ran the fluids wide open and in 40 minutes he had gotten 3 L and had urine in the tube (yes I am one of those people who will stand at the bedside and lift up the foley catheter tubing and watch the urine drain into the bag).. Preparation is everything.

    I have the weekend off, very exciting. Thanks for reading everyone and have an awesome weekend! – Ciao

    #145019
    cardiacrn1cardiacrn1
    Participant

    For some reason I am having problems posting long posts. Anyway, will try again later.

    #145513
    cardiacrn1cardiacrn1
    Participant

    Residency is long and hard and at times you don’t see the light at the end of the tunnel. After a rough call, its easy to lose perspective. I am lucky to be one of those people who is very satisfied with my career choice. I can not see myself doing anything else, I truly love what I do. It is very satisfying when an operation goes well, or you help someone who is critically ill and they are well and discharged home or even when someone comes in with a perianal abscess and you drain them and send them home comfortable. Relieving pain and suffering is our goal. I hope I never lose sight of that and always be humane. It is very easy to focus on the task to be done, the rounds to be done, the cases to be scrubbed and forget that these patient’s of ours are people, with lives apart from that little snippet that we see. I hope to always be compassionate and empathetic towards the patients I am privileged to serve.

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