Thursday, February 26, 2009

Afraid of the V-word

I threw up at school Tuesday.

It's happened once before. Honestly I'm surprised it hasn't happened more. I'm very very sensitive to smells. The other time I was cleaning out my desk after an 8-week block. I picked up a travel mug I thought I'd cleaned out...oh...7 weeks earlier and it sloshed. Oh no is right. 7 weeks of chai sitting on a desk? I don't know why I thought I could clean it out and salvage it, but the only thing that got cleaned out was me. 8 months later I had to throw the mug away because not even bleach could take the smell out.

Tuesday I faced the worse nemesis of medical school so far: the unseen V-jay-jay. I feel like such an ass for writing this, being of the lady persuasion myself, but I have no idea how I'm going to make it through OB-GYN next block.

What do you mean by "unseen", Allison? I mean this particular V-jingo belonged to a lady with a BMI of 60. A very sweet lady, as it turns out, which is why I feel so bad about throwing up. I could barely look her in the eye on rounds that afternoon.

I don't care what anyone says, when you have a lot of fat around your abdomen, you get what is called a pannus. A pannus is a thick layer of fat and skin that laps over and sometimes covers a person's naughty bits. You cannot reach your own delicates for important things like wiping, showering, or otherwise cleaning.

So when Joe the smart-ass circulating nurse asked me to do the Foley, I of course politely declined. I'm no fool. But I had to stay to lift the pannus and otherwise clear the way so he stood a chance.

I thought to myself, hmmm, I don't feel so good. Surely I won't throw up. Well, I might throw up. Maybe I should leave the room in case I throw up. Crap, I really think I might. GET OUT OF MY WAY GET OUT OF MY WAY!

Luckily no one was in the locker room but another student (not on my surgical case) and a kind nurse who advised I sit down and take my surgical hat off for a bit.

Today though, I braved the waters and DID ONE! Her BMI was only 40, but still, I consider it a victory.

Tuesday, February 24, 2009

Harrumph!

Yesterday I was reminded of why I will not work in a clinic. I spent a good fifteen minutes getting shouted at by an elderly man about how horrible his headaches and his neurosurgeon were...as if I could do something about it. My clinic is a hernia and gastric clinic. If you don't have an odd bulge or an outrageous BMI, the real doctor can't do anything for you. I'm even more worthless.

To be fair, I think in the beginning, he was shouting because he was a little hard of hearing. But the more he talked, the more he worked himself up, the more he repeated, the louder he yelled until I wanted to go around the room screaming "Harrumph Harrumph Harrumph!" to help him make his point.

Several times he mentioned that the doctors in his small town--which is in another state-- certainly don't think much of the neurosurgeon here. That's nice. Does Dr. Rural McCocky, DO want to step in next time? (Btw it's true, he was a DO. I'm not being snotty). I DON'T CARE. It would be completely unprofessional to slam another doctor, which my doctor politely mentioned. She was actually quite good at dealing with him. I admired it.

He was also mad that nobody wanted to operate on him again. At 80+ years, with comorbidities and the fact that his last surgery left him with chronic pain (I think that's why he wanted to see us), can you blame the surgeons? There's no rule saying they have to operate on everyone. Thank goodness.

At one point when the resident was talking to him, I had a thought that actually gave me chills. This man and his wife live two hours away. There was no child in the waiting room, no Oats bus driver wondering when they were going to be done. Neither of them were under 80, and neither of them had the best eyesight or reflexes. Those two drove themselves over a hundred miles to get to clinic. I'm always a little more vigilant driving home when I have a clinic day like yesterday.

Friday, February 20, 2009

My reputation precedes me.

Wednesday a medical student approached me when we were all gathered for lecture and asked, "What did you say to Joe (one of the scrub nurses) yesterday? He said you made him blush and then he wouldn't repeat what you said!"

Hmmm...I had to think about that. I say a lot of things in the heat of the moment, which is probably why my mid-month eval comments ended with, "Put a better filter on".

After a few minutes I remembered. Last week, like an overeager idiot, I offered to put a Foley (urine) catheter in on a female surgical patient. A female surgical patient with a BMI of 59. For those who don't know what a Body Mass Index is, let's just say it's an approximate measure of body large-ness. And hers is nearly three times mine.

Though I had two other people helping me hold the body mass back, it was still up to my poor little left hand to find the urethra. I'm sure it sounded like I was shouting when I announced that I'd found it, but that task in itself was some work and I was really proud. Unfortunately by the time I got the catheter with the other hand, the pressure was too much. There was no chance of seeing the urethra again; I was lucky to get my left hand back at all.

So this week the scrub nurses were regaling the tale to the residents about how hilarious it was that I tried my first female Foley on such a hard patient (they also commented on how I'm perfectly comfortable with the male anatomy--hope my parents don't read this post). Then the smart-ass Joe asked if I wanted to try 'er again on another patient with a BMI in the high 50's.

"Not on your life," I said. "Last time I tried it I was so traumatized I couldn't look at my own vagina for days."

I'm pretty sure that's what he didn't want to repeat. I just hope none of them mentions it around my attending tomorrow. I'm trying to be more sensitive.

Find out your BMI!

Wednesday, February 18, 2009

Overexposed.

The week did not start off well in the first place. For starters, I couldn't find my name tag. Still can't, but at least I have an idea of how I lost it.

Friday I was scrubbing in at another hospital. They of course do not allow "outside scrubs", as one snotty nurse snapped at me, so I had to change into their lame-o tapered leg pants and button down scrub tops. Yes, the tops snap closed. Yes, their doors have hooks for handles that are at the perfect waist-height to snag a lady on her way into the OR.

So can you guess who accidentally exposed herself to the OR staff on Friday?

As I was hilariously re-enacting the scene to my fiance and his roommate, his roomie now remembers that he saw the nametag fly off into parts unknown. Where it is still hiding. Which would have been ok had the University decided THIS WEEK to start requiring a ID swipe to get into the OR. Dang it. I certainly would have paid more attention to where that stupid little piece of plastic was if I had known about that little piece of beauracracy.

The first time I tried to get in, a very helpful maintenance man sat on his little carpet Zamboni repeating, "No, Nope, you gotsta have a nametag now. Yeah, you ain't goin get in without one." I'm going to tell myself that he didn't have clearance himself, so that's why he didn't let me in. Luckily, a lady came along with her ID. Unluckily, she said, "No, I don't think I can let you in! Not if you don't have a badge!"

FOR THE LOVE OF DERMABOND I DON'T HANG AROUND THIS PLACE AT 7AM BECAUSE I'M A HOBO WITH A PASSION FOR HERNIAS! Yes ma'am, I'm here to sneak into the OR and hang around until someone needs a Foley put in. Then I'll probably head over to another suite and hope I get pooped on.
An assortment of Foleys. Guess where the little balloon tip goes?

I was planning to bang my head against the damn door until someone let me in, but luckily the maintenance man vouched for me. Not sure why she believed the maintenance man over a woman in scrubs holding out her student ID and listing the surgeries she was supposed to be in on that day, but whatev.

More on this week later. Night night time for this girl.

Monday, February 16, 2009

Reasons why I hate Surgery: Part I

Today word came down the pipe (i.e., an attending asked a resident to tell us) that we, I need to make sure I get this right, "Need to recognize there is a hierarchy in surgery" and that if we have questions, to basically shut up.

That last part wasn't really how it was worded; it was something like "judge when an appropriate time to ask is and otherwise keep talking to a minimum". If you're wondering what that means, all I know is that the "appropriate time to ask" is NOT when you're doing surgery and have a question about the procedure or the anatomy as it appears on the laparoscopic screen. And I don't think it's during clinic when the attendings are too busy shuffling people in and out. And it definitely isn't when you're doing rounds; I'm very sure my job is to make sure I'm the last person to walk in (hierarchy again), the first to get out of the way, and to never speak unless spoken to. So I have no idea when the hell we're supposed to ask questions. I should apologize for even asking, I'm only spending $112 a day to learn here.


Here, take more, I have gobs of it!

It's difficult to go from a rural setting where the doctors were eager to induct you into their club to a university where everyone's chummy until you put a toe over your imaginary boundaries. Now if you'll excuse me, I'm going to go buy some packing tape to wear over my mouth during surgery tomorrow. That way I can't possibly insult someone by showing an interest in my education.

Thursday, February 12, 2009

Sleep deprivation sets in

I know, it's been a while since my last post. But don't worry, I have plenty of stories to tell. I will tell them Saturday when I can't "sleep in" past 4:30am.

So I think I've written a little before about how I lose my freakin' mind when I'm tired or deprived of food. This past week has been an exercise in both.

This morning one of the residents commented on how tired my partner and I looked. Instead of denying it while surreptitiously injected Diet Coke into my arm, I looked right at him and slurred, "It was my own fault. I couldn't go to sleep last night until I found out if Ping Ping really was the shortest man in the world." After a quiet moment where he looked at me like there were horns coming out of my head I continued: "He was."

I really wish I had someplace to go during the long pause that followed. Then to his credit he just shrugged his shoulders and said, "Ok. Well, let's round."

Yikes. I don't know why I'm not sleeping right now. Except I really want to see if the 800lb woman loses the weight! Damn you Discovery Health.

Sunday, February 8, 2009

The Great Testicle Caper

Copyright ý 2000 Medscape Portals, Inc

Yesterday I was in on an scrotal hernia repair. From what I gather, the difference between an inguinal hernia and a scrotal hernia is that the hernia is so big you can't get past the fact that the poor man's scrotum is the size of a softball. But just on one side. So you have a softball and a golf ball basically. And you're like, "Whoa, that's a scrotal hernia!" When the patient lays down, it usually reduces, meaning the intestines and whatever else was in the scrotal bag of tricks goes back into the abdomen where it belongs.

My job during surgeries in general is to 1. Stay out of the way 2. Answer questions and 3. Assist whenever necessary without screwing up. Yesterday that meant spending 45 minutes flattening a guy's scrotum so everything stayed high and tight and they could fix the hole without everything plopping in and out the whole surgery. The pimping wasn't so bad, probably because the surgeon was feeling sympathetic. I answered questions like, "do you feel the testicle under your finger? Have you pushed it back up into the abdominal cavity? Can you keep it there?"

At one point the resident was talking and leaned on my hand for several minutes (it was under the surgical drapes so he didn't realize it was my hand and not the patient). I didn't want to speak up, so I just sat there with my hand being squeezed.

When they were done repairing the hernia my job was to pull the testicle back down into the sack. Even though I was pretty sure the patient was done having kids, leaving it in the abdomen would have been like putting the little guy in a oven. Testicles need their space yo.

Since I didn't figure I should make this blog R-rated, the picture at the top is an intravenous pyelogram of an incarcerated inguinal hernia (the intestines sometimes get trapped on the wrong side of the hole and can't reduce). Image courtesy of Medscape.

Saturday, February 7, 2009

Pimpin' ain't easy.

Since I've been getting up at 4:30 am for the past week and my fiance can't go to sleep until around 2 am, I have a good long time to blog while he's still comatose. So I'll fill you in on the cultural custom in the medical world called "Pimping".

I'm not really sure where the term came from, but my guess is that since anyone higher up than a medical student on the hospital hierarchy (which is most people) could make you stand out on the street and sell yourself if they felt like it, they figured it was a reasonable name. Hey, we work for evaluations. Evaluations determine how competitive for residency we are. That determines where we spend the next few years of our lives. Which determines if we get the job we actually want after residency. So yes, I would probably shake a leg out on the corner if it meant I got in my first choice residency.

Anyhoo, pimping is when an attending, or resident, or intern asks you questions in front of everyone else and then the whole group stands there quietly staring at you intently to see if you're an idiot. Or at least if you're as smart as they are. If there are any other medical students around, they are either a. trying to answer the question themselves so they look smart when you fail or b. Feeling sorry for you while quietly praying that they don't get asked the next question. A good friend will choose c. and whisper the answer to you without moving her lips.














"Alright medical student, let's see if you have any knowledge in that head of yours"

The problem with pimping, or I should say one problem with it, is that you have NO IDEA what the attending will ask. And the questions range from straightforward you-should-have-studied-this anyway (like gallbladder anatomy during a cholecystectomy) to complete crap (such as "what is the falciform ligament derived from embryologically?") For you smart ass medical students out there who know the answer, try getting asked that during a surgery where you're holding the camera, trying not to poke anything you shouldn't, and juggling all the newly learned gallbladder anatomy in front of 2 doctors and 5 snotty nurses. One doctor actually asked me, "What am I thinking?" Last time I checked I wasn't Miss Cleo. And she probably wouldn't have known either.

I used to be pretty good at answering. I was all-district Quiz Bowl after all. But the more tired I get, and the meaner the attendings are, the more I clam up. I could have studied everything the night before, but when I wake up at 4:30 the next morning, the information is as fuzzy as the camera on the Golden Girls. So I stand there, face turning red, all knowledge draining from me, and try to grasp at whisps of information before they are gone completely.

One of my strategies for handling questions I don't know is to start mumbling words that I think are in the general vicinity. Usually what happens is your inquisitor will light on something you said that was vaguely correct, and then explain the answer to the question in way more detail than you could have ever come up with. Which is really what they wanted to do the whole time. Don't believe me? Here's the thing: if you get the questions right, they're excited, but then keep asking you questions. And if you get those right, they ask you harder ones. And less relevant ones. They pimp and pimp until you're in the middle of patching up someone's hernia and they're asking you about the embryologic development of the blood supply to the cerebellum.

You don't always have to have the answers, you just have to know how people work. And anyone who spent a decade learning something doesn't exactly want a third year medical student mangling the precious knowledge; in the end they want to teach you what they know. So I figure my job is to get enough relevant questions right to show them I study and and am not a mere testicle holder (that's another story), then let them teach me the rest without beating myself up over not knowing.

Tuesday, February 3, 2009

There's No Crying In Surgery

As I start the real part of my surgery rotation at 6:15 tomorrow morning (after two cush days of orientation), I'm reflecting on the many pieces of advice given to me:

"There's no crying in surgery"--the RN clinical coordinator, upon seeing my face when I learned I was assigned to the surgery team known for all hernias, all the time.

"Basically, no matter what you do, you're going to get yelled at. So start growing that thick skin."-- fellow medical student who has already completed surgery.

"Oh GOD no, I hated it!"--another student when asked how she liked being on my assigned team last block.

"Well, you have a lot of strong personalities, especially strong female personalities...just don't piss them off."--coordinator preparing us for being yelled at

"Don't EVER hum or sing in Dr. So and So's OR. You will be kicked out." --medical student

"Don't wear shirts under scrubs where sleeves could show. You'll be kicked out." --coordinator

"Always know the anatomy. If you don't, you'll be kicked out." --Anesthesiology resident

"Never turn your head when you sneeze. The sneeze goes out the side of your mask! And you'll be kicked out." --surgery textbook "I'm sorry Ma'am, but your mother sneezed in the holding room. So I broke her legs and kicked her out."

"Every OR in town has had a fire in it at some point. By the way the fire extinguishers are blue and white, not red like you think." --fire safety training nurse.

"The perfect medical student is never hungry, never tired, never has to go to the bathroom, is always happy, and NEVER wants to leave the hospital. " --Intern who I really hope was using hyperbole to make his point.

Wish me luck.