Tuesday, March 31, 2009

Back from the dead.

Surgery is finally over.

My stories about it aren't; I've started plenty when I was too tired to see straight. I'll finish them when I have loads of free time as a fourth year. YAY fourth year!

My suspicions about certain attendings were confirmed: my partner and I got word for word identical evaluations which managed to both be extremely snotty and convey that the authors didn't know anything about us. And that no, they still couldn't tell us apart. Luckily the residents were more discerning.

I can appreciate that it takes a certain amount of ego to be able to cut someone open, I just can't understand how that ego translates into treating students like dirt. Not that every attending did that, not at all. Some were very helpful, some obviously liked their lives. Unfortunately I didn't get to work with them for very long.

Oh well. On to my next adventure--Vaginas! Two months on OB/Gyn to finish out my third year of medical school. I really wish I hadn't thrown up last month. It kind of makes me nervous about this rotation.

Thursday, March 19, 2009

Damn You Bob Barker

In an effort to make my 4:20am wakeup time more palatable, I changed my alarm tone to the theme song from "The Price is Right."

I thought something happy and familiar would get me out of bed in a better mood. For the first three days I popped out of bed and was halfway into my scrubs before I realized I wasn't going to be bidding on a lovely set of living room furniture.

All I could manage this morning was slapping my phone while angrily mumbling, "The Price is WRONG, bitch!"

I have so many stories, so little consciousness. I don't even have the energy to find a good clip art. Considering I fell asleep in rounds and both of my afternoon lectures, I think it's time to say goodnight.

Monday, March 16, 2009

Old Farts Know Best

Neurosurgery started today. At 5:30 this morning.

Unbeknownst to me, neurosurgery for medical students includes a one to one and a half hour session with some old distinguished neurosurgeon who probably hasn't cracked open anyone's skull in a decade but still wants to feel connected to the department.

So they throw him the medical student.

During the first year of medical school we had a series of lectures given to us by a man who I think actually invented the brain. Apparently, he wrote at least part of the end all be all neurological textbook, but by the time he came and lectured to us, it was like having an elderly Helen Keller give me a lecture on brain anatomy. I never understood a single word he said. My notes read something like, "Hmmdy-meeemer thalamus pbblllfff." With a few drawings. Alright, they really read, "What are you doing this weekend? Yeah, me too. Piano bar Friday?"

Once in a lecture he mumbled a question in Furbish and then pointed to me and yelled "YOU!" I swear I was paying attention the WHOLE TIME and still didn't have the first idea what he had just said to me. Not even enough to bluff a little until he answered it himself. So I just said, "Ummm...You got me." Awesome.

In reality, the man knows a ton about the physical exam and its correlations (because he was around before X-rays), so I have something to learn. Unfortunately, learning from him is packaged as the "Socratic Method", which means he peppers me with ambiguous questions (for which he wants specific answers) while occasionally wandering off to tell me a story about the old days. In between listing the many countries he's saved lives in, he also managed to assign me 150 pages of reading (for tonight), two case write-ups, and two oral presentations.

Another secret about the Socratic method I've learned is that your answer is rarely, if ever, the correct answer.

Old Codger, MD: "What is the function of Cranial Nerve II"
My reply: "Sight"
OC, MD: "Weeeell, it's actually Vision. When I opened this child's skull in Tibet I temporarily lost my vision but was able to reconstruct her cranium using muscle memory and echolocation"

Ok, it wasn't that bad the whole time. He had great clinical examples. And he actually did use the word "excellent" when I answered questions correctly. Of course, that was at the end when I had resorted to pulling out a thesaurus, explaining the Greek and Latin word roots, and drawing a picture of my answer.

He asked me the most common cause of acquired hearing loss around the same time my brain turned to jello. I had already resigned myself to only getting 1/3 of the answers right, so I threw out "Loud noises over a long period of time." Nope, the answer was actually ear infections. "Well, I know a lot of old men with guns," I retorted. I guess I really wanted my answer to be right that time. Then the last thing I thought would happen in Pimpfest 2009 happened: He laughed. Out loud. This gray-haired, distinguished man in a three-piece suit and a collared shirt with a hankie in his pocket and his initials embroidered in the cuffs threw his head back and laughed.

After that the session went a lot more smoothly.

Tuesday, March 10, 2009

Worst. Day. Ever.

I started Cardiothoracic Surgery Monday. My first patient had a 50/50 shot of surviving her surgery. Not a great way to start the week, for me but especially for her.

What made it worse was that she was totally with it. I went to meet her before the surgery (only polite if you're going to be handling someone's internal organs I think), and met her grown children. On the way to the operating room, she told me how she had two grandchildren getting married this summer and she planned to live for "20 or so more years".

She repeated over and over to me that she wanted to make it through the surgery. I have a confession: When I looked at that chart I saw an 80 year old patient with an aortic aneurysm who didn't have much of a chance. It was definitely going to rupture if she didn't have the surgery, but like I mentioned above, her chances for survival we equivalent to a coin toss. I have two grandmothers myself, and am also getting married this summer. But my grandmothers aren't exactly with it. The last time I saw one I spent an hour helping her change, putting on her makeup, and brushing her hair. As we were leaving the nursing home to go out, she asked me if I was going to put a shirt on. I was wearing a shirt. I suppose tank tops don't count to grandmothers.

One of the nurses said if she were 80 with an aneurysm that size, she would buy a good bottle of liquor and invite her friends and family over. I think I would agree, but apparently some older people don't know they're old and supposed to go with Jesus soon. After doing a little growing up myself, I can't say whether I would accept things gracefully or be kicking and screaming and utterly surprised that I might actually die.

I think it will probably have a lot to do with whether or not my hubby is still among the living. I'm pretty sure once he goes I won't have long.

Our patient did SO WELL during the surgery, I actually thought she might make it. I really had no idea. I thought I might have a gut feeling, but nope. At one point during the surgery, I asked the attending how many patients actually made it through this type of surgery at her age. He said if she made it, she'd be the first.

Then one of her coronary arteries shredded. In an 80 year-old with an established arterial problem (how else would she get an aneurysm?), this wasn't unexpected. That doesn't mean it didn't completely suck.

When things started to go bad, there was an immediate change in the OR. We all just knew that if something like this happened, she wouldn't have a good chance of coming back.

We ended up leaving her sternum open and taking her back to the surgical intensive care unit still unconscious and on the ventilator.

I asked to go with my attending to talk to her family. I wanted to tell them how I'd talked to her while she was going into surgery, how she lived in a town close to where I grew up, how she talked about wanting to see her grandkids get married, how all the nurses in the room promised her we'd pray for her the entire time before surgery. They started crying when I mentioned I was raised Catholic, like their mother, and that we prayed a few Hail Mary's out loud together, my head lowered right next to hers, holding her hand and leading the prayer.

As we were talking, a nurse came in to get the attending. She had coded. He put his hands in her chest and directly massaged her heart before shocking it out of V-fib.

When I went home that night, it was like I couldn't stop praying for the woman. It was like every Catholic prayer I'd ever learned kept pouring out of my mouth for her. Lately I haven't seen much use in Catholicism. I was tired of going to church out of guilt, tired of sitting angrily in the pews as the priest gave a one-sided lecture on the role of women, uneasy about its marginalization of homosexuals. I didn't see use in it. But to our patient, those prayers, said for her and with her, comforted her at what may be her last waking moments. They brought a measure of peace to her family, knowing she had someone helping her practice her faith during a frightening time.

That was use enough for me Monday.

She was still alive in the SICU this morning. I said a few more prayers that she would be there tomorrow.

Thursday, March 5, 2009

Addendum

The next morning the visiting lecturer starts his power point presentation with a slide entitled:

Who Is This Guy?

It actually won me over.

Tuesday, March 3, 2009

Who brought that guy?

One of the more blowhard-y parts of surgery is the "Visiting Lecture".

The visiting lecture is when some Dr. Pompous from the University of Aren't We Great gets flown in to our surgery department. You would think the "Visiting Lecture" is when that guy would actually give a lecture, but that is not the case. Dr. P lectures at Grand Rounds the next morning when every mucky-muck in the department tries to come. The sole purpose of the Visiting Lecture, from what I can tell, is for two or three residents stand up in front of the distinguished visitor, all the other residents and medical students to each present an interesting case while the illustrious guest tears them a new one.

A sample of the conversation:

Chief Resident: Welcome Dr. Pompous. Thank you for coming, hummdidy humdidy so nice to have you here, this is the greatest day of my life, what an honor, blurby blurby will you autograph my stethoscope?

Dr. P:
So nice to be at this distinguished intstitution. I admire your Chairman, blahbidy blah blah, not as much as I admire myself, doobedoo, your hernia program is cutting edge!

Chief: So my case is a 22 y/o female with a Motor Vehicle accident being brought into our trauma bay. She received 500 cc of fluid in the ambulance--

Dr. P (interrupting): Why would you ever do that? Is that a smart move?

Chief: Yes, her pressures were in the low 70's so I believe it was necessary to maintain perfusion.

Dr. P: Really? Do you really? No, that is stupid. You're going to end up with saline on your boots.

Chief: I respect your opinion, however in order to preserve oxygen delivery we usually keep pressure above 70--

Dr. P (interrupting again): I don't believe in blood pressure cuffs. I believe in my fingers feeling pulses. She could survive a pressure of 70. She's 22! You don't need to pump her full of fluid. I would feel her pedal pulses. If I felt a pulse there, she's above 80. Then I would tranfuse her. So yeah, I would probably transfuse her here, but 500 sounds like an awful lot to me.
(author's note: Yes, he really contradicted himself like that in real life.)

Chief:
Ummmm. So once we got her here--

Dr. P: I'm done with your ignorance. Next bitch!
"I also cure cancer with a mustache ride."

Then another attending from our university joins the lecture, and suddenly I feel very cheated that I don't have a dick of my own to start waving around and making my points with. Though honestly, I think more than a little compensation goes on at those lectures.

Considering I am not going into surgery, I don't give two toots who this yay-hoo is. All I care about is whether I learned something at the lecture or not. Thanks to the residents going up for the slaughter, I did actually. Thanks residents.

I'm so excited for Grand Rounds tomorrow! I'll be post call, so hopefully I won't start falling asleep and hallucinate like last time. I woke up with my hand halfway up in the air fully prepared to answer a question that had never been asked. I'd hate to think of what I'd say tomorrow.