Beat Up By A Girl

Today I broke a 16 year old boy's nose.

Okay, so yes, it was part of a deviated septum repair and rhinoplasty, but the fact still remains it was me on the other end of that mallet and chisel.

Otolaryngology

My ENT rotation is more than a little bit different than the surgery I am used to. Instead of getting to the hospital at 5am to write notes on patients, I roll in at 7. Instead of following patients pre and post op, I just follow a resident from one surgery to the next. It's a great way to get a taste of what an ENT gets to do, without being tainted with what all an ENT has to do.

Frostbite

I have broken my toe...Yes, its one of those times in your life when you wish you could tell some amazing story that involves saving babies playing with puppies from a fire. Unfortunately, it was nothing that dramatic. I was rushing through my living room to grab a textbook as I was hurrying to my first day of ENT, and caught my sweet little baby toe on the ottoman.

I've stubbed my toe before, this was different. I heard a crack. It immediately started swelling. I stuffed it in a shoe, and headed off to the hospital. But walking was miserable, and I watched it slowly turn purple. It is now a nice necrotic diabetic toe color, or for those who are not blessed to know what this looks like, think serious frostbitten toe, with a pretty intense margin of blue.

But, surgery stops for no toe, so my toe and I spent the day in the OR.

Surgery Arcade

After finishing rounds and writing countless orders on our patients, my resident took me to the holiest of holy places for the surgery residents, the Simulation Lab. Only surgery residents are allowed in to practice laparascopic skills and techniques in this roomful of arcade-like games. I felt as if I should take my shoes off before entering.

So, he described to me the different laparoscopic "games" including dropping a bean into a cup, running the "bowel" (which is actually a rope), and the ultimate challenge loading a needle, suturing, and tying, all laparascopically. And, yes, I went for the granddaddy of all challenges.

Surprisingly enough, I owned it. Within 20 minutes, I had finished a knot from start to finish. This is something that 3rd year surgery residents still have trouble with. Now, I realize that this was mostly beginner's luck (because it then took me another 40 to merely throw a second knot without all the suturing), but hey, at this point in my career, I'll take luck.

Whipple

The Whipple procedure, technically known as a pancreaticoduodenectomy, is when you remove a patient's duodenum, part of the stomach, gallbladder, and part of the pancreas. Then, you reconnect everything to a part of the small intestine farther downstream. It's a massive procedure, the surgery lasting 6+ hours. And it doesn't happen everyday. Some residents go through their entire residency without seeing one.

And I helped on a Whipple. I scrubbed in; I suctioned; I helped tie the anastamosis of the stomach to the jejunum. It was absolutely amazing. I had my hands in a patient's abdomen, nearly up to the elbows. I felt a beating aorta. I held intestines. And strangely enough, 7 hours flew by!

First Call

Every morning as the M3s walk into a darkened surgery lounge with residents, interns, and students sprawled across the couches catching precious moments of sleep, we dread the day it will be us. The first question we ask our fellow M3s is "how was it?" quickly followed by "did you get any sleep?" Well...Tuesday night I took my first night of Trauma Call.

I picked up my pager at 4:30, sat down to look at the surgery consult sheet sheets that I'd be expected to fill out. This was the only time I sat all night. The pager started beeping, and it didn't stop all night long. We had two kidney transplants, a GSW/knife wounds, an assaulted prostitute, a ligated ulnar artery, lots of bloody vomit, a scrotum the size of a canteloupe, and a little boy that swallowed a nickel. I didn't even have time to look at one of the couches longingly.

So, 31 hours later, I got to sleep. I put my swollen feet up and slept through the Loo barking up a storm at the mailman, the UPS man, and whoever dropped off the phonebook. It was probably the hardest I've ever slept. Then, entirely too short of time later, I got up, and went back to the hospital. Yep. Welcome to medical school.

When It Rains, It Pours..

So, at the end of last week I was a bit more than a little frustrated at my experience as an M3. Or, to be more accurate, my lack of experience. But, today has compensated and then some. Today I was in the OR for 11 hours plus. My feet hurt. My arms are sore from retracting. But, I must admit it was fun. I got to scrub in, have someone hold open the sterile gloves for me. I got to suture and staple the wounds that I will be required to check tomorrow morning at 5am. It was pretty freakin' cool.

Organ Donation

Seeing as I am the M3 Transplant Team for another week, I feel it is my obligation to make a plug for organ donation. Basically, I'm not going to try to convince you one way or the other, although my personal thought is I'm not going to need them once I've gone on to happier hunting grounds, but I think you should know about some new legislation in MS.

As of July 1, 2008, the First Person Consent Law will take affect. This means if you have that little heart on your Drivers License, you are officially in MORA's (Mississippi Organ Recovery Agency) website as an organ donor. So, no matter what you're family, power of attorney, or great aunt Marge thinks, you're organs are going on to help those in need. (Compare this to when that heart was only a suggestion of your wishes.) In case you haven't registered with the DMV, you can still go to msora.org to be put on the registry.

Thanks. This public service announcement was brought to you by milk. Milk, it does a body good.

Nurse, Scalpel.

We know we are complete and utter nerds, and as green as Granny Smiths, when the talk of the surgery lounge today was the fact that I got to do an I & D today.

An I & D stands for incision and drainage. This is just a fancy way of saying that I drained an abscess today. I donned my sterile gloves, injected local anesthetic although this didn't stop the patients wailing, grabbed the scalpel and made a 3cm incision. Oh, and then came the floodgates of blood and pus. Gross? Yes, maybe to some. But to me, it was a chance to cut. I realize its only my second day, but I've got to admit, I think I like that feeling.

Blog's Namesake

After a riveting day yesterday of M3 Orientation where I was reminded about the rigorous rules of HIPAA, and the incompetency of the UMC Financial Aid Department, I donned my white coat today for Surgery Orientation. We talked about HIPAA a bit more, learned how to throw some knots, and, the highlight of the day, we learned how to wash our hands.

Now, almost everytime anyone does orientation in a hospital setting they are taught to wash their hands before and after coming in contact with patients with soap and water. But, today, I got the mother of all handwashing lessons. I learned how to properly scrub in for surgery. Yes, the count method. Scrub ten times on every surface starting at 2 inches above the elbow. A rough estimate, that is about 6800 scrubs for each surgery.

So, now, I meet my resident to go on transplant rounds at 6:30 tomorrow morning. I have no idea what I'm suppose to do. I barely know where I'm suppose to go. But, if all else fails, I'm going to remember to wash my hands.