The Score So Far

One and a Half Weeks In: 

I have to preface this by saying that I was really, really nervous about the surgery rotation, for a few reasons.  The main reason is that I am not a morning person, I hate getting up at unreasonable hours (and for me, anything before 8 am is unreasonable), I am always late to everything, I am naturally a diehard night-owl, and I do not function well on little-to-no sleep.  Granted, I do it all the time, but I rarely feel like I am functioning well.  Anyway, needless to say, all those factors taken together made me very afraid that I was a) probably going to be the worst surgery student of all time and b) certainly going to be totally and completely miserable on the rotation.

The uniform.

I was also nervous because I hate feeling inept, and even though I feel that way every single day in medical school, I figured that feeling would be intensified on surgery (and this has actually turned out to be more or less true.)

New fall shoes! :)

Other reasons I was nervous include some of the questions mentioned in my previous post (and, full disclosure: the last question/concern was actually mine).  I was feeling really bummed that my heretofore somewhat-respectably-consistent exercise routine would be over forever, and that my much-healthier eating as of late would be out the window also.  

However, I am very happy to say that so far, none of my fears have been realized.  (Major caveat: I am starting out on my specialty surgery half of the rotation, and I am on the plastics service... they are notorious for having amazing hours - read: only somewhat longer than regular working hours, as opposed to inhuman hours - and they are also just a very laid-back and fun service to be on in general.  In other words, THIS COULD/WILL ALL CHANGE when I go to general surgery next.)  

In terms of getting exercise, I have actually made it FitWit most nights so far, and squeezed in a run one night when I couldn't go!

[winner: me]

Haters gonna hate.

How about eating healthy?  For the most part, I think I have done fairly well.  Eggs for breakfast!  Salads for lunch!  Apples for snacks!  Boo-ya!  Today was actually the first time in over two months that I have not packed my own lunch for work.  Pretty good streak, right??  But it might be over, sadly... I have no more groceries at home.  And today I had not one, but two Cliff Bars.  And a burrito.  And a beer.  And lots of Halloween candy.  Soooo... let's call it a wash.

Social life?  Haha... ok, this one has been sort of legitimately sucky.  Thank God I live with people I like talking to, because I have pretty much only seen them.  And I have only seen them a handful of brief times.

[winner: surgery]

But!  On plastics, you basically have weekends off (shhh, don't tell the other surgery students!), so this past weekend, I was able to drive up to Chattanooga to visit my great uncle John along with my mom, aunt Jane, and brother Martin.  Beautiful chilly fall weather, gorgeous leaves, lots of good food, plus seeing my great-grandparents' old home for the first time in probably 17 years...

[winner: me]

Great Uncle John, Aunt Jane, Mom, Martin, yours truly

And of course, there have been some holiday celebrations... that have consisted mainly of making Izzy wear this awesomely adorable costume (hey, it's my first Halloween with a dog!  I couldn't help myself.)  The roommates and I also carved jack-o-lanterns last night, which I haven't done in years.  It was a lot more work than I remembered!  But so fun.  And we also roasted the seeds... yummmm.  It also took a really long time, and so I didn't study at all and I went to bed really late, which made today sorta rough.

[winner: me, I think]

Izzy the WonderDog!

(She doesn't love wearing costumes.)

Also, on a somewhat surprising note, I have found that I am kind of loving surgery.  Like, a lot.  So all in all?  I'd say, so far... I'm still coming out ahead.  :)

Surgery Has Started....

Today, in orientation...

Clerkship director, MD: "So let me just take a few moments to address some of your fears about this rotation."

[Student concern.]

"You are worried about getting enough sleep.... You'll be fine.  You'll be really tired, that's just the way it is.  But you will be fine."

[Student concern.]

"You don't think you will be able to study enough and learn all there is to know?  Ha.  Yeah, you won't.  Don't even try."

[Student concern.]

"Your knowledge of anatomy is rusty?  Um, yeah, none of you know anatomy.  Don't worry, we expect that."

[Student concern.]

"Getting enough exercise and eating healthy??  Oh, forget it!"  [Laughs hysterically.]  [Recovers a little.]  "Seriously, though, take the stairs."  [More laughter.]

Everything Possible?

During my nursery week on my pediatrics rotation, I saw a patient in the NICU who, even in the land of unbelievably tiny, critically ill infants, was doing exceptionally poorly.  She weighed around three pounds, required assistance to breathe, had severe hydrocephalus and a ventricular assist device to help shunt the excess fluid out of her skull.  She had already spent more than two months in the unit, and she was still two months away from her estimated due date had she made it to term.  She had been born via emergency C-section when her mother went into pre-term labor as a result of an infection at 22 weeks of pregnancy.  She had a twin sister that did not survive.

For reasons that aren’t entirely clear – perhaps unreliable dating of the pregnancy and therefore the infant’s gestational age, perhaps poor communication between the patient, the obstetricians, and the neonatologist – the neonatologist who was present at her birth believed that she was around 27 or 28 weeks’ gestational age.  She had to make a quick decision at the time of birth about whether or not to intubate the infant, and she says that even though her visual assessment of the girl was that she seemed terribly small, even for a 27-week preemie, she went ahead and intubated anyway.  She says now that she doesn't know if it was the right thing to do, that she had simply acted on the information she had at the time, and that she often regrets it when she passes by the isolette of this horribly fragile, tiny baby.

Babies born prematurely suffer more adverse health outcomes than term babies, and the more premature they are, the greater the number and severity of the complications they have, both in the short-term and the long-term.  Normally, the cutoff age for viability is 24 weeks’ gestation, and babies delivered at this age have a grim outlook – less than 50% even survive – but in this case, an infant even younger than that was kept alive when prevailing best medical practices would have dictated not to resuscitate such a premature baby.  The reasons behind these guidelines are numerous and range from the sheer probability that the child will live to the overwhelming health challenges they are guaranteed to have if they do.  Another, not at all insignificant factor, is the incredible amount of resources it takes to care for them after birth.  The daily average NICU stay exceeds $3,500 per infant, the average NICU stay costs $45,000, and it is not unusual for the total cost of an extended stay to exceed $1 million.  That is the kind of extended stay that Baby 22 Weeks is currently having here in an Atlanta hospital.  It is unclear at this point whether or not she will ever be well or strong enough to leave the NICU, and if she does, what quality of life she will be able to have.  Her mother won’t entertain any sort of conversation at all with her baby’s doctors about how to manage her case other than to “do everything possible”.  

~ ~ ~

No real deep thoughts here tonight.  It's test week, so I have neither the time nor the energy to do a whole lot of reflecting or writing.  I was just doing a quick little write-up for an upcoming ethics session we have during this last week of the peds rotation.  It is supposed to be about an ethical issue that we have witnessed during the rotation, and this is what I kept coming back to.  I am curious about people's thoughts.  I am not at all saying that this baby does not deserve to live, and I really hate the economic/financial expense argument when talking about the worth of a life.  I am in awe of what doctors are able to do, both before and after birth, to save the lives of infants with conditions that, until only very recently in history, would have had a 100% mortality rate.  I'm not even totally sure there is a real ethics issue here: the obstetricians tried to keep the mother's preterm labor at bay, the neonatologist acted to save the life of an infant she believed to be unquestionably viable, the mother wanted (and continues to want) everything possible to be done for a child that she loves.  Surely mistakes were made and surely this outcome was by no means unavoidable.  Maybe it's just the tragedy of the whole situation that gets to me.  Maybe it's just that, in a medical world with so much potential to do so much good, sometimes a lot of very smart people trying their best still get it wrong.  And maybe it's not the ethics of this case that gets to me.  Maybe it's that sometimes there are just no easy answers to be had.

Tiny Babies

Oh, hey there, October!  Where on earth did YOU come from??!?

This is where I've been all week:

Nursery week!  

Mornings with the healthy babies on the Mother-Baby floor, and then afternoons with the teensy-tiny ones in the NICU.  It is all very adorable and prettttty great.  Especially because the healthy newborn exam is a snap and they are so freakin' cute, and they don't really let students touch the teeny sick ones and they are really freakin' cute too.  So in other words, I have not really done a whole lot this week other than make my ovaries want to explode.  

Why am I still awake right now??  Happy weekend, people.