Smartypants

She was six years old, tow-headed and blue-eyed, whip-smart and just as precocious as she could be. 

She had a raging, fluctuant abscess in her axilla about the size of an egg.  It had been there, erythematous and growing, for six weeks by the time they finally came in to be seen.  It was painful for her - and it looked it.  Luckily, the treatment of an abscess is straightforward: you incise and drain it.  For a pediatric patient, this would be done under anesthesia in the operating room.

She came in to the hospital with her father, and they were shown into one of the day surgery suites, where they would wait until she was taken back to the OR.  The surgical intern went to do her pre-operative history and get consent for the surgery.  When she was asking details about the time course of this rather large lump in the patient's armpit, her father explained that they had noticed it a few weeks back, but that he had not brought her in sooner because he had assumed it was an enlarged lymph node.  She had had a recent cold, and her father chalked it up to that for a while until he realized it wasn't resolving.  

The intern began to explain to him and his daughter that it appeared that the lump, instead of an enlarged lymph node, was actually an abscess. 

"This basically means that it is a collection of pus from an infection somewhere that the body has walled off into this pocket, and that is what we are going to drain today."

The father politely cut off her explanation, "Yes, I know what an abscess is.  I have a PhD in Biology."

The  daughter piped up:

"Yeah, and he thinks he is smarter than aaaallll the doctors!"

Trauma

I don't care what surgery service you're on, even if it's not trauma - it's ALL trauma.

Seriously?  Surgery is trauma for everyone involved.  Even an uncomplicated, routine case involves fairly significant trauma for the patient.  Don't be fooled into thinking otherwise - it is very carefully controlled trauma, but trauma nonetheless.  Minimally invasive?  I mean, sure, you end up with three or four tiny little neatly-closed incisions around the belly, but have you ever seen the whole process?  The way those trocars get maneuvered around in their ports, the shoving things around, tearing things down, cauterizing whole swaths of tissue... man.  I love watching surgeries.  I think it's the coolest thing, and it is super easy to become desensitized to the violence of it.  But yikes.  Surgery is no joke. 

It is also trauma for the residents and the med students.  At least for me it is... the whole time you're standing there during the surgery, the attending can pimp you at will - basically, he or she can just ask you anything they want to ask, related to the surgery or not - and I never feel totally confident about my answers.  It can happen at any time and without warning... you're never free to just relax, you always have to be on guard for random flying tricky questions smacking you in the face and making you look like a total idiot.  It can be trauma for the nursing staff and the scrub techs - some attendings have notorious temper control issues, and all attendings have very different, nuanced personal preferences about how they like things set up, what they like to use, etc, and they are not shy about letting someone know when they don't get it right.

Surgery is trauma physically and emotionally, too.  Being on your feet all day is less than ideal for your back.  The crazy hours lend themselves to terrible self-care.  I have literally not worked out in three weeks now and am starting to feel totally nuts mentally and super crappy physically.  Nutrition has mostly gone to pot - remember the cookie party on Sunday night?  Yeah, it has basically sustained me all week.  Only I have long-since finished the actual cookies and have now started in on the huge batch of gingerbread cookiedough that never made it to the baking stage on Sunday.  That was my dinner tonight.  Not kidding.  Trauma regarding my personal life - today, my attending asked me if I had kids.  When the answer was no, the question was, well, are you married?  No?  Ok, well, what about someone special, then?  I said no, absolutely nothing, nothing at all going on my life.  And his response was wellllll.... at least... at least you can do what you want whenever you want...?

It's even trauma for the floor nurses. Ok, so this incident didn't actually have anything to do with surgery, and I don't even know if it was one of our patients that was involved, but when I got to work a couple of mornings ago, some of the nurses were shaking their heads and muttering in disgust.  When I asked, one nurse told me that everyone was all in a tizzy because one of the patient's parents had been, shall we say, getting amorous in the patient's hospital room.  Not only that, but it was happening while the patient, a young baby, was crying the entire time.  And not only that, but the nurses knew this because they could hear it from out in the hall!  Ugh, really?  Gross.

~ ~ ~

And then there is the actual trauma.  The awful, horrible, heart-pounding, life-flight bloody trauma, that, when you are in a pediatric hospital, can just be too much to bear.  

Last night there was one of those.  

It came in just as I was about to leave at a decent time in the afternoon, and it was absolutely horrific.  There are really no words for when something like that happens to a small child.  But one of the worst,  sickest aspects of the whole experience?  The truth is that a part of me was thrilled to be there for this case.  It feels horrible to admit that.  It was such a hideous tragedy.  I think I was mostly just so happy to finally be helping, to finally be useful, to finally be able to use skills that I actually do have and to feel like I actually did know what to do and how to do it and then actually be able to do it.  I love being in the operating room when I am getting to participate. 

We operated for probably close to seven hours, sewing and sewing, trying to put this little girl back together.  

When we finished around midnight, I went home and slept for roughly about three hours before I got up to go back in this morning.  We rounded, went to grand rounds, had lecture, went to clinic, went back to the school for a lab on advanced vascular access.  

It was sort of a shitty, blah daze of a day.  A reminder that I have not even started to do a fraction of the studying I need to do for the exam that is fast approaching.  No breakfast food left, no coffee made, not even any crappy energy bars left to grab on my way out the door.  A text from my landlord letting me know that hey, fyi, your rent check bounced, again.  Oh yeah, my financial situation is still so far down the shitter that it is actually in the water-treatment facility an hour down the highway.  Half a dozen more automated phone calls from my credit card company telling me that my payment is late, again.  Which was then followed by a voicemail informing me that my precious doggie has finally figured out that she can clear the fence and so now, even though we have finally bullet-proofed the gate that she had continuously, ingeniously found a way to foil until very recently, she is still escaping.  And when she was put back in the yard and tethered to a line set up on her leash, she chewed straight through her leash and severed it completely.  Her dog walker has apparently not been showing up and she has also somehow destroyed the latch on her crate door, so now I have zero good options for her while I am gone for 14-hour days.  

I wore heels today.  My feet were killing me.  When I left the school, it was dark already.  I walked to the parking garage in the dark, drove home in the dark, got home to a completely dark house.  Not a single car in the driveway, not a single person at home.  And I just burst into tears and proceeded to have a small breakdown.  My first cry on surgery.  My first cry in a good long while, actually.  My roommates got home a little while later and walked in and said "hi" to me and I started crying again.  I took a long, hot shower and sobbed.  I am crying right now, sitting in bed and typing.  

I don't really know how to deal with this stuff.  When I started this post a couple of days ago, I meant for it to be sort of a funny "wow, this is super tiring and intense and ridiculous and how about those inappropriate parents?!" post, but then last night happened, and I was mostly really put-together about it until a couple of hours ago.  Now I just feel drained and exhausted beyond belief and I can't think about last night at all without crying.

If you are a pray-er, maybe say some extra-special ones for a little girl in an intensive care unit tonight.  She has a really hard road ahead. 

Surgery Dreams

... dreams that I have while on my surgery rotation, that is.  Let me know if you want to take a stab at deconstructing this one.

~ ~ ~ 

Last night, I dreamt that I was in some sort of indoor/outdoor castle for some sort of interview (unclear what the interview as for - it seemed to be some sort of admissions or job interview, or possibly both - you know how things can do that in dreams) and I was interviewing with a close friend, and the interviewer was a surgeon (again, not entirely clear why, maybe the school/job had to do with surgery, I don't know, but he was a very important and intimidating person.)  And I thought it was all going quite well, until at one point, for some reason, I had to stand up to deliver my responses for that part of the interview, and for some reason, there was what I thought was a hand-sanitizer dispenser on the wall next to me, and for some reason I knew that I had to clean my hands before I would be allowed to speak, and so I  stood up, reached out my hand, dispensed some into my open palm and then proceeded to rub my hands together, immediately realizing that I had made a mistake, and that it was actually regular soap instead of sanitizer, and so now I was in the middle of this very important interview, wearing a suit, with both hands entirely covered in liquid soap.  No sooner had I made this tragic error than the surgeon-interviewer lowered his chin, scowling at me from under furrowed brow, folded his hands on his lap and announced that my interview was over.  And my very good friend, who had been seated behind me while all of this happened, laughed at me and said something to the effect of "too bad for you" before continuing to converse with the interviewer, with whom she suddenly was best friends. 

It was awful.  

And then after that my flying skills came in handy when I joined some sort of outdoor field game involving something like keep-away with a small French horn.  Whatever.

On second thought, if you know anything about dream interpretation, I probably don't want to hear your read on this.

~ ~ ~

PS.  Last night, we hosted a Christmas-cookie-baking party at our house... sooooo you can guess what my dinner was when I arrived home twenty minutes ago.  Also, I am seriously contemplating sleeping in clean scrubs so that I can save the 38 seconds that it takes to put them on in the morning.  Don't judge.  I am also going to bed NOW... it's 8:30 pm and I have to get up in less than 8 hours already. Sweet sleepy Jesus.

Oy.

The costume changes alone are exhausting.

for tomorrow: clinic clothes, OR clothes, workout clothes

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.]