curing people with cold steel …

That’s right it’s time for my rotation through general surgery. To be honest, though I would never admit this to the attending, I had crossed surgery off the list a long time ago. I simply don’t have the stamina – it’s sad but true. I came into medical school a little older than the average student having worked in the real world a number of years before deciding to try medicine and there are aspects of that old life that I really enjoyed and hope to have back at some point after school is done. The problem I have with surgery is that the residency expectations are absolutely insane! It strikes me that the pace set in medical school only gets worse in surgery leaving less time for family, friends, hobbies, or any interest outside of surgery. So, simply from residency requirement point of view, I have never considered surgery too seriously. Mind you I could be wrong as I am an outsider looking in at this point. But if my first couple of days in surgery are any indication I think I have made the right choice.

First I should say that the preceptor I have for surgery is great. Pimps, but not too much, allows me to help where I can and keeps me engaged – and you really can’t ask for much more than that as a student. I have also had the chance to work with a couple of other surgeons and been less impressed. For example, one surgeon had me scrub in on a surgery involving the navel. Sounds interesting you might think, but honestly I could see nothing and had nothing to do but hold the scissors just in case this particular surgeon needed them. Sometimes I fail to see the educational value of participating in operations where I can neither see nor do anything. In cases like the navel operation it seems like it would be better to just take the time and read as opposed to be another body in the room but I guess I’ll have to wait and see if that is the norm or just an anomaly. The good news is that I am back with my preceptor on Wednesday, the bad news is that there promises to be a lot more retractor holding until then!

swimming with the orthopods

The cartoon is stolen borrowed from Scutmonkey … it’s good stuff if you haven’t read the blog – go now.

Time is flying by and it’s hard to keep up. I’ve gone from anesthesia to orthopedics, from administering the gas to hammering on joints. The orthopedic surgeons are a very different breed from anesthesiologists, to say the least. The operating room during their procedures undergoes this transformation into a type of workshop that would would make a woodworker proud. There are all manner of power tools, along with hammers, chisels, bone smashers, etc. The surgeries are fun, but honestly after seeing one of each joint done I began to realize that there wasn’t much variability and that aside from oscillating between right and left there was much variability overall. The bread and butter of the orthopod seems to be hips and joints (thank you osteoarthritis!). With the population aging this is a potential goldmine, especially in a smaller community such as the one I’m in where people are either newly wed or nearly dead … I liked orthopedics, it’s a good field but it seemed a little too routine by the end.

If you have never dealt with an orthopedic surgeon let me just say that the comic is a good likeness, but there are exceptions. My preceptor was one of these exceptions, being a short efficacious man – a Napoleon of the OR, who moved at close to the speed of sound. Despite being twice as tall I had a hard time keeping up with him as he moved from patient to patient, teaching the entire time in a low voice which made proximity key to gleaning the pearls of information he was dispensing. He expected a lot from his students and, needless to say, I learned much in a short period of time.

I’m not quite out the OR yet and start general surgery on Monday.

Finally – the wards!

This past week has had a number of firsts for me – first week on the wards, first on call shift, first breaking bad news session and the first vaginal delivery that I have seen. All in all it was a good week, although things really didn’t start that way.

Start of the week – I was eager to make an impression and so planned to head into the surgical ward a little earlier to meet the doctor. In my eagerness I forgot the critical door code for the change rooms. This meant I had to sneak into the change rooms from the back way through the patients entrance much to the nurses chagrin. By the time I had talked my way past the nurses station and found my way into a set of scrubs I was late. This was definitely not the impression I had wanted to make on the first day. To make matters worse I was with the antagonistic anesthesiologist who forgot nothing and bugged me about everything.

Despite the bad start and the insentient teasing from the attending doctor, I have to admit I learned a tonne. By the end of the first day I could start an IV, intubate and extubate patients and by day 3 I was working on my lumbar puncture skills. This was of course all done under the watchful eye of the doctor who would not let me live down any mistakes made and who was quick to jump in if the IV was taking more than 2 pokes (I do honestly feel for the patients here and want to definitely thank those that I came across for their patience).

As I mentioned above this week also had my first on call shift. The on call policy is a little different here than it is in the big city. For one there is one resident and one medical student on for the entire hospital for the night. You can be (and will be) called for anything and everything. There seems to be a lot of leeway with what I am to do so long as I discuss with another doctor or resident … Vitum Medicinus gives probably the best run down of what the first night is like if you’re at all curious read it here.

This week brought 70 hours of work and a learning curve where it honestly felt like I was preparing for an exam every day (with the exception of the academic 1/2 day). It was exhilarating and exhausting at the same time. I think I am finally beginning to realize just how hard this year will be and how much I will enjoy it. Finally – the wards!

Week 2 of orientation –

So – while the other students in my program were being grilled, roasted and flayed, I had another week of orientation. The 2nd week of orientation was not a lot different than the first week, but did introduce the small group of us to the community hospital where we will be working for most of the year and to some of the staff / procedures we’ll encounter along the way. There was also several “meet and greets” involving the various preceptors we will encounter throughout the year. Aside from a few organizational hiccups things went smoothly and I was left with a very positive impression. The preceptors are keen to teach and the hospital staff are extremely welcoming. I don’t know know how much different this is from the students going through the city experience, but I do know that this past week has made me glad that I have chosen this particular route. Next week I start working on the wards and I can’t wait for it to start. I am excited and ready for the challenge.