My surgery rotation is done … for now.

My rotation through surgery ended for the semester and I am glad that it is done. I did not enjoy it – I worked hard for little gain. The surgeons I worked with all had first assists, senior doctors, or residents to help with the procedure at hand. This meant that I was relegated to the farmer john pose (where ones hands are held at chest level on their imaginary suspenders). On top of this school policy, I found out later, limits third year students from getting too actively involved. I suppose this comes much to the relief of the patient but from my point of view this made for a very tedious 3 weeks. Standing and watching somebody do surgery all day long is probably one of the most boring things you can do. Couple this with 1:4 call and the biggest challenge becomes trying to catch a nap with no one noticing. I found the experience really frustrating to say the least.

It’s frustrating because I feel at this level of training where a large number of medical students are still undecided there should be some encouragement or enticement for the particular specialty. There are ways to get junior students involved (in my humble opinion) that would not endanger the patient in any way, or even slow down the surgery in any aspect. What I found instead was a speciality that almost discouraged junior students from wanting to join. If someone is interested in surgery at this level it would have to be part of higher calling, in order to give you the strength to put up with all the crap. The sad part is that I don’t really see much of a change in the attitudes post graduation.

From the residents I saw working in surgery, they were working damn hard for a few scraps of OR time. The first two years of the surgery residency program, at least at this school, doesn’t seem to offer much other than scut work. By the third year the residents seem to gain some good hands on experience, and their level of responsibility increases from there. Once the 5 years of residency is done there is the need for a fellowship which adds another 1 or 2 years. This is a long time in a system that is geared more to break you down than build you up. I couldn’t do it. I have neither the intestinal fortitude nor the patience.

In the end I suppose I did get something out of this rotation, by this I mean I can definitely cross surgery of the list of things I want to do with my life. I’m not quite done with surgery yet, as I have another rotation after Christmas, something to look forward to I guess…Meantime, Monday brings a new rotation in Obs/Gyne which promises to be good.

I delivered my first baby today

I can’t believe it – today I delivered my first baby. Honestly – it’s a good feeling and I tend to be one of those that really doesn’t get that excited about babies. It left me with a warm fuzzy feeling for the rest of the day and put me in a good mood.

It started with a call at 0530 hrs. I had been on call the night before so was on my 3rd hour of wonderful sleep when my cell phone when off. The attending doctor quickly commented that there was a woman who was 7 cm dilated at the hospital that was expected to deliver soon, and that he was on his way – so I should meet him in maternity in 10 minutes. I should note that when I’m on call I sleep in my scrubs – I think like most do, and since I was already at the hospital it wasn’t a problem to be in maternity 5 minutes after the call. Once there I met the parents for the first time and realized that things were progressing rapidly.

I should stop here – one of the problems with being a medical student on the maternity ward is that you are meeting some of the couples for the first time. This means that you essentially have no relationship with them before you are involved in a very personal and intimate time in their lives. it is no wonder that people say no … So, there is always this period of awkwardness, the time when I am holding my breath, where the attending will ask if it is ok if I am present while the baby is being delivered. The couple simply nodded their heads in agreement, and I exhaled slowly with the hardest hurdle of the moment being out of the way.

The delivery happened fast and I really don’t remember when I doctor asked me to step in. As the doctor (or pseudo doctor in my case) the role you play seems to one where you are more like a coach than anything else. You shout encouragement, you get the mother to focus and then you simply catch the baby as it pops it. I may be simplifying it a little but few would deny that the mother does all the work. Much to my surprise once the baby starts coming out things progress fast. With a bit of popping sound (and maybe I imagined that) I found myself covered in all manner of fluid (name it, I seemed to be wearing it) holding a healthy, bluish pink little boy. I stood up and asked the mother if she wanted to hold her new little boy, and placed it gently on her chest. That was probably the best part and I won’t bore you with the rest of the details because they’re really more academic than anything else. All I can say is that it felt good – it was an honour to be involved and I hope the memory stays with me, to maybe remind me of why I am doing this while up all night on call.

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.

The first week …

It was a decent week back but I think most would agree that we didn’t need to take a full week for orientation. It was great to see everyone again and to catch up on stories from the summer. I’ve included some of the highlights below to give you an idea of what the high and low points were…

Day 1 – meet and greet

The first day of lectures were meant to suck the enthusiasm of even the most dedicated student and by the end of the afternoon most people had ducked out to enjoy the remains of the day, or to catch up with their friends. I stayed for as long as I could, and even made it to the “try not to get sued” lecture but it was too much and I quietly left before the last lecturer had reached the podium. Although this may have dampened my spirits somewhat I needed to remind myself that this was far better than the start of second year.

Day 2 – hand washing, admission notes, & IV fluids

Today was a mix of mind numbing lectures, like “how to wash your hands” and “where to throw things out”, coupled with several anxiety provoking ones, like “IV fluids and you” and “how to do an admission note”.

On a high note I picked up my shiny new pager and new hospital Id tag. Both provided many hours of entertainment. I have a feeling that the novelty of the pager may soon wear off.

Day 3 – Learning in the clerkships and ECG

I have the morning off, which is nice. It gives me the time I need to finally finish the administrative papers from rural practice as well as the required online modules.

This aft is another lecture on “how to learn in the clerkships” where one of my friends from fourth year is giving a talk. Should be fun.

The day will end with a review of the ECG … thank god. Someone better remind where the freaking heart is too, because it’s been awhile since I’ve gone over that stuff as well …

Day 4 – Wounds, sutures, arterial puncture and O2 therapy …

I sewed up a banana to practice stitches. Pig’s feet would have worked better but these were not available because of … get this … health concerns. Whose health were they interested in protecting, the pigs or medical students, I will never know … I’m thinking I might go down to the local butcher and see if I can’t get a couple of pigs feet to practice on at home.

Arterial puncture utilized a prosthetic arm for first poke practice and then we were to practice on one another … after seeing what I had done to that banana in the morning few were willing to volunteer their arms for a little arterial blood gas …

Day 5 – How to break bad news, meet and greet part 2

This was a decent day that ended fairly early. The breaking bad news sessions were ok, but it lacked the feel of a real situation and so I really can’t say how much I got out of it. The sessions were interesting but I’ll have to see what it is like when the time comes and how I react then …

The afternoon started with pizza and ended with another lecture by student affairs. It was good in the sense that it was educational and I know realize what resources are out there. It was bad in the sense that suddenly all these horrible possibilities began to creep into my subconscious and I think my anxiety level actually was increased by the end of the session instead of decreased, contrary to the goals of the lecturer …

All in all it was good start to 3rd year, especially in contrast to the start of the 2nd years classes. I still feel somewhat overwhelmed with what the year will entail I am also excited to finally start on the wards. This weekend I move out to the small community where I will be for the next year and will try and settle before classes start on Tuesday. There is another week of orientation for the students at the hospital, which I don’t mind because it will give me the chance to get my bearings before the hard work starts. Wish me luck!