Amazing and exhausting

So i know that i have not posted anything new in a long time. I am sorry about that, my surgery rotation is two rotations in one, trauma surgery and gen surgery. My hours are long, and exhausting, i have been averaging about 120 hours a week, and LOVE IT!!! i never thought i would ever say that working a 36 hour shift is actually something i enjoy, but as long as we are busy, its fast, interesting and strange enough fun....so i am starting to think i have a future in surgery, esp because i dont drink coffee (except for one cup in the morning around 5am) and i am able to stay awake and energized for the entire shift until i get home and sit down...then its GAME OVER!

here is how a normal day runs....
-get to hospital by 5am, see patients (either on the floors or in the ICU) write notes, check labs/imaging, exam the patient.
- 7:30am walking rounds
- 9am-2pm surgeries/ scut work/ procedures
-2pm sign out rounds to the on call people
- 3:30 till you finish scut work, post op notes, procedures---then you can go home, unless you are on call.

there are also days were we have morning lec from 7am-8am, sit down rounds 2x week 8-9 followed by walking rounds, we also have noon lecture 2x week, and clinic hours 3x wk from 10-1pm

for the on-call days we are able to go home after we finish rounding the following day. For example, if you are on-call wed, then you get to the hosp at 5am wed and will go home when we finish walking rounds on thursday, roughly 12...

my usually schedule resembles the daily habits of a newborn. I eat, sleep, work, poop, repeat.

i will get home take a nap for a few hours, wake up to read/study, eat dinner, shower, bedtime is usually around 9pm sometimes earlier. Then i repeat. Since i basically work 7days a week, all of my spare time is spent sleeping, doing laundry or trying to study.

Luckily for me, i have done well during my first month, made a good impression with the attending's and have been made chief medical student for my second month. This is a HUGE DEAL!! besides the obvious, good recommendation, more experience.....i am the one who makes the call schedule! so next month i will not be working every single weekend, and unlike this month where there were multiple occasions when my schedule had been q2 (every other day i am on call) next month i have a total of 6 calls, and work only 1 weekend. Ah the perks of leadership....


I have been meaning to post for weeks, since there are a lot of interesting cases/ stories that occur when you work trauma call/gen sx....here are some highlights of the cases

- psych patient who put a drill in his ass
- psych patient who liked to unhook his colostomy and play with his poop
- too many MCC's to count (MCC = motorcycle collision), if i have learned nothing else on this rotation, i have learned never to ride a motorcycle, and even helmets dont help that much!
- road rash of the scrotum
- man with metal nut around his penis (came to ER after been there for 2 days)
- man who worked construction, and fell 30ft after cutting a hole around himself...yep its as ridiculous as it sounds, we think about it like a cartoon. The only regret the pt has is 'maybe i should not have gone to work after drinking'
- the bigger the man the more they cry
- sometimes when you fall and hit your head and you think its nothing 2 days later you can be dead..... we had a lady who fell off a chair trying to get a lizard out of her house, and now she is going to die from a major bleed in her head that we cannot stop.
- stupidity keeps trauma surgeons in business, so thats good news!
- if you shoot yourself in the head with a .40caliber weapon, there is no reason to bring the body in via ambulance. you are going to be declared dead.
- regardless of injury two things can be certain if you come in via trauma alert - you will get a Foley and a rectal exam (and it will be done by a student!)

Funny story about the first Foley Catheter i tried to put in....the chief of surgery is running the trauma and tells me to put the Foley in, so i am trying, and all of sudden i hear..."Markle! you have to choke it, like you own it!" i will admit this is probably the best advice anyone can be given in the trauma bay. esp since i have not missed a Foley since then.

Other words of wisdom.....
-never break up a fight! if you need to just spray the people with a hose. We have a kid (17yr) who broke up a fight between 2 people at a party and ended up getting shot, and now is paralyzed from the waist down.
- Do not sleep with a married woman. Another pt we have decided to have an affair with a married woman, while having sex, the husband came home (in florida its legal to carry a concealed weapon), the husband shot the wife 3x in the chest, and shot the man in the ass. I am glad because it ended up perforating the rectum and we got to operate that night, but the man got a colostomy and had a lot of explaining to do when his wife and daughter came to visit him in the ICU
- dont ride a scooter. We have a pt who was hit by a car while on a scooter with no helmet (he was the passenger), they removed half his skull and part of his brain and now is in a vegetative state.
- Ritalin has multiple uses. We use Ritalin in head injuries, and i have seen patients that seem to be in a vegetative state start to wake up thanks to Ritalin. Its pretty amazing, so i am thinking about writing a research proposal about the use in the trauma patient to help stimulate brain function. Its pretty interesting.

I have learned a lot and seen a lot, and there are tons of stories, some from the patients and some more from the hilarious moments in the OR...the surgeons i am working with are awesome and keep the laughter a constant fixture. It helps since we see patients die on a near daily basis.

well its getting to bedtime, almost 9pm....so i need to get some sleep so i can wake up and do this all again tomorrow. I am going to try and post more in the next few weeks when i actually get a day off to sleep in, ie wake up at 7am and work out (thats a 3 hour sleep in!!! ) i never thought waking up at 7 is like a vacation...Similar to how i feel when i finally get to work a 40hr work week, its going to feel like i am on vacation/bored....

best week ever!

Basically the last week of my OB/GYN rotation is what i am calling the best week ever. The dr i love got back from africa, and the hands on experience starting racking up...they managed to let me do entire procedures on my own (under supervision), when i basically stood there with a blank face mumbling, "are you serious right now?" they would simply look at me and say, "there is nothing you can do, i cant fix". In my opinion i could def do something that is un-fixable, but i have learned to never tell a surgeon he/ she cannot do something. Instead you want to continue to make them feel as if they walk on water, so in following with this credo, i preceded to do the procedure and allow them to think they could be god like and fix anything i screw up...

so by the end of the week, i had delivered a baby (vaginal ) - this is really more like playing catch with a greased watermelon than really doing anything special. The placenta was def the harder part, this is where i did screw up a little and the dr came to the rescue. (he later told me it wasnt my fault, it had to do with the patients high blood pressure, than my med student skills, or lack there of). Next was a D & C, this is def the easiest of the procedures, followed by a cone biopsy and another D & C. At this point i am starting to get more confident, and the next case is for a bartholin gland marsupialization.

just as a side note this is a procedure we have been talking about since i learned about it a year ago, first it just sounds really cool (actually very simple) and its incredibly disgusting. So clearly a job i am looking forward to...i have not seen the follow up care for the patient since the rotation ended, but i hope the sutures look good, since i put in a lot, and it was on her labia....oh well, the doc didnt make a comment about it, so hopefully it looked good. I was pretty nervous on this one only because its on the outside, and on her vagina so you know, i dont want to be the one who makes it look ugly....

the climax of the week culminates with a series of hysterectomies. unfortunately one of the women decided not to show up for her pre-op clearance and the surgery had to be canceled. because the next day is my exam, and i am not going to be able to scrub in on the procedure and make it to my exam at 10am, i thought all had been lost. then the greatest page ever came in, the OR scheduling nurse wanted to add on another surgery to her schedule for friday and asked if she would be willing to start her first case at 7am in order to squeeze in the new case right after. she agreed, then asked me if i would be willing to be there at 6:15 to prep the patient. I told her i would be ready, but reminded her i would have to leave since missing my exam, and therefore failing my rotation is not an option. She assured me i would be out in time to make it to my exam. the next morning i am there bright and early, ready to see the patient and scrub in, i reviewed the anatomy the night before and new the procedure cold. i have even been practicing my knot tying with dental floss i carry with me at all times. we get into the OR and the doc asks the surgical assist to leave, and has me assist. when the scrub nurse handed me the scalpel i just stared at it for a few seconds, i knew i was going to help - retract, suction and maybe cut a suture. So when the scalpel is now in my hand and the surgeon is telling me to cut, i had a temp blackout or absence seizure if you will. once the scalpel hit the skin, a calming sensation came over, and it was def GAME ON! for the rest of the procedure, she simply said, watch me and repeat everything on your side. I ended up doing the entire left side of the procedure. i even tied off a vessel that the doc cut because my angle had been better. let me just say leaving that OR and for the rest of the day if felt awesome!!

today i started trauma surgery and i am really excited, nervous and very anxious to start to routine....my hours basically suck, and i will work more in the next two months than i have ever worked in my life...esp because there is someone who is supposed to be working with us who decided not to show up, so the rest of us have to pick up the slack....so that means someone was getting screwed with the schedule, thanks to murphy's law, that someone is me....so for the next two weeks i will work a 40hr shift every other day. yes that is like working 3 full time jobs in a week....or roughly 120hr work week....but it will probably be longer, i am guessing after seeing the amount of patients and the responsibilities of the on call student....its going to be closer to 140...yes, there are 168 hours in a week, so i am guessing the 28 hours left over i am going to spend asleep! so if there are no posts, its that i have nothing to say, its probably because i am so tired i have lost the capability to communicate/type/ stand up/ think. On a bright side, i will probably lose those last 10lbs i have been trying to drop because i dont know if i will have time to eat. The other piece of info that i think is particularly funny, is that when you are an intern its technically (people dont always follow this rule, but its really bad it you dont) illegal to work more than 80hr in a week (averaged over 4wk). But dont worry, the med student doesnt fall into those regulations since we tech do not get paid and are not employees! yay for semantics :)