Monday- i had to be at the hospital from 5am to 8am just to write notes and then had the rest of the day off...kinda put a damper on the day [it was the 4th of july!]
Tuesday was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do...
Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything [some of us have been caught walking like this well after the surgery has finished just because we are so trained to do this during the surgery]. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it... Pressure was on... First the scrub nurse handed me a sterile towel to dry off...immediately i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your hands through the arm holes [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it my fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most of them!]
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “this is f*cking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowels etc etc. All things I have memorized the anatomy of and can finally put that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, whatevs].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope [looked like lil blisters everywhere] and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still had people rummaging around in her pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery. Everyone i talked to and every patient i saw must have thought i was on prozac.
One of the first patients i saw was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending, though a nurse is always there assisting/chaperoning] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion of me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel damn good/confident [though they make you sweat a lot...those things dont let your skin breathe at all!]
Wednesday Clinic- Saw an 18yo bipolar girl with a very flat affect. Made me a bit scared of my future psych rotation.
Saw a 24yo G4P4 who nearly jumped off the table when i barely touched her with the speculum. She was deathly afraid of anyone doing an exam on her yet she pushed 4 babies out of her vagina?
Met a crazy lady who told me the airplanes in the sky are spraying aluminum on all of us and making us sterile. Very nice woman but a bit off...
End of the day I say a very skinny, pale 45yo women who had severe menstrual bleeding. Severe enough to decrease her hemoglobin to 6.4. We did an ECC/EMB on her and then I recommended that she be admitted and transfused because she was feeling so weak and dizzy after. The doctor agreed and I helped convince the lady to stay and be admitted because i was scared she could harm herself by passing out when driving home....she looked as white as a sheep. It was scary to look at her. I ultimately built a lot of repore with her and convinced her to stay the night to get a blood transfusion. When I came back to the hospital on thursday i checked up on her labs and saw that her hemoglobin had dropped from 6.4 to 5.6 in 2 weeks. This is a pretty severe decrease....made me very happy and proud of myself that I got her to be admitted to the hospital and taken care of.
Thursday and Friday clinic I saw a bunch more patients but the one i remember the most is a young hispanic women who had recently been told she had a miscarriage. She had gone to the ER when she started bleeding and they told her the fetus was gone and to follow up at our clinic. She was very upset and crying to me and it was very emotional. I had a hard time consoling her because we were using a translator but ultimately i think i did a good job by explaining to her that 1 in 4 pregnancies miscarry and that it is a completely natural event. I hope she will be able to get pregnant in the future. I was more affected by this patient that i thought i would be. When i went into the ‘hang out’ room i guess i was noticeably sad because someone asked me what was wrong. It was hard to let the emotions go and move onto my next patient.
things i learned:
-i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
-i realize i need to learn spanish but i have also come to the realization that my patients will hopefully be trying to learn english also
-lots of women CAN'T afford their birth control pills, but they CAN afford to get their hair done, nails done, and a cute new cellphone?
- its really hard to stay up past 9:30pm these days!
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