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!
Thursday, July 7, 2011
Tuesday, July 5, 2011
Week #2
Last week:
Monday- Was on L&D today, saw one delivery in the morning and then the rest of the day I spent practicing my sutures as it was a pretty quiet day. I induced several lacerations to my banana and then sutured it up good as new
Tuesday- Clinic day, dont remember anything too special happenin
Wednesday- I slept all day as I had night shift that started at 5pm. I tried to get as much rest as I could since I knew I would not be getting any sleep that night...
When i got to Labor and Delivery at 5pm I was on the move until 8am the next day. One of the patients I admitted around 7pm was a 29yo who had come to the ER because of severe abdominal pain....she then found out in the ER she was pregnant...36 weeks pregnant. How one does not realize you are 36 weeks pregnant I will never be able to figure out but she seemed really surprised. We asked why she hadnt noticed missing her periods and she said they were really irregular anyways and that she was spotting a little so didnt take notice...she also had us talk to her sister because she thought she was playing a joke on her and wouldnt take her seriously. I dont know if this patient was just in serious denial or what but it was a pretty ridiculous story... she must have thought an alien was growing inside her because at 36weeks those babies are kickin!
Soon after we admitted that patient we had a scheduled C- section and though I didnt get to assist, I got to watch the whole thing. One of the nurses asked if I had been in a surgery before and I totally lied and said yeah [so she wouldnt be worried that I would pass out]. She gave me a lil speech anyways saying “dont lock your knees and if you feel light headed or woozy at all just walk right out, no one will say anything so dont be embarrassed”-- she was obviously still worried i would pass out and probably just didnt want to deal with it if i did. I had no idea if i was going to faint or not...i had seen some bloody deliveries and such but really, i hadnt had to smell a cauterizer before so who knows how i was going to react... Well, i was fine. Didnt feel light headed at all...i kept taking deep breaths and reminding myself to not lock my knees but really, i felt fine. It was very good to know that I can handle surgery. It was amazing to watch them yank a new baby out of the uterus of this women and then spend about 20 min closing up each layer of muscle, skin and fascia that they had cut through. While closing, the attending tried to ask me a question about the embryological origin of something. I couldnt really hear what he said so i asked him to repeat the question and he said, “no, no i cant...” He obviously was trying to stump me with a question but was so tired that he didnt remember what he asked.. we all laughed about it and a second later a big squirt of blood hit me, the resident hit an artery accidently and sent a small amount of blood my way. It got all over my scrub shirt. The resident laughed and said, “see, thats what happens here when you dont get a question right.” I laughed and asked if there was any blood on my face. She looked up and said, “oh im sorry did you actually get hit by it? I wouldnt have made such an inappropriate joke if i had known that...” Again, we all had a good laugh at my expensive.
The next delivery I saw was the first episiotomy I have seen. The mom was pushing hard and doing well but the baby’s heart monitor was showing a gradual deceleration and the doctor began to get worried about the baby. She told the mom she needs to get the baby out with the next push or she would have to cut her. the mom flipped out pleading the doctor not to do it. unfortunately, the doc had to tell the patient that it wasnt a question, more of a statement that she had to do it because the baby was beginning to be in danger. The resident eventually cut a lateral incision and the baby came out with the next push...the newborn had the umbilical cord wrapped around her neck twice and the resident and PA quickly unwrapped it, clamped the cord and gave the baby to the NICU team. The baby ended up being fine and we stitched up the mom while her epidural still worked and everything turned out OK.
The next girl I admitted was a 17yo pregnant with her baby [you may think this is young but i have already seen a 16yo deliver her SECOND child]. She was writhing in pain and her bf just sat in the corner of the room texting on his phone. When i asked her what her pain scale was she told me 9.5/10 pain. I then asked if she was planning on getting an epidural and she answered ‘hell yeah’. She hadnt taken any lamaze classes and i dont think she prepared for this delivery at all. im pretty sure she had no idea that she wouldnt be getting an epidural until she was almost completely dilated which could take 10-12 hours in a first time pregnancy. i definitely was not going to be the one to break that to her....
Around 1:30am I started to write progress notes on all the vaginal deliveries and C sections that had happened that day up until midnight. There were 12. I had to look up all their labs, go see them, ask a few questions and do a brief physical. I didnt get done until around 5:15am. Luckily must of them were up feeding their babies. I was glad i didnt have to wake em up because honestly, who is going to be nice to a student doctor that wakes you up at 3am to ask you about your gas, bowel movements, and what birth control options you want?
Rounds were supposed to start at 6:30am but the resident, attending and I got pulled into an emergency C- section. I scrubbed in and assisted on this one. It was the cooooolest. Well, minus the fact that i made an idiot out of myself while the scrub tech was helping me gown up in sterile dressing. its a tricky process. even more tricky when you are being stared at by your attending, resident and the anesthetist. lets just say i didnt make it look graceful. i dont feel too bad though since i am still very new at this and i was being rushed since it was an emergency situation. Anyways, after cutting through all the abdominal layers we finally got to the uterus and after making a long vertical incision I saw a little ear pop out. It took me a second to gather what was going on and then the resident pulled the baby out and layed it down. The surgical tech handed me a suction bulb and i started to suction out the mouth and nose for any mucous. About 30sec after being yanked out of the uterus the baby finally realized something was different and started yelling his head off. It was an amazing site to see and an amazing feeling to know i was one of the first people to touch this new mini-human. The mom consented for a tubal ligation before the c section so after the baby was taken out and the uterus was sutured back up the next job was to ‘“tie her tubes.” i was pretty shocked at how quick it was to do it. They just tie a robe around the tubes, then cut off the part that is tied off. I looked at the resident and said, “thats it?” and she looked at me puzzled sayin,”yeah, what else do you want me to do?” Again, laughter ensued at my expense [im getting used to it].
The attending has to wait until everything but the outer skin is closed and then he steps out. I helped the resident close up the abdomen and then helped clean up the patient. At this point the anesthesia is wearing off and the new mom was awake [getting some morphine of course].
By the time i was done helping clean up and move the c section patient, rounds had already started so i sprinted to the other side of the hospital where the OB and GYN patients are. I met up with the other students, residents and the attending. They were already half way done but I wasnt worried, i was just with this attending in surgery so its not like he thought i was late because i was slacking off...
After rounds we have mandatory lecture from 8am to 9 and i had to stay. I “listened” to the lecture and then took a nap in the on call room until about 10:30am. I drove home, made breakfast and slept all day. Then got up, tried to read, and passed out again for the rest of the night. Sleep is precious.
Friday I was in the clinic, had a couple of interesting patients, learned a lot and got to go home a bit early :)
Monday- Was on L&D today, saw one delivery in the morning and then the rest of the day I spent practicing my sutures as it was a pretty quiet day. I induced several lacerations to my banana and then sutured it up good as new
Tuesday- Clinic day, dont remember anything too special happenin
Wednesday- I slept all day as I had night shift that started at 5pm. I tried to get as much rest as I could since I knew I would not be getting any sleep that night...
When i got to Labor and Delivery at 5pm I was on the move until 8am the next day. One of the patients I admitted around 7pm was a 29yo who had come to the ER because of severe abdominal pain....she then found out in the ER she was pregnant...36 weeks pregnant. How one does not realize you are 36 weeks pregnant I will never be able to figure out but she seemed really surprised. We asked why she hadnt noticed missing her periods and she said they were really irregular anyways and that she was spotting a little so didnt take notice...she also had us talk to her sister because she thought she was playing a joke on her and wouldnt take her seriously. I dont know if this patient was just in serious denial or what but it was a pretty ridiculous story... she must have thought an alien was growing inside her because at 36weeks those babies are kickin!
Soon after we admitted that patient we had a scheduled C- section and though I didnt get to assist, I got to watch the whole thing. One of the nurses asked if I had been in a surgery before and I totally lied and said yeah [so she wouldnt be worried that I would pass out]. She gave me a lil speech anyways saying “dont lock your knees and if you feel light headed or woozy at all just walk right out, no one will say anything so dont be embarrassed”-- she was obviously still worried i would pass out and probably just didnt want to deal with it if i did. I had no idea if i was going to faint or not...i had seen some bloody deliveries and such but really, i hadnt had to smell a cauterizer before so who knows how i was going to react... Well, i was fine. Didnt feel light headed at all...i kept taking deep breaths and reminding myself to not lock my knees but really, i felt fine. It was very good to know that I can handle surgery. It was amazing to watch them yank a new baby out of the uterus of this women and then spend about 20 min closing up each layer of muscle, skin and fascia that they had cut through. While closing, the attending tried to ask me a question about the embryological origin of something. I couldnt really hear what he said so i asked him to repeat the question and he said, “no, no i cant...” He obviously was trying to stump me with a question but was so tired that he didnt remember what he asked.. we all laughed about it and a second later a big squirt of blood hit me, the resident hit an artery accidently and sent a small amount of blood my way. It got all over my scrub shirt. The resident laughed and said, “see, thats what happens here when you dont get a question right.” I laughed and asked if there was any blood on my face. She looked up and said, “oh im sorry did you actually get hit by it? I wouldnt have made such an inappropriate joke if i had known that...” Again, we all had a good laugh at my expensive.
The next delivery I saw was the first episiotomy I have seen. The mom was pushing hard and doing well but the baby’s heart monitor was showing a gradual deceleration and the doctor began to get worried about the baby. She told the mom she needs to get the baby out with the next push or she would have to cut her. the mom flipped out pleading the doctor not to do it. unfortunately, the doc had to tell the patient that it wasnt a question, more of a statement that she had to do it because the baby was beginning to be in danger. The resident eventually cut a lateral incision and the baby came out with the next push...the newborn had the umbilical cord wrapped around her neck twice and the resident and PA quickly unwrapped it, clamped the cord and gave the baby to the NICU team. The baby ended up being fine and we stitched up the mom while her epidural still worked and everything turned out OK.
The next girl I admitted was a 17yo pregnant with her baby [you may think this is young but i have already seen a 16yo deliver her SECOND child]. She was writhing in pain and her bf just sat in the corner of the room texting on his phone. When i asked her what her pain scale was she told me 9.5/10 pain. I then asked if she was planning on getting an epidural and she answered ‘hell yeah’. She hadnt taken any lamaze classes and i dont think she prepared for this delivery at all. im pretty sure she had no idea that she wouldnt be getting an epidural until she was almost completely dilated which could take 10-12 hours in a first time pregnancy. i definitely was not going to be the one to break that to her....
Around 1:30am I started to write progress notes on all the vaginal deliveries and C sections that had happened that day up until midnight. There were 12. I had to look up all their labs, go see them, ask a few questions and do a brief physical. I didnt get done until around 5:15am. Luckily must of them were up feeding their babies. I was glad i didnt have to wake em up because honestly, who is going to be nice to a student doctor that wakes you up at 3am to ask you about your gas, bowel movements, and what birth control options you want?
Rounds were supposed to start at 6:30am but the resident, attending and I got pulled into an emergency C- section. I scrubbed in and assisted on this one. It was the cooooolest. Well, minus the fact that i made an idiot out of myself while the scrub tech was helping me gown up in sterile dressing. its a tricky process. even more tricky when you are being stared at by your attending, resident and the anesthetist. lets just say i didnt make it look graceful. i dont feel too bad though since i am still very new at this and i was being rushed since it was an emergency situation. Anyways, after cutting through all the abdominal layers we finally got to the uterus and after making a long vertical incision I saw a little ear pop out. It took me a second to gather what was going on and then the resident pulled the baby out and layed it down. The surgical tech handed me a suction bulb and i started to suction out the mouth and nose for any mucous. About 30sec after being yanked out of the uterus the baby finally realized something was different and started yelling his head off. It was an amazing site to see and an amazing feeling to know i was one of the first people to touch this new mini-human. The mom consented for a tubal ligation before the c section so after the baby was taken out and the uterus was sutured back up the next job was to ‘“tie her tubes.” i was pretty shocked at how quick it was to do it. They just tie a robe around the tubes, then cut off the part that is tied off. I looked at the resident and said, “thats it?” and she looked at me puzzled sayin,”yeah, what else do you want me to do?” Again, laughter ensued at my expense [im getting used to it].
The attending has to wait until everything but the outer skin is closed and then he steps out. I helped the resident close up the abdomen and then helped clean up the patient. At this point the anesthesia is wearing off and the new mom was awake [getting some morphine of course].
By the time i was done helping clean up and move the c section patient, rounds had already started so i sprinted to the other side of the hospital where the OB and GYN patients are. I met up with the other students, residents and the attending. They were already half way done but I wasnt worried, i was just with this attending in surgery so its not like he thought i was late because i was slacking off...
After rounds we have mandatory lecture from 8am to 9 and i had to stay. I “listened” to the lecture and then took a nap in the on call room until about 10:30am. I drove home, made breakfast and slept all day. Then got up, tried to read, and passed out again for the rest of the night. Sleep is precious.
Friday I was in the clinic, had a couple of interesting patients, learned a lot and got to go home a bit early :)
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