monday- early AM notes, home at 8am


-tues-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. 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...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 gloves through [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 by 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!].

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, “that is fucking 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, bowel etc etc. All things I have memorized the anatomy of and can finally but 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, ill admit it].

So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope 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 have people rummaging around her in inner 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 and was in a really great mood. Everyone i talked to and every patient i saw must have thought i was on something.

One of the first patients i saw was a women who 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] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion on 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 good/confident [though they make you sweat a lot...these damn things dont let your skin breathe!]


things i learned:
i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday