March 27, 2014

Internal Medicine #1

Currently sitting in the Southside office with the other students waiting for the next patients. IM is not too interesting and I really don't enjoy it that much. A lot of hypothyroidism, hypertension, hyperlipidemia, chronic pain, and the likes. Mainly patients with chronic conditions that come for follow-up appointments and medication refills. Definitely missing emergency medicine and surgery at this point!

At least the students are very likable! I'm with 1 PA student from my program, 1 from another school, a NP student, and a pharmacy student. Me, my classmate, and the pharm student all live near each other, so we carpool and stuff. Another perk of working in this rotation are the hours! Mon, Tue, Thur 9:30ish-4:30ish or 5. Off Wednesday and off every other Friday. So that's nice!

So yea…boring update for a boring rotation. Who knows if I'll have anything interesting in the next few weeks to talk about! Can't wait for ortho!

March 8, 2014

seriously loving surgery.

I must say, I've really loved and enjoyed this rotation and am so so sad that my last week is just around the corner! Since my last update, we added 3 new medical students, lost 1 intern, and gained 2 interns. So we are probably one of the largest services right now, with 12 people (counting the attendings). It's funny because all of the other services look at us when we walk by and comment on how huge our team is. I really have enjoyed working with GI surgery and am thankful for how great everyone on the team is. Honestly, everyone is sooo much nicer than I thought they would be!

As for as surgeries go, we've had some pretty interesting cases! One of our patients had a huge abdominal mass that we resected. It probably weighed close to 10 pounds! It was so cool, but the mass has a high risk for malignancy, so that's not so cool for the patient. Another patient presented with some symptoms of bowel obstruction that was thought to be due to an ileus or hernia. When we got into his abdomen, we were shocked to find out that he actually had a fairly large mass that turned out to be lymphoma. Um, we had 1 woman with metastatic colon cancer that underwent tumor debulking, omental resection, and HIPEC (hyperthermic intraperitoneal chemoperfusion). HIPEC is a type of chemotherapy in which the drug is directly exposed to abdominal cavity. It consists of filling the persons abdomen up with the drug, heating it up, and then cycling it through the cavity for 100 minutes. It was pretty cool. Oh, and we had 1 patient with a rectal stump that we prolapsed (outside of the abdomen) and cut off. That was pretty interesting. The rest of the cases have consisted mostly of bowel resections, ileostomies, cholecystectomies, and some others. You may or may not have noticed this, but a lot of the cases we see are related to cancer. My preceptor does a lot of oncological GI surgery, so it's sad to see some of these patients, but also pretty awesome to see these surgeries and how they can drastically change the course of the disease.

We also see a lot of patients with Crohn's and Ulcerative colitis, as well as nonsurgical patients like this one guy with an enterocutaneous fistula. Basically part of this guys colon fused with his skin and formed an opening on his abdomen. So most, if not all, of the food he eats moves through a small portion of his small bowel then drains out of this fistula. Right now he has a bag that fits over it for the contents to drain into, but eventually he will need surgery once the defect gets smaller.

Coming up this week: Gastrectomy, possibly another HIPEC, pancreatic debridement, and maybe a Whipple, plus a bunch of other smaller procedures. So it will be a very busy week, no doubt! And I  hope we have a few lap choles, because for some reason I absolutely love them (classmates, laugh all you want).

So yea, surgery has been great and I'm sad to almost be done. I love seeing these interesting cases, being in the OR, and working with my amazing team. And honestly, I don't mind getting up at 3:30AM, making the patient list at 5AM, rounding at 6AM, and being in the OR sometimes as late as 7PM. I love everything about GI surgery so far and I have to say that this has been one of my favorite rotations. It will surely be better than internal medicine, which I have next:(

This may or may not be my last surgery update, but I'll be sure to write again if anything really interesting happens!

February 21, 2014

surgery, round 2

The last week and a half of surgery has been fairly laid back. No major surgeries, and I've been getting home at a decent time each day. We lost the medical students this week, which I was kind of sad about because they were really great. But we get new ones on Monday, so we'll see how that goes. We also welcomed the arrival of the chief resident back to presby/montefiore. As I said last time, the residents are on a rotating schedule. This guy is really nice and great to be around, as is the rest of the team.

The PA on the team is my age and just started working in the last couple months. She is great at what she does up on the floor, seeing patients, writing notes and orders, etc. She also happens to be from Westerville, OH! So we were excited about that. At the start of the week we gained our new PA student. She is very nice and very eager to learn. I've seen several of my classmates around the hospital and have exchanged notes with them via our lab coats sitting outside the OR. It's always nice to see them and hear about the experiences they are having!

As far as surgeries go…Several laparoscopic cholecystectomies (removal of the gallbladder), radio-frequency ablation of a liver tumor (which was really cool), small bowel resections, ileostomy reversals, a rectopexy (for rectal prolapse). There was one patient with a huge Meckel's diverticulum, which was neat! Other than being in the OR, I'm trying to see patients in the clinic, writing notes, and rounding. It's hard to stay busy at times because there are 8 people on the GI surgery service (well 6 now since the med students are gone). But I'm doing my best.

I am really liking surgery and being in the OR and the long days and the whole experience really, but I wish I was able to do more. I think they are going to have the PA students work with some other GI services that have smaller teams, so hopefully that will go in our favor. This weekend I need to get some homework done and catch up on sleep! 4 hours of sleep and waking up at 3:30AM 5 days a week is not good for the body! Last night I completely crashed from being so tired. But what would surgery be without some sleep deprivation?! Here's to hoping next week is better than this last one!

February 12, 2014

Surgery update #1

So I started my GI surgery rotation on Monday at UPMC Presby/Montefiore. My very first day I was lucky enough to scrub in on a NINE HOUR surgery and watch a complete gastrectomy (removal of stomach) for a guy that has gastric cancer running in his family. He doesn't have it, but opted for a prophylactic surgery, as he has a genetic mutation predisposing him to it. So that was cool, but very very long. My back and feet were miserable! I did get to meet my attending and a few residents and med students, so that was nice.

Yesterday I arrived at 5:30AM for rounds with the GI surgery team. Then I scrubbed in on a TEN HOUR whipple procedure (pancreaticoduodenectomy)! This surgery involves taking out part of the stomach, duodenum (part of small intestines), and pancreas, and complete removal of the gallbladder and common bile duct. Then they reattach all of this stuff and I won't get into the details of that…But the reason for the surgery was because this woman had a duodenal adenoma that had to be removed. It was a cool surgery and I got to help out…and by help out, I mean pass instruments to the surgeons.

Today was an easy day. Rounds at 5:30AM, then 2 hour loop ileostomy performed laparoscopically. This procedure involves taking the ileum (part of the small intestines) and looping it out of the abdomen. Then a small incision is cut into the ileum so that stool/etc can be drained at this point instead of passing into the colon. The reason the woman had this done was because she has perianal cancer, which is not very common. After surgery I spent some time researching different surgeries and going through the patient list. Then the surgery team met for lunch (junior resident, intern, med students, PA and myself), which was nice. I really like the team I'm working with so far. Afterwards I made my way down to the outpatient clinic for a few hours. Then I got to go home 3 hours early! First time in a couple days that I've really been able to see the sun!

So far surgery is both fun and boring and tiring and interesting. But I think as I get used to it and become more familiar with the procedures and with my team then I'll like it more. We'll see! Back to the hospital at 5AM tomorrow. Hopefully I'll get to scrub in on a cool surgery!

OR time = 21hrs

February 6, 2014

i just know it.

After working in family medicine, psych, women's health, urgent care, and two emergency departments, I think I've already decided what I want to do with my career.

There is no doubt in my mind, at this point, that I want to work in emergency medicine. I love everything about it, even if can be draining of time and energy. even if you don't always get to eat on time. even if it makes you sleep deprived. even if treating geriatric patients isn't the most fun thing in the world. even if you walk into a room where a man is unconscious and lying in his own feces. even if you see people die and people live. even if you work past the time you're scheduled. etc. etc. i just know that i love it.

my experience in alaska at the urgent care and homeless clinic, at children's ED, and at forbes have been my favorite and most enjoyed rotations. i know i still have a few more left, but i have a feeling they're not going to come close to matching these ones. hopefully once all is said and done, i'll be working in some kind of emergent setting, whether it's somewhere here in the states, or overseas in a far off distance land. 

a year ago I didn't know if i could get this far or if i even wanted to. i think i'm glad i stuck with it, and can honestly say i'm proud to have gotten to this point. so looking forward to what the future holds!

January 30, 2014

Emergency medicine = sleep deprivation

Not a whole lot to update on right now. I have gotten to sew a few things up and have been complimented on my steady hand and sutures, so that's always nice. I was actually kind of nervous to do some suturing, as I hadn't done any since August, but I was obviously happy and eager to do it.

Nothing too exciting has really happened in the last week-ish. Couple STEMIs, broken bones, a-fib, drug-seekers. Saw a woman the other day with an H&H (hemoglobin/hematocrit) of like 6.8 and 20 something, so she obviously needed transfused. Saw a woman come in with abdominal/rectal pain, which her OB/GYN blew off as constipation and "the baby growing". The baby was growing, only inside her fallopian tube. It turns out she had an ectopic pregnancy and was bleeding into her abdomen. Um, I've seen a couple UTIs, a quadricep tendon rupture, and just a lot of nonspecific things like dizziness, headache, nausea, vomiting, weakness, etc.

On Monday and Tuesday I worked overnight. Wasn't too exciting, especially on Tuesday, which was a  very, very slow and long night. Overnights always mess my sleep up. I think I went like 30 hours without sleep, then got like 1-1/2hrs of sleep after my first overnight shift, then was up for another 15 hours for my second overnight shift. Then I went home and slept for like 8 hours straight and was up until like 4AM this morning before getting up at 7. And I always forget the day of the week, which screws me up even more.

Working again tonight from 4pm-12, and then tomorrow I think from 7am-3. Hoping to go home this weekend and see family before my last week in the ER and starting my surgery rotation the week after. I think I'll miss the emergency room, especially this one because I really like the people who work there, but I am very excited for surgery! Will obviously update again if anything exciting happens, but this may be my last ER post!

January 22, 2014

emergency med update #2

So far I am LOVING emergency medicine! There are still a lot of things I do not know how to manage, but I'm still learning!

I'm starting to get used to the structure and pace of the ER at Forbes. And I love working with my preceptor and seeing familiar faces around the department. I've met several PAs in multiple departments, including ED, trauma, and neuro, so far. It's cool to see how our field is branching out into specialties and how they are all working together. I would've loved the chance to rotate with trauma so maybe I'll get to do a little bit of that when I'm in my ortho surgery rotation.

I haven't seen too many "crazy" cases yet…Well, at least given my own definition of crazy. Last week we had a guy come in with a first time seizure, which ended up being from a large brain tumor. That same day we found out that a woman we had seen the previous day had a thoracic spinal mass that was compressing her spinal cord and causing numbness and weakness in her legs. I also saw a trauma case in which a guy was stabbed in the neck and chest. Apparently he had completely severed his jugular vein and had a tension pneumothorax. Needless to say he was rushed off to surgery. Today I witnessed my first death. A man came in with severe CHF (congestive heart failure) and he went into cardiac arrest and died after the techs spent 20 minutes trying to resuscitate him. I also witnessed a woman have a spontaneous abortion (miscarriage), and even was able to see the fetus/POC (products of conception) after they were expelled. It's a little surreal at times, seeing some of the things I see. It's like I almost remove myself from my body so that things don't phase me like they would other people. I don't know how to explain it.

Other cool things I've seen include subarachnoid hemorrhage, superior vena cava syndrome, crush injuries, incarcerated inguinal hernia, colovesicular fistula (imagine your colon being connected to your bladder and then trying to pee), hypertensive urgency, and appendicitis, among many other things.

So far I've seen a lot of sick patients that have to be admitted, so I'm hoping to switch over to fast track for a couple days and try to see some patients that I can "fix" in some respect. I'd like to sew some people up and drain abscesses. All that fun stuff. Some day next week or the week after I'm hoping to ride along with the EMS in the ambulance for a shift. I think it'd be fun and a good experience to see what is done to a patient before they arrive at the ED. 

That's pretty much all I can think to update about right now! This week I'm on 11AM-9PM tomorrow (in addition to Mon and today), Sat and Sun. Then next Mon and Tues I'm on from 9PM-7AM. I'm actually excited for the overnight shift because I know I really liked it while at Children's. So hopefully it goes well and I get to see some cool stuff. I'll be sure to update again when I get the chance!