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!