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!
Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
March 8, 2014
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!
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
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
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