As the heading says, I finished my surgery rotation last week, and I have to admit that things ended on a better note at the new site that I was at. I was with a preceptor who I had heard was quite rough on other students (eg. telling them to leave the OR, ripping up their histories, and just generally treating them like crap); but for whatever reason, he seemed to like me, and I enjoyed my experience.
Because there weren't any residents at the site, I was treated like a junior resident, and got to do quite a bit. Unfortunately, that also meant that my hours were still quite long, but at least I didn't have to round in the morning on a gazillion patients. One thing I noticed, though, is that quite a lot of the surgeries we did were in order to fix problems a patient developed from another surgery. For instance, one guy needed 3 surgeries for inflammatory bowel disease, but two of the surgeries were required because he developed infection and other complications from the initial surgery. I saw so many problems secondary to surgery while on that rotation that it definitely would make me shy away from getting any unless absolutely necessary.
I'm now currently on obstetrics and gynecology, and although it's only been day 3, I'm pretty sure this is an area I don't plan on entering in the future. I spent my day on call yesterday watching a lady give birth; and I found myself dying of boredom watching the baby slowly creep down the birth canal. It was a little exciting near the end, though, because the baby would not deliver after 2 hours, so the physician decided to use forceps to do it. However, the parents initially wanted a C-section and were convinced otherwise because of the complications associated with it. As it turns out, this particular infant was too big to be delivered easily, and the physician on call eventually had to break its arm in order to get it delivered (a standard procedure, but one avoided unless necessary). The parents were so mad at the outcome that I can imagine some legal action coming up, not that it involves me since I only played an observer role throughout the whole ordeal.
Howver, in general, things have not been too exciting, and there seems to be too many residents and students for the number of patients getting cared for. Hopefully things will pick up, but I don't have my fingers crossed for this.
Wednesday, May 28, 2008
Tuesday, May 06, 2008
3 weeks done, 3 more to go
I'm a bit past halfway done my surgery rotation, and I have to admit that things have not been as bad as I had originally anticipated. The residents have been great to me, and the preceptors patient. The only thing deterring me from considering surgery as a career are the brutal hours (being at the hospital by 6 am and leaving by 5-6 pm hardly gives me time to read, since I have to go to bed early as well), and the fact that I enjoy other specialties a bit more.
My main criticism of the surgical specialty is how superficial the care can get because things are done so quickly: rounds go by in a blur (although in some ways I prefer faster rounds compared to the drawn out internal med rounds) and it's so easy to miss drug re-orders or lab results. Plus, when a problem arises, they tend to treat the superficial problem and not the underlying issue, which isn't a great approach to things. However, otherwise, I saw quite a few interesting cases:
Being that I was downtown and surgery deals with a lot of traumas, stabbings and motor vehicle accidents were a common occurrence during call, especially during the weekend. The first stabbing I saw involved someone who was about my age who came in with an abdominal stab wound. It turns out the wound punctured his lung, so not only was it the first stabbing I saw, but it was also one of the first chest tubes I saw inserted into a person. He recovered fairly quickly and was discharged in a few days...whether or not he'll return with another stab wound remains to be seen. It's tough having to treat when you know that the person will probably be a repeat visitor, but I guess it's not really our job to judge.
Another trauma I saw was a really interesting case of a guy who fell from a ladder and lost consciousness. Because the senior resident was scrubbed in, I was one of the first people to see him. Luckily Emerg had already done an assessment of him before I came, because I didn't know how to do a proper trauma assessment and took way to long, but thankfully the patient was stable. It was interesting, though, because as we took care of him, he progressively had worsening neurological findings, and eventually they found out he had fractured his cervical spine and needed urgent neurosurgery.
Other things that I saw included my first "code" where I was one of the first people there to help out: I was called by one of the nursing units because a patient was having problems breathing and they felt he was going to code at any minute. For whatever reason, the resident couldn't be paged, so I ended up being the first person there. Although in the end, the patient didn't code, ICU was called pre-emptively, and I was involved in helping out in his initial care...quite an experience for me, but one I would have liked to have AFTER I had received ACLS training (advanced life support training).
I also saw a patient who came in with a hernia which had resulted in part of her bowel dying and spilling out the bowel contents. This was the one time where she was lucky that she was obese: if she had been skinnier, the bowel contents would have spilled into her abdomen and likely would have killed her or made her really sick. Instead, because she had so much fat, she walled off the bowel contents, and only part of her abdomen was involved. When we opened her up, though, fecal content was literally oozing out of her wound, and some even got onto the residents' shoes! Yum yum. Anyways, she recovered, but as far as I know, she's still in hospital, because she's so big and has issues mobilizing (she chooses to eat rather than move around). Obesity is such a vicious cycle.
As this entry's getting a little long, I'll bring it to a close. This has by far been the best rotation in terms of hands-on experience. I've done lots of suturing, intubated a few people and inserted a few catheters. I'm still a far ways from being able to do the more invasive procedures, but at least I'm at a point in my training where I think I can do basic management of patients and not worry about killing them over things they really shouldn't be dying over. I can't wait until this rotation's over just because of the crappy hours, but at least I'm not hating the experience.
In summary:
My main criticism of the surgical specialty is how superficial the care can get because things are done so quickly: rounds go by in a blur (although in some ways I prefer faster rounds compared to the drawn out internal med rounds) and it's so easy to miss drug re-orders or lab results. Plus, when a problem arises, they tend to treat the superficial problem and not the underlying issue, which isn't a great approach to things. However, otherwise, I saw quite a few interesting cases:
Being that I was downtown and surgery deals with a lot of traumas, stabbings and motor vehicle accidents were a common occurrence during call, especially during the weekend. The first stabbing I saw involved someone who was about my age who came in with an abdominal stab wound. It turns out the wound punctured his lung, so not only was it the first stabbing I saw, but it was also one of the first chest tubes I saw inserted into a person. He recovered fairly quickly and was discharged in a few days...whether or not he'll return with another stab wound remains to be seen. It's tough having to treat when you know that the person will probably be a repeat visitor, but I guess it's not really our job to judge.
Another trauma I saw was a really interesting case of a guy who fell from a ladder and lost consciousness. Because the senior resident was scrubbed in, I was one of the first people to see him. Luckily Emerg had already done an assessment of him before I came, because I didn't know how to do a proper trauma assessment and took way to long, but thankfully the patient was stable. It was interesting, though, because as we took care of him, he progressively had worsening neurological findings, and eventually they found out he had fractured his cervical spine and needed urgent neurosurgery.
Other things that I saw included my first "code" where I was one of the first people there to help out: I was called by one of the nursing units because a patient was having problems breathing and they felt he was going to code at any minute. For whatever reason, the resident couldn't be paged, so I ended up being the first person there. Although in the end, the patient didn't code, ICU was called pre-emptively, and I was involved in helping out in his initial care...quite an experience for me, but one I would have liked to have AFTER I had received ACLS training (advanced life support training).
I also saw a patient who came in with a hernia which had resulted in part of her bowel dying and spilling out the bowel contents. This was the one time where she was lucky that she was obese: if she had been skinnier, the bowel contents would have spilled into her abdomen and likely would have killed her or made her really sick. Instead, because she had so much fat, she walled off the bowel contents, and only part of her abdomen was involved. When we opened her up, though, fecal content was literally oozing out of her wound, and some even got onto the residents' shoes! Yum yum. Anyways, she recovered, but as far as I know, she's still in hospital, because she's so big and has issues mobilizing (she chooses to eat rather than move around). Obesity is such a vicious cycle.
As this entry's getting a little long, I'll bring it to a close. This has by far been the best rotation in terms of hands-on experience. I've done lots of suturing, intubated a few people and inserted a few catheters. I'm still a far ways from being able to do the more invasive procedures, but at least I'm at a point in my training where I think I can do basic management of patients and not worry about killing them over things they really shouldn't be dying over. I can't wait until this rotation's over just because of the crappy hours, but at least I'm not hating the experience.
In summary:
- I'm halfway done my surgery rotation, and other than the crappy hours, things haven't been too bad. Cases that I've seen have included:
- A few stabbings, and a guy who fell off a ladder and who suffered progressively worsening neurological symptoms. My first experience with trauma patients!
- A patient almost coded on me and ICU had to be called. I learned the fast way how to manage someone going into respiratory failure.
- Another patient came in with a hernia and dead bowel. She was lucky that she was obese, because her bowel contents spilled into her abdomen, but her surrounding fat prevented it from spreading to the rest of her abdominal cavity and likely saved her from becoming particularly sick.
- I've also been able to do a lot of hands-on procedures. I wouldn't trust me yet with the MD (which is why I don't have one yet), but at least I'm getting there!
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