Saturday, July 13, 2013

Guest Blogger: Surgery Feels, by Wendy

Please enjoy my second guest blogger, with #stuffwendysays about surgery rotations.
-Lisa

The last 8 weeks (i.e., my surgery rotation) have taught me amazing things about the human body. I've learned more about anatomy, physiology, and medical management in that short time than I could have imagined, and what I did know already has become that much more intuitive.
I've seen a risky emergency go from near certain failure to amazing success, felt people's organs from inside their abdominal cavities, put in staples and sutures, held a 93 year old man's hand while he got a chest tube placed, talked to amputees, given patients popsicles, and watched a man learn that he had metastatic cancer after what he thought would be a routine operation. I've worked one-on-one with some surgeons while the residents where in conferences, what is known as "first assist", and stood at the back of a crowded OR, trying desperately to see what was going on but knowing that it was more important to keep the patient alive than for me to be learning just then.
Patients have thanked me personally, and asked not to have medical students in the room. Attendings have looked at me like I was too stupid to exist, and praised me for getting a tricky question correct. This rotation has been amazing, disheartening, the coolest thing I've done, and I'm so damn glad it's over.
Things I've learned:
- Always wear a helmet. Specifically, when you're biking or riding a motorcycle, but it seems like it would also help if you're elderly and plan to stand up, like, ever.
- Specifically: well-fitting bike helmet, motorcycle helmets with full face protection
- Don't ride your motorcycle in shorts and a t-shirt even if it's hot out
- Maybe just don't ride a motorcycle
- Stay the hell away from where the bike path intersects Mass Ave in Lexington
- If you're having BRBPR (bright red blood per rectum), just tell us if this occurred soon after trying anal intercourse for the first time. We're really, really, not here to judge.
- Really large fibroids can feel like your patient is surprise!pregnant or has a reeeeallly full bladder on physical exam.
- If you don't secure a J-tube on the outside of the patient in some way, it can decide to fall in and then someone will have to fish it out again and the patient will be sad.
- Occasionally you will actually get a 40-something year old obese woman with 4 kids coming in complaining of RUQ pain, and be like BOOM, mneumonic!
- Diabetic foot ulcers have a really characteristic smell.
- While it would be an amazing coincidence if one were to incidentally diagnose a subungual melanoma the day after a conference on skin lesions, it is more likely after getting some history that the patient (a construction worker) whacked his hand with a hammer last week.
- In a patient with a fall involving hitting her head, don't immediately freak out if one of her eyes has an unreactive pupil. Since she is awake, communicative, and in no apparent distress, she may be happy to tell you that it's a glass eye.
- Crafting skills have some crossover for suturing and knot tying, but I'm pretty sure I'll never look at embroidery in the same way again.
- If you are caring for your patients well enough, they will start asking you things like, "do you even get to go home?" and "how many days do you work here?" and you will feel simultaneously proud and awful.
- It is important to take this to heart during your surgical rotation: eat when you can, sleep when you can, pee when you can, leave when you can.
- Who am I kidding, you don't have time to do any of that nonsense. Load your pockets with free crackers and dream of the day when you can sit down.

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