Long day...

Today was pretty long.... Wednesday's are usually education and conference days. Meaning after we round on patients at 6 in the morning, we have to go back to Baylor's campus for Surgery Grand Rounds, which is pretty much a speaker giving a presentation on a particular topic for everyone in the department of Surgery. Then at 8 we have a lecture just for the medical students in their surgery clerkship. Today's was really interesting by the way, especially with my background as an EMT. It was about the changing standards of care in regards to emergency trauma patients in whether or not to give them large amounts of fluid to raise their blood pressure before any treatment begins. Say if a person has been in a bad car wreck and has lost a lot of blood, usually the first thing the paramedic on the scene would do is to put two huge IV tubes in them and pump them with as much fluids as possible, thinking you had to keep the blood pressure up. Trauma people are starting to change their attitudes on this because of a lot of very new research saying that people who are just left hypotensive until surgery do much much better. So it was actually a very informative lecture.

Back at the hospital around 9 or so, I was planning on a day of just more floor work since I wasn't expecting to go to the OR today, however, Cardiovascular surgery called saying their students were gone for computer training and they needed some from general to help out with two Coronary bypass surgeries. So I got drafted to help out with an open heart surgery case. It was my first triple bypas to help out with, and in that aspect it was really good to be in on. I got to help harvest and strip a vein, and then hold the heart for the surgeons to get a good position for the bypass. Again, it's hard to stand in one position--horribly off balance--and trying to hold something up for a given amount of time, but the surgery went very well and the patient was sent to the recovery room after 6 and half hours.

After that, there was considerable confusion amongst the rest of us as what to do next. Apparently someone had heard that our chief wanted to talk to us, but none of us knew about what. So we hung around, and hung around and basically didn't have a clue what to do about anything. The interns were all either just sitting around doing notes or nowhere to be found. It took us til 7 to meet back up with our teams and even then there was nothing to discuss. It was just a bunch of wasted time when we could have been doing something far more productive than waiting for a team meeting that never happened. Oh well, such things happen.

So is that a scalpel or a Metzenbaum?

Today I began my month of General Surgery. I'm once again back at the Veterans Affairs hospital in the same general area as I was in for Vascular, but with a whole new team. The fact that I'm on familiar territory is comforting, in as much as it won't be the headache of confusion The Methodist was on my first day. I'm already familiar with some of our residents as well from seeing them rounding with last month's group. There are four of us students from Baylor on the Team along with an international student from Italy, and I think we're going to be able to get along just fine and learn a lot along the way.

I definitely like the fact that we're going to have more involvement with the patients' care outside of the operating room. I missed that about the Vascular service. In CT surgery, pretty much my only involvement with patients was while they were asleep and sterile, and then I never saw them again. I never got to know them as people and individuals, rather than just the anatomy before me. So in that aspect I'm looking forward to the month to come. It won't be easy though. We have a lot of work in front of us, and I'm sure the team will be somewhat demanding. But it will be challenging and rewarding, and hopefully a lot of fun.

Easter Sunday

My weekend was fairly uneventful as I pretty much just took it off. However, I met my parents for Easter Mass on Sunday at the church they've been going to lately. It's a short drive away and it looks like an old Spanish mission you might find in New Mexico, complete with a very nicely landscaped courtyard. The priest was Polish, and a little hard to understand occasionally, but other than that it was a very nice service. There were 6 baptisms and plenty of babies all around. We went out to eat afterwards as my parents didn't feel like cooking after the weekend they had had. We managed to snap a few Easter pictures as well.



Me and my Mom on Easter Sunday 2005

Jay and me, Easter 2005

Last Day on Cardiovascular

Today was my last day on CV surgery with Dr. Noon, and with it being a holiday it was actually pretty short. They don't schedule surgeries on most religious holidays (since it's the Methodist Hospital), so I just met with my intern and went over last minute stuff. I wasn't able to tell Dr. Noon goodbye because he was in on a heart transplant surgery which can happen at anytime unscheduled to due the donated organs.

I enjoyed the experience, and I learned an awful lot. I feel a lot more comfortable doing sutures, so I think I feel pretty prepared going into my full month of general surgery. At least I get to take my car and park there for the whole month. That's always nice.

Last night, I made a quick trip to and from College Station to give Kristi her Easter basket. It had a lot of little knick knacks and other things in it that I think she liked quite a bit. We also went and swing danced for awhile too at their Thursday night sessions. It was fun, but just a very quick trip there and back. I didn't get much sleep last night before having to get up early and all. Hence why I just woke up from a very nice nap. ;-)

Start of a new week.

Ok, so it's been going a little better lately from the "chicken with it's head cut off" stage of last week. I still haven't been given a lot of duties other than just be present and watch, but I guess that's ok. There's really not that much that I can truly contribute to heart surgery, which brings up an interesting point that I'll mention later. I pretty much spend my days bouncing from OR to OR at the Methodist observing, and when necessary, holding a plethora of surgical instruments that have names where I have no idea where they got them from. I watched a thyroid lobectomy today, and afterwards the surgeon reimplanted one of the parathyroids back in. I didn't know you could do that. Pretty cool stuff. I really like Dr. Noon and the team I'm on. Everyone is really nice and helpful, although one of the PA's is almost constantly in a bad mood and appears to be annoyed that I have to be with him half the time. Dr. Noon is amazing as well. For one, he's one of the top Cardiothoracic surgeons in the country, has worked with Dr. Debakey for many years including in top research projects including a heart bypass device that is still being used widespread, has travelled extensively around the world operating on high profile cases, and loves to heliski! Since he has his pilot's license, he'll just fly up to Canada or someplace and rent a helicopter to take him to the top of the mountains to go skiing. He also likes astronomy and telescope viewing, so we actually have quite a bit in common. Still, I don't think I'll be taking the surgery route though.

Which brings up what I mentioned earlier. Sam and his brother Mickey were in Houston yesterday on a layover from coming back from a cruise with their parents. They went off on a 7 day cruise to Cozumel and back. I met with them for dinner and some hanging out. In catching up with all the gossip from back in Borger, apparently there are rumors spreading around that not only did I go to medical school but I'm also some fancy schmancy heart surgeon already. I know people always told me I should be one just from my name and all, but it's funny how quickly things have spread. This was all before I started this blog or anything. Funny times.

This weekend also marked the Great American Southwest Lindy Fest, which is always a annual favorite for Kristi and her Swing Cat friends. So I got to see most of them again and have dinner with them once. Having K for the weekend is always a great thing as well. She was gone in lessons and dancing most of the time, but I managed to find a time when she was off to cook her dinner and such. Palm Sunday was nice as well. Can't believe it's time for Easter already.

Easy as heart surgery?

So yesterday, in a new hospital and rotation I was definitely running around like a chicken with my head cut off. I wasn't given a clear indication of where to go, what to do, who to do it with, etc. I haven't really been given any clear duties, just to follow around a person on the team, and be present in the OR as much as possible. Something I think I definitely managed quite well today. I got good practice at standing in one spot, without moving, and staying sterile for 7 straight hours. That's right, I did not move an inch for over 7 freaking hours. I'm still working out the cramps and knots in my calves.

Of course it wasn't supposed to have gone that way. I scrubbed in on an aortic valve replacement which is open heart surgery. They crack the chest and split everything open wide as you would imagine. The actual procedure of putting in the new valve went quite well, afterwards however, the patient wouldn't stop bleeding, and it nearly took us an hour just to find where the bleed was from. We had three suction units going and could barely keep up with all the blood loss. Now this may sound bad to most of you all recalling patients bleeding out in movies and then dying once the blood bank can no longer keep up with the supply of donated blood, however, this is Methodist Hospital, and the Debakey Heart Center of all places so they can afford handy dandy nifty little devices that take all the blood suctioned out, filter it to save all the cells and plasma, and then pump it right back into the patient. All in all, he bled almost constantly from his heart for over 2 hours and after it was all said and done barely lost more than 100 mL's of blood, which is pretty good for a surgical patient. Pretty amazing technology.
We ended up having to give him factor VII which is a very very expensive blood component that helps with clotting to get him to stop, which he did almost immediately after transfusion. Then, everything was great and we were able to close up, after about 7 hours after initial incision in the OR. I guess you could call it a pretty good learning experience into what life as a surgeon is like.

Two weeks down...

I finished my first two weeks in Vascular surgery today. Tomorrow I go into a new hospital, with a new team, and a new rotation in cardiothoracic. I'm probably going to miss my old team, I had gotten to know them really well, and especially enjoyed taking care of our patients. I'm sad to say that we lost one of them this past weekend. He developed a perforated colon due to a CMV virus invection, and despite surgery wasn't able to pull through. I wasn't there when he passed, and he will be missed I'm sure. It's a natural part of medicine I suppose. Taking care of people when you can, and helping out even when you can't. Such is life.

I get to start the new week with a full belly though. My parents took me out to dinner tonight with some good friends of ours, the McMillans. We went to a little steakhouse here in Houston that's been open since the 1930s. Very cozy place with a very well landscaped outdoors area. If it wasn't so expensive I'd like to go back again sometime. It was pricey, but the food and everything was amazing, and I guess that's what parents are good for!

As usual, the morning will come calling awfully early, so it's time for sleep for me.

Clinic day

Thursdays are always a little different on the Vascular service. We round in the mornings as usual, but then we are in clinic for the rest of the day seeing outpatients who get referred to us. It's a nice change of pace and we're interviewing patients more in the sense to what I'm used to. I'm also learning a lot about how you evaluate patients for candidates for surgery or what not. Most of my patients that I saw today ended up not needing surgery, although it's likely they will in the future. It was actually a short day as we had to get back to school early for some tests in Radiology and Pathology. Now I just have some errands to do before cooking some dinner and catching up on some reading tonight. Carotid Endarterectomy studies from the New England Journal of Medicine will probably be some highly entertaining bedtime reading let me tell ya!

The Sun?

Wow, this is unusual. I've gotten used to being at the hospital and coming home all in the dark. Not used to leaving and still having the sun be up. Our team got done really early today. I mainly completed some paperwork projects and got some work done. Everyone got done really early today and got to go home early. Now that I'm actually home during normal business hours I need to run errands!

Such a little thing...

It really is quite amazing the ways in which our bodies are put together. Much of our legs are actually supported and kept alived by tiny little "thread-like" arteries not much larger than a string of yarn. We fought for much of this weekend to save a patient's leg, but in the end we had to take the limb this afternoon because all of our attempts had failed. It was frustrating, but in the end we still did what we had to do for the best of our patient, and what ultimately would prolong his life. We all ended up putting in long hours this weekend, a weekend that we weren't really supposed to have to go in for until this transfer came in. But regardless of the outcome, I think we helped make a difference and that's all that matters sometimes.


On another note, my attending took me and the rest of the team out for dinner and such tonight. It was a nice change of pace and was fun to get to know them all in a different light. It was really nice of her as well.

In's and Out's.....

I find that there is a lot of running around to be had inside a major metropolitan hospital, especially one that typically treats about 750,000 patients a year. In one door, out another, over and again. At what point does it become a blur, just spinning around and around in the revolving door of life? This first week in clinics has gone by very fast, definitely like a blur. I wish that I was on this service longer than the two weeks that I am. I'm really enjoying my team and they're very helpful in transitioning over to clinics. The veterans are also really cool patients, I really enjoy working with them, and also joking around with their unique senses of humor. Today we kind of had some down time. We discharged several of our patients so I was kind of free to do things on my leisure. So I walked in on a varicose vein oblation, and also helped some of my other classmates with an abcess drainage who were on a different service. I'm trying not to let the "medical" aspects of the patients overwhelm me and just concentrate on the simple things that I'm supposed to be doing and learning. These surgical patients are dealing with problems above and beyond what I'm supposed to be doing, and hence learning and realizing that has definitely helped a little. I can worry about that kind of stuff a few more years down the road, and just keep concentrating on the basics for now. I think I'm finally getting the hang of navigating the "Titanic" size hallways of the VA, since apparently the main hallway is longer than the Titanic as some have said. It's not so bad once you get used to it. I have some time off this weekend as well. I don't have to go in at all tomorrow, and just for morning rounds on Sunday which should take at most an hour and a half, the rest of the time I can just relax, have some fun, and do some reading etc. I'm sure I'll take advantage of it. :-)

Fresh blood..

I definitely feel like fresh blood in the hospital. For one, the place is huge and hallways are always twisting and turning on themselves and you're almost always lost and disoriented in there. Not to mention constantly being reminded of just how little you know compared to most everyone else there. I'm catching on though. It seems like mostly lectures and conferences still, we actually spend much much less time with patients on the wards than I was expecting. But I did manage to make it in on my first surgery today. It was what's called a carotid endarterectomy. It's a procedure where you go into the neck to uncover and open one of the carotid arteries in order to remove all of the fatty plaque that builds up in there with age. It's to increase the flow of blood to the brain and "hopefully" prevent a stroke. It was impressive to see them working around such a delicate artery and all the while having the patient be totally awake during the entire procedure.

Tomorrow, everyone is on vascular clinic, but I think we have lectures all day back at the school.
Honestly, one of my main complaints about this service is that we always seem to have lectures or conferences to attend, and no one bothers to tell us what time or where they are. We always just have to find out second hand. We think we have lectures tomorrow, but no one is even sure how many or where. I'm sure we'll find out though, things have seemed to work out so far.

Another Beautiful day in the City....

and more orientations for me in the hospitals. We were able to take advantage of the amazing weather yet again by enjoying a brief lunch outside in the sunshine. It's going to be short lived I think though. It's supposed to storm like crazy tomorrow, or at least that's what it looks like. Today we took tours of the O.R. and got acquainted with our teams. Still don't have access to the computer system though, which is pretty much vital at the VA as that's where everything is done. The VA is a completely paperless hospital here in Houston. Great in theory... Today was somewhat short as there was more getting to our way around and the people we were with. Tomorrow will be more like a real day I'm sure. I'm excited about our residents, they appear to be a pretty cool bunch. I think overall I'm going to end up enjoying this rotation, lets see if hindsight plays itself out as well...