The really interesting thing happened after surgery, though, when as we were closing up the wound a nurse came in. "Dr. R! Dr. R!" Dr. M, in urology, had something he simply had to see. K told Dr. R and I to go ahead, go on, she'd close up. So I tagged along, excitedly.
Dr. M was doing a laparascopic orchiopexy. That's where they take a camera through the belly button and use it to move an undescended testicle down into the scrotum. And he couldn't find the testicle. And then he saw the testicular vessels arching over the abdomen. And then he saw a double vas deferens descending into the left scrotum. Sure enough, this kid has two descended testicles...on the left. It was fascinating. I put on sterile gloves and palpated them. One was high - which explains why he missed it in clinic and on pre-op exam. Apparently, this is "transverse testicular ectopia" and it's pretty darn rare. At least, this is the only case that Dr. M's seen in 20 years, and the literature describes "over a hundred cases" since 1886. It's associated with Persistent Müllerian Duct Syndrome, which involves the Müllerian structures not going away, producing boys with a full complement of reproductive organs (including uterus and ovaries). This kid didn't have that, that we saw...just the two vas's going into one scrotal side. And a hydrocele. It'll be interesting to see if Dr. M does anything about it. As it was, he just closed up the surgery and went to talk to the parents.
Got caught by stealth rounds in the afternoon, hence the truncated post. Was feeling lonely and unhappy and generally blah, so I convinced Angel to meet me for dinner in Muncie. We had Steak & Shake. I buzzed ahead and asked him to get Tylenol for me as my headache was returning. He showed up at Steak & Shake with extra-strength Tylenol and a rose.
I love this man. Even just getting to see him for 45 minutes at a restaurant was enough to make my day worthwhile.
Got up this morning, shirked my duties toward the girl who had the lap chole yesterday, as she will be going home today and they never ever actually listen to anyone presenting about a patient on 4B. It's just plain unheard-of. I suppose if I could talk fast enough to say "AVSS, good urine, no stools, no emesis, home today" before Dr. C did, they might listen - but more likely they'd just ignore me. So I didn't even bother to do a note. They won't do a note. She was only here because we can't send her home right away after general anaesthesia and poking holes in her belly.
Rounds, and then M&M and Grand Rounds. Dr. G absolutely tore into a resident today, and with good reason. Apparently there was a gross miscarriage of communication. I won't go into detail. LG was our presenter today, so I stayed awake and played Tangrams while listening to his presentation. The OR of the future will be so cool.
Scrubbed in on a circumcision - shall I tell you how we did the circumcision, O Best Beloved? I think I'll cut it for the squeamish...
You'll find a picture of the instrument in question right here. I'll be referring to that diagram.
You take part E, the bell, and tuck it under the foreskin and above the glans penis, to push the glans down. Then you stretch the foreskin up over it with a pair of hemostats. Then comes the fun part. The top crossbar bit of Part E threads through the large hole in part D. Use hemostats and pickups to continue to stretch the foreskin up. Put part B on part D so that the threaded bar on D sticks up through the hole in B, and the crossbar of E is notched into the part of B that sticks out. Then apply part C to the threaded bar and tighten. B pulls E up, sealing the bell against the edge of the hole in D. Tighten very tightly, because this is how we keep it from bleeding later.
Then take a knife and run it along the edge of the D-E junction. Then leave the clamp on for a while after you remove the foreskin, so that there's a little edge of clamped-down cuticle to peel off of E later. In this case, we just left it on until we were done with the PEG tube.
PEG tubes are easy. I got to hold the endoscope this time, and play with it a bit, and Dr. S complimented me. Yay, me.
Went down to see Nancy post-op. Had been forewarned that this little girl was scrappy. She has marks on her legs where she was tied to a bed with ropes in China, and the ropes burned her skin. Had a conversation with her, asked how she was doing, got permission to examine her, and it went swimmingly. Mom and Dad are neat people. She's a very bright and cooperative little girl. She looks great. She's going to do well.
Found out that Abby (the 18-year-old with Crohns, and the brand-new ostomy) has been referred to psych by the ostomy care nurse, because she can't stand even to think about this hideous thing coming out of her stomach, let alone change the bag by herself. So sad.
Am now hoping that A remembers to page me when something interesting comes into the ER. Will probably have to hunt him down and tag along, or I will never get my fourth H&P. Speaking of, I should go turn the third one in and get some lunch while I can.