October 7th, 2003

White Coat

"No, take a bigger bite, and right here..."

Today I got to suture in Surgery.
That makes today, in case you couldn't tell, a red-letter day.
I wasn't scheduled for surgery today; we only had a few to pick from, complicated by the 0700-0800 workshop on nutrition (thank you, Dr. E, for making us all feel like total dumbasses and then picking up the pieces) and the 0815-0930 mandatory Paediatric Surgery lesson (thank you, K, for being interesting enough that I only slept through 10 slides or so). We finished rounds and went our merry way before conferences, but as two of the three Interesting Surgeries were scheduled for 0730, we were pretty much SOL. Dr. C, in afternoon rounds: "That was a beautiful transanal pull-through. Why did nobody show?" Because we were busy. Bugger it all.
Went to lectures, obviously, and then called over to see about exorcising my pager. You see, on Sunday night it began to do Strange Things. All of my messages were garbled random characters, and it would randomly die and come back to life, announcing its Miraculous Resurrection with a loud beeping noise. This will not do. When I got paged for rounds on Monday and couldn't read the message as it was overlaid with the previous day's football scores, I e-mailed MN, who is the computer guru for the school. The series of exchanges follows here:
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In summary, I got the name and number of the person I needed to call with my pager problems. And I dialed her up.
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I walk my pager over to her. I explain once more that it has been possessed of a malevolent pager spirit, and she grins. "Is it giving you gobbledygook?" Yes. Yes, it is. Apparently, they do that sometimes. Now I have a new pager, and it (1) does not fall out of its holder every time I move my pants, (2) has a spiffy GUI instead of a text interface, (3) doesn't have the cool ringtone I was using, which is okay because it's always on vibrate, which might be why (4) I can't find the stupid thing.

So I took a 20-minute break or so from my duties on the way back from the other hospital to check e-mail and generally get my mind in gear. Went back to the hospital with the express intention of checking the white board for a work-in operation that I could scrub in on in the afternoon (work-ins almost invariably are afternoon operations), rounding on all four of my patients, writing their notes, finishing that work by 11:45 (it was now 10:45 or so) and then settling down in the mythical Heart Center conference room for some Quality Time with my chapter on paediatric surgery until the work-ins were ready to go. Efficient work, efficient scheduling. It was going to have been great.
Got into the OR to check the board and get my clipboard, and saw "Emergent - laparotomy and possible partial bowel resection" on the board, and a handful of my residents standing nearby. When did it come in? Just now. May I scrub in? Please.
I got to hold retractors, help hold the small intestines as we pulled them all out of B's colon and went searching through them for an obstruction, and then about halfway through closing the skin incision Dr. L put down the needle holder. "Come finish this up." Me? "Come over here and finish closing." Yes, sir! M walked me through my very first set of dermal border running sutures, and we closed the wound up nice and tight. Then I wrote the op note.
And there went my afternoon - it was 1:30 before I got out of surgery, and then Dr. C paged us for rounds at 2:00. I wrote my notes for the kids as we were rounding (yay for clipboards) and ran ahead to do physicals before the team got there. I sucked in rounds today because of it - not prepared to present my kids, not ready to grab the charts and put them back as Dr. C held out his hand to give them to us, and having to admit that I hadn't gone in to do a PE on the little girl with the pyloromyotomy as her mother was a scary woman who didn't want anyone - and especially not more than just one person - near her nervous little child. He said "Don't worry about that," and gave me the findings for my PE.
And then it was 1600 and we were done with rounds. Go home. What? See you guys later. A whole hour of extra time, which means that now at 1900 I have taken a long hot shower, had dinner, and am ready to set down and write my Iatrogenesis article to e-mail in. 500-700 words, she says. My last LJ entry was 595. That's a short article.
Tomorrow: Rounds at 0530. M&M at 0700. Grand Rounds at 0800. That makes for a short morning, as most of my rounding time has disappeared. Surgery scheduled tomorrow: CVL placement at 1445. I'll get out of rounds, as the patient is one I'm covering and we're required to be there for our patients. So tomorrow, notes and exams at 0900, followed by some chart review and organizing time, followed by Quality Time with my book. I think I might go to bed a little early, I'm already tired.
But first, I've put this article off long enough.
  • Current Mood
    accomplished accomplished
Nescafe rabbit

"But you're the most organised one, so I called you..."

Pager went off this evening. Shubi wanted to know, since she got out late, if I knew what surgeries were taken for tomorrow. This morning, I looked at Andy and offered him his pick from the list of un-spoken-for patients, as one of his was slated for discharge. He picked one, handed my list back. Jokingly, I asked him if they were going to get me something for Secretaries' day. "We should." Dr. C commented on my notecards today. "Those are pretty slick."
I'm not naturally organised. Honest, I'm not. But I know if I don't overcompensate for my naturally disorganised state by being compulsive about things I'll die a horrible screaming death from not having things done. And then someone will get mad at me, and yell, and that will be the end of the world.
M started to pick my notes apart today, before she got called to the OR. Little things - she had to get nit-picky about whether the orders from this morning were the orders that had actually been carried out in the end, whether fever and sepsis were two different problems, whether I had done things exactly right. All the other residents just sign the bloody things. They're impressed with my thoroughness. I don't know enough to get by on skill and experience; I must rely on being compulsively thorough, or I'll miss something. But M found things to pick at, and I felt a knot in my throat as I reflexively tried to defend myself. And she has this extremely clear diction, and a soft voice, and a hint of some kind of accent that makes her sound like Dr. S, my third-grade teacher. And I just wanted to cry suddenly because it wasn't perfect.
I'm over that now. But it's there in me, this beast of compulsion and the tears I try so hard to control. Maybe that's why I try so hard to overcompensate, to be organised, to do things right. Because I'm afraid of failing. And I'm afraid now that I look like a ringer, like I'm trying too hard and it shows, that I'm bossy and pushy and overbearing. And I'm afraid everyone secretly hates me and won't tell me. I don't want to be the person everyone's nice to at school but never invites to parties.

It's late, O Best Beloved, 9:30 already, and I was going to go to bed early. I'm posting this entry and one more after it, then to sleep.
  • Current Mood
    worried worried