Yesterday, I was maladroit and started talking about 'assigning' patients to people, as if I were any more than a secretary and scribe. Asher, the kind soul that he is, pointed out to me that I was getting too big for my britches. In a very gentle way. Asher and I don't see eye to eye on...well, hardly anything, ideologically, but he is one of the most astute men I know. And he's good at pointing things out. No harm done, none at all that I know of, but I spent the rest of the night thinking about it.
And this morning, my Lily left the channel after I said something. And I couldn't - literally couldn't - force myself to get up and go to the hospital before I'd established that she wasn't mad at me, that it was just another maladroit moment. And I'm still bothered by it. I know I'll be flipping out all day.
I'm too bloody sensitive.
To be specific, I got a chicken fajita or something like that, with onion and pepper and lettuce and cheese and beans in it. I should've foregone the beans; they were squishy. I also got a drink, in celebration of surviving surgery with Dr. B, almost completely unprepared. "So...how many stages are there of these?" I scanned Recall before the surgery. Four and a half, I say, and get an odd look. Well, there's I-IV and IVS. Good girl.
Patient is T, who's four and a half. She presented to her primary doctor with two weeks of nonspecific abdominal pain and a six-pound weight loss. Primary doctor, unheard of, got a CT. Showed a gigantic mass lying in wait above her kidneys, coiling around her aorta, and displacing her inferior vena cava and her pancreas. It was huge. She's tiny (14.1 kg). How this gigantic haemorrhagic thing was non-palpable I don't know. And then we made a little incision and went rooting around, unsuccessfully almost, trying to figure out if we were working on tumor or pancreas, while her bowels (did she drink an entire case of fizzy drinks before surgery? They were entirely full of gas) got in the way. A lot. Got our sample and sent it to pathology, waiting for the frozen sections. Stuffed a wet lap towel into the wound, and stood around chatting until Path called back. Neuroblastoma.
That was what we had wanted to hear, in all honesty. As sad as it sounds, as disturbing as it is, hearing that she has a form of cancer gives her a better prognosis than if this horrible mass were benign. Because if it were benign, we'd have to take it out. And it wraps around everything in there. And it's safer - for her - for us to just close up the wound, call in the specialists to get a bone marrow biopsy, and tell her parents that she has a 25-40% survival chance, than to try and remove this huge haemorrhagic thing from the abdomen and pelvis of a four and a half-year-old-girl without her bleeding out or dying in the operation. She'll go for chemotherapy, and the tumour hopefully will shrink, and we'll be able to take it out later.
Neuroblastoma. I watched them do the BM biopsy. They drill into the hip...it looks horrible. She's four and a half. They couldn't get her into the OR until her dad dressed in a protective suit and carried her in.
Apparently the doctors think we should be following patients if we're there for the surgeries. Makes sense. Dr. B wanted to know what was going on, why Shubi was following patients that Andy scrubbed on, etc. And here I am scrubbing because Asher doesn't feel good enough for the OR, and this patient wasn't mine, but the way Dr. B was looking at me, I think I have to take her now.
We'll reorganize the list this afternoon, on rounds. And tonight is choir night, so I'll go home, clean my room, and study a bit before bed as Angel will not be around to distract me. I should also find the chart this afternoon for my third H&P patient, as I have the sneaking suspicion that I need to find the drug dosing for her before they send her home and I get in trouble for not having an adequate plan.
It's hard to believe that I've been doing this for three and a half weeks, or that there are only two weeks left. I can't friggin' wait. :P
Asher paged me after I posted. "I hear rounds in radiology, 3:15." Thank you so much, Asher. Went to rounds, rounded, ran into Dr. R. in a patient's room. She has a congenital diaphragmatic hernia. Late presentation. "What do you know about late presentation DH?"
There was silence. Finally, I spoke up. Well, it's a less severe defect than immediate presentation...which would mean less lung hypoplasia...which means a higher survival rate? He was pleased. "That's a hundred percent correct. Survival for late-presentation is nearly 100%." And then he looked down at Y. "Except I think she may be the exception. She had that ischemic bowel..." Apparently this kid presented with grunting and cough, and turned out that most of her small bowel was dying to dead from strangulation. What a mess. We're trying, though. We're not going to let her go without a fight.
Tried to work out with my fellow students what we were going to do for the next day, as half our surgeons for clinic and OR were gone. Asher wanted the right breast mass excision. I was confirming that he still wanted that and clinic when Dr. C walks up to me. "So, Nicole...what do you want me to do tomorrow?" It was totally deadpan. I was left completely without a comeback.
I was too flustered. We were all the way back to the OR after rounds when Shubi said "You should've told him he could take the day off." I should've assigned him to the temporary CVL placement, told him maybe he could work the fluoroscope.
Decided to hang out for a bit and make sure I missed the 17:00 traffic bolus, as I prefer my traffic on a slow steady maintenance drip. Tomorrow clinic in the morning, with Dr. W (I like Dr. W) and then nothing in the afternoon. No faux pas or maladroit words today, just people teasing me, which flusters me greatly. Silly me.
Tonight's plans haven't changed, except that I will not be in the planned OR, so I think instead I'll go over things for Friday morning. I plan to sleep much the next three days; Angel will be at choir tonight and Mom's tomorrow and RP on Friday night. As he is the main reason I come online when my time is so limited that I can't really RP with most people, I think I might catch up on some reading.
But as it stands I won't get home until 18:30 now, time enough to heat up some food and then tidy my room if I'm lucky. Until then, O Best Beloved.