October 28th, 2003

Nescafe rabbit

Sunday Monday Happy Days...

I think the two Extra-Strength Tylenol I took are having an effect on my headache. Good. I get to see a lap chole today, and it will seriously suck if I have a headache.
Yesterday I got up early and then read my friends' page, which wound up making me late to get to the hospital. Met up with the others and handed out all the patients who weren't cared for, as is my wont. Picked up another infant for me. Read the schedule for the OR and snagged a ventral hernia repair; another easy surgery. I just don't care enough to scrub in on anything really difficult, not in my last week.
Will pick up today or tomorrow a patient for my final H&P, which means "page me on an ER call" and all that. Hopefully, it'll be a kid with only one or two problems, not an entire freakin' list of them. Sometimes, I hate working at a children's hospital.
Yesterday afternoon around 1500 we were discussing the probability of rounds, given impending cases in the OR. 1505: paged to rounds in radiology at 1515. 1545: J, the only intern in the room, looks at five medical students. "Want to be interns for an afternoon? Go do post-op checks." So we scattered to do post-op checks. 1610: Called down to ask what I should do as my baby had only been on the floor for two hours, and had no vitals recorded. Got Dr. C. "We're in Radiology." I'll be right there, sir.
1630: Residents called to ER to see a patient. "Anything vital about your patients?" No, sir, but why is N on Nystatin still? "We'll take care of it. Get out of here."
Called Angel. Bitched at him about something completely spurious for no reason at all. I have an impending migraine today. I'm pretty sure it's PMS. Gotta love it.
Went home, slept a bit, got nothing done again. I've had my third H&P done for almost a week; why can't I just print the friggin' thing out? Went to bed around 2130, half an hour late and an hour and a half after I planned to.

Got up this morning and spilled my tomato soup in my car, hopefully mostly cleaned up now. Came in and did all my charting. I keep meaning to write about how early morning and early evening are beginning to look the same, but I keep forgetting to.
Today: lap chole at 0730. Class on wound and ostomy care from 0700-0800. I hope I don't miss it; it seems like a real shame to waste interesting cases just because we have to go to stinkin' class.

ishotkenney and amasashi, any interest in being in the student newspaper this time around? I told Emily yesterday that I'd do another "notes from the wards" and either profile a med student somewhere or do some more interviews.

And it's time for rounds.
Nescafe rabbit

Something to write home about...

I did get to see my lap chole, despite it starting at 0730 and me having lecture (all about ostomy care) until 0815. Because, you see, it didn't actually start until about 0800. I walked down there after Andy said "You know, I think I saw Dr. R just coming in...maybe it's late." And I put my mask on and stepped in and said (after checking to see if it was safe to speak) "Can I watch? Sorry I'm so late."
Yeah, sure, by all means. Go scrub up. Scrub? He said scrub!

It's one thing, O Best Beloved, to watch a procedure from the sidelines. It's another to scrub. And scrubbing is always, always better. Unless you want to be able to leave. Or sit down. But when you know you need time in the OR in order to get good reviews at surgery review time, you want to scrub. And I'm deathly afraid that they'll all notice I never scrub in on the big long procedures, mostly because everyone else is excited about scrubbing in and I'm not. So when the chance to see the lap chole came up I was all about scrubbing in.
And it was a neat operation, with K and Dr. R doing all the work, and me holding the camera now and then. A lap chole, if you didn't know, is short for "laparoscopic cholecystectomy", which means they take your gall bladder out through your belly button. It's a nice piece of work. No pimping, but in true Dr. R style he came to me after the operation. "Suppose we made a mistake. Suppose we clipped the common bile duct instead of the cystic duct. What would you expect to see?" Right on, baby. I stuttered for a few minutes, thinking he must mean something harder than what I was thinking, which turned out to be exactly what he was looking for. Conjugated hyperbilirubinemia, jaundice, acholic stools, and dark urine. Bingo. Every now and then I get something right.
Furthermore, not only was I asked to close up the skin on two of the lap wounds, he told me what he wanted me to do, watched me do it, and he and K both sounded Genuinely Impressed at the stitches I did. Now, knot tying...This was the first non-instrument tie I ever tried on a real person, and while my efforts were passable they were not sterling. Tonight, I think I will practise knot-tying a bit, as I understood it quite well once.

Left surgery feeling good already. Dr. R tends to have that effect on me. Paged Andy. No answer, which meant that he was in cardio surgery still and I was to go to his case as well.
Nancy is four, a little girl adopted from china with an imperforate anus. Second girl I've told a story like this about. This time, she's already been repaired and we're going to take her colostomy down so she can look - and poop - like a normal little girl.
Surgery went fine - I got to cut sutures, suction and watch K freak out about how she didn't think it was a perfect enough anastamosis. It's really an interesting way to do it, O Best Beloved. Think about the problem at hand: How do you sew two hollow tubes together so that (a) they don't leak, (b) they stay sewn together, and (c) they don't obstruct the passage of things through them? The answer? Later, after rounds.
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