Thursday, July 9, 2015

a day in the life: general surgery

3:32: I wake up from a sound sleep and maybe silently curse to myself (I promise, I'm not always this dramatic....ish)

3:35: After a quick glance through my phone to see what happened since I went to bed at 9:30 the night before, I get out of bed, go brush my teeth and wash my face, and then throw on a bit of make-up. I stick to just eyeliner, mascara, and eyebrow powder today because I'm feeling particularly lazy. Hair gets clipped back.

3:45: I'm not hungry at all, but I know that I need to eat something. I usually eat beans with breakfast too, but there's no way I'm eating beans at 3:45 in the morning. After I finish eating, I turn on the coffee machine CR prepped for me last night, and then go change into the dress clothes literally no one will see me in.

3:55: ready, break!

4:00: It takes me a little under an hour to get to the second campus of my hospital. I only have to go to this hospital for two weeks total, but man does it suck driving that long. I know that later in the day we will be doing laparoscopic cholecystectomies, so I listen to a podcast from Surgery 101 about them. After that I listen to some Mister Wives because I need to wake up.

 4:48: home sweet hospital!

4:57: I walk up to the PACU where our locker room is, and change into scrubs. Today I'm wearing my sneakers, but I have been switching them for my Danskos every other day. In my pockets I keep Maxwell's reference book (an essential), my phone, pens, a small notebook, and my many sheets of papers.

5:00: I meet up with the surgical intern and the PA student, and we all sit at computers looking up the patients on our service. If they are new to us, we look up their past medical history, why they are currently in the hospital, and all relevant current information (vitals, labs, imaging). If they have been seen by us before, we look to see what has changed and where they currently stand.

5:25: We start out first set of rounds with the intern. We follow her into each room as she wakes them up by gently knocking on the door. We take a look at the various incision sites and ask them if anything has changed since we last saw them. We ask them all the fun questions like whether they have passed gas or had any bowel movements, and everyone very much enjoys going into details ;)

6:00: We meet up with a 4th year resident, and quickly do another set of rounds. The intern fills him in on all of the pertinent information as the two of us students duckling behind. As we are about to go into another room, we are paged for a consult in the ER. We finish rounds and head to the ED.

6:25: In the emergency department, we see a woman who is having abdominal pain. The intern and resident do a work-up on her after checking her chart and imaging. They decide to admit her to the floor for observation in hopes that her suspected small bowel obstruction will pass.

6:45: Another set of rounds, this time with the Chief Resident. The intern goes over each patient again, and also explains their plans for each patient for the chief to sign off on.

7:00: Rounds with the attending (aka the guy in charge). He has already been informed about each of the patients from the residents, so he just stops in to see the patients face to face.

7:15: We're back to the computers, and I use this little down time to eat a bar. It's only 7 in the morning, but I've been up for almost 4 hours and it's going to be a while before we get lunch.

7:30: Our first case of the day is a simple colonoscopy....or what the doctors thought would be simple. The bowel prep wasn't complete, and several polyps had to be removed. What was supposed to take only 30 minutes total took close to an hour all together.

8:35: It's time to go get ready for the first surgery of the day. We put our white coats away, put on these cute little nets and shoe covers, and go scrub in. Today is actually my first day actually scrubbing in, so I'm extra nervous!

8:45: A very nice scrub nurse helps me get my gown and gloves on, and tells me where to stand. All four cases today are laparoscopic cholecystectomies ("lap choles") but all are so vastly different from one another, as I'll soon find out. The basic procedure of a lap chole is the following: the doctors cut a small hole into the abdomen, and inflate it with gas. They then put in the camera, and various other forceps and extractors (I'm still getting used to the right terminology...). After taking a look around the abdominal cavity, they located the gallbladder (here's an idea of what that all looks like). They then dissect away the fat and fascia from the cystic duct and artery. Each is clamped once they have verified that is actually what they are, and then cut. Then the gallbladder is basically pulled off of the liver, and pulled out of the abdomen through the initial hole that was made. The surgeons then do another sweep of the abdomen to make sure everything looks complete, and then they close up the few small incisions.
In the first case, there were many adhesions on and around the gallbladder, so the dissecting took longer than it usually does. Once the gallbladder was removed, they let me cut it open. I found two large cholesterol stones - it was so interesting to see and feel them in real life (it looked very similar to this picture)!

Once the resident and attending have finished the operation, they leave to go prepare for the next surgery. I stay behind to help the nursing staff clean up the patient and room, and move the patient from the operating table to the hospital bed.

10: 45: After a quick bathroom break, it's time for the next case. Again I scrub in, and feel a bit more comfortable standing in the OR. I was sure to make everyone aware that today was my first day actually scrubbing in so that they knew that they just had to tell me when I was doing something wrong. The nursing staff was super helpful with making sure I was doing the right things. This case was a bit more straight forward as there were no adhesions, so it went a lot quicker...until the gallbladder was nicked. Not a big deal, but it just takes a bit more time to clean everything up. Again I got to cut open the gallbladder, but didn't find any stones. After the surgery is complete, I again help break down the room and move the patient.

12:05: Lunch! I am starving, especially since breakfast was over eight hours again. Our cafeteria is fairly small, but our salad bar is pretty good, so that's what I have every day. We meet up with the other resident and the PA student, and sit in the physician's lounge while everyone discusses the recent shark attacks (it is shark week after all!).

12:30: Third gall bladder removal

2:00: Fourth gall bladder removal

3:30: All patients are doing well post-operatively, and since all patients in the hospital are also doing well, the PA student and I are told to go home. We find out what the operations the next day are so we can read up on them ahead of time. Then it's the hour drive back home.

4:25: Guess who's excited to see me! :) We play outside for a little bit, and then go inside to change. I clean up a bit, get the mail, and start a load of laundry.

5:00: I've been working on this ask me anything post for a while now, so I continue looking through the 600+ answers from the survey to find the questions applicable to that post. On the side we have the Real Housewives of Beverly Hills (the best spin off, trust).

5:45: I hear CR pull up, so I go outside to greet him. We go into the garage to open our couch that was finally delivered today. We talk about what our days were like, interesting things we saw, and what we learned (like the true definition of diarrhea. Aren't we so cute? .....). It takes like 20 minutes to get the couch unwrapped, and I can't help but test it out. I can't wait to move it into the house!

6:15: We're starving, so we decide to walk down to the barbeque place that's just a few blocks away. We make it all of half a block when one of neighbors stops us to let us know it's about to rain. We chat for a few minutes, and just as we start walking back home (all three houses away), it starts to pour. Guess we're driving...

 6:35: Pulled pork, coleslaw, and a side salad. YUM.

7:45: After getting home and switching the laundry, I spend a little bit of time finishing up the post. Loft was having a great sale that day, so I picked out my favorite dresses to include. I'm so tempted to pick up this pretty printed dress that's majorly on sale, but I'm trying to be good right now!

8:15: I prefer showering in the morning, but I shower at night now during this rotation. I don't want to get up even earlier in the morning, and I don't want to go to bed with surgery smell on me.

 8:25: I find CR on our bed with the cat. We have been watching Orange is the New Black, and we only have a few episodes left in the season (anyone have recommendations on series to watch next?!).

9:05: It's officially my bed time, so I turn off the TV, throw one of these dark curtains over our nice white curtains (because it's still light outside...), and eventually fall asleep.

Day in Review
hours slept: 6
hours exercised: 0
meals cooked: 1
hours studied: 0
steps walked: 7452
patients seen on my own: 0

previous days in the life