21 October 2010

Surgery Synopsis

Surgery is over. I enjoyed it, but I'm glad it's over.

I was on vascular surgery at Parkland. A typical week would start out at about 4:45 on Monday morning. I would pre-round on my patients and make a sheet for my residents and attending with all the vital signs of all our patients. Then we would round with the residents and then with the fellow. After rounding with the fellow, sometimes we had 15 minutes to grab breakfast and run to clinic.

Clinic was always chaotic. There were 6 students, 4 residents, 1 fellow, and 1 attending in clinic. The students saw patents, presented them to someone more qualified, and then wrote a note. It was interesting to follow up on patients that had previous surgeries and see how it looked to care for a patient that was a few weeks post op. I got to take out some staples and look at some fresh amputations.

I feel like we did a lot of that in vascular surgery. If we couldn't reestablish blood flow, we would cut someone's leg off. Sad, but I guess it's what has to happen.

I also got to look at how a pre-op history and physical exam works. I figured out all the "important" H&P questions that the attending really needs to make sure you ask and document: "Are you taking any ASA or blood thinners?" "Have you had recent chest pain/ trouble breathing?" Etc.

And I got REALLY proficient at finding someone's pulses, either with my fingers or with a Doppler, which is an ultrasound wave you can hear. I learned to differentiate between triphasic, biphasic, and monophasic pulses. I began to recognize the difference between arterial and venous problems. And the plan to treat people with those problems. I also got good at using the electronic medical records system. It took a while to figure out where everything was, and I had to ask a lot of questions, but eventually it became pretty easy.

After clinic on Monday, we would all eat lunch in the cafeteria with our attending doctor and he would lecture us on a vascular issue. I loved listening to him, because he was so knowledgeable and he would tell us everything and then let us ask questions.

Most other days we pre-rounded, rounded, and went to watch a surgery. Or went to watch a surgery get cancelled. I scrubbed in to 2 cases. I got to watch a few more from the OR, but with 3 students and 1 attending, it was hard to have enough to scrub in to.

Wednesdays were fun. We had lecture from 7 am to noon, then lunch. I got to work in small groups with med students for 2 sessions each morning and we discussed practice patients. I enjoyed getting to talk through patients. I felt like I learned a lot! I also got to work with Dr. McClellen and have tutorial sessions with him on Wednesday and Friday afternoons. We would each present a topic and then talk through it with our group. He had a lot of wisdom to share with us.

My fist surgery was lame. It was endovascular, so I got to watch them stick wires up a man's groin to his carotid artery. I didn't touch anything. It was neat to wear lead and watch the screen to see where the wires were going. I liked getting to read about a procedure before and then see it in action.

2nd scrub: intimidating. Still not sure exactly what to do. Or even really why scrubbing is SO important if we rinse our hands in non-sterile water and then put them inside of 2 layers of sterile gloves. It was a lot cooler. They cut the patient's whole stomach open and made 2 cuts in each groin. They let me stick my hand up one of the groin cuts into her abdomen. It was neat to feel the inside of someone! I liked getting to watch them cut and then sew in a graft to the aorta and then connect it to her femoral artery. My favorite part was watching the graft pulsate when they let blood flow through it! They let me staple the woman's abdomen. I need a bit more practice with staples before I'm good enough at it!

Coolest thing: Getting to be part of a patient care team. Being asked to change wound dressings and using that time to make sure the patient didn't have any questions and answering them when they did. Gettting to watch the patient's face when the resident "explained" something, and then going back to see the patient and spending time to actually make sure that they understood what the resident was talking about earlier and they were too scared to ask questions about.

I liked getting to work on a team and be a part of something. Working with Med students, doctors, nurses, PT and OT, I really got to see how a patient moved from a clinic appointment, to surgery, then to another clinic appointment where their problems were resolved.

I liked surgery, but I don't think it is what I want to do. The OR is too high stress. And So disconnected from patient contact. Most procedures your patient is asleep for!

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