Today was a pretty routine day in surgery ... never thought I'd be saying that!
I saw three hysterectomies (two laparoscopic, one vaginal), and they were all pretty unremarkable. One patient had some pretty serious fibroids, but that apple-peeler thing I talked about last week took care of them, though they did go through two blades! I also saw a D&C and endometrial ablation, which was pretty quick, but I got to be the first assist on that one, so that was cool! It didn't really mean much more than holding things out of the way while the doctor did the procedure, but it's always nice to be able to help.
Also, today I did some more suturing on one of the laparoscopic hysterectomy patients, and I did so well that I got a high five AND a fist bump from my preceptor! It's so cool when he gets excited about something I've done well. I think he likes seeing my progress almost as much as I do! :)
Tomorrow will be a short day in the clinic, which is good!
Wednesday, June 26, 2013
Friday, June 21, 2013
Surprise! C-Section!
Today was a great day! I got to see a C-section this morning, and I also had a really great day in the clinic. And, to top it off, tonight there were some fireworks in town that I watched with one of my new friends!
When I was driving into the clinic this morning, I felt my phone buzzing in my pocket, and noticed it was my preceptor. He told me that there was going to be a C-section this morning at 8:00 (it was about 7:45 at this point), and was I in scrubs? I wasn't, since I thought it was going to be just a regular day in the clinic, so he told me to get to the hospital as soon as possible, put on scrubs, and meet him in the OR. The patient had really low platelets, which was why she was having a C-section. After scrubbing in and putting on more protective gear than usual (including shoe covers that went up to my knees!), we got ready to start. And when I say "we," I really mean that the surgeons and nurses got ready, and I stood there and tried not to get in the way! I thought it was going to be a relatively calm procedure, but I was definitely wrong. Because the mother had to be under general anesthesia in this case, they were racing against the clock to get the baby out of the mother before her anesthesia medicine reached the baby. At 8:50am, the two doctors began slicing into the abdomen mercilessly, and my preceptor even had to rip through some tissue at one point! When they reached the uterus, they sliced through that too, and then popped the sac that holds the "water" (like when people say their water broke), which went everywhere. The whole thing was way more messy and bloody than I was expecting! At 8:52, the baby was out and had been handed off to the team of OB nurses and the pediatrician. After that, the doctors tied the patient's tubes with actual suture string - probably where the phrase comes from - and then sewed up probably 3-5 layers of tissue on their way out of the abdomen.
After that, we rushed back over to the clinic because my preceptor was already running a little behind in seeing his patients. The actual appointments today weren't anything too exciting - a bunch of prenatal visits and annuals - but I was doing really well at everything during those visits. I love when a patient is describing her symptoms, and I can come up with the diagnosis before my preceptor even says anything that would let me know what he's thinking in the moment. At this point, I feel like I have enough experience and have seen enough cases (and read enough!) to accurately diagnose at least 90% of what comes into the clinic. That's a good feeling! Also, I was doing really well at measuring fundal height and doing the Leopold maneuvers (feeling the belly and figuring out what parts of the baby are where), and also being able to find the fetal heartbeat quickly, so that was gratifying as well. Overall, I'm getting much more comfortable in the setting and starting to enjoy everything rather than just being a strange mixture of terrified and excited all the time.
Tonight, I met up with my new friend who's also living in the dorm, and we went to grab dinner in town. After that, she taught me how to play cribbage, which was really fun! Then, we walked downtown again and watched fireworks on a dock on the river. It was the perfect end to a really great week!
When I was driving into the clinic this morning, I felt my phone buzzing in my pocket, and noticed it was my preceptor. He told me that there was going to be a C-section this morning at 8:00 (it was about 7:45 at this point), and was I in scrubs? I wasn't, since I thought it was going to be just a regular day in the clinic, so he told me to get to the hospital as soon as possible, put on scrubs, and meet him in the OR. The patient had really low platelets, which was why she was having a C-section. After scrubbing in and putting on more protective gear than usual (including shoe covers that went up to my knees!), we got ready to start. And when I say "we," I really mean that the surgeons and nurses got ready, and I stood there and tried not to get in the way! I thought it was going to be a relatively calm procedure, but I was definitely wrong. Because the mother had to be under general anesthesia in this case, they were racing against the clock to get the baby out of the mother before her anesthesia medicine reached the baby. At 8:50am, the two doctors began slicing into the abdomen mercilessly, and my preceptor even had to rip through some tissue at one point! When they reached the uterus, they sliced through that too, and then popped the sac that holds the "water" (like when people say their water broke), which went everywhere. The whole thing was way more messy and bloody than I was expecting! At 8:52, the baby was out and had been handed off to the team of OB nurses and the pediatrician. After that, the doctors tied the patient's tubes with actual suture string - probably where the phrase comes from - and then sewed up probably 3-5 layers of tissue on their way out of the abdomen.
After that, we rushed back over to the clinic because my preceptor was already running a little behind in seeing his patients. The actual appointments today weren't anything too exciting - a bunch of prenatal visits and annuals - but I was doing really well at everything during those visits. I love when a patient is describing her symptoms, and I can come up with the diagnosis before my preceptor even says anything that would let me know what he's thinking in the moment. At this point, I feel like I have enough experience and have seen enough cases (and read enough!) to accurately diagnose at least 90% of what comes into the clinic. That's a good feeling! Also, I was doing really well at measuring fundal height and doing the Leopold maneuvers (feeling the belly and figuring out what parts of the baby are where), and also being able to find the fetal heartbeat quickly, so that was gratifying as well. Overall, I'm getting much more comfortable in the setting and starting to enjoy everything rather than just being a strange mixture of terrified and excited all the time.
Tonight, I met up with my new friend who's also living in the dorm, and we went to grab dinner in town. After that, she taught me how to play cribbage, which was really fun! Then, we walked downtown again and watched fireworks on a dock on the river. It was the perfect end to a really great week!
Wednesday, June 19, 2013
Another surgery Wednesday!
Sorry I haven't posted anything in a while, but the end of last week and beginning of this week was really uneventful. Mostly just routine visits - lots of annual exams and prenatal checkups. I'm getting much better at doing just about everything, though! Today was a cool day in surgery - I saw a tubal ligation that was done with this new-ish procedure that just involves putting little metal coils inside the fallopian tubes. Then, the tubes heal around the coils and block the tubes so fertilization can't happen! The procedure only took about 10 minutes, and it was cool because the doctor used a scope to see inside the uterus to place the coils, so that was interesting! Our next case was a more run-of-the-mill vaginal hysterectomy, and I got to hold the bladder retractor again. Thankfully, today I was standing so that I could use my right hand to hold the retractor instead of my left, so it wasn't as taxing as last week! The last surgery was a complicated one. It started out as just a regular laparoscopic supracervical hysterectomy, but once we were inside the abdomen we could see that there wer a ton of adhesions - meaning that the uterus was basically stuck to the abdominal wall. It took about an hour just to cut it free so they could start the actual procedure! There was also a lot of bleeding during the surgery. All in all, what should have been a 90-minute procedure ended up taking about three hours! The coolest part was the tool they used to take out the uterus at the end. I was wondering the whole time how they were going to do it - since the cervix was going to be left intact, and there were only four small incisions on the abdomen, I thought it would be pretty difficult to get a big uterus with multiple fibroids out. But there was this tool that basically carves the uterus into little finger-sized strips by spinning it around a blade, kind of like an apple corer. Then, the strips are sucked out through one of the holes in the abdomen! Pretty cool. After that, there was a delivery, so we went to go do that right after the hysterectomy patient was closed. The delivery was fairly normal, but the baby had aspirated some meconium during birth, and had to be monitored closely. When I left, the baby still wasn't 100% stable, but my preceptor seemed confident that he would make a full recovery.
Whew! It was a long day, but full of good experiences. It's also really great that my preceptor, along with the other doctor he works with and all the OR nurses, is really funny and nice. It definitely makes long, stressful surgeries easier to handle and more fun!
Whew! It was a long day, but full of good experiences. It's also really great that my preceptor, along with the other doctor he works with and all the OR nurses, is really funny and nice. It definitely makes long, stressful surgeries easier to handle and more fun!
Wednesday, June 12, 2013
Another day of surgery!
I think surgery day is my favorite day of the week. Even though I'm usually in the way and constantly worried about breaking the sterile field, it's really fun and a great experience. The hospital I'm in is pretty small, and they don't have any other students but me right now, so I get all the help and attention from the other doctors, nurses, and even the anesthesiologists! They all love showing me things, and they're very patient with me.
Today I saw a laparoscopic tubal ligation, and I got to drive the camera while my preceptor cut the tubes! I also got to practice suturing on a real person for the first time, which was intimidating because about four people were watching me. I did okay, but I was definitely shaky. Good thing the incisions were small and you can just use Steri-Strips to close them anyway! I also saw two vaginal hysterectomies, and I got to hold the bladder retractor both times. Holding the same strength and positioning for 30 minutes is not easy! My preceptor and the nurses said they were glad I was there, because normally one of them has to hold it. They were happy for a break, and I was happy for the chance to actually help and do something, so everybody wins! The other surgery I saw today was a LEEP, and that went really quickly. In fact, the whole day was over pretty fast! I'm currently on a break, but I have to go back to the clinic in about half an hour to see the patient with the infected C-section so we can change her dressing one more time. After that, though, I'm done for the day.
I really do think I like surgery, or at least assisting with surgery. I'm not sure I'd like to be the one actually cutting and making decisions, but I'm happy to watch and help! Guess it's a good thing I want to be a PA and not a doctor, then. :)
Today I saw a laparoscopic tubal ligation, and I got to drive the camera while my preceptor cut the tubes! I also got to practice suturing on a real person for the first time, which was intimidating because about four people were watching me. I did okay, but I was definitely shaky. Good thing the incisions were small and you can just use Steri-Strips to close them anyway! I also saw two vaginal hysterectomies, and I got to hold the bladder retractor both times. Holding the same strength and positioning for 30 minutes is not easy! My preceptor and the nurses said they were glad I was there, because normally one of them has to hold it. They were happy for a break, and I was happy for the chance to actually help and do something, so everybody wins! The other surgery I saw today was a LEEP, and that went really quickly. In fact, the whole day was over pretty fast! I'm currently on a break, but I have to go back to the clinic in about half an hour to see the patient with the infected C-section so we can change her dressing one more time. After that, though, I'm done for the day.
I really do think I like surgery, or at least assisting with surgery. I'm not sure I'd like to be the one actually cutting and making decisions, but I'm happy to watch and help! Guess it's a good thing I want to be a PA and not a doctor, then. :)
Monday, June 10, 2013
"I don't have a favorite song, or a favorite book that I read over and over, or a favorite game that I play ... what I love is what I do."
Today, I finally got around to asking my preceptor why he chose OB/GYN. His answer was simple: it's what he loves to do! I hope that someday I can find something that I love as much as he loves delivering babies and helping women. So far, I really like OB/GYN myself, but I wish I had the rotation a little later in my clinical year. Right now I feel overwhelmed by the concept of being on rotation, period, and I don't think I'll get to appreciate this specialty as much because I have nothing to compare it to. But, I do like it right now!
Today and Friday were just regular clinic days, nothing too spectacular. I've started going in on prenatal visits myself, which is nice because it makes me feel important and needed. Shadowing is great and everything, but I think I do best when I'm busy, so getting to do things makes me feel more involved and happier to be there! Plus, prenatal visits are easy and there's not much to mess up, so that's good. Also, today I changed the dressing on the patient with the infected C-section scar all by myself (with my preceptor's supervision, of course), and that was stressful. Obviously, it's painful for the patient for you to pull out the old packing material, clean the wound, and put in new packing material. But, it's necessary for the patient to feel better in the end, so even if the patient is groaning and crying you have to keep going, which kind of goes against your natural instincts. So that was stressful! But I did it, and bandaged her up again, and I'll do it all over again on Wednesday.
I'm also getting better at being more confident and forceful when it comes to exams. Last week, my preceptor would laugh at me for being too gentle when I was doing a pelvic exam or feeling a pregnant woman's abdomen. Now, I do it correctly and confidently, and he is proud!
Tomorrow is another clinic day, and Wednesday is surgery. This week I get to see a LEEP, as well as a laparoscopic tubal ligation. Pretty cool!
Today, I finally got around to asking my preceptor why he chose OB/GYN. His answer was simple: it's what he loves to do! I hope that someday I can find something that I love as much as he loves delivering babies and helping women. So far, I really like OB/GYN myself, but I wish I had the rotation a little later in my clinical year. Right now I feel overwhelmed by the concept of being on rotation, period, and I don't think I'll get to appreciate this specialty as much because I have nothing to compare it to. But, I do like it right now!
Today and Friday were just regular clinic days, nothing too spectacular. I've started going in on prenatal visits myself, which is nice because it makes me feel important and needed. Shadowing is great and everything, but I think I do best when I'm busy, so getting to do things makes me feel more involved and happier to be there! Plus, prenatal visits are easy and there's not much to mess up, so that's good. Also, today I changed the dressing on the patient with the infected C-section scar all by myself (with my preceptor's supervision, of course), and that was stressful. Obviously, it's painful for the patient for you to pull out the old packing material, clean the wound, and put in new packing material. But, it's necessary for the patient to feel better in the end, so even if the patient is groaning and crying you have to keep going, which kind of goes against your natural instincts. So that was stressful! But I did it, and bandaged her up again, and I'll do it all over again on Wednesday.
I'm also getting better at being more confident and forceful when it comes to exams. Last week, my preceptor would laugh at me for being too gentle when I was doing a pelvic exam or feeling a pregnant woman's abdomen. Now, I do it correctly and confidently, and he is proud!
Tomorrow is another clinic day, and Wednesday is surgery. This week I get to see a LEEP, as well as a laparoscopic tubal ligation. Pretty cool!
Thursday, June 6, 2013
Deliveries, surgeries, and more deliveries
It's been a busy couple of days! Let's see, where to start...
On Tuesday, I saw my first delivery (and my second)! The actual delivery went way faster than I thought it would, and even though it was pretty bloody I managed not to pass out, throw up, or get emotional! My preceptor let me clamp the cord so the dad could cut it, and then he showed me how to deliver the placenta. Pretty incredible! During the second delivery, he let me deliver the placenta on my own. That one actually happened at around 6pm, after we had all left the office for the day, but my preceptor called me after he got the call about the delivery and I went in to see it and help! The rest of our patients on Tuesday were mostly prenatal visits, which are pretty straightforward if the mom doesn't have any problems to report.
Wednesday was surgery day! I got to the hospital at 7:15am, ready to scrub in on the first surgery of the day at 7:45. When we learned how to scrub in at school, the whole process took 10 minutes and was very thorough... but I am quickly learning that real life is nothing like the textbooks! I had about a five-minute head start on my preceptor at the scrub sink, and he was done scrubbing in before me! The surgeries he did yesterday were two laparoscopic hysterectomies, and one TVT-O placement (basically a sling to hold the ureter in place for people who have stress urinary incontinence). The hysterectomies were really cool, because the way they do it is to actually put gas in the abdomen to blow it up like a balloon so there's room for their instruments. Then, when they put the camera in, the abdomen looks just like a textbook picture! For some reason I thought it would be more messy-looking or something, or more like the insides of a cadaver, but it looked just like everything I had seen in books. For the first one, I just watched, but for the second one I got to hold the uterus in place for a little while so the doctors could cut around it, and then help suture and put steri-strips on at the end. During the TVT-O, I mostly just watched, but also held some things in place for my preceptor while he did all the work. There was also a delivery that day, so we were pretty busy! The delivery took longer than the ones the day before, because this was the first birth for the mom, but it went well and I got to deliver the placenta by myself again. When I got home at 4:30, it felt like I had been to war! I didn't have anything to eat or drink all day, and was standing pretty much the entire day as well. I think I fell asleep at like 6pm that night!
Today was a more routine clinic day, lots of prenatal visits and a few consults for other problems. My preceptor has started to send me in on my own for prenatal visits, and I feel pretty comfortable doing everything he wants me to do for them. Our last patient of the day had had a C-section about three weeks ago, and was coming in because her incision site hurt really badly and was red. She had a pretty serious infection, and we ended up draining it and packing the wound. At first, it seemed like there would just be a little pus, but then my preceptor started pressing along the incision site and more and more kept coming! It smelled pretty terrible and there was a lot of it ... about 200 mL, which was the most my preceptor said he had ever seen in his 20-year career. But the worst part was when he was packing the wound later, because he had to stick the packing material deep into the wound with a Q-tip, and it was pretty gross. But the patient felt so much better afterward, even though she was in pain while we were draining it. So that was rewarding! Sorry if that was too gross of a description :)
So, I'm having a great week! Tomorrow is another clinic day, so it should be relatively calm. I'm excited for the weekend so I can explore the town where I'm staying!
On Tuesday, I saw my first delivery (and my second)! The actual delivery went way faster than I thought it would, and even though it was pretty bloody I managed not to pass out, throw up, or get emotional! My preceptor let me clamp the cord so the dad could cut it, and then he showed me how to deliver the placenta. Pretty incredible! During the second delivery, he let me deliver the placenta on my own. That one actually happened at around 6pm, after we had all left the office for the day, but my preceptor called me after he got the call about the delivery and I went in to see it and help! The rest of our patients on Tuesday were mostly prenatal visits, which are pretty straightforward if the mom doesn't have any problems to report.
Wednesday was surgery day! I got to the hospital at 7:15am, ready to scrub in on the first surgery of the day at 7:45. When we learned how to scrub in at school, the whole process took 10 minutes and was very thorough... but I am quickly learning that real life is nothing like the textbooks! I had about a five-minute head start on my preceptor at the scrub sink, and he was done scrubbing in before me! The surgeries he did yesterday were two laparoscopic hysterectomies, and one TVT-O placement (basically a sling to hold the ureter in place for people who have stress urinary incontinence). The hysterectomies were really cool, because the way they do it is to actually put gas in the abdomen to blow it up like a balloon so there's room for their instruments. Then, when they put the camera in, the abdomen looks just like a textbook picture! For some reason I thought it would be more messy-looking or something, or more like the insides of a cadaver, but it looked just like everything I had seen in books. For the first one, I just watched, but for the second one I got to hold the uterus in place for a little while so the doctors could cut around it, and then help suture and put steri-strips on at the end. During the TVT-O, I mostly just watched, but also held some things in place for my preceptor while he did all the work. There was also a delivery that day, so we were pretty busy! The delivery took longer than the ones the day before, because this was the first birth for the mom, but it went well and I got to deliver the placenta by myself again. When I got home at 4:30, it felt like I had been to war! I didn't have anything to eat or drink all day, and was standing pretty much the entire day as well. I think I fell asleep at like 6pm that night!
Today was a more routine clinic day, lots of prenatal visits and a few consults for other problems. My preceptor has started to send me in on my own for prenatal visits, and I feel pretty comfortable doing everything he wants me to do for them. Our last patient of the day had had a C-section about three weeks ago, and was coming in because her incision site hurt really badly and was red. She had a pretty serious infection, and we ended up draining it and packing the wound. At first, it seemed like there would just be a little pus, but then my preceptor started pressing along the incision site and more and more kept coming! It smelled pretty terrible and there was a lot of it ... about 200 mL, which was the most my preceptor said he had ever seen in his 20-year career. But the worst part was when he was packing the wound later, because he had to stick the packing material deep into the wound with a Q-tip, and it was pretty gross. But the patient felt so much better afterward, even though she was in pain while we were draining it. So that was rewarding! Sorry if that was too gross of a description :)
So, I'm having a great week! Tomorrow is another clinic day, so it should be relatively calm. I'm excited for the weekend so I can explore the town where I'm staying!
Monday, June 3, 2013
The First Day!
Whew! My first day was a long one, or at least it felt that way. I was only in the clinic from 8 until about 4:30, so it was a pretty normal day, but I was so tired and nervous (and hungry) that it felt much longer. But, it was really interesting!
My actual preceptor wasn't in the office today, so I was with the other doctor in the practice, and she was really great! Since it was my first day, I mainly followed her around during all of her visits. I did, however, get to listen to the heart and lungs on two patients, and also work the ultrasound wand on another. I was also able to feel a breast lump that was most likely a cyst. But even though there wasn't a lot of hands-on stuff for me today, I still got to see a lot.
Most of the appointments were for prenatal visits at varying stages, so I got to see a lot of pregnant people at various stages in their pregnancies. Honestly, I wouldn't have thought that this many people in rural, coastal Maine would be pregnant! It was really interesting to me, as someone who hasn't been pregnant, to hear what they had to say about what they were experiencing and how their pregnancies were progressing. Quite a few of the patients were even substantially younger than me and were on their second or third child, and I was amazed at how calm they were about everything and how mature they seemed. I got to do an ultrasound on one patient, and it was amazing! I had never seen one before, and it was really cool to see the baby's little face and fingers in there!
Other visits I saw included a woman with a breast lump (turned out to be just a cyst), and two women who were looking to have their tubes tied. Nothing too exciting or earth-shattering there, but still interesting. Tomorrow I'm going to see a delivery! A woman came in today with PPROM, so they are going to induce her tomorrow morning, I think. So ... that will be interesting! I'm definitely glad I have a little bit of a heads up - at least I know that I'm going to see a delivery tomorrow, so I can prepare and it won't be a surprise. I'm excited!
My actual preceptor wasn't in the office today, so I was with the other doctor in the practice, and she was really great! Since it was my first day, I mainly followed her around during all of her visits. I did, however, get to listen to the heart and lungs on two patients, and also work the ultrasound wand on another. I was also able to feel a breast lump that was most likely a cyst. But even though there wasn't a lot of hands-on stuff for me today, I still got to see a lot.
Most of the appointments were for prenatal visits at varying stages, so I got to see a lot of pregnant people at various stages in their pregnancies. Honestly, I wouldn't have thought that this many people in rural, coastal Maine would be pregnant! It was really interesting to me, as someone who hasn't been pregnant, to hear what they had to say about what they were experiencing and how their pregnancies were progressing. Quite a few of the patients were even substantially younger than me and were on their second or third child, and I was amazed at how calm they were about everything and how mature they seemed. I got to do an ultrasound on one patient, and it was amazing! I had never seen one before, and it was really cool to see the baby's little face and fingers in there!
Other visits I saw included a woman with a breast lump (turned out to be just a cyst), and two women who were looking to have their tubes tied. Nothing too exciting or earth-shattering there, but still interesting. Tomorrow I'm going to see a delivery! A woman came in today with PPROM, so they are going to induce her tomorrow morning, I think. So ... that will be interesting! I'm definitely glad I have a little bit of a heads up - at least I know that I'm going to see a delivery tomorrow, so I can prepare and it won't be a surprise. I'm excited!
Sunday, June 2, 2013
Anticipation!
Hi everyone! I arrived in my first location today, and even though I'm pretty tired and want to get some rest before my first day tomorrow, I thought I should write a short post.
I'm Kristen, and I'm a second-year PA student. I'm starting my clinical rotations tomorrow (!) and wanted to chronicle my journeys as a way to keep a record for myself, my friends and family, and any first-year PA students or aspiring PA students out there. The first year of PA school was tough, and I'm glad it's over, even though I miss all my friends from school. But, I'm glad that I get to enjoy traveling the country and actually practicing the things I spent almost a year learning about!
My first rotation is OB/GYN in coastal Maine. I drove up here from home (in NJ) over the course of two days, and had a really nice trip! I'm in a very small, very rural town that is extremely remote. I don't want to say the name of the town on here for HIPAA reasons, but it's really beautiful!
Anyway, I don't have much to say except I'm nervous, and excited, and don't know what to expect at all! I will definitely post more tomorrow with details about my first day in clinic.
Here goes nothing!
I'm Kristen, and I'm a second-year PA student. I'm starting my clinical rotations tomorrow (!) and wanted to chronicle my journeys as a way to keep a record for myself, my friends and family, and any first-year PA students or aspiring PA students out there. The first year of PA school was tough, and I'm glad it's over, even though I miss all my friends from school. But, I'm glad that I get to enjoy traveling the country and actually practicing the things I spent almost a year learning about!
My first rotation is OB/GYN in coastal Maine. I drove up here from home (in NJ) over the course of two days, and had a really nice trip! I'm in a very small, very rural town that is extremely remote. I don't want to say the name of the town on here for HIPAA reasons, but it's really beautiful!
Anyway, I don't have much to say except I'm nervous, and excited, and don't know what to expect at all! I will definitely post more tomorrow with details about my first day in clinic.
Here goes nothing!
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