Another busy week! Well, the beginning of the week wasn't too bad, but yesterday and today were pretty busy clinic days. Clinic at this rotation is a little more intense than at my last rotation, because in-office procedures are way more common when you go to see a general surgeon. Today, for example, I saw a punch biopsy of a skin cancer, an incision & drainage of an abscess on someone's leg, and a breast biopsy, as well as removal of some venous catheters used for dialysis. Plus, we did another laparoscopic cholecystectomy this morning, and had a bunch of other regular clinic visits, like consults for surgery and follow-up visits from previous surgeries.
I've decided that I really like being sent down to the ER to take a history and do a physical before my preceptor gets down there to assess the situation herself. It's really cool to not know anything about a patient (except that a consult with my preceptor was requested) and just go into their room, talk to them, and figure out what's going on. Today, I saw a patient with an abscess, and even though they're pretty obvious to diagnose, it was still cool! Then, my preceptor came down and did the incision and drainage. Pretty cool!
I really like the surgery setting because you get to see a good mixture of things - clinic visits, ER consults, and actual time in the OR. Today I got a mixture of all three of those things in the same day! It would definitely keep things interesting as a career. However, I'm not really that crazy about all the gastrointestinal stuff and diseases... it's just not that interesting to me. I mean, I like it, but I'm not super excited about it like I think I was about women's health things. As of right now, if I had to choose between general surgery and OB/GYN, I think I would choose OB/GYN because you still get to see surgery, and the cases are more interesting (to me). But, this rotation is really great and I'm enjoying every day!
Thursday, July 25, 2013
Friday, July 19, 2013
What a week!
Well, this rotation makes the longest days at my last rotation look like a joke! Every day this week has been at least 10 hours in the hospital, typically 11 and sometimes 12. It's nonstop - there's always something to do, even over the "lunch break." But ... I love it! The surgeries are so interesting and always different, and my preceptor and the other surgeons that work with her are really nice. I think she was just really stressed on Monday because it was her big operating day, plus she had to deal with some paperwork issues for me (on the hospital's end, nothing that was my fault!). She and her surgery partner have been really patient with me and have taught me a lot about suturing, knot-tying, and taking good patient histories.
One thing I really like about being in the hospital every day is that you get to see your same patients a couple times each day, and monitor their progress. For example: I got to check up on two of the colon resection patients from Monday each day this week. One of them recovered really well and was discharged yesterday, and the other is having a little more trouble and is still in the hospital. That patient is doing fine, but they just didn't bounce back as quickly as the other. It's nice to keep track of them and watch them recover, especially after seeing them before the surgery and being there during the surgery.
I've also been sent to see patients by myself a bunch of times this week, and I really like that. One person came into the ER with acute abdominal pain, and I got to take their history and do a physical so I could report to my preceptor in case the patient needed surgery. A resident from the ER had already seen them and taken their history, but I didn't read their note before I went down there, but I ended up asking the right questions and looking for the right things on physical exam and I correctly diagnosed them!! It's pretty exciting when textbooks and practice on classmates pays off. :)
Anyway, I am exhausted and am really looking forward to this weekend so I can relax and spend some time with my boyfriend!
One thing I really like about being in the hospital every day is that you get to see your same patients a couple times each day, and monitor their progress. For example: I got to check up on two of the colon resection patients from Monday each day this week. One of them recovered really well and was discharged yesterday, and the other is having a little more trouble and is still in the hospital. That patient is doing fine, but they just didn't bounce back as quickly as the other. It's nice to keep track of them and watch them recover, especially after seeing them before the surgery and being there during the surgery.
I've also been sent to see patients by myself a bunch of times this week, and I really like that. One person came into the ER with acute abdominal pain, and I got to take their history and do a physical so I could report to my preceptor in case the patient needed surgery. A resident from the ER had already seen them and taken their history, but I didn't read their note before I went down there, but I ended up asking the right questions and looking for the right things on physical exam and I correctly diagnosed them!! It's pretty exciting when textbooks and practice on classmates pays off. :)
Anyway, I am exhausted and am really looking forward to this weekend so I can relax and spend some time with my boyfriend!
Monday, July 15, 2013
On to the next rotation!
Sorry it's been so long since I posted anything... last week was full of end-of-rotation exams, packing, and traveling, so I didn't have much of a chance to write anything!
My last few days in Maine were uneventful but very nice. Monday and Tuesday were a lot of typical clinic visits (prenatal and annuals), and Wednesday was a light surgery day. However, I did get to see (and assist on) a ruptured ectopic pregnancy, which was pretty cool. I got to drive the camera and do some suturing!
Yesterday, I flew out to Kansas, where I am for my general surgery rotation. Today was my first day, and I think it went pretty well! My preceptor seems nice, but very intense. Everything she does is at lightning speed, and she wants everyone around her to be on the same wavelength. It was intimidating at first, but to be honest, it reminds me of how I'll be someday when I've been at a job for a while and am comfortable where I'm working. The rest of the staff at my new hospital is also very nice and patient with me, though they don't seem as eager to teach as the staff at my last hospital. Today was a long day - 11 hours - but luckily I recently bought compression socks so my legs and feet didn't get too sore!
Anyway, today I got to scrub in on four surgeries - two laparoscopic cholecystectomies, one laparoscopic colon resection, and one portacath insertion. I did sutures for all of them, and drove the camera for all of the laparoscopic procedures. I also helped to write post-op notes for all of these patients. This rotation is definitely different material from my last one - I really need to review my abdominal anatomy and disorders!
The surgeries were really cool! The colon resections were probably the craziest. They start out laparoscopically to separate the colon from the anterior abdominal wall, then open up to take out the big piece of colon they're removing. The way they reattach the remaining colon pieces together is pretty wild ... it's basically this big stapler that goes all the way around the bowel, then cuts it and staples it at the same time. They do that on both ends, and then somehow magically do one more between the two pieces and it joins back together as one tube. I'm still not entirely sure how that works ... something to watch on YouTube! But what I do know is that the patient ends up with a functional colon at the end of it, which is pretty amazing.
The cholecystectomies were also pretty cool, and pretty quick! Basically, after the four laparoscopic incisions are made, the gallbladder is just dissected away from the liver, the cystic artery and cystic duct are cut, and then the gallbladder is taken out in this little bag through one of the port holes! Then you just close the incisions. The portacath placement was interesting, and also really quick. It's for patients who are going to get chemo, and it's basically an easy way to get continuous access to a vein so the patient doesn't have to have an IV placed every time they go for treatment.
So, that's all for today! Tomorrow I'm seeing a robotic surgery of some kind, which will be a first for me, and Wednesday is a busy clinic day. Based on those facts alone, I'm thinking that the next time I write something will be Wednesday!
My last few days in Maine were uneventful but very nice. Monday and Tuesday were a lot of typical clinic visits (prenatal and annuals), and Wednesday was a light surgery day. However, I did get to see (and assist on) a ruptured ectopic pregnancy, which was pretty cool. I got to drive the camera and do some suturing!
Yesterday, I flew out to Kansas, where I am for my general surgery rotation. Today was my first day, and I think it went pretty well! My preceptor seems nice, but very intense. Everything she does is at lightning speed, and she wants everyone around her to be on the same wavelength. It was intimidating at first, but to be honest, it reminds me of how I'll be someday when I've been at a job for a while and am comfortable where I'm working. The rest of the staff at my new hospital is also very nice and patient with me, though they don't seem as eager to teach as the staff at my last hospital. Today was a long day - 11 hours - but luckily I recently bought compression socks so my legs and feet didn't get too sore!
Anyway, today I got to scrub in on four surgeries - two laparoscopic cholecystectomies, one laparoscopic colon resection, and one portacath insertion. I did sutures for all of them, and drove the camera for all of the laparoscopic procedures. I also helped to write post-op notes for all of these patients. This rotation is definitely different material from my last one - I really need to review my abdominal anatomy and disorders!
The surgeries were really cool! The colon resections were probably the craziest. They start out laparoscopically to separate the colon from the anterior abdominal wall, then open up to take out the big piece of colon they're removing. The way they reattach the remaining colon pieces together is pretty wild ... it's basically this big stapler that goes all the way around the bowel, then cuts it and staples it at the same time. They do that on both ends, and then somehow magically do one more between the two pieces and it joins back together as one tube. I'm still not entirely sure how that works ... something to watch on YouTube! But what I do know is that the patient ends up with a functional colon at the end of it, which is pretty amazing.
The cholecystectomies were also pretty cool, and pretty quick! Basically, after the four laparoscopic incisions are made, the gallbladder is just dissected away from the liver, the cystic artery and cystic duct are cut, and then the gallbladder is taken out in this little bag through one of the port holes! Then you just close the incisions. The portacath placement was interesting, and also really quick. It's for patients who are going to get chemo, and it's basically an easy way to get continuous access to a vein so the patient doesn't have to have an IV placed every time they go for treatment.
So, that's all for today! Tomorrow I'm seeing a robotic surgery of some kind, which will be a first for me, and Wednesday is a busy clinic day. Based on those facts alone, I'm thinking that the next time I write something will be Wednesday!
Wednesday, July 3, 2013
A crazy day... well, week!
This week has been really busy and stressful so far! Actually, Monday wasn't so bad, but I did see two deliveries that day, so that was cool! But we also had a ton of patients in the clinic, so it was a lot of running back and forth, and I was there for about nine hours of continuous work. Our clinic patients weren't anything very exciting, lots of annuals and prenatal visits as usual, so at least that was nice. The two deliveries were uneventful; both went really quickly and had no complications.
Yesterday, I got to the clinic and saw, much to my surprise (and, as I later found out, everyone else's), another student there! She is a nurse practitioner student who is almost done with her rotations, and she also previously was a nurse for many, many years. At first, I was a little annoyed that she was there, even though she was really nice, because she has way more experience than me and was stealing my thunder at "my" rotation! I quickly realized that I was just re-experiencing the older-sibling syndrome, however, and got over myself pretty quickly after that. It was actually nice to hear about some of her experiences from her previous job and her previous rotations, and we also traded names of helpful textbooks and pocket guides like true students do! Unfortunately, I think she rubbed my preceptor and his partner the wrong way a little bit, because they seemed annoyed by her presence (and the fact that she wouldn't stop talking during surgery! That's a big no-no for a student!!). Apparently, her program hadn't told them she was coming on that particular day, and they thought she wouldn't be there until after I was gone. Having two students in an already small office can get crowded, so I understand their frustration. We also had a surgery yesterday afternoon, which was strange for a Tuesday, and that was uneventful as well - a supracervical laparoscopic hysterectomy. As usual, I got to scrub in and hold things here and there, and close one of the incisions at the end.
Today was insane! We started out with a C-section, and that was really cool because I've been seeing the patient every week when she's come in for her regular visits, so I knew her and had seen her in the office four times already. It was really cool to see even a small fraction of the full-circle process! The C-section went well, and I got to scrub in and was placed in charge of sucking up all the blood (very glamorous). After that, we had a vaginal hysterectomy, and the NP student scrubbed in on that one (and had to hold the bladder retractor for 20 minutes, so I consider myself lucky for that!) while I watched. The next one was another supracervical laparoscopic hysterectomy with left salpingo-oophorectomy, and while the surgery itself was a pretty routine procedure, the patient made it difficult. She was morbidly obese and had severe diabetes, and her blood glucose was through the roof on her pre-op labs, which is never good. Also, because she weighed so much, anesthesia was very difficult, especially because the surgeons need the patient in Trendelenburg (head tilted down), which compresses the lungs even more, to get the bowels out of the way during the surgery. It was very complicated, and the two doctors were very stressed during the entire procedure. After that was all over (and I sutured two of the four incisions that were made), I was paged to OB for a delivery!
Originally, my preceptor had planned to let me do the delivery on my own while he watched. That's one of my goals for this rotation that has yet to be accomplished. So, I was really looking forward to it, even though I knew that this particular patient had a worrisome history with all of her prior pregnancies and this one, so I wondered why my preceptor thought I should be the one doing it. Anyway, I checked her and thought she was fully dilated because I could feel the head, and she started pushing. After a few minutes, though, the OB nurses weren't seeing the fetal heart tracing anymore, and that's when the panic started. Of course, not seeing evidence of the baby's heartbeat is scary. So, they put two monitors on the baby's scalp through the vagina, and then they were able to see the heart rate again. But then, they started seeing decelerations of the baby's heart rate, which is not good either. At that point, my preceptor was worried enough that he decided we had to do a C-section, stat. So everyone springs to action, calling the OR and trying to get everything set up. Meanwhile, the patient is screaming and moaning in pain, and she's even having pain between contractions, which is not normal. Luckily the husband kept calm, but he was very pale! And then, once everyone was there and ready to wheel her away to the OR, she said she needed to push right then! My preceptor checked her and said that she was actually ready for a vaginal delivery, and she could do it right then. So only about five minutes later, the baby was out! But the trouble didn't end there ... the placenta didn't come out fast enough because it was attached really securely to the uterine wall, and the cord wasn't attached to the placenta very well either, so pulling the cord to get the placenta out was out of the question. My preceptor ended up having to go in vaginally and manually detach the placenta and pull it out in two big, bloody pieces. It was a very stressful, very bloody delivery, but luckily both mom and baby came out okay.
And, after doing all the cleaning up and paperwork, my preceptor got us both ice cream. He said he needed it after such a long and crazy day!
Thankfully, we have tomorrow off. And another delivery should happen on Friday, so hopefully I will get to run the delivery myself! :)
Yesterday, I got to the clinic and saw, much to my surprise (and, as I later found out, everyone else's), another student there! She is a nurse practitioner student who is almost done with her rotations, and she also previously was a nurse for many, many years. At first, I was a little annoyed that she was there, even though she was really nice, because she has way more experience than me and was stealing my thunder at "my" rotation! I quickly realized that I was just re-experiencing the older-sibling syndrome, however, and got over myself pretty quickly after that. It was actually nice to hear about some of her experiences from her previous job and her previous rotations, and we also traded names of helpful textbooks and pocket guides like true students do! Unfortunately, I think she rubbed my preceptor and his partner the wrong way a little bit, because they seemed annoyed by her presence (and the fact that she wouldn't stop talking during surgery! That's a big no-no for a student!!). Apparently, her program hadn't told them she was coming on that particular day, and they thought she wouldn't be there until after I was gone. Having two students in an already small office can get crowded, so I understand their frustration. We also had a surgery yesterday afternoon, which was strange for a Tuesday, and that was uneventful as well - a supracervical laparoscopic hysterectomy. As usual, I got to scrub in and hold things here and there, and close one of the incisions at the end.
Today was insane! We started out with a C-section, and that was really cool because I've been seeing the patient every week when she's come in for her regular visits, so I knew her and had seen her in the office four times already. It was really cool to see even a small fraction of the full-circle process! The C-section went well, and I got to scrub in and was placed in charge of sucking up all the blood (very glamorous). After that, we had a vaginal hysterectomy, and the NP student scrubbed in on that one (and had to hold the bladder retractor for 20 minutes, so I consider myself lucky for that!) while I watched. The next one was another supracervical laparoscopic hysterectomy with left salpingo-oophorectomy, and while the surgery itself was a pretty routine procedure, the patient made it difficult. She was morbidly obese and had severe diabetes, and her blood glucose was through the roof on her pre-op labs, which is never good. Also, because she weighed so much, anesthesia was very difficult, especially because the surgeons need the patient in Trendelenburg (head tilted down), which compresses the lungs even more, to get the bowels out of the way during the surgery. It was very complicated, and the two doctors were very stressed during the entire procedure. After that was all over (and I sutured two of the four incisions that were made), I was paged to OB for a delivery!
Originally, my preceptor had planned to let me do the delivery on my own while he watched. That's one of my goals for this rotation that has yet to be accomplished. So, I was really looking forward to it, even though I knew that this particular patient had a worrisome history with all of her prior pregnancies and this one, so I wondered why my preceptor thought I should be the one doing it. Anyway, I checked her and thought she was fully dilated because I could feel the head, and she started pushing. After a few minutes, though, the OB nurses weren't seeing the fetal heart tracing anymore, and that's when the panic started. Of course, not seeing evidence of the baby's heartbeat is scary. So, they put two monitors on the baby's scalp through the vagina, and then they were able to see the heart rate again. But then, they started seeing decelerations of the baby's heart rate, which is not good either. At that point, my preceptor was worried enough that he decided we had to do a C-section, stat. So everyone springs to action, calling the OR and trying to get everything set up. Meanwhile, the patient is screaming and moaning in pain, and she's even having pain between contractions, which is not normal. Luckily the husband kept calm, but he was very pale! And then, once everyone was there and ready to wheel her away to the OR, she said she needed to push right then! My preceptor checked her and said that she was actually ready for a vaginal delivery, and she could do it right then. So only about five minutes later, the baby was out! But the trouble didn't end there ... the placenta didn't come out fast enough because it was attached really securely to the uterine wall, and the cord wasn't attached to the placenta very well either, so pulling the cord to get the placenta out was out of the question. My preceptor ended up having to go in vaginally and manually detach the placenta and pull it out in two big, bloody pieces. It was a very stressful, very bloody delivery, but luckily both mom and baby came out okay.
And, after doing all the cleaning up and paperwork, my preceptor got us both ice cream. He said he needed it after such a long and crazy day!
Thankfully, we have tomorrow off. And another delivery should happen on Friday, so hopefully I will get to run the delivery myself! :)
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