absite as myth
I’ve been thinking: the surgery in-training exam is really like a recitation of legends, orally recounted histories, not too closely related to facts, that define our community.
The test runs through a long series of stories, which are so familiar to surgeons and surgeons-in-training, that we only have to mention a few words of the story, to have the whole thing immediately recognized and understood.
These are some of the legends: gallbladder cancer, incidentally discovered after lap chole, invading through the lamina propria (snap answer: resect a surrounding rim of normal liver tissue); projectile vomiting in a 4wk...
Source: Cut On The Dotted Line - February 2, 2010 Category: Surgery Authors: Dr. Alice Tags: medical education Source Type: blogs
discretion
I had to calm one of the medical students down the other day. We were in a crowded elevator, and he was carrying on the conversation we’d started before getting on, about what he’d liked about the surgery rotation so far.
“I got to see a craniotomy the other night on call,” he exclaimed. “They let me touch the brain! It was kind of squishy.”
In the middle of the elevator. Full of visitors. (Source: Cut On The Dotted Line)
Source: Cut On The Dotted Line - January 26, 2010 Category: Surgery Authors: Dr. Alice Tags: medical education Source Type: blogs
recognition
It’s kind of touching when patients and their families notice the hours we’re working.
The service I’m on right now is particularly opportune for this, since the attendings start operating so early, and demand such detailed knowledge of the patients by the residents, that the entire team (intern, resident, chief, couple medical students) has usually come through each patient’s room, severally and ensemble, by 6am every day. Which is certainly annoying, but also noticeable.
In the course of the day we’ll round with an attending. Then we all also come through around 5-6pm, as well as the intern ...
Source: Cut On The Dotted Line - January 16, 2010 Category: Surgery Authors: Dr. Alice Tags: patient relations Source Type: blogs
in review
I’m going to try not to comment on this too frequently, as I get to operate more. But:
I had a case the other night. I did most of it myself. Being as objective as I can manage, I think I did not do it too badly, perhaps even very well at some points, but overall I was certainly slower than the attending doing it all himself would have been.
Now, a few days later, the patient is struggling through the post-op period. Nothing frankly technical (no vascular bleeding, or suture lines falling apart) – but I can’t stop going over the case again and again, trying to decide, definitely, whether if I had tied tho...
Source: Cut On The Dotted Line - January 11, 2010 Category: Surgery Authors: Dr. Alice Tags: ethics in the OR surgery Source Type: blogs
baby steps
The last few months have seen me being allowed to operate far more than previously. My performance in the OR seems to consist of occasional stretches of competency, mixed in with a good many more episodes of apparently completely failing to grasp what I’m being told to do.
So I rather enjoyed the other day, when, after about six hours of operating with one particular attending, we came to a crucial and difficult step, deep in the abdomen, close to the aorta. She was just starting to try to explain the maneuver, when I had a sudden flash of insight, and, building on a couple of moves she’d been trying to teach m...
Source: Cut On The Dotted Line - January 8, 2010 Category: Surgery Authors: Dr. Alice Tags: in the OR Source Type: blogs
second chance
I admitted a patient from the ER one night over the holidays. The ER called with a CT scan showing diffuse pneumatosis, and the most obvious portal venous air I’ve seen so far. The patient himself looked far better than the scan, and was amazingly comfortable, considering that he had a heart rate of 140 and was already in acute renal failure. He was so comfortable that it was very difficult to persuade either my attending, or the patient, that he needed emergency surgery. (“Pain out of proportion to exam, Alice. You can’t tell me he has ischemic bowel and no pain.” I insisted, so we didn’t rea...
Source: Cut On The Dotted Line - January 7, 2010 Category: Surgery Authors: Dr. Alice Tags: death faith memorable patients Source Type: blogs
theory of relativity
My perspective on time in the hospital has certainly changed in the last two and a half years. I remember, even as recently as the end of my intern year, watching the clock intently as the end of a shift got closer, and being very antsy if something came up at the last minute to prevent me from leaving. I also used to spend a good deal of time pondering my days off for the month, and exactly when they fell, and how far apart they were.
I don’t pay as much attention to those specific times any more. I come in as early as I need to so that I can round on patients to my satisfaction. (To me, that means reviewing all the...
Source: Cut On The Dotted Line - January 7, 2010 Category: Surgery Authors: Dr. Alice Tags: residency Source Type: blogs
not just a test question
Steering back to safer, less political waters:
I’ve been having a peculiar experience lately. Of course I’ve grown inured to the embarrassment of concluding that a patient needs surgery, and making my case, and then being informed by the attending that I’m insane, there’s no such indication, and the patient is best left far outside the OR.
But recently, I’ve encountered the slightly more disconcerting phenomenon of being told by the chief resident that the patient doesn’t need surgery, adjusting my presentation when talking to the attending, and then being told by the attending that we s...
Source: Cut On The Dotted Line - January 2, 2010 Category: Surgery Authors: Dr. Alice Tags: surgery Source Type: blogs
the early results of Obamacare
I’ve been trying to avoid talking about health-care reform (or deform, if you want to be accurate) on here, because it makes me so angry that I’m virtually speechless. I’ve also stopped talking about politics with my liberal friends at work. I used to enjoy a friendly debate, but there’s nothing fun about the looming disaster.
I can’t not talk about this any more. I just opened a mass email to all the physicians at my hospital, informing us that, in addition to compazine (a very basic anti-nausea medicine; cheaper and more effective than zofran, and less sedating than phenergan; my go-to drug ...
Source: Cut On The Dotted Line - December 23, 2009 Category: Surgery Authors: Dr. Alice Tags: politics Source Type: blogs
teachers
It’s starting to dawn upon me that all the chiefs and attendings I’ve found very annoying or stressful have actually been teaching me a great deal. Most of them, because it was their personal demand for excellence and thoroughness which was irritating me; a very few, because their laziness was forcing me to take more responsibility for being the thorough member of the team.
Too bad that it usually takes me six months after a rotation to realize what any particular chief or attending taught me.
But I recognize now that my regard for getting some degree of social history; my attention to looking at all the availa...
Source: Cut On The Dotted Line - December 22, 2009 Category: Surgery Authors: Dr. Alice Tags: ER residency Source Type: blogs
