I've been meaning to post this but I always forget!
So for the past year I've kept a little notebook of thoughts/quotes/ideas/tricks that I learn on each rotation. I write down things, not really notes, but things that I learn from and go back to. Whether its a new enema recipe that I hear an old doc talk about that works every time for ileus or constipation(yes this is cool to me), or a moment that I really don't want to forget, or just some funny quotes from patients, I write it down because I want to look back years from now and hopefully bring back some humility. I want to know that even if i gear towards being a "know it all" doc or even somewhat cynical, i still can remind myself that I was not so savy once and to not lose sight of the little things that really matter and where I really started. Ok so anyway, this post is just to share some of those quotes that i wrote down....
In the ER:
Chief complaint- testicular pain/infection
Pt with testicular abscess: "Doc I'm pretty sure one of my hoe's gave me the shit!"
Me: "We're talking about your testicle right?"
Chief complaint- possible small bowel obstruction
Me: "Do you have any history of high blood sugar or do you take insulin?"
Pt who is barely awake: "no, i've never been sick"
Pt's brother: " She's been great, her sugar was a solid 379 this morning, like it always is"
Me: "........."
Chief complaint- rectal bleeding
Me: "has this ever happened to you before?"
Pt who is clearly is too high to remain awake: "oh no, i'm very healthy, not one health problem"
Me: "hmm, what color was the blood?"
Pt, awake again: "oh here, i saved a clot for you so you could see it!!" [shoves tissue with blood clot in my face]
Me: [trying not to vomit] "that's ok, i really don't need to see it....."
[I stepped out after doing her physical and read in her chart that she has HEP C, she's MRSA+, and positive for every illicit drug on the planet almost. Nope, not one health problem!!]
On the Med Surg Floor:
Chief complaint: leg abscess
Pt who made it through the ER fast because she was demanding surgery on her leg abscess: "Hey doc i just need you guys to go in and drain my site, it's infected again, and it's my only site left"
Chief resident: "Site? you mean your shin?"
Pt: "yea if you don't do it tonight I'll go through withdrawals again, that's how I wound up in the ER, and I really don't like shooting up in my neck"
Chief resident: "ok well thanks for your honesty!"
S/P diverting loop colostomy
Me: "how are you doing this morning? how is that colostomy coming along?"
Pt with Stage IV colon cancer: "well, if i have to have to wake up to talk to people about my shit at 5am, I'd rather it be with pretty girls like you, at least I know if this doesn't scare you away, I still have hope"
Me: "It takes more than some shit in a bag to scare me away..."
Pt: "well I've got a lot of shit..."
[he was my favorite patient] :-)
S/P perineal reconstruction with abdominal flap and total proctocolectomy aka a huge operation and she almost died
Pt, 3 days out of surgery: "I'm going to be fine, don't worry"
Me [almost in tears that she is comforting me, came to tell her it was my last day of the rotation and I wouldn't see her again]: "It's my last day with you, but you have the best doctors taking care of you and you're going to do great"
Pt: "thank you for taking care of me, never give up, I love you"
Me: [balling my eyes out like an idiot]
Presentation in weekly Morbidity and Mortality conference [ this is where interns and residents present cases that had a negative outcome due to a preventable reason and they get torn a new one by the attendings, very scary]
Dr. O: [presents a case about a pt who had a tear in his esophagus repaired, and then had to return to the ED because the repair failed and tore open again] "the failure of the repair was due to the patients diet immediately post operatively"
Dr. G (an intern, not the sharpest tool in the shed): "actually, It wasn't Dr. O's fault, it was mine. I gave the pt a sandwich the following morning and asked him if it hurt. He said no, so I thought it was fine."
Attending Physicians: [first silence....then the lions unleashed and attacked poor Dr. G]
Dr. G: "...but it wasn't the whole sandwich, he just had a couple bites!!!"
*note to everyone- if you have a hole in your esophagus and then have it surgically repaired...DON'T EAT A SANDWICH THE NEXT MORNING!!!
*note to self- do not yell back at your attendings when they are yelling at you during M&M...they WILL kill you. And if they don't, your fellow residents will.
So those are just a few of the quotes/moments from my rotation that I wrote down. It wore me out, made me cry, made me feel like I was dumber than a pre-schooler at times, and made me feel stronger than I ever imagined other times. It really is crazy how far we've come but even more crazy is how much more ground we still have to cover. I don't think it ever ends. Actually, I hope the learning and pushing limits never ends. Oh yea, and saving lives is pretty dang cool too...
My ramblings about this crazy journey we call life...
Thursday, December 31, 2009
Wednesday, December 9, 2009
I look at people's butts before 5am...
So it's been a while since I've written anything in my blog. I've been really busy! General Surgery at Maricopa Medical Center in downtown Phoenix takes up about 16 out of my 24 hrs in the day. Although I have to wake up at 2:45AM every day, drag myself out of bed, smell cauterized flesh and colostomy bags before breakfast, endure heartburn from endless coffee and no food until about 3pm...i'm loving the rotation! At first I was really unsure if I would enjoy it at all because I really didn't think I would enjoy surgery. I'm always cold, i can't stand for long periods of time, and I lose interest in a case after 2 hours, maybe that's just my ADD. But to be honest, it's been great. I love the satisfaction that you, the surgeon, are the one that does the final intervention. And it's not that I like the whole "I'm God" feeling at all, i think i have an aspect of my personality that wants to fix things...and as a surgeon, you do exactly that with your hands. But at the same time, I don't know that I like surgery enough to want to endure the residency/lifestyle. If I did do surgery, trauma surgery would probably be where I'd go, but that's just insane (which I am at times), but i'm still leaning towards ER, just ER.
So far i've learned so much on this rotation. Def learned stuff about medicine itself, but mostly I've learned about dealing with people. This is hospital is so big and busy all the time, people in the OR just move at a faster pace i think, well my team does. In the midst of all the bustling and million things that need to be done I've found myself easily forgetting about the patient itself. People are always paging, calling, ordering, yelling, etc. They always tell us in school to have compassion, sensitivity, always treat the patient how you would treat family. And i've always just thought "oh yea well duh, i'm not a jerk, i'm never going to forget to have compassion, etc etc etc..." But in the past 3 weeks alone i've had to catch myself and actively think to do all of those things they tell us in school. I find myself in the OR trying to get op notes, admit orders, set up the meds so fast so I can be more efficient and move on to the next case without delay. That's fine and all, but today I realized that i was just falling into a routine. A routine that really didn't include, make sure patient isn't afraid, and look for the little things that make a big difference (warm blankets, reassurance right before/after anesthesia, etc). When i'm in lecture its easy to say I'll do all of those things. But when you're in the OR and in that environment, I can see how people easily lose that aspect of medicine. I'm going to try my best to realize that now is the time to form the right habits and that no specialty is too busy to do the right thing and go that extra mile for the people we take care of.
On a more inspiring note, I almost cried today in front of a patient. Ms. AC is a 55 yo lady who weighs about 80lbs, has crohns disease with active colitis, the beginnings of colon cancer, and severe perirectal fissures and abscesses. She's in so much pain that she can barely move when I see her at 4am everyday. She gets food by IV in addition to normal diet because she's so malnourished. Her eyes are sunken and her arms and hands are just bones with red nail polish. She is a very sick lady, but also one of the sweetest people I've met in a long time. She will most likely need her colon removed along with the region of skin and muscle around her rectum and will need subsequent reconstruction of her anal canal, and chemotherapy, which may only make her worse. She has a very rough road ahead of her. All that being said, I went to see her today in the evening before I left to explain the surgery plan. I explained the entire extreme plan, the risks, possible consequences which, to me, makes me cringe just thinking about the recovery and overall outsome. And after I got done telling her what seemed to be like torture, all she said was this "vayamos todos adelante, nunca para atras". It means "let us move forward, never backwards". Even after I told her that she mght die from the surgery and treatment to try to save her life, she just smiled and still was positive. She then said "I could cry, but for what?" I felt the tears sort of welling up in my eyes as I just looked at what almost looked like a skeleton smiling back at me. I was thinking "i hope that I one day have as much strength as this lady". It's remarkable how some people are resilient beyond belief and no matter what, remain hopeful and strong throughout. They're the ones I really love to serve everyday. And then you get those people that don't appreciate anything you do, only complain, and make decisions to worsen their condition everyday. I don't think I'll even understand it and it really frustrates me. But if for every 20 frustrating patients, there's just 1 patient like Ms. AC, that's good enough for me.
So, my surgery rotation is awesome overall. I'm amazed my the dynamics of personalities, perspectives on life, and just plain old social skills that some people lack. But more than anything, I'm learning that no matter how big, how smart, how awesome I think I am, I will never be above doing the little things, i guess it's that extra mile that really matters in the end.
Bed time for me...i have bellies to push on and colostomies to check in the morning!!!
So far i've learned so much on this rotation. Def learned stuff about medicine itself, but mostly I've learned about dealing with people. This is hospital is so big and busy all the time, people in the OR just move at a faster pace i think, well my team does. In the midst of all the bustling and million things that need to be done I've found myself easily forgetting about the patient itself. People are always paging, calling, ordering, yelling, etc. They always tell us in school to have compassion, sensitivity, always treat the patient how you would treat family. And i've always just thought "oh yea well duh, i'm not a jerk, i'm never going to forget to have compassion, etc etc etc..." But in the past 3 weeks alone i've had to catch myself and actively think to do all of those things they tell us in school. I find myself in the OR trying to get op notes, admit orders, set up the meds so fast so I can be more efficient and move on to the next case without delay. That's fine and all, but today I realized that i was just falling into a routine. A routine that really didn't include, make sure patient isn't afraid, and look for the little things that make a big difference (warm blankets, reassurance right before/after anesthesia, etc). When i'm in lecture its easy to say I'll do all of those things. But when you're in the OR and in that environment, I can see how people easily lose that aspect of medicine. I'm going to try my best to realize that now is the time to form the right habits and that no specialty is too busy to do the right thing and go that extra mile for the people we take care of.
On a more inspiring note, I almost cried today in front of a patient. Ms. AC is a 55 yo lady who weighs about 80lbs, has crohns disease with active colitis, the beginnings of colon cancer, and severe perirectal fissures and abscesses. She's in so much pain that she can barely move when I see her at 4am everyday. She gets food by IV in addition to normal diet because she's so malnourished. Her eyes are sunken and her arms and hands are just bones with red nail polish. She is a very sick lady, but also one of the sweetest people I've met in a long time. She will most likely need her colon removed along with the region of skin and muscle around her rectum and will need subsequent reconstruction of her anal canal, and chemotherapy, which may only make her worse. She has a very rough road ahead of her. All that being said, I went to see her today in the evening before I left to explain the surgery plan. I explained the entire extreme plan, the risks, possible consequences which, to me, makes me cringe just thinking about the recovery and overall outsome. And after I got done telling her what seemed to be like torture, all she said was this "vayamos todos adelante, nunca para atras". It means "let us move forward, never backwards". Even after I told her that she mght die from the surgery and treatment to try to save her life, she just smiled and still was positive. She then said "I could cry, but for what?" I felt the tears sort of welling up in my eyes as I just looked at what almost looked like a skeleton smiling back at me. I was thinking "i hope that I one day have as much strength as this lady". It's remarkable how some people are resilient beyond belief and no matter what, remain hopeful and strong throughout. They're the ones I really love to serve everyday. And then you get those people that don't appreciate anything you do, only complain, and make decisions to worsen their condition everyday. I don't think I'll even understand it and it really frustrates me. But if for every 20 frustrating patients, there's just 1 patient like Ms. AC, that's good enough for me.
So, my surgery rotation is awesome overall. I'm amazed my the dynamics of personalities, perspectives on life, and just plain old social skills that some people lack. But more than anything, I'm learning that no matter how big, how smart, how awesome I think I am, I will never be above doing the little things, i guess it's that extra mile that really matters in the end.
Bed time for me...i have bellies to push on and colostomies to check in the morning!!!
Subscribe to:
Posts (Atom)