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!!!