weekEND

YAY!  Finished with surgery, at last!!!  Actually to tell the truth, it wasn't all that bad. Aside from all the attitude, I enjoyed it (ok this is starting to sound like my last blog).  So I think I've come to a temporary consensus...since I like both internal medicine and surgery, they will dictate my electives for this year and depending on how my electives pan, I will rank those 2 possibilities accordingly.

On another note, I really hoped that the weekend would have been responsibility-free for me, but unfortunately, it was not.  After I finished the surgery SHELF exam this past Friday, I was inundated by random phone calls from random people telling me that I should finish all sorts or random paperwork needed for all sorts of random happenings (I will be more specific when these "nebulous" random happenings begin to corporialize themselves - I hope that's a word...my spell-checker is telling me otherwise).  So I moseyed on down to the school library and along the way, passed by this girl in my surgery rotation who I have a wicked crush on.  Let me preface by saying that prior to bumping into her, I was chowing down (as is my custom) on a Nature Valley granola bar (the ones with the almonds and peanut butter - so good...).  After exchanging pleasantries and whatnot, we said our goodbyes, she headed back to the hospital, I to my cubicle in the dungeon. So I waved goodbye and in my usual way, finish with a cheery grin. I later find out to my horror, when I visited the bathroom, that a fairly sizable piece of almond skin had secured itself snugly on my front tooth, making me look like one of the inbred characters from Deliverance. "Nice..." I groaned.  Oh well.  Damage done.  Next. 

So after that whole debacle (yes, I removed the almond skin, thank you), I found an empty cubicle and proceeded to the task of busy work.  Then out of nowhere, a strange girl (strange as in "stranger" not strange = weird), said "Hello" to me.  I must admit, I was at a loss until she saw the blank expression on my face and pitied me.  Turned out she is a visiting student who was assigned to my Internal Medicine rotation back in January.  I didn't recognize her because she sat in the back of our mini-lectures and I never really got to talk to her.  Well, after this little encounter, she sure chatted me up some, like I was a long lost friend or something...even gave me a stiff, jovial smack on the shoulder for a random joke I let fly.  It stung like the Dickens, too.  She was nice, but was really up front/mildly aggressive about any topic in our conversation...she even tried to hook me up with her sister who lives in Virginia.  Really didn't know what to make out of it all.  One thing that didn't jive all to well with me, she was wearing a navy blue peacoat, almost the same as the one that the last Ex wore.  But, flashbacks and PTSD aside, I got over it fast and spent the next half hour of our encounter reviewing pediatric Boards questions with her.  The whole situation was weirdly nice.  Then she left to go to a surgery convention happening at our school that same day.  She's cute, but still not my type.

That evening, I told my brother-in-law about the encounter.  He asked if I got her number.  I said no. Then he proceeded to ask me if I was gay (no offense). Again, I said no.  Then he said, "You don't have to always date the perfect chick or a white chick all the time, you know. Just go out and have fun with a girl."
I didn't know how to respond to that one.

Now, I'm an equal-opportunity guy.  It doesn't matter to me what ethnic background you are - if I like you, then I like you.  However, I am known to be very picky about the girls I date (I find it a hell of a lot easier to commiserate with someone who has similar tastes as I do - which, is both a good and a bad thing, especially if you're single).  And unfortunately, there haven't been many Asian (single) women in my previous dating pools, hence the whole thing about dating white women.  And the ones that I developed an eye for have been way too uptight or were/are engaged/married.  And for some reason, they all just can't get past the geek side of me.  I've toned it down some, but I'll be damned if I have to change myself for that nonsense.

And so we come to my present state.  Soon to be 30, single, and in a whole lot of debt.  I disagree with my Bro-in-law about just going out willy-nilly with some woman, because I tried that once and it turned out to be a complete waste of my time and energy, and of course it's not fair to me or to the girl. So I learned from that point on that: I can't compromise (too much) about the aesthetic/idiosyncratic parameters I would like my woman to have; flings and one-night-stands is not what I'm about; I want a relationship based on friendship, passion, and a keen interest for each other; I don't care what color you are, so long as you dig me and I dig you.

Bottom line - I don't want perfect, just the one who's perfect for me.

Song of the day: "Hey Julie" - Fountains of Wayne

The dark side

So I'm coming to the end of my surgery rotation.  Despite the attitude and the crappy work schedule...I did enjoy myself.  Does this mean I like surgery? I'm not sure.  Does this mean that I would forsake my initial idea of going into family medicine and go for a surgical internship? I don't know.  I am absolutely torn and I'm not sure if I even have what it takes get into surgery. I've been toying with the idea for a little over a week now and it hasn't been pretty. Lots of things are jumbled up in my head along with study material for the end-of-rotation exam and it's gotten me in quite an anxious state, that even my teeth today were hurting because they were anxious.
I need guidance.  I need direction.  I need a drink.
Wish me luck on Friday.
Next week, Ob/Gyn. I got my baby-catching glove ready.  Bring it.

Song of the day: "California II" - Mason Jennings

More snow, part deux

Well, that was anti-climactic. The "perfect" storm that everybody was so worried about didn't even last that long today. By the afternoon, all the slush on the ground had melted. At most, six inches on the grass...and only because some of the old snow was still below the new one. Granted, I did get stuck going in the parental units' driveway, but that's neither here nor there. I seriously thought I would get another snow day out of that storm. Wouldn't you know it, the damn School Emergency Alert System canceled the inclement weather alert and opened the damn school @ 8 in the morning, but that didn't do me any good either way cuz I had to wake my sorry ass up @ 6 in the morning to dig my car out and shovel the driveway so I can be in the hospital by 7. Lemme tell you, that made the day feel like forever.

I WANTED MY SNOW DAY, DAMMIT! Seriously, Ol' Man Winter, don't get our hopes up like that. It's like what they say in the Olympics: Go big or go home! So next time, don't go half-assed about making it snow and just do it!

Song of the day: "Ne Me Quitte Pas" - Regina Spektor

More snow

I have high hopes for this incoming snow storm. Apparently this one is a merger of 3 other storms from the northwest, northeast and south, ganging up to become the worst winter weather of this season, so far. As testament to this, it looks like pea soup outside and the snow is blowing sideways. And the wind is whipping something fierce, very loud even from the inside.

On the upside, We got another early dismissal from surgery again today. Our cases were done by 1pm (a thyroidectomy, an excision of a Left ear non-healing lesion (possibly squamous cell carcinoma), and a lipoma removal) and even got to catch lunch. By then, the snow was steadily falling and the emergency school alert system was sending all sorts of closing details. So our residents cut us loose and I hightailed it out of there for home and caught a glorious 3 hour nap.

Don't know what's up for tomorrow but I'm just happy to be home tonight and have some rest for another round of studying. SHELF exams in 1 week so I have to be ready. Glad the snow is helping with this one.

Song of the day: "Just Ain't Gonna Work Out" - Mayer Hawthorne

The pot calling the kettle "black"

I'm a ridiculous person.

I get really giggly when I see people fall asleep or nod off during a lecture. I look at them and guffaw at how stupid/moronic (I know...harsh, right?) they look, dozed off or fighting back their eyelids to stay awake. I get a bigger kick when they get caught snoring/drooling.

Then I realized...Crap! I do that too! Case in point, me in today's morning conference, getting caught by my intern for 1. nodding off, 2. snoring, and 3. waking up all surprised and confused...all within the first 5 minutes of the lecture!

Excellent.

Gotta love them 6am classes.

Song of the day: "I Turn My Camera On" - Spoon

My moment of zen

When the alarm goes off @ 4:45am, I have to hit it a few times before I can roll off the bed.  If I'm lucky, I eventually get up by 5 and it's off to the shower. A quick 10 minutes in the glorious hot water (btw, the house is a balmy 65 degrees when you wake), and I'm out again, shivering, drying off, and crazily getting geared up for the hospital: dress shirt-check, slacks-check, white coat stuffed with granola bars, pens, crackberry, itouch, ID badge, med/surg reference books-check, my lucky celtic spinner ring-check, check, and triple check. Then I grab my glasses, change bag, scarf, coat, and shoes and I'm off to do battle once more as a lowly med student in the germ-infested, pimp-question laiden halls of the hospital.  12+ hours of moving and shaking, and I'm back home to read and study some more (every once in a while, tutor and work @ the library) and sometimes the day doesn't end until after midnight. 

I don't get much calm from the time I wake up to the time I hit the sack.  So I thank God for what ever peace I can get...and lately, it's been the 5 minutes I spend warming up my car before driving to work.  I turn the engine on, breathe a big lungful of crisp, cold air, and stare out at the winter sky, witnessing the first rays of dawn barely breaking through the dark velvet. I watch my breath form small cloud vapors and just zone out as they disappear silently. I quietly meditate on the windshield frost and wait patiently for that first water droplet to fall.  Before I know it, it's time to go.  So I hit the radio switch and tune in to NPR.  And if I'm lucky, the morning show would play a song that gets me in the groove.

This morning, I got lucky (songwise, not...you know...but It'll do for now).  And today was a good day.

Song of the day: "The Book Of Love" - Peter Gabriel (Scrubs sdtk)

Week 4

Recovering from 32+ hours of being awake (studying, putting together a presentation on burns, making jambalaya).
I'm realizing that this fear of public presentations is getting way out of hand.  I was so nervous that it took me forever to piece a 15 minute powerpoint presentation.  I stayed up all night rehearsing and re-rehearsing and coming up with all all sorts of possible questions my preceptor could ask me about my topic.  Then when I got home from school (At this point, I've been up since 9am, Sunday to 4:30am, the next day), I couldn't even sleep a wink.  So I took a shower, got dressed and went to the hospital an hour early for morning report...an hour early. 
Good thing my Resident that day was cool and the service wasn't too busy. We spent most of the morning just talking about my presentation and peppering it with random bits of baseball news.  We even got time to get breakfast and coffee! So We finished by 11:30am, and I was off, driving back to school to give my schpiel.  It went without a hitch.  My Preceptor liked it and I felt stupid because I had all this other material that I did not even get to present nor needed to present.  Completely over-prepared!
So back home I went. It was now about 5:30ish by the time I dropped my bookbag and crawled into my jammies.
Fade to black.
Woke up at 12:30am, Tuesday morning.  Thought I overslept and almost fell out of bed, scrambling to get dressed.  After swallowing my heart back into place, I went back to sleep.
3:30am, same day. Woke up this time, a lot calmer, and was coming off of a dream of me thinking about how much I love my bed...

"My Bed"

By TOitB

My comfort, my fortress,

My tall ship on the wild sea.

Ain't no place I'd rather be.

My inspiration, my destination,

At all times with no reservations.

And parking is always free.

My real estate, my property,

I know its peaks and valleys,

Every inch of space just for me.

My dream maker,

My battery charger,

My diesel generator...

My Proton Pack-

My sex machine-

My...peachy keen, jelly bean...

My Protest to War and Corruption-

My Green Power to End Pollution-

My Solution to Health Care 

and this Great Recession!

Everybody loves it.

Just try it, you won't regret it.

I promise, you will enjoy it!

My One,

My Only,

My delicious Bed.

 
OK, not exactly Oscar Wilde Material, but hey, I have my aspirations still.
And now, I'm back in the library, blogging to y'all instead of reading my articles. I hope you appreciate the sacrifice I'm doing for your sakes.
FYI, nothing too crazy going on in surgery land.  Last week's Anesthesia rotation was pretty tame...and abbreviated, due to snow.  Lots of snow. Like 30 inches of it in 2 separate days! But I digest...anyways, the coolest surgery I saw thus far was a thyroidectomy...this woman's thyroid was about the size of a small baseball or a big golf ball...and it had a long ass tail (pyramidal lobe for all you sticklers out there) that went all the way up to her chin! 5+ hours of surgery.  Lots of standing.
Good times.
That is all.

Song of the Day: "Something" - The Beatles

...cuz Abbey Road Studios is up for sale =(.

Some people are just born romantics

Check this out.
I had a 64 year-old patient today who was going for penile implant surgery. Seriously. A few minutes before we headed to the OR, I asked him the question that every guy would have asked if they were in my place...

Why?

Why would you go through such a seemingly painful (and it sure looked painful, afterwards) procedure?

He looked at me straight in the eyes and answered with a faint smile:
I love my wife...and Valentine's Day is coming up.

I just had to smile after that one.

Ah, l'amour.

Song of the day: "My Funny Valentine" - Chet Baker

Watch out for that first step

This morning was a surprise. Like, took my breath - kind of surprise.  As I step out from the driveway to my car parked across the street, a patch of ice gave way and my foot was plunged into a bone-chilling slurry of half melted salt and ice.
So now I have to go back inside, change out of my freezing wet socks and wear another pair of dry shoes. Oh, you bet I was cursing up a storm.
It's official.  I hate winter.

P.S. Vancouver called.  The winter olympics want their snow back.
P.P.S. Another snowstorm is coming tomorrow (today, actually). 10 more inches.  Great...

Song of the day: "If I Could Give All My Love To You" - Counting Crows

2 down, 4 more to go

5 days of sleep depravation, and week 2 of surgery rotation is over. Remember when I said that most of the residents in surg are douches, at the beginning of this week, I thought, yea...that's about right. Today, however, proved to be the exception to the rule. The chief resident, who was supposed to be gunning for me, turns out to be not so bad...he can joke around, despite being blunt most of the time. He even took a little bit of time to teach us something today after a colostomy reversal case. On the flip side, one of the 4th year residents, who I thought was really nice, was somewhat feisty today...perhaps because she's on call tonight and there's supposed to be this huge blizzard coming to our area that's gonna snow trap us all by tomorrow. Anyhoo, I was getting a history on a new ER admit, and I wrote down something stupid that the patient said (I'd rather not repeat it...it was too embarassing, and it was something I knew was a medical impossibility, yet I continued to document, none the less). Well, I certainly looked dumb when I mentioned it to my resident, for which she scolded me for it...I deserved it I suppose. But then she smacked me in the arm...something I don't think higher ups do to their subordinates, unless they were totally being familiar. And I'm not sure if she was trying to go for that effect to make me feel better. So I felt bad, then I got confused...which is not a good combination to go with sleep deprivation. Luckily, there was more work to be done and less time being a dolt.

BTW. New pet peeve: poor medical historians. Cantstandya!

So, by 6pm, we gave our reports, said our goodbyes, and changed out of our scrubs. Wouldn't you know it, the Scrub dispenser machine decides to get snippy with me and takes my scrubs without giving me back my credit (FYI scrub machines only give you new scrubs if you have credit, and you only get credit if you give back your used scrubs). So I was stuck in the locker room for another hour, waiting for housekeeping to give me a new pair to load, so I can get credit back. On the bright side, I used that time practicing one-handed surgical ties. Finally, with my scrub credit replenished, I head out to the call room to retrieve the rest of my effects. I round the corner and all of the sudden, the 2nd year surgical resident pops out of hiding, screaming bloody murder. I nearly poop my pants in fright and he's rolling on the floor laughing his brains out. He got me good...
So, overall, a fun-loving bunch. They definitely have their bad sides, but this week, they were human beings. Fairly nice ones, I might say.

Since I haven't kept up with this week's daily blogging, I'm opting to list the surgical procedures I saw this week:
1. Laparoscopic appendectomy
2. Femoral-to-popliteal artery graft bypass
3. Hemicolectomy + Hartmann's procedure
4. Groin abscess incision and drainage
5. Reverse Colostomy (sigmoid-rectum end-to-end anastamosis)
6. Laparoscopic Roux-en-Y gastric bypass

Next week, Anesthesiology. Should be interesting.

P.S. For those who are keeping score, I never did give the thyroid CA presentation, but I did learn a lot from the readings.

Song of the day: "Heaven When We're Home" - The Wailin' Jennys

Conflicted

Is it wrong for me to hate Wegman's but love it at the same time?

Song of the day: "Cartoons and Forever Plans" - Maria Taylor

BTW, This is the type of doctor I want to be =)

4th day

Surgery day 4
6pm - New day, new resident. I didn't get to follow up on the patients I was with yesterday. I hope they're doing well after surgery.

8pm - Today was all about management. For the most part, the resident and I spent a good deal of the night trying to maintain people's blood pressures and hemoglobin counts until the next morning, where other surgeons can come in and eventually work on them if need be. So the night wasn't too crazy, but still we kept people from tanking, which is a very good thing.

My resident tonight was very cool. He started out as a flight doc for the air force, but wanted to be an ENT, so he had to go back and do a surgical residency, which set him back a few extra years. He's a family man and very easy going. He likes to teach and all the nursing staff seem to adore him. On the way to a call from another hospital, we were blaring Boston on his CD player! Heck, when we got there, my resident even ended up singing a country duet with the patient while he got blood and fluids. Did not expect to see that at all. So apparently not all surgical residents are bitter SOB's.

At around 4:30am, The resident and I caught a break and finally got a half-hour nap before radiology review @ 6am.

All in all a decent 4th day. Now I'm pooped and ready for a nice nappy nap. See you later.

Song of the day: "Submarine Symphonika" - The Submarines

Something New

Surgery day 3
6:30pm - Today was busy. Real busy. Started out with attending to a few patients in the ER. 1st was a middle-aged lady with a 3cm abscess on her left breast which needed some I&D (incision and drainage). She was a diabetic and her sugars have been running unchecked for a while. She was worried it was something more serious, like breast cancer, but luckily it wasn't. Nice way to start an evening with the resident, with a little procedure.

9pm - The evening continued on at another hospital...as my resident gets a call from another facility she was covering. So we take a ride to the town next door and check out another ER case. Another middle-aged lady, this time she's having nausea and some vomiting with abdominal pain for the past 3 days + a history of chronic constipation. Her belly was getting pretty distended and after further imaging/testing, it was decided that she needed surgery to decompress her abdomen, fast! So the surgeon and the resident allow me to scrub in with them. Mind you this is my first time scrubbing in, so I have no idea as to what to do nor do I have any clue about the dos and don'ts inside the surgical suite. I felt like a bull in a china shop.
Remember when I told you that surgery people are mean (see Jan 24th blog)...well this was not the case. The scrub nurse was very eager to teach and she guided me pretty well with scrubbing, gowning up, and keeping myself from messing up the sterile field. The surgeon was very cool and he let me assist as much as possible.

12am-ish - This ain't no cadaver. Everything about this is so different from anatomy class. Everything was so...Fresh! 1st incision was made, from the suprapubic, up around the umbilicus to the halfway mark between the xiphoid and the bellybutton...a straight vertical line going down the belly. Soon after, I was wrist deep in intestines, suctioning, retracting, and cutting sutures. At one point, I got fixated on the small bowel doing its peristaltic action (way cool).

2am - after much exploration and looking through every nook and cranny of that poor lady's bowels, we finally figured out what was causing this poor woman's belly pain...a small perforation, about a millimeter in diameter, located in her sigmoid was releasing fecal material in her peritoneum and this was making all sorts of abscesses all over her guts. We irrigated and washed all of her bowels for what seemed like forever. The woman got a hemicolectomy (the portion of the perf-ed bowel was removed) and the open end of the large bowel was made into a colostomy.

3am - Once the colostomy was in place, we began decompression immediately. There was no way we can put this woman's guts back inside because she was so full of S*%#! This was the REALLY MESSY AND GROSS PART. I'll save you the gory details save for one...the surgeon was milking and squeezing the large bowel like a giant tube of toothpaste. You can fill in the rest of the details yourselves (or not).

4:30am - The surgeon was finally satisfied that everything looked clean, that there was no more bleeding, and the ostomy was in place, so we finally closed her up. It was pretty impressive to watch both the surgeon and resident truss up the patient like a stuffed bird, as blunt as it may sound. But they did a very good job. The patient was brought out of anesthesia and was sent to recovery with no other issues at that time.

5:30am - My back hurts. My feet hurt even more. After that surgery, there was another emergent appendectomy that I got to scrub in on too. This time the surgery was done with a laparoscope so it wasn't too traumatic (only 4 dime-sized holes were needed). I got to hold the fiberoptic scope as the surgeon removed this thumb-sized appendix with pincers and cautery tools. The whole procedure took about 45 minutes. And the patient did well.

And so goes my 3rd day in surgery. Way cool.

Song of the day: "Jungle Drum" - Emiliana Torrini

Cut, cut...slice, slice

Surgery day 1
15 minutes late for orientation. Starting out real swell...
The Chief attending surgeon outlined what it takes to honor the rotation...in a nutshell, I'd have to be a soft-spoken genius/a subtle brown-noser extraordinaire/a dogged army private/a profssional slave...and to top it all off, I'd have to like it and ask for more of it.
Lovely.

Surgery day 2
I have night call from Tuesday to Friday for this week only (6p-6a). Mind you, this is followed by a lecture series from 6-9am...
So far, my ID badge won't let me get OR scrubs from the dispensing machine so that made me late. Again. Thankfully, another doctor (Anesthesiologist) was nice enough to pity me and loaned me a clean pair from his own batch! Also, my resident for tonight is a sweetheart and a half. She gave me an early break so I decided to hole up in the on-call room and study.

10pm - Hungry. My stomach is growling and I finished my 4th granola bar. The cafeteria is closed and I can't leave yet! I need protein. Or a tasty Greek salad (grape leaves, olives, feta, chicken...nummy...best stop before I faint).

So if all is quiet tonight, perhaps I can get some shut-eye before morning rounds and a 3 hour lecture series that's sure to titillate the mind...hurray...

Tonight's tunage is brought to you by the sassy Ms. Single and Picky. Enjoy!

Song of the day: "Why Try To Change Me Now" - Fiona Apple

Arghhhh!

So I have surgery rotations tomorrow...AND I CAN'T SLEEP!

Figures.

Multiple songs of the day (random tunes heard on the radio that made my commute home today a hell of a lot better):
1. Valentin Sylvestrov (Composer)


2. "You Send Me" - Sam Cooke


3. "Lisztomania" - Phoenix


4. "Drop It Like It's Hot" - Snoop Dogg + Pharrell Williams


5. "Kick Drum Heart" - The Avett Brothers

Mack the knife

So, it's goodbye Internal Med, Hello Surgery.
It was fun while it lasted. I hope I did well in my exam...

I was prepped tonight over sushi by friends that being in surgery is a practice of patience, endurance, and ninjitsu (art of invisibility). It seems that a good deal of the surgical residents and attendings are douches (and that term is used in the most endearing way). They make you come in at 5:30AM, they make you stand for hours on end, they don't give you lunch breaks, they deny you catered food from their meetings (vs. Internal med docs who are nice and quite willing to share the catered goodness), and they treat you as if you're a lackey who is undeserving of their respect. Apparently these people are likened to the prototypical petty high school jocks and socialites who are highly prone to back-stabbing and trash-talking.

One must be blind, deaf, and mute to survive in such a rotation, so they say. Avoid the drama, if I can...but keep eyes and ears open for potential blog topics on this rotation. Wish me luck.

Hmmm...six weeks of this? At least I get to wear comfy scrubs.

Song of the day: "Slow New York" - Richard Julian