Sunday, October 31, 2004
Surgery...
I guess I'm the first to go through a surgery rotation. And you were wondering where I was the past 2 weeks, right? Let me explain -
First, I had the family medicine departmental exam and the NBME Family Medicine shelf a week past. I'd heard the Family Medicine shelf is the hardest of the shelves, so I took some time to study because I wanted to do well. That took a few days of hard-core studying, then 2 days of exams. The really sorry thing about it is after the departmental exam, we had to go back to the clinic. It isn't a bad idea, just not the best setup for studying for the shelf. I was worried, but I think I did fairly well on the shelf. I'll see in 4-6 weeks, I guess.
The weekend was a glorious time off. I didn't do a damn thing, except rest and relaxation. It was beautiful. I wish every day could be like those 2 days.
Surgery began last monday, 10/25/04. It began with an orientation (like every rotation). I thought it was particularly humorous when the head of the department of surgery told us we were to work no longer than 80 hours per week - including study and academic time. We are to divide our 80 hr/wk into thirds and divide it between hospital, academic (meaning lectures, etc), and reading.
Obviously, he has never been over to the hospital where I am assigned. It is a VERY busy county hospital where noone EVER gets out on time. Let me break down the past week for you - keep in mind, call is every 4 days...
Monday: 0700 (orientation) - 1400 = 7 hours
Tuesday (Call): 0600 - 2400 = 18 hours (call not finished)
Wednesday (Post-call): 0000 - 1600 = 16 hours
Thursday (clinic): 0530 - 1800 = 12.5 hours
Friday (Precall): 0600 - 2000 = 14 hours
Saturday (Call): 0630 - 2400 = 17.5 hours (call not finished)
Sunday (Post-call): 0000 - 1300 = 13 hours
Grand total for week 1: 98 hours
And remember, that's supposed to be 1/3 of my total time spent per week. I still have to read and go to academics for a total of 294 hours per week. The only problem with that is there are only 189 hours per week actually available.
I think it is important to spend time in the hospital in order to learn, but 1/2 the total time in a week is a little insane. The only good think about it is that we have had some really cool traumas this week. Sounds pretty morbid, huh? The thing about medicine, especially Emergency Medicine or Trauma, is that you become cynical and begin to view the morbid as exciting.
For instance, my first night on call (Tuesday) we had a patient with a GSW (gunshot wound) to the left anterior chest. He was shot by a police officer after he'd first tried to break into an apartment, flee the police, then shot at the cops. He was down for 15 minutes in the field without a pulse and an idioventricular rhythm on the monitor (per EMS). When he arrived in the ED, he was in about the same condition - no pulse, no pressure, no spontaneous respirations. He was intubated and manually ventilated. CPR was in progress and there were 2 large bore IVs draining wide open for volume support. His GSW was just below his left nipple; there was no immediately obvious exit wound. Given the location of the entry, we were concerned for cardiac and pulmonary damage. As a result, the chief resident performed an emergency thoracotomy. It was F-ING AWESOME!! I was performing CPR on the patient's right as he was opening up the left. He spread the ribs and about 2 liters of blood and fluid poured out all over the place. I could see the heart and lungs plain as day.
They delivered the heart from the pericardium and examined it. They found a large laceration in the posterior portion of the left ventricle - no wonder he didn't have a pulse or blood pressure, right?
They repaired the defect and everything was re-started. We were giving intracardiac epinephrine, direct cardiac massage, open defibrillation - the whole works. It rocked... in a sick and twisted sort of way.
The patient died - as most people in that situation do, but it still got all our blood pumping.
Ok.. I'll write more later. I've been up since 0530 yesterday - I'm really freaking tired.
And by the way, never ever EVER EVER EVER be on call when the time change goes back.. that extra hour really sucks. ¶ 8:54 AM
First, I had the family medicine departmental exam and the NBME Family Medicine shelf a week past. I'd heard the Family Medicine shelf is the hardest of the shelves, so I took some time to study because I wanted to do well. That took a few days of hard-core studying, then 2 days of exams. The really sorry thing about it is after the departmental exam, we had to go back to the clinic. It isn't a bad idea, just not the best setup for studying for the shelf. I was worried, but I think I did fairly well on the shelf. I'll see in 4-6 weeks, I guess.
The weekend was a glorious time off. I didn't do a damn thing, except rest and relaxation. It was beautiful. I wish every day could be like those 2 days.
Surgery began last monday, 10/25/04. It began with an orientation (like every rotation). I thought it was particularly humorous when the head of the department of surgery told us we were to work no longer than 80 hours per week - including study and academic time. We are to divide our 80 hr/wk into thirds and divide it between hospital, academic (meaning lectures, etc), and reading.
Obviously, he has never been over to the hospital where I am assigned. It is a VERY busy county hospital where noone EVER gets out on time. Let me break down the past week for you - keep in mind, call is every 4 days...
Monday: 0700 (orientation) - 1400 = 7 hours
Tuesday (Call): 0600 - 2400 = 18 hours (call not finished)
Wednesday (Post-call): 0000 - 1600 = 16 hours
Thursday (clinic): 0530 - 1800 = 12.5 hours
Friday (Precall): 0600 - 2000 = 14 hours
Saturday (Call): 0630 - 2400 = 17.5 hours (call not finished)
Sunday (Post-call): 0000 - 1300 = 13 hours
Grand total for week 1: 98 hours
And remember, that's supposed to be 1/3 of my total time spent per week. I still have to read and go to academics for a total of 294 hours per week. The only problem with that is there are only 189 hours per week actually available.
I think it is important to spend time in the hospital in order to learn, but 1/2 the total time in a week is a little insane. The only good think about it is that we have had some really cool traumas this week. Sounds pretty morbid, huh? The thing about medicine, especially Emergency Medicine or Trauma, is that you become cynical and begin to view the morbid as exciting.
For instance, my first night on call (Tuesday) we had a patient with a GSW (gunshot wound) to the left anterior chest. He was shot by a police officer after he'd first tried to break into an apartment, flee the police, then shot at the cops. He was down for 15 minutes in the field without a pulse and an idioventricular rhythm on the monitor (per EMS). When he arrived in the ED, he was in about the same condition - no pulse, no pressure, no spontaneous respirations. He was intubated and manually ventilated. CPR was in progress and there were 2 large bore IVs draining wide open for volume support. His GSW was just below his left nipple; there was no immediately obvious exit wound. Given the location of the entry, we were concerned for cardiac and pulmonary damage. As a result, the chief resident performed an emergency thoracotomy. It was F-ING AWESOME!! I was performing CPR on the patient's right as he was opening up the left. He spread the ribs and about 2 liters of blood and fluid poured out all over the place. I could see the heart and lungs plain as day.
They delivered the heart from the pericardium and examined it. They found a large laceration in the posterior portion of the left ventricle - no wonder he didn't have a pulse or blood pressure, right?
They repaired the defect and everything was re-started. We were giving intracardiac epinephrine, direct cardiac massage, open defibrillation - the whole works. It rocked... in a sick and twisted sort of way.
The patient died - as most people in that situation do, but it still got all our blood pumping.
Ok.. I'll write more later. I've been up since 0530 yesterday - I'm really freaking tired.
And by the way, never ever EVER EVER EVER be on call when the time change goes back.. that extra hour really sucks. ¶ 8:54 AM
