The last 7 weeks have been pretty awesome. It took a lot to get used to waking up before 4 and prerounding on patients at like 430. Pre-rounding involves going around to check up on the patients and see how they did overnight. As students we have to do this on our assigned patient and be ready to present them to the residents during rounds. I would go to the hospital before and do a history and physical on patients, but it always felt staged even though the patient and setting was real. Now, I was writing notes, updating the residents, and advocating for my patients. I realized that even as a lowly, but yet incredibly funsational 3rd year student, I was part of the medical team. This is where it starts and as I keep getting older and even more wiser (as if that's possible), I move up the team ladder and gain more responsibility which is both an exciting and terrifying idea. Lives WILL be in my hands. But for now, granted my knowledge and skill set is limited, I still have the very important ability of communicating with people, especially patients. It also doesn't hurt that I can make people laugh. And of course, I'm capable of learning. It's why I pay tens of thousands of dollars a year to be at the hospital for 13 hours a day: to learn... and look good in scrubs
It is exciting to pick up a new skill or learning how to manage patients. What to do after this? After that? The first two years, we just learned and only applied our knowledge when it came to exams. Now we have to try and bring that all back to understand what is going on with the patients and why the physicians do what they do. And of course to allow us to answers when we get pimped. And even though we are here to learn I love being able to do things, even if they will be the most tedious things when I become an intern. But now I can put a foley catheter in females (haven't done males yet... ah sorry peepees of the world), suture incisions, change wound dressings, and place skin staples.
But, I'm in surgery, which means, I get to be in the OR. Yes, I go to the operating room and get to scrub in and gown up. I had no idea how serious everyone is about being sterile. You touch something by mistake and you have three people yelling at you, which has happened a few times to me. But of course when it happens to the much older and experience staff, you can only laugh on the inside. There are even little "dances" i call them to getting gowned up and moving around the OR table. And yes, I'm right there at the table. How awesome is that? Mind you, I don't do anything major, but I help out. Retracting skin and cutting sutures isn't glamorous but hey, it's something. And when it comes down to it, I'm helping out the attending/resident/nurses, and making their job a little bit easier which makes the surgery go a bit smoother which is a plus for the patient. And it's ALL about the patient. But, as people trust you more, they let you do more. So I've had nurses asking me if I wanted to put in foleys, or residents allowing me to close wounds. And while being on your feet anywhere from 1 to 5, 6, 7, 8 hours is tough, I'm sure what I get to see is a lot more interesting than what most people see at their jobs ever. Unless you're a photography, cause that's kind of cool.
Though today, I saw a breast reduction. Why would anyone do that? My friends asked. That's like slapping God in the face, they yelled. Well, she had back problems. I mean, as great as those bags of sand can be, wearing a 42DDD bra is probably excessive. I just hope the next time I see some boobies I want to play with, my mind doesn't flashback to what I saw today...
As much as I enjoy being in the OR, perhaps it is not THE best part, soley because I feel like I'm in this field to help people, and so accomplishing that is the greatest reward.
Two things stick out in regards to that:
1. There is a patient I was following while on the Trauma surgery who had a gunshot wound and has been off and on with his health. I only followed him for two weeks and I was able to communicate with him the best because he spoke spanish, so I felt like I was able to help explain things to him and make him feel more comfortable. I even gave a small presentation to other classmates on his case. But what struck me as cool was that other students and interns would always let me know how he was doing even though I was no longer on the service or following him. I don't know how to describe it, but it was nice in a way. I should remember to stop by and say goodbye to him when I'm done with surgery.
2. A patient was gonna undergo surgery so in the waiting room the anesthesiologist was placing an IV. The patient was scared so I held her hand. She was nervous and apologizing for being such a baby about the needles and I kept reassuring her it was all okay. That it was normal that she was afraid of needles. I joked and told her it would be normal if she was excited about it. I went into the operation as well and then afterwards I checked up on her in the recovery room. She was panicking and asked if I could get the attending to talk to her, so I did. I checked up on her a few hours later and she smiled and looked more relaxed. She thanked me for being there for her in the morning and for checking up on her. That was nice.
The tough parts about surgery of course have been the schedule. It's not fun going into work at 4 am Saturday morning and seeing house parties still raging on and drunk people walking around. I was once driving to the hospital and saw a drunk guy stumbling down the street. He then fell onto a car, slid down, and fell asleep on the curb with his head on the car. He obviously had a good night. Even though I couldn't enjoy my summer too much, I'm happy I did surgery in the summer, because at least I got out while the sun was up. I can't imagine how it will be for people in the winter when it is dark at 4 pm. They won't ever see the sun unless they try and catch a glimpse of it through patient room windows. They'll be all pale and pasty like vampires, and not the sexy kind, cause I don't think they make black or leather scrubs.
Eating is also sometimes tough. Sometimes you can get lunch sometimes you can't. So I made it a point to always have at least 3-4 snacks in my pocket at all time, whether they be crackers, fruit snacks, or granola bars. They are key. Luckily, I got good at finding graham crackers and juice cups throughout the hospital to quell the hungry demon in my belly.
Oh, and one of my favorite things about the hospital is the on call room. Just think about it. It's just a bunch of rooms designated for napping. NAPPING. The 4th best activity after eating, drinking, and mating with other humans. It's also a godsend when you have to be at the hospital for at least 24 hours in a row. Those nights are rough, but if you're lucky, you're either so busy you can't be tired (until you're falling asleep writing notes and realize you have to rewrite the entire thing because it's all scribbles) or you can sleep a lot. And yes, I will try to have sexy time in the on call room at some point in my career.
So it's been fun on surgery, and I wonder what the other clerkships will bring. I will miss the OR but I will probably return to it when I'm doing OB/GYN. I am excited to deliver a baby.
BUTTT... why did I want to write this note? Because of something that happened today.During an operation today, a nurse walked in and told us about a patient in another room. It was a 2 year old baby who had fallen out a 2nd floor. It was obviously an emergency. She was brought to the hospital and they were having trouble stopping the bleeding. The nurse left and the mood of the entire room changed. The nurse came back about an hour later and informed us that the baby had died. They couldn't stop the bleeding. I noticed that the nurse had been crying before she walked into the room. And it made me think...
How many people come into the hospital knowing that they are going to die? How many parents bring their children in to die? Those parents had no idea that today was their last day with their child. A simple accident and it was all over. What will happen to that family? Will it destroy them? Will it bring them closer? Who knows.
And of course, people die in the hospital often. But no one wants it. Especially in a baby.
There are two patients I was seeing, who I learned from the residents, had only at most a few months to live. That they would probably not leave the hospital and would die here. Did these patients ever think when they were admitted that they weren't leaving? I doubt that they know now, but what about when their death is close. They came in feeling a little sick and that was it. And as I looked down at them, all I could think was, what would you do if you were just able to get out of here? You have the same amount of time, but you're not tied to this bed with all these tubes. And then I thought "I'm sorry, you'll never get out of here."
I guess patients go to a hospital to get better or to die. Sometimes they know they will die, which can be comforting in a way because you can settle your affairs while you wait. They are given time. Something that little baby and those parents didn't have. I think it's the time that makes the difference between a spiritual or type of release rather than a disaster. A patient who has been dying for months with cancer can finally rest after settling their affairs and seeing their family and friends. It could even be described as a beautiful experience if the patient is allowed to pass peacefully and surrounded by love. But of course we have on the other hand, death that comes out of nowhere and rips us apart when we lose someone.
Who knows how I will feel about death when it happens to a patient I'm directly caring for. Who I have responsibility for. Who I tried to fight death for and lost. I think my one fear was that a patient would die in the OR table while I was there. I have no idea how I'll react or how any of the staff will react. Here we were trying to save this patient's life and we couldn't. Could the operation have waited? Was it our fault? Was it inevitable? Again, who knows.
I guess it really comes down to the medical team trying to prolong a patients life or improve their quality of life for as short as it may be. Sometimes we can cure them and they can live for years. Or sometimes, we can make them feel better and let them have a few months more. But in the end, we are all powerless at one point to save the ones we love or ourselves.
