Wednesday, September 18, 2013

Surgery rotation update!

Currently on my first rotation - Surgery! I have so much to say, no idea where to start!! It is so exciting!! Can you tell by all the exclamation points I am using!?!?!?!?! SO EXCITED!!!!!!!

My surgery rotation is at Holy Spirit Hospital in Harrisburg, PA with the Kunkel General Surgery Group. My first week here was rough. I mean really, really rough. Like, chicken running around with head cut off rough. Starting off rotations is overwhelming in itself, but starting with surgery is so incredibly intimidating. Probably the most mentally/physically drained I've been in my life. You don't know anyone, the hospital is a maze, you don't know how to use their computer system, you are working from 6am-6pm after being used to sitting on your butt in a classroom all day. Maybe it's just me, but even for the simplest things you have no idea where to start. I even remember freaking out to myself about where it was appropriate to sit down and have a glass of water (Do I sit in the physician's lounge? Or go to the nurse's lounge where they may all eye me suspiciously??? Maybe I'm not supposed to sit...didn't they say something about not taking breaks???). Just constantly walking around with this clueless, glazed over look on your face.

Every morning starts off with doing rounds. Rounds is when you do progress check ups on each of your inpatients, do a quick physical exam, check labs, vitals, then write a note, come up with a plan. In a nutshell: Are they pooping? Peeing? Walking? In pain? How do their incisions look? Feeling better, worse? Ready to be discharged? Can I feed them yet? This gets pretty routine but its fun when you get to know a patient after seeing them every morning.

After this, me and the other PA student, Jes, grab breakfast with the two surgical residents, Jordan and Chad.  They are cool. Always in a good mood. Answer our questions. Pimp us. Teach us. Make fun of us constantly. We make fun of them back. Share corny medicine jokes. We sort of follow them around like little puppies.

Then we head to the OR. Cases start as early as 7:30. We check the board to see what's on the schedule, decide which ones we want to scrub in on. Most of the time we stick with the general surgeons, so alot of the cases I see are lap choles, lap appys, hernia repairs, mass excisions, colectomies. Occasionally we get the rare treat of seeing a tumor removal, or some sort of emergency surgery. Sometimes I sneak into vascular for carotid endarterectomies. Those are my fave :) There is something so satisfying about watching someone slowly pick off the plaque from the inside of a carotid artery. Especially that moment when it finally becomes loose. Here just watch:

It gets good at 4:00 ;)

Anyway, before the surgery, I usually introduce myself to the patient, ask them about their history of their condition. Then I help with the pre-surgery prep. If they need to put in a foley, sometimes I ask if I can do it, or I might ask to do the intubation. When I can tell it's a complicated case or that everyone is in a rush, I hold off on trying to do things so I don't disrupt the flow. Prepping the skin is fun too. Maybe I am just easily amused. I do a pretty good landscaping, if you know what I mean har har har :P During the actual surgery, I am usually retracting, picking up skin, using the suction, holding the camera, deploying the endocatch bag, and I LOVE to suture. I am getting better and faster at closing up the incisions but I think it takes a while to get as fast as the residents and surgeons are. The lap choles and lap appys get a little repetitive but I still like scrubbing in on them because that just means lots of port sites for me to close!

After the surgery, I usually help with transporting the patient out. Then I go find the resident and ask to write-up the post-op orders or write prescriptions. It's good practice because you only remember things like dosing after writing them over and over again. 

Between cases, sometimes we get consults on the hospital floors to do things like take out drains, I&D abscesses, do biopsies. I cannot tell you how many anorectal abscesses I have assisted with draining in my short 5 weeks of being here. It just seems to me like an unusually high frequency. Other consults involve doing a thorough H&P on a patient and deciding if they need to go into surgery or not. These are nice because OR work mostly just tests your anatomy knowledge. Being on the floor lets me test myself clinically, see how good I am at figuring out what info is important, when surgery is absolutely necessary, interpreting labs and imaging, stuff like that.

When there is down time, I might go to the outpatient office with one of the surgeons. This isn't exactly my favorite thing to do since the point of being on a surgery rotation is to see surgery, so I've only gone to the office twice, but I still think it's important to get a full idea of how everything works. In the office, we mostly do pre-op checks, post-op checks, remove sutures/staples, and minor procedures like removing small cysts, lipomas, I&Ds. It's nice to see patients doing so much better in their post-op office visit after I helped operate on them the previous week. Sometimes Jes and I just hang out with the residents in the lounge and ask them to teach us about a topic. On Wednesdays, we have our weekly educational lunchtime meeting where we listen to presentations about various topics. I had to give a formal presentation myself last week. It was aite. I'll talk more on this later.

When I first got here, I was a little caught of guard by the surgeons here. Man are they feisty. Not all of them, but the ones that are...they like to bring up some pretty taboo conversation topics in the middle of the surgery. Some teach more than others, some make fun of you more than others, but overall I feel like they have a good attitude towards students. Sometimes you just need to have a thick skin and not be easily offended/embarrassed. Occasionally I see a temper tantrum, like a no-holds barred, foot-stomping, war-cry in the middle of the operation. I feel like I get pimped quite a bit, but I actually don't mind. When I get a question right, it just builds my confidence, and when I get something wrong, at least I'm learning. But you can bet I get a good amount right ;D.

OK I need to stop here because it is late and I need sleep!


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