weeping with joy

it’s official. i am done with surgery. my two hour shelf exam is completed, and i walked out with that feeling of passing. if i’m lucky, i will achieve an 80/100 and “honor” the shelf, and then hopefully the whole rotation.

it didn’t start well though. the shelf was at 8, and i woke up at 737. you’d think after 3 months of waking up at 4-5 am that i could get a grasp on this waking up on time thing. being accustomed to waking up late, i did manage to make it on time.

the shelf exam wasn’t too bad. there will always be those questions where i read it and have no idea what the answer is. unfortunately, questions on the shelf are never what does this patient have? they expect you to know that. they want to know, given that you know the patient has “x” disease (they never 100% confirm it), what would you do next? however, it’s over and i can finally clean the house properly (you don’t even want to know).

as for “honoring”, this is the only way to get ahead in medical school from a class rank stand-point. at my school, you have to achieve a certain, pre-set percent on the shelf, in addition to getting excellent marks from your clerkship attendings and residents. this is challenging because you typically have to do one of two things: 1. get to hospital early and leave late to show your committment to working hard or 2. sneak away every chance you get to study. it’s difficult to find that balance for both.

for now, i have the opportunity to clean, wrap presents, hang out with delilah.

surgery

i will write one note on surgery.

before i did my surgery rotation, i knew i didn’t want to do surgery. surgery is one of those fields, you either love it or hate it. i’ll start by detailing a typical day.

as a student, the goal is to see as many patients before your intern. keep in mind the intern will start seeing patients at 530-6 am. so you need to be there at least a half hour before them.  your sole function in the morning is to write a “progress note” on the patient, which on surgery consists of:

• Subjective: no acute event. no n/v, f/c, 1 bm, + flatus
• Exam:
  • VSS stable, afebrile. u/o 500
  • Abdomen: s/nt/nd, +bs
• A/P – continue current care

what i just wrote there is a lot. the abbreviations don’t matter. i have had patients talk to me for 15 minutes, and that’s still all i write. if i wrote more, i get scolded by the intern, because then he actually has to read.

after i see the patients, i then have to walk around with my intern and tell him everything i wrote in my note anyway. then we wait around for the senior resident to arrive. the group of us now go around and see all those patients again, telling the senior what we saw upon which he goes and sees the patients anyway.

 after this charade, i am blessed enough to scrub in on surgeries. i was fortunate enough that while on surgery, my scrub nurses were extremely nice (which is unusual because normally the medical student is the brunt of their displaced anger – it’s a food chain).

attending – resident – everyone else at the hospital including janitors – medical students

at this point, i am standing by the patient, usually scrubbed in. i stand there for most of the surgery just watching or retracting skin or fat out of the way. sometimes i get to cut sutures (exhilarating). sometimes people talk to me, usually not. and when they do, i’m not paying attention because i’m used to being ignored for 3 hours. and a lot of times it’s not enough nice conversation, like what’s your name, it’s more like…

“what is the arterial supply of the inferior thyroid pole”

“the inferior thyroid artery”

“where does that artery originate?”

“the thyrocervical trunk”

“what is the embryonic tissue from which the thyroid is derived?”

“…eh…hm…i’m not sure.”

“you clearly aren’t studying. you can no longer capable of even retracting. stand there and don’t talk.”

“yes sir.”

toward the end of the surgery is the pay-off – i get to suture the body closed. this is not something you get to do right away. first you must prove you can tie a knot and use scissors (we’ll come back to this).

after the case is done, i stand around for awhile. if there is another surgery, i go to it. then in the afternoon, we do that same walking around the hospital thing, this time with the attending/surgeon (same thing). we tell him what we told the senior, and he goes and talks to the patient who tells him all of what we told him anyway.

by now it’s 4-5 pm and i can go home. to study.

scissors – unbeknownst to me, there is about a 50 page book just on proper scissor technique in the operating room. in the left scissor hole, you put your thumb. in the right, your ring finger. you index finger rests on the neck of the scissors. when holding the scissors, you must have the screw up. you place one blade on the suture, run it down the suture until it hits the knot. if you are in the body, 3 mm will suffice; if it’s the skin, as close to the knot as possible. when you raise your scissors to the 3 mm knot, you must turn the scissors to a 45 degree angle. you are now ready to cut. to properly scissor, one must push down with the thumb and lift up with the ring finger, to optimize the cutting power. once you cut, and you note the length of the tail of the suture, the surgeon will either tell you it was too long or too short.

i am not kidding.

 however, i will say not all surgery is bad. once you get to know a surgeon, they begin to trust you (assuming they like you) and they let you do more and talk to you. however, you rarely ever rise to a level higher than basic suturing and cutting.

med school in a nut shell (“help i’m in a nutshell”)

Some basic facts you have to know about med school, especially if you have a family member in it.

med school is 4 years. 2 years of book studying, 2 years of paying to work in the hospital. (and paying a lot). i don’t know how many times i have had to explain this. in your third year, the year i am currently doing, you do six “clerkships” or “clinical rotations”: internal medicine, surgery, psych, family medicine, peds, ob/gyn. these are the foundation of medicine. each clerkship has electives. we have a test at the end of each clerkship (the aforementioned shelf). fourth year is the amazing time of all month-long electives, interviews, match day, and every kind of fun when you don’t have tests any more.

i have spared you the trials and tribulations of step 1, which is a major test taken at the end of m2 year (second year of medical school, get it?). step 1 is a component of the national board exam, of which there are 3 components: step 1, 2, and 3 (crazy, i know). step 2 is at the end of m3 year. step 3 is during residency, ideally during your intern year.

step 1 basically determines your residency. if you do poorly, you can make up for it on step 2, but it’s better to not put that kind of pressure on yourself. step 1 is the bane of most medical students existence because of the study commitment it requires.

terms that will be helpful from a med student point of view:

• intern – 1st year of residency. the person medical students work with the most
• resident – indentured servant
• attending – the doctor you’re accustomed to

let’s get down to business

i will begin with the best news: i am officially done with surgery. on many medical school blogs, you will see a large number posts regarding this rotation, and they are all pretty true. however, i purposely waiting until the end because while i hated surgery, i did not want it to consume my writing.

i spent 9 weeks on this rotation, and i will tell you, i went out with a bang. during a morning presentation with all of the attendings and resident, i got up to use the restroom. i should add that whenever i leave to go to the bathroom, it is really that i am so bored with the presentation, i have to leave. as i walk to the back of the room and a my favorite senior resident steps up to the podium, i manage to trip on nothing. and i mean nothing. i fell flat on my face with only the heart surgeon to buffer some of my fall. and as i am crashing and burning, my senior resident says “OH MY…GOD” directly into the microphone. let’s leave it at that.

 that’s tidbit number one.

before i share this next story, i will add that i have a test tomorrow. a test during your third year is called a “shelf”. this will be helpful for future reference.

so after my 2 hour nap, i decide i study at our local coffee house, arabica. i am driving down a busy 4 lane road in my city in the right lane, and as i look down the road, i see a white truck back out into the left lane, and pull into the right lane and stop. i stop behind thinking he will start moving, but he remains. i honk my horn. he doesn’t move. i drive around him in the left lane, and as i do this, he proceeds to speed up and drive in my blind spot. at this point i was probably going 60 in a 35 to try and get back in the right lane (i had to turn right at the upcoming intersection), so i decide to slow down, which he follows. all the while, i can see him yelling at me, so i flip him the bird. he speeds ahead of me, brake-checks, i move to the right lane, he brake-checks again. i get stopped at a light (conveniently) and he gets out to yell at me, at which point i tell him, “i have your license plate number and i’m telling the cops.” and i did. i decided to do all this, instead of study for my test tomorrow.

the cop said he’ll yell at him. that will show HIM.