Ortho for a Day

You know sometimes good things really can arise from unfortunate events. The unfortunate event is that my dad had to get a partial knee replacement a couple of months back. The good news is that during the whole pre-op and post-op process my mom mentioned that her son was also in medical school and was interested in orthopaedics. So I guess the ortho attending took an interest in me without even meeting me and invited me out to a day of surgery with him during my Christmas break. This was of course a win win situation for me because I got to observe some really cool operations and I got a chance to interact attendings and residents that I would see again when I did a sub-internship there during my 4th year.

So basically my day began with me waking up at 5 a.m. because the operations started at 7:30 a.m. and I had no idea what the traffic was like headed to University of Maryland in Baltimore. My wife dropped me off and I headed towards the operating room with the help of staff. Fortunately I had packed my LLU SOM id in my wallet (because I thought I would need it to get student discounts for movies), because having it allowed me to look more official in my scrubs, lol. So when I got there I was introduced to the 5th year resident that I would be working with for the day. He was pretty nice and he told me that we were waiting for the attending to arrive. When the attending arrived he started to visit each patient in the PACU (pre-op area). He would talk with the patient, see how they were feeling, ask them which extremity had a problem, and once they confirmed the op site, he would take a marker and sign his name in huge letters on the extremity. There was a really personal element to the way that he did this that is hard to relay in words, but I really admired his style. The first patient that we took back was a University football player and he was huge, probably 6’6 / 350 lbs. He had anterior shoulder instability and the way that the attending fixed it made so much sense as I watched it. Since the guy’s arms and shoulders were so massive the operation took longer than expected but once we were done, his shoulder was definitely much tighter. The next patient that we worked on was a college soccer player who we suspected had entrapment of her peroneal nerve which was causing her extreme pain. So they went in there and released the nerve that had been trapped in scar tissue from a previous operation. The next patient needed a scope for us to see whether he needed a partial or full knee replacement. When the attending put the scope in I knew immediately that what I was looking at did not look good. I didn’t know what to categorize the bone in his knee as but it didn’t look normal, and the attending confirmed that he patient would need a full knee replacement. We did some other cases but the coolest one was a lateral collateral ligament reconstruction on another college football player. Basically they took an Achilles tendon from a cadaver and decided t0 use that as for ligament reconstruction. They drilled a hole superiorly into the head of the fibula and with a screw, secured one end of the Achilles tendon into the hole that they made. Then they took the other end of the tendon and screwed it into the lateral surface of the distal femur. Before we closed up the attending tried the move the knee joint laterally to see if our tendon would hold the knee properly and it was so amazing to see it tense up and basically do it’s job. I really enjoyed seeing that surgery because it summed up what has been appealing about orthopedics to me. The surgeries for the most part make a lot of sense, and the patient usually is immediately better.

The surgeries were great but I think that the best part of my time with the attending and the chief resident was the advice they gave me about what to look for in a program, and the strengths and weaknesses of the local programs. I had mentioned to the attending that I wanted to do an away rotation at Union because it seems like a nice close-nit program and they are the team doctors for the Baltimore Ravens. The attending told me that he would give me his honest opinion and the resident could back him up or refute what he was saying after. He said that as a medical student looking at different orthopedic programs, the fact that the attendings are the team doctors for a NFL team is actually a con and not a pro. He was saying that at his previous job, he was the team doctor for a NFL team and while it was cool to do that, he is quite sure that his residents didn’t receive as much of his attention as they do now at UMD simply because NFL teams require a serious time commitment. And chances are that as a resident you really won’t even be touching  the NFL team members so it shouldn’t really factor into your decision to chose a residency.The resident piped up and said that the main difference between Union and UMD was the fact that Union has fellowships in almost all the orthopaedic subspecialties while UMD only had a fellowship in Trauma. Less fellows means more OR time for residents. The attending relayed to me that when he was a fellow at one of the top sports fellowships in the country, the residents at most would scope the joint before he and his attending would do the case, without them. The attending also stressed that I should look for a program that was balanced in all the orthopaedic subspecialities. He honestly pointed out that UMD’s weak points were that they got very little foot and ankle experience and that they didn’t have a pediatric guy in house (they rotate at Hopkins for Peds and Tumor). While their Hopkins rotation is good, not having an in-house attending is a downside to a program that you have to consider. Overall I got a lot of good advice that has helped me to really narrow down where I want to do away rotations at during my 4th year.

Orientation for my Surgery Clerkship starts at 7 a.m. tomorrow morning and I can’t wait!!!

2 Responses to Ortho for a Day

  1. Jeff W says:

    It’s been a while since I’ve stopped by. When did you change your theme? Looks good.

    And it’s awesome you got to get in on some surgeries!

    • DoctaJay says:

      Hey man I switched my theme after seeing Twitter incorporated into your own blog. I liked the concept and set out to find one that was similar.

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