The title of this post pretty much sums up what I haven’t done while I have been in the hospital for a 1 1/2 weeks. For those who have been keeping up with my posts, at LLU they put us in the hospital for the 2 weeks before we you even start your first year of medical school and for the last 4 weeks of your 1st year. The first 2 weeks before this school year started was almost unbearable because you didn’t know anything and most of what was said by the attendings, residents, 4th years, and 3rd years was way over your head. The wards experience has been much better now that I have gone through a whole school year and I understand alot more of what is going on. But there are still problems with the whole process; with the addition of 1st years to the hospital the medical team is even more crowded, and of course if there is something that is beneath the attending and the resident to do, then the 3rd year will get to do it…definitely not us. So I definitely understand alot more now, but I can’t DO anything; my main job is the stand around and watch or observe. I have had some cool experiences, which I will share below.
I was assigned to a 3rd year who was on her vascular surgery rotation. I truly think that I have the coolest 3rd year; she doesn’t try to push her knowledge on me and she doesn’t make me stay in the hospital as long as she has to. So yeah, being on vascular surgery was pretty interesting. I got to see an AV fistula that was made so that the patient could use a dialysis machine. They basically dissected the basilic vein from where is drains into the axillary vein all the way down to the antecubital fossa. The vascular surgeon meticulously tied off all of the tiny veins that drained into the basilic vein. Once he did that, he cut the vein at its distal point, injected different solutions into the vein to dilate it, and then he connected it to the brachial artery. As I observed different surgeries I started to glean different attributes of the surgeons that I would think of emulating and others that I would try my hardest to never repeat. The particular surgeon doing this case was a pretty cool guy; he taught everyone, including me as the case progressed and he even pimped me with some anatomy questions. What I really didn’t like was that when the chief resident helping with the case tied off a vein too close to the basilic vein the attending said, “Don’t put the stitch so close to the vein BOY”. Obviously the mistake wasn’t serious enough to kill the patient so I didn’t see the need to call a grown man a boy. It is things like this that make people think that all surgeons are a-holes.
I got to help scrub in on a amputation of a leg, which was pretty interesting. As much as I hated anatomy throughout the school year, they really did teach us well. A couple of days after this I accompanied my 3rd year to one of her lectures (yes, you still have class during your 3rd year). That day, the attending decided to quiz the medical students and the residents on the different aspects of the small bowel. When she learned that there were first years in the group, she started to pimp us with anatomy questions (I think anatomy is the only class they think we learned, lol). The attending asked one of the other first years, “Is the duodenum intraperitoneal or retroperitoneal?” The first year answered that it was both. Then she turned to me and asked me how it was both. I knew this answer so well that I didn’t even think about it which was my downfall. Because I blurted the answer out without collecting myself first in my head, I switched the parts of the duodenum around that were inside and outside the peritoneum. A resident had to correct me. OOOOhhhhhh, I felt so embarrased and stupid. As the lecture continued I started to beat myself up, scolding myself for being the only black person in the room and getting the answer wrong. Eventually I started to laugh at how angry I had gotten at myself. I realized that I will probably get many questions wrong in the future (whether I’m the only black person in the room or not), and that rather than taking it out on myself I need to think and speak more slowly, and be more prepared. I slightly redeemed myself later when the attending asked me to name a hernia that had a high risk of small bowel strangulation. I (more slowly) answered with “Spigelian hernia”. She raised her eye in surprise, because she didn’t think we had learned about that. That made me feel better, but I learned that day that I need to grow a thicker skin when it comes to getting asked questions on the spot.
I really enjoyed seeing all of these amazing surgeries…but then a little wrench was thrown in the mix. My 3rd year was actually at the back end of her vascular surgery rotation. The next rotation she switched to (this past Monday) was Anesthesia. I honestly couldn’t imagine a more boring specialty to do, and even worse WATCH someone do. The only exciting parts are when they intubate and extubate. But that was the hand that I was dealt, so I made the best of it. I figured that since I was still in the operating room it wasn’t a complete loss. So while I was on the anesthesia rotation, I witnessed an ENT surgery, where this guy had recurrent otitis media (middle ear infections). The surgeons decided that they needed to basically cut out all of the patient’s mastoid air cells. The surgery was really cool to watch, but it kind of made me claustrophobic because they were working in such a small space. They did get to use a really expensive looking microscope while they operated. When the attending arrived to the case (they usually arrive after the resident starts the case) he started to explain to me what was going on and ask me anatomy questions. He asked me questions like “What is the importance of the chorda tympani nerve?” and “What foramen does the facial nerve exit the skull?”. This info was still fresh in my mind from the anatomy mock board so I answered the questions correctly. When I answered the questions about the chorda tympani nerve I added where the parasympathetic fibers come from and how the nerve joins the lingual nerve, etc. etc. This was more than he expected and he congratulated me on getting answering the question correctly. His praise made me feel good, but then I started to be more quiet because I felt like I was getting too prideful. I foresee that I might have a problem with balancing that. Where exactly does line between diligence in knowing your stuff and pride about knowing everything get drawn? I’m not exactly sure, but I would rather err on the side of not looking like a prideful gunner. (I’m not sure if that will affect me in the long run or not)
The coolest surgery by far that I got to see (even though I was on the anesthesia side) was an open heart surgery on a 10 year old boy. He had a patent foramen ovale and a serious ASD murmur. Watching the surgeons cut the sternum, then the pericardium, and then the right atrium was almost orgasmic. The heart was beating almost like it was angry, and I just couldn’t believe that the surgeons were actually cutting into the heart. CT surgery definitely jumped into the top of choices I think I could go into. After the surgery was done, the cardiothoracic fellow thanked all of the scrubs nurses and the anesthesiologist. I had never seen this done before and I really liked it. It really made it seem like it they were all an integral part of the procedure (which they are), and it showed that the surgeon appreciated all of them. I would like to be the kind of surgeon that does that.
So far the wards experience has been pretty cool. The hardest part for me though really has been watching and not doing. As a first year you are not even at the bottom of the totem pole, you are under it. But being in the hospital and wearing my white coat is much better than being in the classroom. On Wednesday I start my neurology rotation so we’ll see how that goes.
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