Things I am going to miss about Surgery
--Wearing scrubs all the time.
--Wearing fun socks without worrying if they match my outfit.
--Accomplishing A TON of stuff before the clock strikes 9am.
--On a related note: two breakfasts a day.
--OR humor (attending dependent, but awesome when it occurs.)
--Being encouraged to listen to music while working.
--"And none of that classical Kenny G stuff! Something loud with guitars." - Attending Surgeon
--Really feeling like a member of a team that is Accomplishing Things™

Things I'm not going to miss about Surgery
--Wound vac changes
--Seeing patients get extubated (mucus...)
--Those times I had to wake up at 4:30am or earlier
--The times lunch and dinner were iffy propositions
--Being told to ask questions to show off what I know.
--Trash talking the "long rounds" on Medicine... after needlessly discussing a patient plan for the fifth time

That's all I can think of right now. I'm officially done with my Surgery clerkship. I started the day by waking up at 6:30. That's right folks, I slept in. This clerkship is unique in that it has an oral exam with an attending in addition to the shelf exam. My oral was this morning with the director of the surgery residency program. At first I was really nervous: I had to keep covering my mouth and coughing to hide the fact that my teeth were chattering. But I calmed down and things actually went really well.

It was only 9:45 when my oral exam ended, so I went and got my final second breakfast. The written exam wasn't until 1, so I did some last minute studying for that. Good thing, because there was a question on one of the diseases that I specifically looked up. There were also quite a few questions that I only felt comfortable with because of info I'd picked up on my Medicine rotation. Things would've been a lot tougher without that foundation.

Now I've got a long stretch of OR-free days, to try and get through until July. Remember when I was afraid of Surgery? Teehee.

The hospital I'm at has something like forty operating rooms, in various locations throughout the medical center. The biggest block of ORs (twenty, I think) is on the third floor of the main hospital, and is appropriately called "The Main." It's interesting to note that during my three months of Surgery, I've never been on a service whose base of operations was the main OR. Colorectal and Urology are both based in Medical Center East (MCE), and on ENT I split time between The Vanderbilt Clinic ORs (TVC) and the outpatient surgery center (called FEL for a reason I won't explain here). Each place has its own quirks, so to speak. For example, FEL has catered lunch brought in for the attendings, residents and medical students (in that order) every single day. And because each place is home to different services, there are different staff who are trained to assist with the specific types of operations going on there.

I say all that to explain why today was such a jarring experience for me. The Urology service had a joint case with the Cardiac service: a simultaneous coronary artery bypass and kidney removal. Since pretty much any organ is going to play second fiddle to the heart, that meant that we were strangers in a strange land today. The home base of cardiac surgery. The main ORs. The flurry of activity getting ready for the case was kind of intimidating. It was actually the same as in any operating room for any case, but it seems more hectic when you don't know who anyone is or where anything is or what anything is. I was even more useless than I usually am. Since bypass/kidney removal is not a common occurrence, there was a lot of confusion about how, exactly, everything would be set up. I honestly thought it was going to be one giant cluster. But everything got straightened out and the operation actually went quite smoothly.

I'd been warned by staff in MCE and TVC that the main OR was a lot more uptight. They weren't wrong, but it's not necessarily a bad thing. I'd be uptight too if I were in the business of regularly stopping people's hearts like it's no big deal. When hearts are being cut on, stuff needs to happen when the attending wants them to happen. Rectum? Prostate? Nose? Not the same sense of urgency.

One of the nurses asked me if I want to be a surgeon. When I gave an emphatic yes, she told me, "Set a high standard for yourself. I don't want to sound sexist, since I'm a woman myself, but a lot of these woman surgeons... I don't know, maybe it's because most of them are ob-gyn, and they may be great obstetricians, but they're mediocre surgeons. Be efficient, be about your business and get the job done. Don't be a mediocre surgeon." She said all this to me before I could get out that I plan to be a gyn surgeon. Perhaps that's just as well. Good thing I never planned on being mediocre.

I like urology, don't get me wrong. Given a choice, I'd rather be doing this than shadowing in clinic every day like the people on ophtho. But the general surgery-esque hours, so clse to the shelf exam, are wearing on me. I thought these last two weeks would be pretty lax. Prerounding on 3 patients for 6am rounds is not lax. Granted, I've gotten a lot faster than I was back in January (and let's not even speak of July!). I'm still jealous of my colleagues with later start times. Y'all, I'm genuinely angry EVERY TIME my alarm goes off at 4:30. I'm not going into a specialty with late mornings, so how long will it take to get over this?

I called my parents to tell them about Match Day etc. My dad asked if I now feel like the end is approaching. The thing is, third year isn't anywhere CLOSE to done. When I saw that Coldplay is coming to Nashville in June, I thought "I have to be on summer break by that point..." But no!! I'll still have WEEKS left. WHY IS THIS GODFORSAKEN YEAR SO LONG?? And why did I think it'd be a good idea to finish the year with three months of zero operating and very few procedures?? I think I am going to have a rough go of neuro and psych.

Today in the OR: this patient had scarring and narrowing of his ureter, one of the tubes going from his kidney to his bladder. (That means urine was backing up in the kidney, which is not a good thing.) So we cut out the scarred part. Then we cut a flap out of his bladder and basically rolled it up to make a pseudo-ureter, attaching it to the stump of ureter that was left. To quote Beth, "That sounds like a thing that it shouldn't be possible to do." But done it was.

Okay. WAKE FOREST???!!!. We need to talk. But not right now, because I might break things.

I recently updated my LJ profile to explain the diamond shoes thing. Which I explained earlier, but now it's in a place for easy reference! It's also about time for six new random facts about me, but I'm running out of ideas.

Today was my second day on the urology service. Urologists basically take care of everybody's urinary tract, and the male reproductive system. (The female reproductive system, as we all know, belongs to my future specialty.) In two days, I've seen/helped with two partial nephrectomies (taking out part of a kidney), a bladder biopsy, a bladder removal, and two prostate gland removals. The Da Vinci robot has also re-entered my life. You may remember the times I described robotic operations while on gyn oncology. Well, same robot, same region of the body... same not scrubbing in. But I'm not complaining! I like having the ability to stand unnoticed in the corner, especially this time of year, if you know what I'm saying and I think you do!

So yeah, the cases are cool, I like the residents, the attendings are nice. The mornings are just as early as my colorectal rotation, pre-rounding included! Breakfast is a priority, which is nice. The only downside is that in just two days, I've pretty much had my fill of both penis jokes and "that's what she said" jokes. Every time somebody asks for the suction? Really?

Match Day is coming up for the class of 2009. This is kinda nervewracking for me, as a member of the class of 2010. For one thing, I know more members of this year's class than any of the classes before. These are the people who welcomed me and my classmates to medical school, who spent time holding review sessions for us, who threw candy at us on more than one stress-relieving occasion during first year, and who've given us advice throughout all three years. (Sometimes more advice than we may have wanted...) I consider many of them friends, so seeing them get the residency spots they want means more than when it was just random people I'd never seen before.

Secondly, the class of 2009 is the only buffer between us and the whole scary process of choosing a career and trying to obtain a residency spot. After this week, the next time there's a Match Day, it'll be ours. That's scary!!

Did you know that Selection Sunday is Sunday? I didn't realize that until today! March Madness has really snuck up on me this year. I can count on one hand the games I watched in their entirety this season. And I didn't go to any games. Boo. It seems like I didn't miss a whole lot, as far as the SEC is concerned. This season wasn't too kind to the conference. Nor to Vandy in particular, but that was expected with a team of freshmen.

I finished up my clinic week today. Overall, my favorites were spine clinic with a neurosurgeon, and thoracic surgery. There was interesting stuff in all the clinics I did, but those were the two where I was allowed to see patients on my own. Nevermind that I was sent to do neuro exams without even a reflex hammer (holy unpreparedness, Batman!). I just appreciate being given the chance. Neurosurgery clinic was mostly herniated discs and spinal stenosis. Thoracic clinic included several post-op visits for lung cancer, but I also saw a lung transplant evaluation, and a patient with an overactive parathyroid gland that just happened to be behind his heart.

I also did urology clinic, as a little preview of what I'll be doing for the next couple of weeks. It was actually urologic cancer clinic, so I saw a lot of prostate, renal, and bladder cancer.

Because I got all my clinics out of the way, I'm free to do whatever I want tomorrow. Three day weekend!! My plan is to sleep relatively late, and then coffeeshop the day away. But no more studying tonight, because...

Here's a sign that I may be studying too hard: I dreamt that I was in some sort of learning session with my old Physical Diagnosis group. Our tutor, Dr. G., said that he wanted to quiz us on some scans. So he pulled up all these old images (Xrays, CT scans) of me, from back when I broke my toe (at age 9). For some reason, I'd gotten multiple full body scans for a broken toe. However, in a nod to logic and sense, the images were appropriately grainy for being fifteen years old and sent by fax from an outside hospital. So Dr. G. starts going over all these images with us, asking us to describe the abnormalities. I was dumbfounded, but my classmates were yelling out all these things that were wrong with me on the inside. I got more and more confused, because I felt fine. After this went on for a while, Dr. G. asked "So what should we do?" and I said, "Fix the broken toe!" Which was the right answer, because all those other abnormalities weren't actual problems, and "We treat patients, not imaging." (Basically a direct quote from my main study resource.) Then Dr. G. and I exploding-fist-bumped. Then I woke up.

I finished my time on the Head and Neck service on Friday. My last big case was on a patient who had a rapidly-growing cancer of the soft tissue of his face. In the hope of curing him, we did what was officially called a composite resection. In layman's terms, we took off half his face. Any thoughts I might have been entertaining about doing ENT flew far away when we got to the enucleation (removal of the eyeball). The attending and chief resident kept trying to make sure I had a good view of everything. I really, really didn't want a good view of everything. I want nothing to do with eyeballs. Or with bone drills, which were also involved.

The weekend was dedicated to Cadaver Ball, which I've already talked about.

I'm now on Clinic Week, which features the most lax schedule of the surgery clerkship. We're supposed to spend seven half-days in various surgical clinics. I gave myself the morning off, to study and meet with the Ob/Gyn residency director. She was really nice, and gave me a lot of helpful information and tips about planning my fourth year. I'm pretty excited about it.

This afternoon, I went to hand surgery clinic (Hand surgery is a division of orthopedics). The doctors were really nice, and I saw some interesting stuff. A couple of followups from crush injuries, a huge elbow hematoma that got drained, a wrist fracture that got set, and more. All in just an hour and forty minutes. Not too shabby!

The past couple of days, I have seen some ridiculous operations. I'll try to describe them in terms that are as nontechnical as possible. First, for a patient with floor-of-the-mouth cancer: they removed the affected part of her mouth, jawbone, and part of her tongue. They took out all the lymph nodes on that side of her neck. They removed part of a small bone in her leg, with skin and blood vessels attached. That was used to make a new jawbone and new floor of the mouth. Then a skin graft from the thigh was used to cover the hole where the leg bone used to be. Then, for a patient with voice box cancer: took out all the lymph nodes in the front part of the neck. Took out the voice box, and a bit of trachea. Made a connection between trachea and skin, through which the patient will now breathe. Cut the chest muscle loose from most of its attachments, with a bit of skin attached, and swung it up into the neck, to fill the hole we'd just made.

Both of those sound pretty cool, right? Taking out cancer, doing wacky things to help the patients function as normally as possible? The only problem is, it takes a loooong time. The first case I described lasted from 7:30am to 10:30pm. Because of stuff like lecture, getting pulled out to go take out a thyroid, and the ability to say "Okay, I'm gonna peace out," I did not truly appreciate the marathon-ness of that case. The second case I described, which was today, went from 7:30am to 6pm. I felt all those minutes. Maybe it's better when you're the actual surgeon. Maybe I just need to get new shoes.

We got through over 200 songs on the attending's iPod, one of which was thirty straight minutes of screeching "vocals" and wailing guitar that propelled Led Zeppelin from the 'Indifferent' to 'HATE' category in my mental file cabinet. It is clear that Jimmy Page is a guitar virtuoso within the first minute; I just don't understand why there must be twenty-nine more. I like decent, well-mannered songs with clear beginnings, middles and ends. The thing that sucks when it's the attending's music (as opposed to say, the scrub nurse picking it out) is that you can't really talk shit about it...until you get home.

Il a neigé hier soir, mais aujourd'hui il fait du soleil et toute la neige a disparu. Moi, je suis encore malade, mais je me sens mieux que vendredi. Il faut que je recouvre parce que j'aurai une semaine difficile avec les chirurgiens de la tête et le cou.

Okay, enough of that. Just practicing my French...I don't know why. Hopefully I didn't butcher it too badly. Translation: It snowed last night, but it's sunny today and all the snow is gone. As for myself, I'm still sick but I feel a lot better than I did on Friday. I need to recover since I'm going to have a tough week on Head and Neck Surgery.

Why do I think Head and Neck is going to be tough? Well, the cases are going to be longer, for one thing. I also anticipate more pimping. I didn't get much of that on general ENT. There was just one otologist who had me discuss the path of the facial nerve (geniculate ganglion???!) and one laryngologist who asked about the intrinsic muscles of the larynx. Head and Neck will have bigger cases with more obvious anatomy. The easier to pimp me with, I fear. I've been doing some reading so I don't look like a complete ignoramus in the OR this week. Neck anatomy is just as not fun as it was the first time around! All these triangles, and muscles going every which way. Sterno-omo-thryo-hyoid?

Cadaver Ball is this weekend! It snuck up on me this year, unlike first year when it consumed my thoughts for months. The third year class historically has a pretty poor showing, despite the fact that we're excused from clinical duties from noon on Saturday to noon on Sunday. It doesn't help that ticket prices went up a lot this year. I'm going, because as an ISTJ, I value the traditions of the institutions to which I belong. I also want to see what hilarity the class of 2009 comes up with.

Cadaver Ball celebrates the fact that the end of medical school is rapidly approaching for the class of 2009. That means that fourth year is rapidly approaching for my class. We've already had our class meeting with the registrar, about how to sign up for our mandatory rotations: emergency medicine, sub-internships, primary care. Sometimes I feel like orientation wasn't that long ago. How can we be almost fourth years?? I feel pretty fortunate in that I'm 90+ percent sure about the field I want to go into. There's really not that much time to decide!

In other news, I gave up meat for Lent this year. No problems yet, but I've been sick for most of the days. I haven't felt much like eating anything. My mom expressed concern that I would starve to death, but I think that as a 24 year old future physician, I can figure out how to get my nutrition on without meat. Don't worry, there's approximately zero chance that I'll go vegetarian permanently, or start angrily ranting at people who eat meat in front of me. I'm giving up meat because it's difficult, and it's difficult because I find it oh so delicious. That said, if any of you have some especially delicious vegetarian recipes you want to send my way, please do so. When I have free time and am not sick, I'm already planning to try to make a vegetarian chili that can equal my beer brat chili. I'll let you know how that goes.

This week I've been on the general ENT service. ENT stands for ear, nose, and throat. The specialty's more formal name is otorhinolaryngology, which is a fancy way of saying... ear, nose, and throat. Luckily it's a pretty laid back specialty, and nobody has a problem with calling it ENT. You never know, people can be touchy about stuff like that. For example, I did not get a good response when I called the Colorectal service "Guts and Butts."

All day Monday, I was in the OR watching sinus surgery done by one of the rhinologists. I spent Tuesday morning in clinic with the same doctor. Then I went to the OR to watch a vocal cord injection and a rhinoplasty. Wednesday, I got OR time with an otologist. I saw two patients go from deaf to hearing, which was pretty cool. The first patient got his stapes bone taken out and replaced with a prosthesis. The second patient got a cochlear implant.

Today I was with a laryngologist, and one of the cases I saw was amazing!! The patient had vocal cord paralysis due to nerve injury from a previous operation. The procedure today, placing an implant into his vocal cord, was done with the patient awake. Right before placing the implant, the attending had the patient count from one to ten. He did, in a hoarse, weak voice. Then, while placing the implant, the attending had him count again. Between "four" and "five," the guy's voice went from hoarse to a deep baritone that made me literally jump back in surprise. The patient jumped too, which made the attending comment, "That's why we strap you down on the table." The senior resident told me that was her favorite surgery in all of ENT. I can definitely see why.

My Weekend

As you all know, my general surgery rotation came to an end on Friday. My partner and I were lucky: our chief told us we were done around 1:30pm. I was ready to start partying right then. Unfortunately my friends who were also on general had chiefs who were way less cool than mine. They didn't finish until after 6. I killed the time by watching TV, catching up with the blogs I read faithfully, and having a private dance party. Lady Gaga's "Just Dance" is my jam, y'all. (On a related note, weird and improbable though it may be, I'm convinced that Lady Gaga is Gwen Stefani having some fun with us all. I will believe this until I see the two of them in the same place at the same time. I know that in the distant past I've also been equally convinced that Taylor Hanson was a girl and Jennifer Lopez's music career would never take off... but this time I think I'm right.)

When the workday officially ended for everybody, I hit the town with three friends. First we went to a nearby microbrewery for pizza and beer. Then walked to another restaurant for dessert. Then we went to another place and split some appetizers and a bottle of wine. Then we walked home. No cab fares, no dealing with tourists at the honky tonks, it was a great night. Best of all was getting ready for bed around 3am, and realizing that if I'd had to go in to the hospital, I'd be waking up then.

Saturday was a lot of sleeping, with a teeny bit of work thrown in. (After all, I haven't finished the whole clerkship, just one part.) For weeks my mental calendar has ended on February 13, so the whole Valentine's Day thing was a non-issue for me.

Sunday was church, followed by brunch, followed by sleeping, followed by some reading for the week ahead that I really could have skipped.

Which brings me to the now. I'm on the part of the Surgery clerkship called Critical Skills Week. It's run by the anesthesiology department, and covers things like airway management, ventilators, and intraoperative monitoring. The highlight of the day was the vent lecture. I feel like I actually understand ventilator settings now! Lowlights were a couple of SUPER BORING lectures, but they can't all be great.

I am ridiculously happy right now. No more weekly presentations and near-constant pimping and the pressure to be amazing and wonderful all the time. Five weeks was a long time to go through all that.

After doing gastrointestinal-type things on Medicine, Peds, and Surgery, I can now say with certainty that I will not be pursuing gastroenterology as a career. Which is, I suppose, the reason we are not locked into the career "decisions" we make as first year medical students. Or, come to think of it, as second years. (aside, concerning that link: I loooove that I used ear tugging as an example of why working with kids is better. Delicious irony.)

No, I do not think my Livejournal is Twitter. It's just that sometimes, I feel like I have something to communicate, and not a lot of time to do it. All of my recent short updates have been posted from my iPod, during the tiny breaks I have throughout my long, long days. But here's a nice long post to captivate you all!
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On Saturday The Moons, one of my very good friends and an avid cyclist, crashed her bike while riding in a local park. I found out through back to back calls from her mom (who is out of state and was kind of frantic) and a classmate who is rotating through trauma. His words were, "My attending said I should try to get in touch with people." My thoughts were, "Shit." In related news, I now know for a fact that I can get from my living room to the hospital in under three minutes. I was quite relieved to relieve to find The Moons scraped, bloody, and concussed, but otherwise okay. Didn't actually see her helmet, but I've heard it that it's not pretty. Of course that means it did its job, for which all who know and love The Moons are grateful. She was in the hospital for a few days, which sucked. But on the bright side, as a med student she was able to have a constant stream of visitors (fellow students) despite being on a floor with restricted visiting hours. Moons, if you're reading this, I hope you're feeling better!!
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Before starting Surgery, back when I was still expecting to be miserable every day, I planned to make my personal mantra "They can't stop the clock." Meaning, no matter how much it sucked, the rotation couldn't last forever. Turns out I didn't really need any mantra to motivate myself. Also, turns out I didn't pick the greatest mantra. This week hasn't been the best for me. They might not be able to stop the clock, but they sure can make it go really effing slowly. And they can make me stay at the hospital for most of the time on the clock. So whatever. I can do anything for two days.
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I had clinic on Monday, which was good. One of the most striking things about colorectal clinic is seeing patients react when the doctors broach the subject of having an ostomy. It's very emotional, to say the least. Some patients are very resistant, even when suffering from almost-constant abdominal pain and upwards of a dozen bloody poops a day. The attendings do their best to help patients see that saving their quality of life and saving their colon isn't always the same thing. With all my time on GI, I'd never thought about it that way.
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Yesterday was not a good day. Only three cases, but the middle one was a beeyotch. It went a couple of hours longer than it was supposed to, which means our last case didn't start until almost 6pm. That combined with the fact that I still had a powerpoint presentation to work on, AND the fact that rounds were early today, meant that I could feel my precious minutes of sleep slipping away. I love my sleep more than anything, so that was pretty frustrating.
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Today was much better. The cases I scrubbed on were really interesting. Even better, I had time to eat lunch! My group's case presentation went very well, and I was free to go home by 5pm. I'm thinking, maybe I should start looking for a specialty with shorter hours. One that lets me sleep until 8 or 9 in the morning. Which specialty (and residency) has that? Anybody know??

Procedure just completed: a complete excision of my will to live.

Zero caffeine intake today was a mistake. But there's nothing like the sudden need to convert from anal to abdominal approach (translation: gotta flip the patient over) to wake me up.

I am feeling quite refreshed after sleeping from 5 yesterday evening to 4 this morning. I really, really needed those extra hours. Today was my day off, so I did some shopping and some cleaning, but mostly lazing about. I needed that, too. Thinking back, I'm angrier at baseline than I have been during any other rotation. Maybe instead of thinking up questions to show my interest, I can just yell "Serenity now!!" in the OR.

I have six days (Sunday-Friday) left on general surgery. Not that I have a countdown or anything.

We've all seen the thing going around Facebook, and now LJ. Well, for waaay more than 25 random facts about me, click here.

Now that I've blown your minds, let's talk about the things going on in my life. I am almost done with the fourth week of my general surgery block. Things continue to go well overall, though, like every rotation, there are rough spots. For example, the mornings suck. I know I'm going to have early mornings no matter what I do. There's just something soul crushing about 4am when it's 10 degrees out.

It's also hard going through really long stretches during which my time is not my own. Now, that's a common theme of third year, no matter what the rotation. I feel like it's more true on Surgery than anything else I've done so far. On Medicine, for example, I was pretty free to go do whatever while waiting for a patient to come in. Even after the resident would page me with an assignment, I could take as long as I wanted to read about them, work them up, and then work on my presentation. Hell, on Peds I once went out to eat while on call. At a restaurant. God, I miss those days. Now I feel like every second of my day is regimented, with somebody paying close attention to where I am and what I'm doing. That makes already long days seem even longer. Today I had thirty minutes of free time, and it was like a gift from the Lord.

Only two weeks left on Colorectal! I gloriously got the entire weekend off. All the Surgery residents had to take an exam on Saturday. Our chief told us not to bother coming in. I'm glad, because based on what I heard from people who did have to go in, the whole day was a cluster. And then we were told that only one of us needed to come in today. My rotation partner quickly volunteered, and I quickly agreed. Two days in a row of sleeping past 7am? Yes please.

Abrupt ending to that last entry. I was still pretty tired, and ran out of entry-typing steam. To explain a little further, when the second trauma patient came in, most of the team was in the OR with the first guy. The second year resident and I ended up going down to the ED to wait on the second patient. The resident told me that I could do the secondary survey. That's basically a quick head-to-toe exam of the patient, yelling out whatever findings there are. It's kind of important, and that is why I'm glad the guy ended up being in (nearly) pristine condition. Nothing for me to mess up.

It's worth noting that I managed to sleep from 3-5 Tuesday morning. So my long call on Labor and Delivery is still the only time I've ever gone more than 24 hours without sleeping.

So Tuesday, I didn't leave right after rounds. I scrubbed for the first case of the day, because that's what residents do when they stay overnight. I want an authentic surgery experience. It wasn't that bad! But staying any longer would've been pushing it. I came home, was dead to the world for four hours, and then, like a fool, went to trivia. Which we WON despite the fact that when told to name long-running Broadway shows, we forgot the existence of "Les Miserables" AND "Fiddler on the Roof." Excellent.

In completely unrelated news: why had I never even heard of "Oh, Calcutta!" before?

Today I helped the team's intern take care of all the floor patients (that is, post-op, consults and the like). We saw a consult, and followed up on several imaging studies, and changed a couple of wound dressings. We've still got that one epic wound, which this time took six people fifty minutes to do. Not fun, for us or the patient.

I have to give yet another talk at conference tomorrow. Wish me luck!!

On Sunday, I went in for rounds, expecting to be out by 9 in the morning. As we were wrapping up with our patients, we heard about a patient being life-flighted in with a huge GI bleed. I ended up scrubbing in on that case. It was my first emergent exploratory surgery, so it was interesting to see how things differ from elective cases. Unfortunately, the patient is still very sick and has a long hospital course ahead should they recover.

I spent Monday in clinic, then took m first overnight call of the rotation. We're supposed to take one Trauma call and one EGS (emergency general surgery... think acute appendicitis) call. I was going to do EGS, since the case I saw Sunday was technically a trauma. However, when it came down to laparoscopic appendectomy vs. hanging out on the Trauma unit, the choice seemed easy. Stuff started to happen around 10pm, with two car accident victims coming in. The first person's condition was more serious, and I mostly observed and stayed out of the way. The second person was in better shape, and I got to do more. Of course, I found out that I would get to do more before knowing the patient's condition. Standing there waiting for them to get to the ED was more than a little nervewracking.

Yesterday
1) Chief rounds: short and sweet. I think I'm getting the hang of post-op management. It usually involves the words "await bowel function."
2) Multidisciplinary conference: The other student and I each talked about a recent CRS patient's hospital course, with input from radiologists and pathologists. It was a lot more laid back than I expected, and also short and sweet.
3) Teaching rounds: I answered most of the questions stupidly, but whatever. Less than an hour long.
4) Colorectal clinic. Among other things, I saw three patients with a rare colon cancer syndrome. Interesting, but I'm kind of over the whole shadowing thing. Unfortunately I'm told that most of my clinic time on Surgery will be spent shadowing.
5) Afternoon rounds: In my head, I know that surgery rounds are short. In my heart and soul, they feel like forever. Being fast and being efficient aren't the same thing.

Today
1) Chief rounds
2) Grand rounds: this morning's guest speaker talked to us about pancreatic tumors.
3) Breast surgery clinic. I briefly considered giving a wishy-washy answer when the attending asked me and the other student what we're interested in doing. ("I'm not really sure... I'm interested in surgery...") Instead I was honest, and as a result I got to see and examine a patient all by myself. Booyah.
4) Wasting a perfectly good forty minutes in which I could have eaten lunch.
5) Small group discussion about breast disease
6) Afternoon rounds
7) Changing a wound vac, which is a special type of wound dressing. Apparently this is a simple task for most patients. Nothing's simple on Colorectal. This particular wound is pretty impressive, so the dressing change took two residents and two students, working together, almost forty minutes to do. Yikes.

You might notice the lack of operating. Monday will be more of the same, since I get a full day of clinic. The fun never stops.