Island Med Student

I’ve spent the past two weeks rotating in anesthesiology, which means I’ve basically put in a lot of hours in the operating room (or theatre, as it’s called here). In just two short weeks I feel like I’ve come a long way. When I first started, I barely knew the right way to put on my mask or sterile gloves, and now I understand most of the rules (both unwritten and otherwise) in the OR. I can hold the oxygen mask properly, start IV lines, and I even intubated my first patient the other day! I haven’t yet scrubbed in for a surgery, since I am with the anesthesiologist, but I know that I’ll be doing that in the near future.

At this point, I’ve only seen 20-30 surgeries, so I know that I am still “green,” but I have enough knowledge to at least avoid getting yelled at by the nurses and surgeons, and I can even help out every once in a while.

The doctors and nurses that I’ve seen working in the OR absolutely amaze me. They handle patients so efficiently that it’s obvious that most of them have been in this business for years. In fact, they are so good at their routines that they sometimes forget to explain their procedures to us ignorant med students.

I think the relationship between the surgeon and the surgical nurse assistant is the most fascinating. The nurse has seen enough surgeries that he or she knows exactly which instrument the surgeon needs at any moment. I realized during a surgery the other day that the surgeon rarely had to request an instrument. Rather, the nurse had it prepared and waiting for him before he even asked. Some of the nurses even know the details and personal preferences of each surgeon, and take that into account when assisting.

During a surgery, there is a wonderful ballet between the anesthesiologist, surgeons, nurses, and techs. When you add the sound of the beeping heart monitor, the ventilator, and all the other various background noises, it really does create a scene reminiscent of a spectacular performance. And as with any good show, the actors and actresses are all dressed in elaborate and purposeful costumes. Perhaps the United States has it wrong in calling it merely a room. It seems that it is much more similar to a theatre.

Watching the surgeon skillfully slice, clamp and suture reminds me of cheironomy, or the process of using hand gestures to indicate melodic shape. This process was used beginning all the way back in the Middle Ages, but has since mutated into the modern conducting baton, which is used more to keep the beat of an orchestra. And similar to a conductor, the surgeon’s hands, scalpel, and needle provide the beat for the entire operating theatre.

(The picture is of my friend and me preparing to head into the operating theatre.)

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I forgot to write this post on Friday, so here goes:

1) Soaking gauze with adrenalin is a good way to create hemostasis.

2) Surgery on someone with a heart murmur can be an indication for prophylactic antibiotics.

3) When performing surgery on the nasal sinuses, it’s a good idea to pack the throat with gauze to prevent blood from accumulating.

4) When extubating someone who has a lot of blood or secretions near their airway, you should try to put them on their side.

5) Forced expiration against a closed epiglottis can cause acute pulmonary edema.

6) Acute pulmonary edema is a life threatening emergency. Also, I had learned about pink frothy foam in class, but seeing it in real life was a totally memorable experience.

7) STAT furosomide works well for acute pulmonary edema. Discontinuing IV fluids is also important.

New York Governor Spitzer, why would you ever think of getting a prostitute in the District of Columbia? This being my former home, I’m all too aware of the number of high-profile cases of politicians hiring prostitutes in the District. Did you not learn your lesson from the DC Madam, Deborah Jeane Palfrey? Was DC’s former mayor, Marion Barry’s prosecution for smoking crack with a prostitute not memorable enough for you?

Here’s a tip for all politicians out there. If you have to hire a prostitute, avoid the nation’s capital!

Oh yeah, and if you’re a politician in a bathroom stall, you might want to avoid tapping your foot no matter where you are.

Note: To be clear, I am not against prostitution in the least. I actually think it should be legalized for many reasons. And I have no problem with politicians hiring prostitutes. But they should let their families know. And of course, they have to deal with the media and public opinion more than us regular folks…

My head is throbbing right now, so I’ll keep this post short and try to elaborate later. The gist? I spent the day in the ICU at the hospital today. What a stressful place! There was a patient with a suspected brain tumor who was comatose. PMH doesn’t have an MRI or neurosurgeon, so unless he gets flown to another island, his prognosis is poor. There was another man with HIV who was not responding to antibiotics and is in bad shape. The patient we spent the most time with today was a 10-year old boy with sickle cell disease. He was in so much pain, that it killed me to look at him. He was extremely anemic, so the decision was made to put in a femoral line and give him a blood transfusion. I held his hand for a while and tried to keep him awake. I was absolutely amazed by how quickly he improved after the transfusion. He went from almost completely unresponsive to awake and talking to me. I wanted to stay and comfort him all day, but alas, I was too tired. I also visited my friend Rennady on the Winston Ward (more to come on that later).

The pic above is Kristina and I a few weeks ago getting ready to head into the operating theatre.

Today was another fun day at the hospital. I got to intubate my first patient. I missed the first time, and went into the esophagus, but the second time around I got it into the trachea. Because my surgery days are on Mondays, Wednesdays and Fridays, I’ve seen tons of Ob/Gyn surgeries. Mostly, I’ve seen myomectomies (removal of uterine fibroids) and hysterectomies. I pretty much think I could do one now (with close supervision, of course). When you spend hours upon hours in the OR without eating, you find yourself absolutely starving by the end of the day. It’s a strange juxtaposition to be fantasizing about eating sushi and burritos when you’re staring at the intestines and other internal organs of another living being. But such is life, and such is the life of a med student.

The pic above is the welcome sign at PMH. In the coming days, I’ll try and get some more shots of the hospital for your viewing pleasure.

Thursday I had a clinical skills exam. Basically, I had to do a head to toe physical exam in less than 45 minutes while two doctors watched and evaluated me. We had to do almost every exam possible (each cranial nerve, cardio, respiratory, etc.), so I was super nervous. But I practiced a bunch (thank you Micah!), so I felt pretty prepared.

At the end of the exam, I heard one of the best comments that I think I’ve received since beginning med school. One of the physicians (who happens to be one that I respect very much and think is amazing) said that before he went through the grading process, he wanted to let me know one thing. He said, “I can tell by watching you that you are going to make an exceptional physican some day. You care about your patient and it shows. You enjoy what you’re doing and it shows. You’re paying attention to the details and it shows.”

I couldn’t have asked for a better compliment. Med students are so very low on the totem pole. We work our butts off for years only to get yelled at by our attendings, residents, and even patients. But on Thursday, I felt like my almost 2 years of hard work had finally paid off. And I earned the respect of a respected physician. It makes all the hard work seem worthwhile.

Note: The pic has nothing much to do with the post. I just happened to find it when going through some random shots. It’s another one in the “pictures of my hair with flowers taken with a cell phone” series.

Here ’tis, as promised… Enjoy.