Luxor...my new fave!

So my mom introduced me to this computer game that I am addicted to. It's called Luxor and I've been playing it for most of my visit. Who needs to visit your mom that you rarely see when you have this awesome game to play?!??!?!?! Needless to say, I will finish the game by the time I leave to go home.

Mom and I returned from my aunt's place in the Rockies! There was freshly fallen snow and mountain sheep in my aunt's front yard! My cousin, uncle, and my other cousin's boyfriend went skiing on the 27th...fantastic hill with fantastic powder skiing. But, boy was I sore that evening! But totally worth it! Got to see the rest of my family as well. In all, there was my 2 aunts, 2 uncles, 3 cousins, a cousins wife, another cousins boyfriend, my mom and I. One big happy family! The power went out the night we came home from skiing, so we had a nice fire to keep warm and had dinner by candlelight. Cozy.

Mom and I made turkey pot pie and turkey soup today (in between rounds of Luxor of course!). We're going to watch a movie this evening and eat our homemade soup. I am flying home tomorrow, only to return in 2 weeks for an elective in family medicine.
TTFN!

Holidays...really?!?!??!

Well, my first semester of 3rd year is over and I am now at my mother's place relaxing. It is almost 4pm and I am still in my PJs. I'm thinking about having a beer.

I forgot to tell you about the last few days in anesthesia...Wednesday, I was assigned to an OR that was doing cardiac surgeries. The first case was a procedure called a CABG ("cabbage") which stands for Coronary Artery Bypass Grafting. A patient had a heart attack at one point because the blood vessels feeding the heart became clogged up. One procedure to fix this is a bypass. They harvest a vein from the leg (or another vessel if they choose), open up the chest, put the patient on a "heart lung" machine which keeps their blood oxygenated while they operate on the heart. They bypass the clogged up vessels with the harvested leg vein which gives the heart a new blood supply. This surgery was perhaps the COOLEST thing I've seen so far in medicine. The anesthesia was WAY over my head, but I enjoyed being there. You haven't lived until you've seen a beating heart inside someone's chest! Auntie D, I don't think you want to know what happens during this kind of surgery so I'll spare the details!

The day after that I did obstetrical anesthesia...this means more babies!!! It was different to be on the other side of the vagina! I did 4 spinals and watched 2 sets of twins and 2 singleton C-sections...that's 6 babies in all! I worked with a great resident and preceptor who let me do a lot and taught a lot. All in all a good day.

Friday brought the orthopedics and anesthesia exams. Glad they're over. I passed...and that's all I have to say about that. Afterwards, I went home to clean my place, had a nap and went for dinner with some classmates! We had an awesome time! We went to one of their places afterwards and had some drinks...3am came too fast!!! I was happy to see them and hear their stories from what they've been doing.

Yesterday I got on a plane and came to my mom's place. We spent the day lounging around and baking yummy Christmas goodies. We are making the world famous "wife saver" for breaky tomorrow morning...my personal favorite for Xmas morning! Mom made the mistake of making toffee for me, so my dentist will be pleased with her! Tonight we're going to the Zoo Lights...a Christmas light show at the Zoo. I'm looking forward to it.

We're planning on going to my aunt's on boxing day so I can go skiing...another winter fave! Hope the snow stays on the hill and not the highways!

Well, take care all! Have a Merry Christmas!

Not the sharpest knife in the drawer

Today was one of my not-so-bright days. Since I have the weekend off (OK...I'm kidding myself...I'm supposed to be studying) I thought I'd do some chores around my house that I've meant to do for a while. I went through my filing and tossed out tons of crap that I will never use. I organized my school stuff. I took care of my recycling (doing my part to save the earth, you know!). Later, I am going to get groceries (I'm not so good at remembering to eat these days).

One of them was cleaning off that yucky yellowish crap off the bathroom ceiling and walls. I don't know if anyone else has this problem, but it seems to seep out of the walls after so many showers. It's kind of sticky and looks like someone sprayed it everywhere. After so long, it sort of runs down the walls.

Anyhoo, I mixed together some bleach with water in a spray bottle, got my rubber gloves on, wore eye protection (see...I'm thinking) and proceeded to spray the ceiling and walls so I could rub them down. I didn't consider the fact that I was spraying in a small, poorly ventilated area. I am now coughing and have a sore throat and my eyes are burning. I have since opened up all the windows in my apartment (good thing it's sunny out) and went for a walk for a bit to get away from the odors. What a dumbass I am!

I think I have lost some 'practical, independent living skills' memories since being in medical school. I haven't even mentioned losing my childhood memories or my social skills. I'll tell you about that at a later date!

How embarassing!!!

Today was one of those days that was just...weird. Firstly, there was a huge storm last night and the power went out all over the city. Commuting anywhere was chaos dues due the lights and the 100 year old trees blocking the main streets. So I finally arrived at the hospital only to find out that I am being supervised today by Dr. X (my classmates will know him as the current Block Chair for the cardiovascular block). "Ah crap" I said to myself...he is relatively well known as a pretty hard pimper who puts students through the wringer. He is also known as quite a 'ladies man' and has a reputation of hitting on med students. "But I didn't do any reading last night due to my Grey's Anatomy addiction" I thought (piss damn f**k it was a re-run last night). So I resign to being humiliated yet again.

I actually enjoyed today after all. He was a really good teacher, and although he did ask a lot of questions, he helped me get a better grasp of cardiovascular and pulmonary physiology and made me think about my answers and back them up. I felt slow, but I never felt like much of an idiot. He had me start 3 IVs (yea...I got 3/3 today!!!) and had me do 3 spinal anesthetics as well (putting needles and drugs into a patients spine so they are numb from tha waist down during surgery)...a bit scary but he walked me through it. The only thing was having to discuss how excellent the cardio block was and how he's improving it (sarcasm intended).

The funny part came when we were wheeling a patient into the recovery room after his surgery. Half asleep, slurring, and a bit disoriented as most are when they are coming out of anesthesia, here's the conversation we had:
Patient: "Are you guys married?"
Me: "Excuse me sir?"
Patient: "I said are you guys married?"
Me: "Umm, no, we aren't."
Patient: "Well, you should be...you guys look like a great couple. Your kids would be very beautiful!"
Me: (snickering) "This is your anesthesiologist. He's my teacher and I just met him today"
Patient: "Well, just be sure to invite me to your wedding...is your face turning red?"
Me: "Perhaps. You should just close your eyes and rest for a bit sir".

I couldn't look at Dr. X for awhile for fear of further embarassment.

Wacky World of Anesthesia Part 2

Re: pimping

Anesthesia is unique in the fact that there is nothing but 1 on 1 teaching with a supervisor. Once the patient is under anesthesia and stable, a machine keeps track of their blood pressure, heart rate, oxygen and carbon dioxide levels in their blood, etc. There are alarms that sound if something goes wrong. I am making it sound simple even though its not, but the fact is there is plenty of time to talk with your supervisor.

This is where pimping comes in...the supervisor fires questions at you and you stand there looking like an idiot for the most part. Once in a while (~40% of the time) I manage to answer correctly, only to realize how superficial my knowledge really is because I can't answer the follow up questions. No wonder it takes 5 years after medical school to become an anesthesiologist!

The questions can be random: What is the size of a red blood cell? What are some causes of fast heart rates during surgery? What size tube should you put in a 85kg man? What is the normal level of carbon dioxide in the blood...arteries and veins? How much saline fluid should you give patients in surgery...how do you know? What drugs are totally contraindicated in particular patients? These are just some I have encountered so far.

I had a really helpful supervisor who sent me to the library to learn about the anesthetic implications for patient with diabetes. After I did that, we went over what I learned and the reasoning behind it. Some supervisors are not that helpful and clearly don't enjoy having a student around. I try to ask questions but when a standard reply is "Hmmff...you don't know?" (shoulders shrugging and eye-rolling included) I choose not to keep asking questions and resort to reading on my own. No dumbass...that's why I am asking you!!! It seems that these docs have forgotten what it is like to be a medical student who has limited knowledge. Seems to me they should teach me properly so that when they are old, sick and dying, I can treat them.

Ohhhhhh...the table will be turned sooner or later!

Wacky World of Anesthesia Part 1

Apparently I cannot get away from orthopedics...my first day of anesthesia I was assigned to an OR that was doing ortho cases all day! More knee replacements and arthroscopies! This time I was on the other side of the surgical field.

So far, I have tried to insert IVs (I am 1 for 4...not bad I think). Most of the time I blew right through the vein and gave the patients a big bruise. A big SORRY to those kind patients who let me try things on them! I am still learning, please be patient (pun not intended). Even setting up the IV tubing was something to learn how to do.

I also intubated a couple patients. This means putting a big metal thing in their mouth to look for the vocal cords and then putting a plastic tube through their vocal cords so they can breathe during surgery. This is also a skill to learn, but I think I am better at that than IVs!

I am learning about all the drugs that are used to put someone under for surgery. This is my weakness (thanks to the lack of teaching at my med school), but it also happens to be one of the main knowledge bases for anesthesia. We give 1) something to sedate/relax them, 2) something to make them unconscious, 3) something for pain relief to control their body responses to the surgery, and 4) something to paralyze their muscles (if the surgeons require that during the surgery). These are the drugs that are required for general anesthesia. That's not including the drugs to treat side effects like nausea and vomiting, post-op pain relief, blood pressure medication, or any fluids that we give. There are a few drugs in each class that we should know about including their doses and various routes of administration (oral, IV, rectal, injection into muscles or skin...)...PHEW! Oh ya, and pediatric doses.

I spent today at the children's hospital doing anesthesia for dental surgeries (those who know me know that I HATE DENTISTS). We had 2 and 3 year old kids who had rotten teeth that needed to come out and some other stuff done. Poor things. I felt so sad for them. They were so scared and in pain and away from their parents. Not really my cup of tea but I learned a lot.

Looking forward to returning back to adults who can communicate and who I am familiar with.

Oops...I was ____ and I fell and broke my ____!

So, turns out that being on-call on the weekend after a big snowfall is not the smartest thing you can do...especially if your call shift was optional! I was asked by one of the docs I am working with if I wanted to be on-call with him for the weekend. "Don't worry, we hardly ever get called" he said to me. "Sure why not", I said. I'll probably learn lots by being on call and see more acute stuff that doesn't come into clinic.

We saw variations of the "Oops I slipped on ice and fell" story...they were "I was at a Christmas party and had a bit to drink and I fell on my _____"

Friday: 7:30am-12:30am...4 surgeries
Saturday: 7:30am-12:30am...8 surgeries
Sunday: 7:30am-9pm...6 surgeries (should have been 8 but we were bumped by other more urgent surgeries)
Today: 8am-4:30pm...2 surgeries
Tomorrow: 7:30am with 5 surgeries scheduled.

I've been first assist on 16 of these so far (this basically means that I help the surgeon out while they operate and I get to help close up the incision...stitching!)

Ummm, excuse me, but I think I am in the wrong rotation! I'm in orthopedics, not surgery!!!!!! Seems to me that I'm doing more in surgery than my fellow classmates are in their Surgery rotations! Learning a ton, but a bit tired after all that. Lesson learned: Don't be on-call after a big snowfall.

The 12 days of Ortho

"On the 12th day of Ortho (OK, it's only been 5, but who's counting), my tutor gave to me:"
12 hip replacements
11 knee replacements
10 ACL repairs
9 arthiritis in the hips
8 arthritis in the knee
7 vague back pain
6 twisted ankles
5 finger dislocations
4 rotator cuff tears
3 elbow dislocations
2 broken pelvises
1 million broken bones!!!!

Here is my day:
7-8am: rounds seeing patients in the hospital
8am-12:30pm: in office doing consults and follow-ups
12:30-5:30pm: 3 surgeries
5:30-7pm: 3 new consults (more broken bones)
7-10:00pm: 2 more surgeries
10pm-12am: 4 more consults
TOMORROW we have 7 or 8 new cases booked for surgery...and more may come in overnight! Wish me luck!!!!!!!!!!!!!!!!!!!!!!!