Puella cum Cultello

girl with a knife – the tired ramblings of a female surgeon-in-training

Month: June, 2012

Outside Hospital

Some humor for the new interns – you’ll discover that it would be funnier if it weren’t true.

Excuse letter to my readers

Dear readers,

Please excuse my absence from the internet for the last few days, as I have been traveling.  I have had limited internet access and excessive physical and mental exercise.  I shall be back to my keyboard by next weekend.

Yours most apologetically,

girlwithaknife

No, really…

I’m not that good.  The lovely Gemma appears to disagree and sent me a completely undeserved “One Lovely Blog” award of appreciation.  It comes with a few rules, but I’m going to be a wet blanket and only observe the first two:

1) Thank the person who nominated you and link them in your post.

Thanks for the recognition!

2) Share seven possibly unknown things about yourself.

Here goes nothin’:

1.  When I started medical school, I had a list of specialties that I didn’t want to go into.  Surgery was number one.

2.  The first time that I first-assisted on a case during med school, I knew I was in trouble.

3.  My alternative career choices for medicine were to be an astronaut or a journalist.

4.  I wanted to be the next Christiane Amanpour but later realized that I would have been a terrible journalist.  I would have quit because the editors messed with my writing too much.

5.  I would have also been a terrible astronaut.  I’m a nervous flyer.

6.  I didn’t eat chicken for a full year after doing a dissection in high school.  We were dissecting a cat and the muscles looked way too similar.

7.  I think Scrubs really is the most accurate medical show.  Not only were the generally quite accurate on the medical facts, they also captured the emotion quite well – the minor victories and losses that we experience in the hospital everyday.  Though I have yet to reenact West Side Story in the halls.

Think I’ll skip that ER, thanks

Do you know what they call alternative medicine that works?

Medicine.

Words (not) to live by

See one, do one, teach one.

It’s an old phrase in medicine, and it embodies a teaching philosophy that has been passed on for decades – observe, practice, then pass on the skill.  During my third year medicine rotation, that expression was turned on its head once or twice.

Do one, see one, teach one.

I was asked to access a chemotherapy portacath – despite not having seen a port or the needles inserted into them.  The intern dictated a list of supplies and told me the requisite steps, along with a couple of technical tips (namely, “it’s a big-ass needle, don’t stick yourself!”).  I scurried off to the supply closet, eager to get started.

In many institutions, physicians are responsible only for placing central access catheters, which go into the large vessels of the neck and chest.  Specialized nurses will place difficult IVs or peripherally inserted central catheters, and they also access ports.  This allows these nurses to gain experience and develop immense skill in a small range of tasks.  They truly become specialists, and they are far more proficient with those tasks than most physicians.  However, this hospital didn’t have an IV therapy team, union contracts prevented nurses from dealing with most vascular access in a timely fashion, and these issues fell to the already overworked house-staff.

So, here I was, a medical student with less than a year of clinical experience.  I was about to stick a large bore needle into a patient’s chest, aiming for a small device that carried silicone tubing straight into the heart.  I had no frame of reference, no prior experience, for what I was doing.  I had some understanding of the potential complications (infection, thrombosis, air embolism), but the intern didn’t review them formally with me.

Yet no one questioned the appropriateness of this situation.

My intern was happy to have another task checked off his seemingly endless to-do list.  The nurse was glad to have vascular access in her patient without doing it herself.  I was excited to actually be allowed to do something, anything (“I get to touch patients!”), though I definitely had some trepidation about the matter.  And the patient was eager to just have the whole ordeal over with.

Of course, I struggled a little.  I improvised a lot.  I kept hearing a voice in the back of my head – “fake it till you make it”.  And, eventually, both the patient and I survived the procedure relatively unscathed.

But would this situation be acceptable to me as a patient?  Absolutely not.  However, the hierarchy of medicine and my eagerness to be helpful prevented me from insisting on more appropriate conditions.  I was too chicken to refuse, for fear of stirring up trouble, delaying patient care, and losing future opportunities.

Every doctor has to learn, and we all start with very little knowledge.  We slowly gain knowledge and experience under supervision, an apprenticeship if you will, before we’re left to our own devices.  But this should happen in a stepwise fashion, with incremental increases in latitude and responsibility.  Instead, all too often, it’s haphazard, and junior trainees are left to sink or swim – along with their patients.

The three hapless amigos

Friday nights are perfect for hanging out with your buddies and partying, maybe going a little nuts.  It’s just innocent goofing off, all fun and games… until someone wraps a car around a lamp post and the three amigos are pulled from the wreckage.

Well, first, there’s the dead one.  He never had a chance.  The impact tossed him around for a few seconds, until he was ejected.  He landed 30 feet from the car.  There was no life left in him to salvage when the cops arrived.

Then there’s the organ donor.  He was driving.  By the time the medics got him out, his body and brain were already giving up.  They kept his body alive long enough to get him to the ER.  Then we were able to keep him alive long enough to gather the family.  Mom, dad, and little brother look shell shocked this morning.  Grandma’s still crying.  There’s about thirty friends with tear-streaked faces loitering about in the hallways.  People are asking each other, “How could this happen?”

Easy peasy, I want to reply,  Take three young men who believe that they’re special immortal snowflakes, add a case of beer, and the keys to dad’s sports car.  Voilà.  Instant wreckage.

Instead, I walk past, head down, in respectful silence.

Finally, there’s the spoilt brat.  There’s always one.  He has a couple of extremity fractures and the delightful attitude of Verruca Salt.   He appears to be doing his best to antagonize the nurses. Periodically, you’ll hear him bellow from across the ward, “Nurse!  I want some water!  Nurse! Where’s my food, I’m hungry!  Nurse!  Gimme my pain meds!”

I wonder if he’s confused and believes that he’s at Burger King.  You don’t get to have it your way in the hospital, buddy.

Perhaps, for now, he thinks he’s the special-est snowflake of them all.  But eventually,  even he will melt into nothingness.