November 6, 2007

• Getting my surge-on. Also, a CONTEST

  Woke up this morning feeling amazingly refreshed. You ever have those mornings, where you wake up without an alarm, you feel good, and you know you had just the right amount of sleep? That was me today. Of course, it was 4:30 am, but hey, what can you do, right?

  Saw two surgery cases this morning. The first was an open appendectomy. I scrubbed in and then watched as a 7cm incision was made straight down from the navel. It’s amazing what a handy landmark the belly button is for surgeons. Could be because that is where the linea alba is, and an area of weakness ideal for entering the peritoneum. Or it could be because everyone knows where the belly button is and it helps make procedures standard. Regardless, I got to fell the underside of someone’s belly button. It was neat.

  The remainder of my job on this surgery was basically to hold retractors while the surgeons manipulate bowel folds out of the way to get at the appendix. The smell was god-awful, due to the ruptured appendix and pus filled abscess that had resulted. And yet, while being utterly revolting, it still was not that bad…maybe i am just used to terrible smells now…future pre-meds be aware…kiss your nose goodbye.

  Retracting is basically waterskiing. You hold tension on these large metal pieces like big people shoehorns that pull back the fat and organs, giving the surgeon a clear room to work in. An open appendectomy is a lot different from a laparoscopic one…it is more raw, gritty and feels like real surgery. I speak in contrast to the video game feel of the lap appy i previously had seen, which was no less a real surgery, but is seen on a screen and doesnt involve the surgeons grabbing your finger and shoving it onto a bleeding artery to hold pressure while he takes care of his business elsewhere in the bowel. Good times.

  Once the surgery was completed, the wound was left to heal by delayed primary intention. Basically, the sutures were placed, but not tied, as the wound will be left open for the next couple days and allowed to granulate back together by itself slightly. Then, if it is still clean, the sutures will be tightend and the patient is free to go without their entrails falling out.

  Second surgery was a laparoscopic cholecystectomy, or lap chole for short. Similar to the lap appy, but this time it was the gallbladder being removed. Similar to a lap appy, several small incisions are made, the peritoneum is infused with carbon dioxide to inflate the chest giving the surgeons room to maneuver, and then a small camera and several tools are inserted through tubes placed in the holes. Once again, i got to drive the camera, this time with no outside meddling, just directions about where to look and zoom. Had no trouble with the controls this time, and at the end of the procedure, I even got to suture two of the cuts closed all by myself! This is why it’s called practicing medicine my friends…because every time you get just a little bit better. And for the record i suture equally well both right and left handed. Right handed in ED, but left handed due to ease of angle in OR. Southpaw pride. w00t.

  The interesting thing to me about this case (well unique-its all interesting) is that this patient was essentially mine the entire way through. I admitted her from the ED, took her history, participated in pre-op care, scrubbed on the case, and I will be following her post op care tomorrow. All with minimal looking over my shoulder at least where my responsibilites are concerned. It felt good. Almost like i was a big boy. And just like popular TV shows, a little bit of politicking had to occur for the patient to get the surgery. Since she was uninsured, an elective procedure like this normally would not have been covered. However, she was also two month post partum, and with a little tweaking of the wording, this becomes covered as a post pregnancy complication and the patient is able to get a surgery she needs, but otherwise wouldnt be able to afford. Yes, ultimately it is our tax dollars paying for it, but it still feels darn good to beat the system.

  

  And Now we continue

  CONTINGENCY PLAN

  four-THE CAST

  “Damn Damn Damn! Why did it have to be clowns! I freaking hate clowns!” Crystal shouted at the TV. She had been playing dead rising non stop for the last few weeks, ever since her boyfriend had beaten the game. Crystal had always had a healthy fear and respect for zombies, but playing xbox was slowly diminishing that. She just imagined each zombie as one of the people she had to deal with working for the IRS, and BOOM! she didnt even have to think about killing them, it just happened. Until the game threw a chainsaw wielding clown at her anyway.

  “Phil! come beat the scary clown for me!”
  “Just shoot it, it’s only a clown!” Phil laughed as he walked into the room.”What would you do if it was in real life, call for me to help you?”
  “No, I would probably kick his clown ass with my aikido so hard he would think he was being shot out of a cannon”

  “That’s always the first resort for you asians, isn’t it? Kung fu the problem away”
  “Whatever mister…first off, I’m Thai, not ‘asian’, second, i’m a blackbelt in aikido, not kung fu, and third, you’re korean, so you would have to kung fu him too-or would you just world of warcraft him to death.”

  Phil lauged good-naturedly. “Of course not…i would pick up the nearest object…” He grabbed the controller from Crystal, “like so, and bash his zombie brain in.” As the clown finally went down for the count, Phil tossed back the controller to Crystal. “Of course, that is why I am the one with the zombie contingency plan, and you are the one running from clowns. Speaking of people who fear clowns, you talked to Josh lately?”

  Crystal saved the game, shut it down and turned on her computer. “Yeah, he’s doing his surgery rotation in Chicago.. learning a lot of cool stuff, but he is swamped right now with a bunch of patients who have that bug we keep seeing on the news. Apparently it’s a lot worse in close-knit cities like chicago where everyone is in such close contact.”

  Phil rolled his eyes. “Oh good at last Los Angeles’ complete lack of public transportation and city organization is good for something. Everyone who gets sick is quarantined off because they are too weak and disorganized to drive. I hope they find some way to treat it soon though, it’s been a couple months and it just keeps getting worse.”

  Crystal checked her email while responding to Phil. “I’m sure Josh will be the first to hear about it and let us know if anything happens. It pays to have medical friends. Oh hey, he sent an email.”

  “What’s it say?”

  “Nothing much. Hello, how are you, still no word on the epidemic. Oh wait, he said the method of spread is unknown, but a lot of patients have had bites or scratches. He also said that we should probably stock up canned goods since the CDC is trying to figure out if fresh meat could carry the virus. The he says hello to you, and tells us both to make sure we have bikes just in case. Heh, it’s almost like he’s preparing for some sort of nuclear disaster without really thinking about it. I guess med school makes you see the worst possible outcomes.”

  Phil had a strange look in his eye when he answered Crystal. “It never hurts to have a contingency plan…”

  ………………

  Brian was chatting on AIM, and dicking about on the computer, as usual. He should have been out looking for work, but he was in between films right now, and with the writers strike, studios weren’t likely to be hiring. However, he still had some money left from his last couple of films, a low budget sci-fi flick that had gotten picked up by Warner Bros, and a documentary that had won him an award at a local film festival. So he felt he was entitled to a bit of R and R. Making movies was hard work. Suddenly he received the tone that told him of an incoming message. It was his brother, Josh.

  coffeeweasel: hey little bro
  teamonkey: shouldn’t you be working?
  coffeeweasel: shouldn’t YOU?
  teamonkey: touche. So what’s going on
  coffeeweasel: not much…wanted to see how you guys are doing with this whole superbug thing. We are swamped here, and I think the city is only another few hundred cases away from quarantine
  teamonkey: really? It’s not that bad here yet…a bunch of nursing homes have shut down, and a few daycare centers, but the hospitals as far as i know are not overflowing yet
  coffeeweasel: well that’s good. Just do me a favor will ya?
  teamonkey: sure…what?
  coffeeweasel: get my old bike repaired and make sure you got plenty of food okay?
  teamonkey: okay, cuz that’s not a weird request or anything
  coffeeweasel: whatever, i just have a feeling about this disease. For that matter why dont you make another documentary about the course this bug is taking…i am sure it will be a hit once this all resolves
  teamonkey: not a bad idea actually
  coffeeweasel: oh and one more thing…if you decide to do any interviews, please don’t get bitten or scratched…the bug seems to spread through wound infections, or at least that is the working hypothesis
  teamonkey: yeah yeah yeah
  coffeeweasel: just do it to humor me. gtg ttyl

  Brian went back to his browsing. Don’t get bitten? weird…

   TO BE CONTINUED…

  BUT WAIT! THERE’S MORE! So I think I know what direction I want to take this story in, but I need one or two more characters. So if you would like to be featured in the ongoing Novella Contingency Plan, all you have to do is these easy steps

  1)Comment on the site with the name and location of your character
  2) in the comment include what ability or knowledge YOU could contribute to a contingency plan.

  The story will continue on from here, but the best responses will be introduced in later portions of the story.

  oh the things i do for readership

  -J

  • 8:47 pm
  • 5 Comments