November 30, 2007

• On the Cutting Room Floor

  One of the neatest parts of surgery, is the fact that in surgery, you get to make a diagnosis, and
  then see if you were right. You see a patient acting a certain way,
  with a certain set of signs and symptoms, and you make an educated
  guess that their gall bladder is inflamed. So you open them up, go in,
  and see if your pre-operative diagnosis matches your post-op diagnosis.

  The other great thing about surgery is that there’s really a limited
  number of things you’re really worried about. As opposed to internal
  medicine, where you’re trying to manage 20,000 chronic diseases with
  30,000 medications to treat them, surgeons seem to care about, in order
  that I’m thinking of them: infection, farting, pooping, blood clots,
  fluids/dehyrdation, peeing, nutrition, vital signs, and walking around.
  If you’ve ever had an inpatient surgery, you have been asked these
  questions. Over, and over, and over, and over, and over again, by the
  medical student, the intern, the resident, the chief resident, the
  nurse, and the attending. We cheer if you pass wind, we applaud when
  you eat all of your meal, and we scold when you lay in bed all day.

  In fact, the 5 biggest problems post surgery can be remembered with the mnemonic the 5 w's: Wind (pneumonia) Water (urinary tract infection) Wound (wound infection) Walking (blood clots from lack of mobility) and Wonder Drugs (drug interactions or side effects). Its like a little Captain Planet Battalion of Sickness. Your complications combined, I am CAPTAIN POST OP

  The cutting itself is pretty fun too-when you’re allowed to do
  anything. The medical student’s role is usually reserved for observing,
  being pimped (asked questions rapid-fire by a resident or attending),
  suctioning, retracting (which I call water skiing, since you basically
  lean back on these retractors and hold them for a while) and, if you’re
  lucky, suturing incisions closed
  at the end.  I remember the first time I saw
  laparoscopic surgery (where they use a camera to look in the abdomen),
  and I was Simply. Blown. Away. Now I still think its neat, but my joy in life is derived from more than just driving the laparoscopic camera

  During other surgeries when I was invited to stick my hand in an open patient and feel
  a liver, a spasming colon, the appendix, and then the beating heart, it
  was almost too sci-fi to be real. This is a person. MY HAND IS INSIDE A
  PERSON! I’M INSIDE A PERSON AND THEIR HEART IS HITTING MY HAND! Does
  their heart have any idea this is going on? This whole surgery thing?
  That it has a HAND next to it? It’s even stranger when you take care of the
  patient after their surgery, and you think to yourself, “My hand was
  inside you.”

  Insert Rectal Exam Joke Here

  OH SNAP! A TWOFER!

  But yeah, as the weeks have gone by, it has come to my attention that while I enjoy surgery, I dont LOVE it. There are literally hours at a time when i have nothing to do, and there are no operations going on. I am up at ridiculous hours both leaving and returning to my home when it is dark outside. I am always tired, and go to bed at 10pm even on days I am not working. And there have been times, despite the neatness of it all, when I drift off during surgery thinking about other things I like to do outside the hospital. The real surgeons do not do this. Sure they dont get excited about every surgery, but they are all scrapping for their next chance to be in the OR, while some days i just want to be done and relax. So it is with only a modicum of indecision that I think I am going to rule out surgery in favor of internal medicine

  Guess all those folks who have been telling me over the last several months they could see me as an IM doc knew what they were talking about. So the first of december and I finally know what i want to be when I grow up. Well, still have to decide GI or ID. But you get the point. This doesnt mean I wont still take full advantage of my remaining time in surgery however. This is the last time I will be able to see a lot of these procedures free of responsibility and able to ask all the questions I want, and I intend to make the most of it.

  Just thought I would fill all y'all in until the next post, which may not be for a while.

  • 9:41 pm
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