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remind me again why i would consider applying for residency here?

I start obstetrics/gynecology tomorrow

oh and those of you who saw that 70% number, dont sweat it...i would totally eat strangers first. you're safe, yo

Ahh and its back to work...sort of. You see, after having completed rotations in internal medicine, family medicine, emergency medicine, and surgery, my first rotation of the new year is psychiatry.

And working in psychiatry is not in quite the same class of work ethic. Now for 6 weeks, it is going to be great to chat with schizophrenics and veterans, hearing war stories and the like. However, psychiatry as a field seems basically like babysitting. Very few people get better, if any, and the main job to to simply talk to the person to evaluate their mental status du jour

One of the attendings said it best during grand rounds- "In Psychiatry we are not treating the person, we are treating the disease. It is just inconvenient that these diseases happen to reside in people"

And while I am looking forward to 6 weeks of rather kickback work and low expectations, I must admit that if I went into a specialty that did not require a stethoscope, physical exam, or white coat, i would kind of feel like i had thrown away my medical degree. Well, lets see how things go, shall we?

It's like every time i begin to have a thought, no matter how terrible (or perhaps specifically the terrible ones), there is a webcomic about it. discuss

And just so some of you can imagine how that might pan out

I should probably study now. Doesnt mean i will, but i probably should anyway.

So its the halfway point of the surgery rotation and I have been able to see some amazing things

like open heart surgery. watched as the surgeons busted open the chest cavity with the bonesaw, pried it apart to reveal a still beating heart, which they then proceeded to stop, because hey who wants a heart jumping all around when you are trying to operate on it, and dump a bucket of ice (sterile) onto the heart. The ice is for basically cryogenically freezing, albeit ghetto style, the heart. It causes the oxygen requirement to become much less due to the cold. And you thought the heart didnt breathe. Of course, with the heart not beating, you may be wondering how the rest of the body gets blood? The gas monkeys (anesthesiologists) handle that, circulating the entire, erm, circulation in and out of the body through a series of tubes (just like the internet!) Then the surgeons open up a leg, and "borrow" some veins from there to graft to arteries in the hearts that were too clogged to function anymore. The arteries were too clogged because SOME people dont know when to put the burger down. Not that i am silently judging you or anything, fatty mcfatterson.

Also got to see a roux en y. What is that you are wondering? well basically, the surgeons go in, remove the patients entire stomach, and then connect a distant part of the jejunum directly to the esophagus. Of course, this requires a lifetime of tube feeding, but in the case of gastric cancer it is a pretty neat solution. No stomach? no more stomach cancer

So yes

while on the one hand i have been able to see a great deal of procedures, on the other hand, the novelty wears off rather quickly. The first time you see a lap chole, it is sweet. The second time it is neat. The fifth time...well, you feel like you could do the surgery already. So I am starting to get a little bored. Also, I am apparently retarded when it comes to using scissors. Seriously. everything else i can handle, but i actually start sweating the moment the surgeon asks me to cut sutures. Not because i am afraid of harming the patient. But because i know that no matter which hand i use, i wont be able to cut a piece of string in half with surgical scissors without making two or three attempts. And once that has happened, it doesnt matter how well you know about the procedure, or complications, or anything else that you might be pimped on. You are just the student who cant even be trusted with the simple task of cutting a string. It is disheartening. Not that more than one attending has ever specifically mocked me for it, but they dont have too. It is likely to be the final straw that could tip the scales against going into surgery

Which i have not fully decided one way or the other yet, but i am kinda leaning away from surgery at this point. Hmm...seems like halfway through third year and all the things I thought i wanted to do when i got into med school have turned out to be things I simply am not cut out for, one way or another. go fig.

time for a much needed nap, and then perhaps another zombie story update.

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