AMATEUR TRANSPLANTS: Anaesthetists Hymn LIVE

While you were sleeping....

Last night was the worst call Ever! (or maybe it was the best call ever because I learned a lot about myself and how I handle bad situations). I finished up a 16 hour elective case at 11pm. Meanwhile the traumas just kept rolling in.

I was in the OR constantly for nearly 24 hours. I have chafe marks on my face from where my mask rubbed me. Ouchies!

a brief summary of the highlights:

Some lunatic attorney who robbed a pharmacy for narcotics last week tried to kill himself in jail and was brought to our hospital for treatment. While at our hospital yesterday, he managed to elude his guard and baracade himself inside his room, break the window, and stand on the ledge of the 5th floor for 4 hours (entertaining the media) before he finally did a swan dive off the ledge. Little did he realize he would land on the roof of the 3rd floor, thus making his dive a critical injury rather than a deadly one. We got to add him to our endless list of traumas that came to the OR last night. He was definitely the most interesting one.

I cut my finger on a contaminated knife I had just used to put in a central line on a patient. It's a more high risk cut (more blood involved) than a needle-stick, but thankfully, my patient was a 74 year old lady with ovarian cancer, and not some gang-banger drug addict who probably has hepatitis C. I still can't donate blood for a year, though. I can't believe I did that. There is a small silver lining to this: going to employee health to fill out the paperwork and get blood drawn was the only break I got yesterday.

One case I had was a guy who ruptured his spleen in a car accident. He was white as a ghost but his blood pressure was holding through our OR prep and putting him to sleep. As soon as they opened him up, his blood pressure dropped to 50 and his heart rate went up to 160. I was by myself and about had a litter of kittens right then and there I was so scared. I pushed a bunch of blood into him quickly and he did okay. I snowed him with narcotics before I woke him up so he wouldn't hurt. (hurting sucks!) Good thing I did. I snowed him so hard he didn't wake up for me, but in recovery, when he did wake up, he went apeshit and tried to attack the nurses helping him and had to be tied down.

Oh the things that happen during the night while sane people are fast asleep!

Weird things people have said to me this week

1. Wow, you have great scalenes!
2. Do you wanna see my testicles?
3. My surgery is over and you never gave me a kiss! I want my kiss!
4. Look at your juicy jugular vein!
5. I'm still waiting for my kiss!
6. It's okay if you knock out my loose tooth, it's gotta come out sometime.
7. Katy, do you mind coming over here and tying up the surgeon?


#2 was a scary guy that I was working up for a pre-op evaluation. He was a total pimp-daddy trying to hit on me. He was real inappropriate and actually put his hands on me. I should have reported it, but I was tired, it was late, and I wanted nothing more than to leave his room because I was afraid of him.

I learned today that my neck anatomy on ultrasound is incredibly clear.....the best the ultrasound tech has ever seen, and now she wants to use me as a model when she gives demonstrations.

She also informed me I have a thyroid nodule. Blah!

I'm tired. I was on call yesterday and had a busy night. My hospital OR has turned into an elective procedure OR 24 hours a day. We're also supposed to be a level 1 trauma center, but it's kind of hard to fulfill that responsibility when all the staff is too busy doing elective cases. It kind of makes me mad and I've been a little vocal about it. Elective cases are for Monday through Friday during the day. Period. Nighttime is for sleeping and traumas.

Last night was really busy for me. In July, I made up my mind to make sure I worked harder than everybody else. I volunteer for the cases, if someone else is up all night, I'm up with them. I just don't want to be known as a slacker. No need to worry. The other resident in my class that I worked with came in hungover and made it clear all he wanted to do was sit on his ass all day, so I spent all morning in a long spinal fusion case, while he volunteered for easy cases. Then I had a trauma come in. A drunk guy who was "just minding his own business" when someone slashed his throat. Pretty weird. His thyroid gland was hanging out of his neck. The big trauma came at 10pm. A lady came in with 3 broken bones in her legs. When she got to the holding area, she was really hurting, crying, and scared. I felt so bad for her, I gave her a big slug of fentanyl (I usually don't do that until they actually get to the OR). Considering her injury, I didn't think it would touch her pain, but she told me I gave her better pain relief than she'd been given all night in the ER. She was really scared and asked me not to leave her during the surgery. I just wanted to hug her and tell her everything would be okay. Her surgery went on all night. The hungover resident told me would we "tag team" her case with me, but he went to bed and left me high and dry. It was the upper level resident who got up in the middle of the night to relieve me, but I stayed until the case was over. I hate to not finish what I started. Upper level resident commented to me about how hard I work. : )

This resident is actually really nice. My call room linens hadn't been changed, and he went to the linen storage and helped me change my bedsheets. I was blown away by the kindness of that at 5am when I know he was really tired. Hungover Resident would not have done that.

On call again tomorrow. God, will this ever end? Can I physically do this for 3 more years?

Me: Average Joe

So I FINALLY got the results of my anesthesia practice boards exam that I have to take every July. It's the same exam given to become board certified, but we are given the test as residents to gauge how we are doing each year. Unfortunately, our department has big aspirations and requires the residents to score in the national 50th percentile. If you don't, you are not allowed to "moonlight" (ie...make LOTS of extra money by working on the weekends as a general practitioner- usually in a rural ER, botox clinic, or quick-care clinic). And if you do REALLY bad you are placed on departmental probation and could get terminanted if you score poorly a second time. Anyway, we got our scores today in our 6:30am conference. I managed to barely scrape by. Any other year, I would look like a total superstar by scoring in the 53rd percentile (which is good, right? It means I did better than 53% of the first year anesthesia residents in the entire country!), but not in my class. The year I applied to residency programs, anesthesia was competitive, so I'm in a class full of smarty-pants overacheivers. How I got mixed in with these brainiacs is beyond me. Almost everyone did better than I. One person did worse and I tied with another person.

Ah well. At least I'm not lamenting that I came in last. I think I'll keep quiet at work-don't want to hurt anyone's feelings.

Current Events

Despite working 13 hour days, I have managed to keep up with this week's top stories...

1. Britney Spears may have put a "hit" out on Kevin Federline. It's a sad day when Fed-ex starts to look like a responsible parent.
2. Iran's President wants to visit the World Trade Center site. Uh..Why? To gloat, perhaps?
3. OJ's in trouble....again. Maybe this time he'll have a smart jury.
4. Some nursing mother who attends Harvard Medical School sued for extra breastfeeding time during her USMLE. Denied. Sorry. You don't deserve special treatment. Residency sure won't give it to you, so why don't you start acting like a grown up and quit whining. (note to all: I am pro-breastfeeding. Anywhere. Anytime. But you don't deserve special priviledges not available to the rest of us.
5. Hillary announced her plans for HillaryCare 2.0. No thanks. Keep the government out of my doctor visits.
6. My football team is doing awesome this year and may go all the way.
7. Barry Manilow won't appear on The View unless Elizabeth is absent from the set that day. Typical. First Amendment rights don't apply to people with conservative views. Who watches The View, anyway?
8. I found out tonight from a magazine that Carmen Elektra is now a lesbian.


That's all I can think of.

What's grosser than gross?

This afternoon I took full advantage of my post call day by going to Barnes and Noble for some much needed studying. While there, I visited the ladies room. While washing my hands another lady came in. She was talking quietly. At first I thought she was talking to herself. The more she talked, I started to realize she was talking on her cell phone. OK whatever, kinda weird but surely she'll get off the phone in a second. The lady went into the stall and started doing her business, and WAS STILL ON THE PHONE! OMG!

I really cannot believe that there are people out there who think that is even remotely okay.

Ok so maybe you're wondering why I posted that random video. Well, it just reminded me so much of medical school. Just watching it gave me a mild case of PTSD. It doesn't really matter what medical school you attend, the drill is the same: you study ALL the freakin' time, and it isn't pleasant. In fact, I think my first year of medical school was one of the most miserable times of my life. This year is a close second.

So now I'm in the full swing of things. I'm either on call, post call, or pre-call. All the other days I pretty much work 12-13 hours a day. Last night I worked until 7pm. I'm really trying not to complain. I chose this. It's just by the time the weekend comes around (if I'm off) I don't want to see anyone, talk to anyone, or do anything other than stay home. I'm worried this is really depression and not work related. I guess time will tell.

Yesterday, I got to work with one of my least favorite attendings. He's a really nice guy, very personable and all, but he is really freaky in the OR. I'm pretty sure he's OCD and needs to be on medication. Just being around him in the OR makes me nervous. Our day was going reasonably well (other than the fact that he completely paralyzed one of my "asleep" patients right before the case was over. GRRRR! He's done that to me 3 times in a week! I think I'm going to have to start hiding the Nimbex when I go on break).

OK anyway, our day was going reasonable well until he freaked out when my patient moved a little while the surgery resident was finishing his skin sutures. I always start bringing the patient down off the anesthetic during suturing. Otherwise, everyone is going to be standing around waiting 20-30 minutes after the case is over for the patient to wake up. That's not good form. It slows down the surgery schedule and makes me look bad. I've never had a patient start to wake up during sutures before until yesterday. Honestly, it was no big deal. People get sutures in the ER all the time totally awake. My attending however, freaked out. Personally, I think the patient was a bit tolerant to our anesthetics because he's a big-time drinker, but anyway, my attending was quite pissed at me. So be it. He will always find something.

One cool thing happened to me early in the day. A guy I kind of like sat by me at our 6:30am anesthesia meeting!

StudyBack

Me, today, in the OR talking to one of my classmates who is now a urology resident

Him: making snide comments about how easy anesthesia is and how hard urology is
Me: How is your arm feeling today?
Him: Huh?
Me: Your arm, how is it today? Does it still hurt?
Him: What do you mean?
Me: Well, it must be hurting because somebody must have twisted your arm pretty hard to make you go into urology.
Him: silent
Everyone else in the room: HaHaaa!!! She told you, didn't she?

Snarky Me

I was on trauma call last night and was up all night helping out in a big heart case that came in. I was just counting the hours until 7am when the fresh call people came in and relieved me and the other resident. Around 6:30am, the perfusionist asked one of the nurses if she wouldn't mind going and getting her a Mountain Dew. Not a selfish request since the perfusionist can't leave the room and she had been in there since 10pm and was dead tired and thirsty. The nurse refused. She asked another nurse. Again, refused. That really made me mad, so when I got free, I went down and bought her a Mountain Dew. The case was not going well and she was probably going to be in there another 4 or 5 hours. I mean, show some mercy people! It's not like the nurses were even busy. They were all just sitting there.

Oddly enough, I lost my giving spirit an hour later. All night long I'd been thinking I'd go to Panera Bread and get a mini souffle for breakfast. I got there and realized I'd left my wallet in my locker at work. Had to drive all the way back to the hospital, park in an unauthorized spot (because the resident lot is 1/2 mile away and I'm too tired to walk that far), go back inside, get my wallet, walk back to my car and drive back to Panera Bread. By then I'm cranky because I've wasted an hour. I got inside, stood in line, and watched with disbelief as the guy in front of me bought the last souffle. I was furious! I wanted to really hurt that guy. Funny what sleep deprivation does to you.

When I got home (sans souffle), some friends had called and had an extra ticket for me to go to a big football game with them. They were on their way to pick me up as soon as I called them back. Any other time I would have jumped at that, but I was completely wiped out. Don't you hate it when you want to do something so bad, but you know you are just too tired? That's how I felt. I was so torn, but seeing as how I had homicidal thoughts toward the guy that bought the last souffle, I thought it best not to surround myself with 85,000 drunk, screaming people at a football game. That was my public service duty of the day.

Who is this?

I posted this for Robyn and Pink. If I didn't know any better, I would think this was someone else. Do you like the hat?

Hey, at least my patient is still alive, as evidenced by the monitor behind me!

Move over, Angelina!

I recently learned that I work with Brad Pitt's Aunt.

Hmmmm......

Does anyone wonder what would happen if you suddenly became sick? As in really sick? I do. If I came down with a chronic illness, I really don't know how I would deal with it or how I would pay my bills. I've always thought I'm too young to get anything really bad, but truthfully, I'm not. One of my oboe friends who can't be any older than me, just emailed me and has spent the summer recovering from surgery. We went to go see "Wicked" together in June. That night she kept complaining that her stomach was growling nonstop. I just thought she ate something bad and didn't think anything else of it. Well, it got worse and she finally went to her doctor and was found to be severely anemic. Nothing showed up on a CT scan of her abdomen (anemia in someone over 40 is colon cancer until proven otherwise). A few days later, she became really ill, went to the hospital, was rushed to the OR where they found she had colon cancer that had spread to some lymph nodes. She's spent her whole summer recovering and trying to deal with chemotherapy. The whole thing just sucks. I don't know what else to say about it. She's really lucky she has a good job and mostly likely good benefits, but missing work that much has got to be a financial strain. But in the end, I hope she is concentrating more on getting better rather than worrying about money.

This has me freaked out. I've never really thought about how I would handle a life threatening illness. I cannot afford to get sick. In residency, there is no such thing as sick. If you are breathing, then you better be at work. Funny how the medical community that cares so much about healing people tends to have the opposite opinion toward their own. I like to joke around about how "nurses eat their young", but in reality doctors do it much worse. This is a good cue for me to quit smoking. Again. For good.

I don't know why I'm blogging about this, but I keep thinking about it so it must be important. This year, I've tried hard to have a nice, fun demeaner in the OR. I insist everyone call me by my first name. It just makes the whole day go smooth when everyone is chatty and happy. It's easier to do this when it's just residents and nurses in the room, no stern surgery attendings who must have total silence in order to work. However, in doing this, maybe people forget I'm a doctor and get a little disrespectful around me. I think being a female doctor is hard. You are either not assertive enough or you are labeled a bitch. Last year I was repeatedly told in my evaluations from nurses that I was not assertive enough.

So yesterday, I was helping the other resident assigned to a case bring the patient from the ICU to the OR. He was intubated so I ventilated him during the trip. A young nurse was also with us. She was crabby and slow. It makes no difference to her whether or not the case starts on time because she is a shift worker, but the rest of us are under the gun because we don't get to go home until all the cases are done. She was already short with me because I had warned her to watch out for the patient's foot that was hanging off the bed because I didn't want it to get hit or smushed when we wheeled his bed through the doorway. Once in the room, I'm busy trying to get all his monitors situated and then I started pushing drugs through his IV to get him to sleep so the case could start. In the middle of this, the young, crabby nurse hits me in the arm and says, "Hey!" and points to some cords on the floor. One of the surgical residents saw all this and turned to her and said, "THAT, is Dr. (insert my last name)! "Oh." was all the nurse said.

I guess it made me feel good to get back up from a surgery resident. Anesthesia has such a strange symbiotic/adversarial relationship with surgery, so it's nice to be liked.

Another weird nursing event. I was in a big gynocology-oncology case in which a woman had a humongoid tumor in her belly. It looked like she was pregnant with triplets. The tumor contained 22 liters of black, stinky fluid (that's 44 pounds of fluid!) which gushed out really fast when they opened up the tumor. Anyway, with all that fluid loss, the patient starts to drop her blood pressure so we order blood. The nurses start squabbling over who's job it is to check the blood and make sure it's the right blood for the patient. I'm usually one of the people that do that, because if I'm the one giving it, I'm going to check it. One of the nurses said anesthesia doesn't do that. This caused an arguement between the nurses, then somehow the scrub tech got involved and pretty soon they were all screaming at each other at the top of their lungs. I'm just sitting back behind the curtain thinking to myself, "these people are all nucking futs!". By the end of the fight, they were arguing about something totally different than blood. Keep in mind that during the entire fight, there are 3 surgeons hard at work on this patient. It was surreal. I've never seen anything like it.

The lady survived. She doesn't have cancer.