Saturday, February 22, 2014

Surgery: 4 AM Wake Up Calls, The List and other Assorted Drudgery Pt. I

Im sorry. I really want to keep up with this blog, I have so many things I want to say but sometimes it just falls off my list of things to do.

The past few months I have been dealing with some significant family health concerns coupled with my surgery rotation I've had little to no time for anything extra.

But the show must go on! Just as with everything else on this blog these are my personal thoughts and opinions--not meant to offend but merely to inform and present one naive young person's perspective.


Surgery.  Those of you who are not in medical school probably don't know but the moment this rotation comes up in conversation it strikes fear into the heard of 98% of us.  There is that bizarre little group of people who are giddy with excitement and actually electively choose to spend the rest of their lives doing this.

To be honest before I started this rotation I thought it was what I wanted.  I love working with my hands.  I've always been a tinkerer and I thought surgery would be the perfect way to merge my personal passion and strengths with my career.

I was wrong.  Lets first discuss how awful the hours are.  For the last 8 weeks I've been waking up at 4 am everyday, barring the one day a week we get off.  I arrived at the hospital between 4:45 and 5 and am expected to see my patients and have my notes completed before 6 when the team will round with the senior resident.

That wouldn't be all that horrible except for another menial task that is assigned to students: The List. What is the list you may be asking yourselves?  Let me tell you.  It is a print out of the list of patients the team is responsible for that day it includes the name and age of the patient in a grid like format.  You would think with the electronic medical records (EMR) that we use (the hospital I was at had the cadillac of EMRs, EPIC) there would be the option to say right click all the things you wanted for the patients and have them come out in list format. WRONG.  Every morning myself and the other two students on our team would by hand have to fill in for every patient in the 1 cm row like space the following information: reason for admission, overnight events, vitals [temperature, heart rate, respiratory rate, blood pressure], total intake, total output, urine output by shift, medications, diet status ([NPO (if they can't eat anything], clear liquid diet, full liquid diet, pureed diet, heart healthy, general, etc).  That is completely absurd.  It would take between 30 and 40 minutes every morning to make this list and to be honestly most of the time nobody even used it.

After pre-rounds with the residents were completed we were expected to split up the surgeries on the board for that day and scrub into those and keep an eye out for when attending rounds would happen.  Thats another disaster.  As students nobody really ever remembers us and attending rounds occurred on a pretty haphazard basis so we had to rely on our interns to let us know when and where they were happening.  This led to one too many occasions where we would run into one of our team members somewhere only to have them let us know that rounds had just finished.

Frustratingly enough there was a second list we were asked to make during the day too.  Sometime between pre rounds finishing at 7 am and attending rounds occurring whenever the attending decided to show up we were expected to record the labs values for every patient.  This entailed printing out another blank list and filling it with hemoglobin, hematocrit, platelets, WBC, sodium, potassium, Cl, bicarb, BUN, creatinine, glucose, calcium, phosphorous, magnesium and any other assorted values that were recorded such as PTT, PT, INR, CEA, etc.  The worst is when we would scramble to finish the labs only to find out we missed rounds.

Although there was a lot of busy work involved with it being in the OR was quite a unique experience. The excitement of holding the camera during laproscopic procedures did start to wear off but I can definitely appreciate the fact that surgical interventions are kind of mind boggling.  More on the woes of scrubbing in and accidentally touching your face and other comedic moments during my surgical clerkship.

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