Surgery, What's it like?

Morning round at 6:30 AM, end of shift 6PM if you're not on call, and the next day at 6PM if you're on call (36-hour duty), 6 days a week. What's up?

I've never felt or been so out of time for so long in my life. What's it like? Forget about having the slightest bit of time for anything unexpected like your car breaking down or your grandmother getting sick. These have no place in your loaded schedule and most days you have too little time to make a phone call or even to think about it!

On the floors, busy with more tasks than you can count, armed with a loud beeper that won't shut up or stop interrupting you, paged relentlessly by your numerous superiors and their ridiculous requests that could not come at worst times. You feel the need to be at 5, 6 places at the same time, and soon as the day goes by, like butter spread over too much bread.

You feel disrespected, unappreciated, and you want out. Out of the misery, the stress and humiliation. But somehow you pull through it all and get home almost too tired to get out of your clothes and crash on your undone bed and fall asleep to wake up a few hours later for it to start all over again. "Bring it!" seems like the only attitude to take if you are to have any chance of succeeding.

Here's what you do on the first year of a surgery residency.

First call on all your patients's issues.
Loads of paperwork.
Seeing and preparing all new admissions.
Keeping track on all occurrences and treatments done on patients in real time.
Making sure all the labs ordered on patients are within normal and making corrections as needed.
Handle incompetent nurses and be thankful that there are a few who want to help and actually know what they're doing.
Handle all of your superiors' scut work like ordering labs, getting consent forms signed, and transporting blood units or specimens back and forth between the OR and the pathology lab.
Keep track of everything your students are doing and making sure they don't screw up.
Dealing with obstinate and overconfident hypertalkative students, patients, and colleagues
Catering to every attending's immense ego.
Playing secretary and delivering messages between residents and attendings in the hospital who are just too stupid to talk to each other directly.

The list goes on. And the worst part of it is that you never get any form of recognition when you get all of this done right, but get reprimanded heavily at the slightest delay or bureaucratic mistake you make, to the demise of any shred of motivation you might still have had.

What a rush, what a time hole, making you appreciate your only off day in the week like someone starved for a year would appreciate a Big Mac. Wow.

But you know what? I love it! I love that feeling that no matter what happens this year, or the next, or the one after that, something is being built that seems to be worth all the crap you are forced to take. I have students under my supervision now. Students I have to teach, supervise, and help write progress notes. Students who - mostly - look up to their intern with respect and admiration.
And the single most rewarding feeling you have, that will make all of the above seem like a very small price to pay, is the recognition you get from your patients, who often are very sick people that you can help provide with a better life. And it's amazing just how grateful they can be, not because your attending surgeon just performed life saving surgery on them, but more because you devised a way for the dressing on their colostomy to stop leaking stool, the smell of which requires no description when it comes from s diseased colon, from their abdomen and onto their skin and bed sheets, keeping them awake at night. You do something like that, and you end up getting a disproportionate amount of gratitude, and that patient will smile every time you walk into her room.
This feeling, this gratitude, is worth more to me than the highest awards, from Penrose all the way to Alpha Omega Alpha (some of the most coveted awards), making them seem completely trivial once a sick patient calls you their guardian angel just because something you did helped them get a good night's sleep.
There's no beating that. And this mini surgeon is sticking round for more.

Overheard

At the nurse's station desk.

Urology resident on the phone: "the 'testicle' is coming make sure you get all the bloodwork by tonight.

It took time to realize he was talking about about a new patient coming for testicular surgery.

How random.

It's here... It's finally here!

Here's to ending another long and intricate chapter in an incredibly long book -and to the first page of a new chapter with more and more drama  - Loving every page. Graduating in a few weeks and having this to look forward to is simply... Sweet ...!

This is everything I've wanted. The news is still sinking in 10 days after it came in.

You can bet everything that I will be thinking... Did I just bite off more than I can chew? ....

.... And shortly thereafter, answering : Bring it, Surgery! How bad can you be? I'm too excited to have second thoughts!

How bad? Well I've heard stories here and there. But I will be the judge of that this time, thank you. I'll be reporting live right here, faithful readers tag along :)

Another Catch-Up Post

Well it has been a while since my last post. I've been busy lately, and last night I happened to check out my blog and realized that I'd 'left' on a very sad note. Sorry about that!
So what have we missed? One relationship anniversary, one uneventful new year's eve, another goodbye to another good friend leaving the country, another monumental governmental failure (but we're used to those), another stupid Internal Medicine rotation, a few breathtaking days on the Faraya slopes. All these, among other things I've meant to blog about that would have kept my readers busy/amused/annoyed. No such luck; instead, here I am, once more, overwhelmed by my flying ideas, frustrated by my tantalizing muses, pressed for time (but we're used to this one, too), and struggling with my vocabulary trying to make something out of this heap of interweaved trains of thought.

Let's start here. I am happy. Happy, of course, being a word surrounded by a cloud of relativity, and perhaps a few drops of evanescence, but for the first time in a few long med school years, I can really say that I am happy. Happy with the way things are going in my life. Happy that I'm just starting to peer through that window onto the next steps in my life and career. Happy with my lovely L. Just overall, in a good moment I guess, the likes of which I haven't seen in a very long time.

Trying to pinpoint it is hard. but I think what has drastically changed my outlook on things is the fact that I'm done guessing what I want to do with my life. Over the course of one day, my career path has become clear to me; I am to become a surgeon, people, go crazy. There has never been a specialty better suited for me, I've always known it, and since I've applied to a surgery residency at AUH for next year, things have been different. It takes much more to worry me, I am more relaxed in my work, I'm optimistic and feel so hungry to take on this next chapter that I don't even feel like a med student anymore. Med IV is almost over. A few months ago I was excited at the prospect of beginning my last year of med school. Time flew, that's all I can say. and if you've read that post, you'll understand why I'd be keeping with the continuum if I say, Bring it, Surgery! Bring it, Residency, Bring it, long on call hours! I want to work my ass off in something that fascinates me, instead of sitting around the morning rounds in internal medicine for 5 hours wondering what the hell I'm doing there, trying hard as I can to stop my eyes rolling into the back of my head from boredom!

Did I mention I hated internal medicine? Well I'm sure it's obvious now! (Some other post, for sure)

So there you have it. The main update and now we can look forward to my admission (wish me luck) and to my Surgery internship next year which I'm sure will bring you many long posts.

Will keep you posted!

Drafts from the Past

For a few days now, I'd been wondering how to get back on the blogging track. For me it's one of those times when you have a lot to write, but not enough time. So much to write you can't just cram it into one post and expect it to make sense... So I thought why not see what I had been up to before my unjustified hiatus...

Here's to fishing a few drafts from the past, a few posts that were never posted. Figured we'd go from there!

August 22, 2009 - A Med Student's First Patient Crush

"Well here it is. It finally happened... It had to, I guess it was only a matter of time. I guess it's always only a matter of time before any med student gets infatuated with one of his patients. I had to check on a total of 6 patients yesterday, and these include two patients from my previous post.

So after a long on-call day at the hospital, I get beeped for my last admission of the day. I thought to myself, "here we go. One more intestinal obstruction or jaundiced patient and I'll be on my way..." And so I got to 7 South. I saw Dr. K (one of our residents) and R. (a visiting student from Syria) at the end of the long hallway leading to the desk. As I got closer, I started hearing tidbits of what they were saying, and the little that I could put together was "She's status post whipple procedure in 2007".

When I heard this, I tought "ok, here comes another 90 year-old... [end of draft]"

September 26, 2009 - Enraged Med Student Slays Many in Elevator Frenzy.

"What is wrong with people? What is wrong with Lebanese literacy? what is wrong with normal psychomotor and cognitive development?

You're probably wondering why I'm asking these questions... Well let's see. In order of appearance and respectively, here's what they... [end of draft]"

November 6, 2009 - Some Will Never Learn...

"Ever wonder why you seem to keep making the same mistakes... [end of draft]"

December 24, 2009 - Wandering Attention, You're Welcome

It's 2 am and I'm awake, wondering what it is that drives the seemingly coincidental encounters, the apparently arbitrary events, large and small, that seem to just explode in apparent randomness until they inevitably crash back together and make up that mess that we call life... [end of draft]

I had been thinking about a few of these posts, the few worth posting, that is, and wishing I had posted them when I remembered more of what made them worth writing. But I have to say that while a bunch of fine-script details are lost to hazy recall, some memories are tenacious and come out vividly as soon as they are elicited.

Like L., my 26 year-old patient with not only the most intriguing and sorrow-inspiring medical history and problems, but also with the most unforgettable face and big blue eyes and out of this world sweetness one could imagine. One of the many patients I will never forget.

Or that insane feeling I get everytime I get in the elevator at AUH and people start pushing and shoving to get in before anyone has a chance to get out. When they look in at some of us 'elevator insiders' and ask: "Going up?" with that bewildered look on their faces! And finally, when stuck in a packed elevator for 10 floors with a stop at each and every single floor with agonizing slowness and the same sketch of pushing, shoving, and moronic questions, the nice feel of less-than perfect hygiene: the 9 out of 10 people with breath odors prompting the eloquent question: "WTF???" and let's not forget the 8 out of 10 people with body odors worthy of wildebeest! I used to think about that frenzy every day! "LOOK OUTSIDE YOU MORON! THERE'S A LARGE ARROW POINTING EITHER UP OR DOWN! AND GUESS WHERE THAT !@@#$% ELEVATOR'S GOING!! AND TAKE A GOD!@#$ SHOWER AND BRUSH YOUR GOD AWFUL TEETH!" Oh that felt good!

As for the last two drafts, I can't seem to remember what I was on about. I'm sure it would have been interesting though!

Ok so there was my flashback. My way of dotting the i's and crossing the t's paving the way for a few more memories fished from the past as I catch up.

Patient Insanities on 10 North... Have a Laugh

Well I figured it was about time I shared some more stories about our dear patients on the surgery rotation. Here are the three cases that spring to mind... Actually there's a fourth one, but she deserves a post of her own so come back soon ;)

The crazed grumpy old man on 10 North.

K.H. has been driving all the floor insane for about a week now. Anxiety attacks, flamboyant claims and accusations that make me wanna scream out in anger... To put things in perspective, one of his latest complaints was having a nurse that smiled too [damn] much!! He even told her that to her face! Hilarious and sad... The poor guy has been one of the most complicated medical cases we've seen so far, with several operations, intestinal leaks and what not... Understandable? Granted. But it is still annoying, and yet funny in a marginally twisted sense, if you see what I mean, to hear him complain about things the world of medicine has never known, like diarrhea caused by walking!!

[Note]: "Patient is not doing very well, complaining of general anxiety and unable to tolerate hospital stay. He is pain free and is refusing to take his anti-hypertensives and anxiolytics by mouth. He refuses to ambulate for fear of diarrhea." Making sense are we? LOL

[Plan]: "Start I.V. Lexotanil"

The nice and healthy middle aged Man on 9 South.

M.D. is A previously very healthy, strong man. After extensive surgery, he seems to be recovering nicely, and is happy to see me every time I walk into his room. Always a good sign to see a patient greet you with a smile. It is so rewarding and puts an inexperienced mini-physician such as yours truly at ease and makes the job that much easier. I walk into the room, M. smiles and brags about how well he's doing, is always anxious to show me how good his breathing is getting, or how comfortable his lazy-boy chair is, with its fancy electric recline and foot support functions. Me, smiling "I wish I had one of those at home, Mr. D!!" It has been a pleasure following this one up. He's staying till the end of the week.

[Note]: "Patient is doing very well, tolerating regular diet, passing stools and flatus, ambulating freely and using incentive spirometer as instructed. Bowel movements normal, no pain or discomfort reported upon defecation. Patient is pain free and has no new complaints. Plan for discharge soon."

The distant old lady on 10 North.

S.D. was a 70-something-year old lady we followed up for about a week, some few weeks ago. I had completely forgotten about her, until I met K.H.

She had her own set of problems, like being too good to look at us med students, or letting us examine her without her attitude, or having not one, but two of her private nurses in her room taking care of her and making our lives miserable... Case in point: M. my colleague was about to draw blood from S.D.'s arm. It was her first time doing that, and she was looking for the vein, taking her time to locate it with some degree of certainty. After all, you don't want to poke her majesty for nothing! Some odd 20 seconds later, S. just lost her patience (bear in mind that M. hadn't even picked up a syringe yet!) and with her face turned away from M., called her nurse and said: "ta3e shoufe hayde shou 3am ta3mel sarla se3a!!" Translation "come here and see what this one is doing, it's been an hour!" Priceless!!

[Note 1 ]: "Patient is pain free as confirmed by private nurse. She is non compliant and refused to be examined, claiming that the nurses already gave her a physical."

[Note 2 ]: "Patient is pain free as confirmed by private nurse. Physical exam not done because patient is sleeping"

And for the record, all that the nurses do is take temperature and blood pressure and stuff like that so...

Difficult patients are a real challenge! I still need to work on that area! Something about them shakes my confidence! But they're funny to tell your friends about!

S.D. and K.H. ? a match made in heaven! We couldn't help but try and imagine what these two would be like living together! Imagine the children!!!

Those of you calling out outrage, relax. We're not making fun of our patients. It's not like that. It's just that these few cases are too entertaining to forget. So we document them! See? it's a noble cause! But seriously, they all get the same respect and standard of care... Rightfully so!