I realize i haven't posted here in a while, so I decided to do some updating today. Why haven't I posted you ask? Well, nothing exciting has come my way at Coney Island. My last two call nights were very uncharacteriscally boring: not alot of consults, and no emergency surgeries. I basically read.....and ate.....and talked. Although on wednesday I did have the pleasure to finally palpate the spleen. Normally, it is not palpable but in this particular gentleman it was as big as the liver. He has a disease called polycythemia vera (disorder where too many red blood cells are made), which causes congestion within the spleen and an increase in size.
Last week in surgery was the dreaded "Specialty Clinic" week. A few clinics at Coney Island are run well, and are a pleasure to attend and participate in (Plastics, ENT, Breast, Ortho). The rest are disorganized and unenjoyable. It makes it hard for the patients....and for us to be there. By the end, I am exhausted, frustrated, and mentally sapped. It would be hard to explain how this all occurs. I think it is a combination of which doctor/doctors are at the clinic, which patient charts you pick up, what language the patient speaks, what paperwork you need to fill out (booking for a surgery can be long and uneventful), etc. All I can say is I never have to set foot in a surgery clinic at Coney Island ever again!! :)
So yesterday I had lots of plans and a very fun day/night. I got up early (6am), had breakfast, did some reading, went for my hair appointment, went tanning, walked around Park Slope looking for a dress, ate a bagel w/cream cheese toasted, headed to Macy's in manhatten to find a dress, spent 4 hours in Macy's, found a dress on sale, bought it, proceeded to walk around trying to find a decently priced bar for dinner, stumbled upon The Rodeo Bar and Grill on 27th and 2nd, it was Happy hour so I ordered a margarita, also ordered a burger and fries, started talking to the guy next to me who is attending Hunter College for Physical Therapy, had a beer, continued talking, had another beer, went to the bathroom where I stumbled upon 2 girls who were out with their husbands and having a bad time, got invited to hang out with those girls for the night at there hotel, went back to the bar for more talk with PT man, felt a little drunk, recognized that PT man wanted to continue the night at a bar up the street, paid my tab and politely left the bar, walked 15 minutes back to 34th street (actually stumbled along), sat at a table at 34th street people watching for a while, think I fell asleep while people watching, got on the Q train at 11:04pm heading back to Brooklyn, walked into my apartment at 11:37pm, brushed my teeth, stripped down to my nakey suit, had 2 full glasses of water with some advil, passed out until this morning at 8am!
Today was also eventful although not as much as yesterday: Woke up with a slight headache :), had coffee and breakfast, played a little on the internet, went to do my laundry, had a turkey/roasted red pepper pannini and a skinny latte for lunch, did some grocery shopping, came home, watched some Sex and the City, did a little reading for surgery, made dinner (spaghetti with turkey meatballs and bread/butter), sat down to write my blog!
In closing, tomorrow I start 2 weeks of Surgical ICU. I have to be there at 6am, which means I am back up at 4am every morning. Tonight I have decided to take a break, watch a movie, and relax. I am so looking forward to Thursday. I'm heading home for Sacco's wedding this weekend. Can't wait to see family, friends, and of course....MY PUPPIES!!!!
Everyone have a great night! :)
Sunday, July 26, 2009
Sunday, July 12, 2009
One more week of surgery done....as well as one more call night
Well, week #7 is done. I spent the entire week in Orthopedics. I had a really, really great time. Bones are fun, especially when they are broken and shattered and you get to use various tools that one could find in Lowe's or Home Depot to fix your patients. This week I saw a total knee replacement, a total hip replacement, a hardware change of an infected hip replacement, and the start of an I and D on a knee (incision and drainage). In clinic, I saw multiple patients for follow-up on broken bones. I also got to experience (several times) the following: the patient with severe arthritis in the knee who is experiencing difficulties in walking and excruciating pain, yet does not want the only treatment option, surgery. As explained by the doctor, there is nothing else but a knee replacement, yet the patients refuse. One of these patients happened to see Dr. H, who proceeded to say "Okay, well continue to take ibuprofen and come back to see me in 3 months. Hopefully, by that time you will be in such excruciating pain that you will consent to the surgery instead of wasting my time here in clinic." I also had a rather hilarious experience with Dr. W and a 79 year old woman. While looking at her X-ray of the titanium rod that was placed in her femur, the woman says "Wow, that is a big rod in me!!" Dr. W broke out in hysterical laughter as did I :)
My call night was friday. It started off really, really slow but picked up around 11pm. I had the pleasure of seeing a 12 year old boy with abdominal pain. It was my first time examining anyone under the age of 18. I asked all of my relevant questions about history to the parents and then examined the patient. Soon after, I had my diagnosis...Acute Appendicitis. Of course, I had my differentials too (gastroenteritis, Meckel's diverticulitis, testicular torsion, cystitis, pyelonephritis). A ct scan was ordered and because there was what appeared to be an abscess, surgery was not performed. I did get to present this patient as well as my findings to my preceptor the next morning. I did fairly well, except I did forget to perform a few tests to rule out my differentials. But overall, my presenting skills were pretty good :)
Yesterday I slept all day :). Today I did laundry and ran in the park. And, for the first time in my life, I went tanning.....in a tanning bed. It was interesting. Only 10 minutes. It got really hot under the lamps. I decided to go completely naked, because I had that option and if you know me you know that naky-ness should be my middle name! Why am I tanning?? Well, I have a wedding to go to in August, and my date is a tan-a-holic. She looks like she walked off a beach....year round!! So as to not look pasty white next to her in any photos, I decided that i must do some tanning. If I wasn't spending so much time in the hospital, I would try to lay out. But that is not an option, so fake and bake I must. Hopefully, I get a nice color!!
Okay, time to do some studying. This week I do anesthesia. Hopefully, I get to intubate someone!! Everyone have a great night!
My call night was friday. It started off really, really slow but picked up around 11pm. I had the pleasure of seeing a 12 year old boy with abdominal pain. It was my first time examining anyone under the age of 18. I asked all of my relevant questions about history to the parents and then examined the patient. Soon after, I had my diagnosis...Acute Appendicitis. Of course, I had my differentials too (gastroenteritis, Meckel's diverticulitis, testicular torsion, cystitis, pyelonephritis). A ct scan was ordered and because there was what appeared to be an abscess, surgery was not performed. I did get to present this patient as well as my findings to my preceptor the next morning. I did fairly well, except I did forget to perform a few tests to rule out my differentials. But overall, my presenting skills were pretty good :)
Yesterday I slept all day :). Today I did laundry and ran in the park. And, for the first time in my life, I went tanning.....in a tanning bed. It was interesting. Only 10 minutes. It got really hot under the lamps. I decided to go completely naked, because I had that option and if you know me you know that naky-ness should be my middle name! Why am I tanning?? Well, I have a wedding to go to in August, and my date is a tan-a-holic. She looks like she walked off a beach....year round!! So as to not look pasty white next to her in any photos, I decided that i must do some tanning. If I wasn't spending so much time in the hospital, I would try to lay out. But that is not an option, so fake and bake I must. Hopefully, I get a nice color!!
Okay, time to do some studying. This week I do anesthesia. Hopefully, I get to intubate someone!! Everyone have a great night!
Monday, July 06, 2009
Call #7....in all its 4th of July glory!
I spent the prior week wondering what my night call on July 4th would be? Nice day + beach + lots of drinking + lots of food + lots of people out and about = drunks, fights, MVAs, and sunburns!!
Saturday started off okay. I spent the first part of the day in SICU managing the sick patients plus helping out on some of the floor patients. I flushed an NG tube, helped the nursing staff change bedding on the 450+ pound patient, changed the dressing on a diabetics amputated foot, changed the dressing on a lower limb fasciotomy (for compartment syndrome following AAA surgery), etc. I also had some down time away from patients where I read all about breast pathology and surgical techniques for fixing said pathology.
By late afternoon, the ER started to pick up so I headed down there with my resident. First up, pneumothorax take 2 guy. He was a young 28 year old man who was involved in an altercation on tuesday and was stabbed. He went to another hospital, was treated for the stab wound and a pneumothorax that had developed. On friday, they took out his chest tube and sent him home. On saturday, he was in our ER with difficulty breathing and alot of pain. Turns out the pneumo was not resolved. So, we had to place another chest tube and since this young gentleman had already had one placed a few days back, he was well informed of the intense amount of pain he was about to feel!!
Next up, 87 year old male from nursing home in respiratory arrest. By the time I was assigned this patient, he was already intubated making the interview process a tad bit hard. My only source was a good physical exam and the nursing home notes which were not detailed at all. My senior resident managed to get a hold of the gentleman's nephew who was of even less help than the nursing home. We stabilized him and sent him to SICU.
During this time the red shirt brigade started piling up. You are asking "what the hell is that?" Well, its a wall of stretchers with patients all wearing a red shirt and handcuffed to the bed. These are all drunk patients who are too intoxicated to be released. They put red shirts on them so they are easy to spot in case they escape. Of course, everytime you walk past them they scream (in a slurred, slowed speech) "Doctor, doctor!!!" And once one starts yelling it, they all start yelling.
An older gentleman came in with really bad chest and abdomen pain. On CT exam, he had a aortic dissection that started at the distal end of the arch of the aorta and traveled down to the common iliacs. Unfortunately for him there was no vascular surgeon on call this particular night so he was immediately transferred to Maimo for treatment.
Our last patient was an 80 year old female who was experiencing some abdominal pain. On CT scan she had an internal hernia (a section of small bowel was protruding through another section of small bowel). We had to rush her immediately to surgery for an exploratory laparotomy. Once the doctors reached the small bowel, they realized she had an ischemic bowel and a portion of the small intestines was dead. So, I got to see my first small bowel resection. 2 feet of distal jejunum and proximal ileum was removed. Then the ends were stapled and sutured back together again. Unfortunately for this patient, her outcome was not that good. While closing the incision her blood pressure suddenly dropped to 35/28 and her heart rate shot up to 130 beats/minute. A central line was placed in the patients jugular and we pumped her full of fluids. That coupled with levophed brought her blood pressure back up but she is currently in SICU in very bad shape. The doctor thinks she may have suffered a pulmonary embolus while on the table (she had a history of prior DVTs).
I scrubbed in for the above surgery, and it started at 2:15am. It didn't finish until almost 5am and I slept for about 30 minutes in a chair. I was exhausted when I got home at 9am, so what did I do??? I walked around Union Square with Dy and Amanda!!! Around 2pm, after extreme exhaustion, I took the subway home and at 3pm I crawled into bed and didn't wake until 4am this morning!!!
These call nights are so tiring!! I hope everyone's 4th of July was as exciting as mine!! Take care.
Saturday started off okay. I spent the first part of the day in SICU managing the sick patients plus helping out on some of the floor patients. I flushed an NG tube, helped the nursing staff change bedding on the 450+ pound patient, changed the dressing on a diabetics amputated foot, changed the dressing on a lower limb fasciotomy (for compartment syndrome following AAA surgery), etc. I also had some down time away from patients where I read all about breast pathology and surgical techniques for fixing said pathology.
By late afternoon, the ER started to pick up so I headed down there with my resident. First up, pneumothorax take 2 guy. He was a young 28 year old man who was involved in an altercation on tuesday and was stabbed. He went to another hospital, was treated for the stab wound and a pneumothorax that had developed. On friday, they took out his chest tube and sent him home. On saturday, he was in our ER with difficulty breathing and alot of pain. Turns out the pneumo was not resolved. So, we had to place another chest tube and since this young gentleman had already had one placed a few days back, he was well informed of the intense amount of pain he was about to feel!!
Next up, 87 year old male from nursing home in respiratory arrest. By the time I was assigned this patient, he was already intubated making the interview process a tad bit hard. My only source was a good physical exam and the nursing home notes which were not detailed at all. My senior resident managed to get a hold of the gentleman's nephew who was of even less help than the nursing home. We stabilized him and sent him to SICU.
During this time the red shirt brigade started piling up. You are asking "what the hell is that?" Well, its a wall of stretchers with patients all wearing a red shirt and handcuffed to the bed. These are all drunk patients who are too intoxicated to be released. They put red shirts on them so they are easy to spot in case they escape. Of course, everytime you walk past them they scream (in a slurred, slowed speech) "Doctor, doctor!!!" And once one starts yelling it, they all start yelling.
An older gentleman came in with really bad chest and abdomen pain. On CT exam, he had a aortic dissection that started at the distal end of the arch of the aorta and traveled down to the common iliacs. Unfortunately for him there was no vascular surgeon on call this particular night so he was immediately transferred to Maimo for treatment.
Our last patient was an 80 year old female who was experiencing some abdominal pain. On CT scan she had an internal hernia (a section of small bowel was protruding through another section of small bowel). We had to rush her immediately to surgery for an exploratory laparotomy. Once the doctors reached the small bowel, they realized she had an ischemic bowel and a portion of the small intestines was dead. So, I got to see my first small bowel resection. 2 feet of distal jejunum and proximal ileum was removed. Then the ends were stapled and sutured back together again. Unfortunately for this patient, her outcome was not that good. While closing the incision her blood pressure suddenly dropped to 35/28 and her heart rate shot up to 130 beats/minute. A central line was placed in the patients jugular and we pumped her full of fluids. That coupled with levophed brought her blood pressure back up but she is currently in SICU in very bad shape. The doctor thinks she may have suffered a pulmonary embolus while on the table (she had a history of prior DVTs).
I scrubbed in for the above surgery, and it started at 2:15am. It didn't finish until almost 5am and I slept for about 30 minutes in a chair. I was exhausted when I got home at 9am, so what did I do??? I walked around Union Square with Dy and Amanda!!! Around 2pm, after extreme exhaustion, I took the subway home and at 3pm I crawled into bed and didn't wake until 4am this morning!!!
These call nights are so tiring!! I hope everyone's 4th of July was as exciting as mine!! Take care.
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