Hurricane Jill

A clone of myself would be handy right about now

Happy day yesterday…I found gloves that fit, both in width and length. I have had the worst time trying to find the right size gloves. My hands are long and narrow. Almost marfanoid, I have to admit. So gloves with long enough fingers are too wide, and gloves that fit snugly around my hand have fingers an entire centimeter shorter than mine. It’s very hard to tie knots when your gloves don’t fit right.

Anyway, today was match day for neurosurgery, and amazingly enough, the Tulane students matched better than the Baylor students. Ours went to UVA and UT Southwestern, and theirs went to Baylor and Penn and two other places I can’t remember, but which didn’t grab my attention.

I have so much work to do this evening, and so little time in which to do it. This semester is going to be completely manic. Two MPH classes, research, being an ethics preceptor as well as a physical diagnosis preceptor. It makes me anxious just thinking about it. And the stupid Blackboard program only sometimes works right. Tonight I managed to get it to work for one class’s lectures, but not the other. And of course, it’s the other class where I have a deadline to meet tonight. This totally sucks. I gotta write to the professor and tell him about it.

And tomorrow I think I have to be two places at once. Maybe not…it depends on how long the lab meeting lasts. It starts at 10am, and I have an ethics small group to lead at 11am. Which I haven’t done the reading for yet, by the way. I have the objectives, so maybe I’ll just wing it. But that’s not fair to the students, and it’s kind of an important topic. So I really need to get off this blog and get back to work.

Futures

So the first half of my neurosurgery rotation is over. Now I go from the county hospital to MD Anderson, AKA the “mother ship”, for another 2 weeks. The residents call it the mother ship because it’s huge and has lots of money to throw around, and it’s also the home hospital of the department chairman. They used to call Methodist the mother ship, before the split with Baylor, and apparently it had the sweetest call rooms of any hospital at the medical center. At MDACC, the residents take home-call, so now Ben Taub is the only place where they take in-house call anymore. And the call rooms there suck. In fact, the students don’t even have one for neurosurgery.

I had a long talk with one of the attendings at Ben Taub, and he gave me a lot of good advice about places to go for away rotations, and how to approach the process in general. He seems very interested in helping women get into the field. Part of our discussion was about american society, and discordance between the role of women here versus in other, supposedly less egalitarian, societies, where there is in reality much less of a barrier to their ascendance to positions of real power and authority. He is from India, and went to a school that was originally intended solely to train women physicians. He said that it began to admit men in 1947, and is now one of the premier medical institutions in Asia. We talked about how women are often viewed just as commodities, and I mentioned my own experience with having gained and then lost quite a bit of weight, and how I had noticed a significant change in how I was treated by others as a result. I hadn’t changed at all, but suddenly I was rewarded for things that had been completely ignored before, and helped in ways that made a huge difference in my ability to succeed. So I remarked that now I always question any help or praise I receive from men–do they see me as a whole person, or do they just see a pretty face?

One thing is for sure, this attending is a very perceptive person.

one hour and five arterial catheters later…

I placed my first arterial line. That poor lady. I must have stuck her 8 or 9 times before I got it all completely right. The first three times I missed, and from then on I hit the artery, but something else went wrong. Once the nurse didn’t have tubing ready, and the catheter clotted off before the tubing could be hooked up. Once the person helping me said it was venous blood, but when I took the catheter out, the profuse spurting blood said otherwise. Then I reused that catheter, hit it again, and got nothing because the catheter had clotted. Finally, I got it in and working, and the tubing attached, and the stitch placed. But whenever I got it in, it seemed like the rest of the world started moving in slow motion, and nothing else could get done fast enough. It was really hard not to snap at someone. But in reality, I had only myself to blame, because I was not completely prepared when I started the procedure. So now I know what I need to have ready, and I’ll just be sure it’s all there before I start.

And after making almost every mistake possible on this attempt, I’m quite certain I won’t have a problem starting a line like that ever again.

And, on another happy note, I figured out what I was doing with the sutures, and why they weren’t staying taut after I tied them. It turned out all I needed was a small adjustment, and that solved the problem.

Bad day

Today’s fortune cookie: Among the lucky, you are the chosen one.

Does anyone ever get a bad fortune in one of these things? I doubt it.

In any event, today was one of those days when nothing seemed to go well. I pulled someone’s femoral line, held pressure, made sure the bleeding stopped, bandaged it up reasonable well, and then an hour later the 3rd year resident tells me the patient is now bleeding profusely from the site. Apparently she got up to go to the bathroom and it started bleeding while she was on the toilet. I’m guessing it was #2, and she valsava’d and it blew out the clot. And then of course, the nurse says to me she’s only seen a femoral line bleed like that once in the 20 years she’s been a nurse. Hey, thanks, that makes me feel SOOOO much better…

And then there’s the fact that I can’t seem to tie a skin closure tight enough, and no one can figure out what I’m doing wrong. I look like I’m doing everything right, but there must be some little thing that people don’t realize they’re doing, that I’m not. It also freaks people out that I tie left-handed when I’m actually right-handed. Also, people flip out when I put my finger near any kind of sharp, especially sutures. They don’t understand that I sew, and that I know exactly where the needle is and where it’s going, and it’s not going to stick me. And while I can understand to some extent their nervousness when it’s my finger and their needle, it irritates me when people yell at me for doing it when I’m holding the needle. Don’t get me wrong, they’re a great bunch of guys. But no one teaches their little boys to sew, and most girls are taught basic mending of clothing at a relatively young age.

bring it on, neurosurgery

My first true 30 hour call day. And it wasn’t too bad, except between 1am and 3am, and again between 8am and 10am. After that, my second wind set in, and I probably could have stayed another 6 hours or so without deteriorating into a pool of protoplasm. Once that 6 hours was up, though, all bets would have been off.

Thursday and Friday were difficult days for me. Nothing seemed to be going well between me and the residents on the service, and I thought I’d be condemned to spectatorship for the entire two weeks of my county hospital rotation. But my call day on Saturday was a whole different experience. I can’t even really remember the beginning of it–it seems like weeks ago. But there was a whole lot of nothing going on for hours on end, and then suddenly around 2pm it was one surgery after another till the following morning. I got to drill some holes in a couple of heads, which although a relatively idiot-proof procedure, was still pretty cool. And, most importantly, I discovered that I too can build sufficient muscle strength to do most of this stuff. Even over the last week, I’ve felt myself getting stronger, and more able to lift things and drill things, and position patients with less assistance. I still need a lot of help, but I can tell that with practice and training, I can do what I need to be able to do. And also, as you develop more technical finesse, the need for brute strength decreases.

In the small world category, back when I was a staff pharmacist at Methodist, I’d actually had to call the resident who’s now chief resident on neurosurgery about some medication order that had been written on a patient in my ICU. he was an intern at the time, and if I recall correctly, it was one of those situations where it was impossible to get hold of anyone who would admit to having any responsibility for the patient in question, and for whatever reason, I ended up calling him about it, and I think he went ahead and OK’d whatever it was. The only reason I even remember is because of the unique name, which I’d asked him to spell. (That’s the trick I use whenever I space out while someone’s telling me their name. Which happens embarrassingly often.) I also remember because whatever the specific circumstances were, I was expecting him to be short with me and angry at having been called, and instead he was genuinely nice. Which is just how he is with everyone, even 6 years later after almost an entire neurosurgery residency. And that’s how I’d like to be at the end of my residency as well.

In any event, it ended up being a good week, despite being somewhat shaky in the middle.

This is so not work

Day one of neurosurgery. Went by like a spring breeze. Rounds start at 6am for the whole team, and there are NO PRE-ROUNDS. Not even for the med students. I love this place already. Then it’s off to the OR for most of the day, and when that’s done, see whatever patients haven’t been seen, hang out a little bit in the residents’ office, and go home. Or stay, if you’re on call. Either way, it’s pretty benign.

It’s like they read my mind…let’s see, what are the things that Jill absolutely hates about medicine? pre-rounding at o’dark-thirty? not necessary. being just a spectator? OK, let’s let her put in an ICP monitor, or at least do part of it. writing ridiculously long notes, just to prove what I know? here, 4 lines is plenty: AFVSS, neuro exam stable, doing well–continue monitoring, placement/surgery in AM. I mean, no, I didn’t get to eat lunch. But the whole purpose of lunch is to have an excuse to get away from work for an hour. So if you like your work, who needs lunch?