Saturday, October 28, 2006

CT stuff

I have just officially worked my first 80 hour work week. Monday is usually the day when we have nothing to do aside from working in the hospital—no lectures, teaching rounds, etc., so I went ahead and just wore scrubs instead of professional dress. Big mistake. At about 6:30 I overheard another student telling her resident that we had OSCEs (interviewing fake patients) that morning. I and the other student on CT surgery had totally forgotten about it. I ended up having to drive all the way home (30 minutes in good traffic) to change and all the way back, getting to the test site with about five minutes to spare. A very annoying way to start the morning. Tuesday I saw a triple bypass in a 45 year old man. That evening the clerkship director had dinner at his house for all the students on surgery. His wife is a “3/4 time” family practice physician and they have four very energetic children all under the age of nine. The oldest child was having fun talking to all the medical students about electrons and hormones.

Wednesday was lecture. Like last week, I was hoping to leave after lecture and go to the library and study and finish writing up H&Ps. Also like last week, these hopes were dashed. I ended up having to go into the tail end of a (you guessed it!) bypass. I left at about 8:00, so I did manage to make it to Bible study. Then I had to stay up til midnight finishing the H&Ps.

Thursday was my day to go over to Children’s hospital to watch a pediatric surgery. It was a several month old child with pentalogy of cantrell, a very rare congenital disorder. The child essentially had an opening between the two main chambers of her heart which needed to be closed. It was really quite amazing—her heart was about the size of a golf ball. The surgeon sewed in a patch to fix the defect. Unfortunately, when he tried to take her off bypass, her heart didn’t want to start again. They got an echo and found that the middle part of the patch was buckling and blocking her aorta. The surgeon opened the heart again, finnagled with it, then tried to take her off bypass. Again, no success. He ended up having to take the patch out. They put her on ECMO, a form of cardiopulmonary bypass, and are going to let her rest for a couple of days before trying anything else. I left the case at 1:30 am, thus setting a new record for the longest surgery I have ever been in: 16 hours. Unfortunately I was wearing contacts so I had to drive home to take them out, sleep two hours, then go back. Had I known I would be there so late I could have just worn glasses and slept at the hospital which would have been a lot easier. At about 9:00pm I decided that I am just not meant to be able to study for the exam on Tuesday.

Friday morning I saw a consult, a woman with a newly found lung mass, had the cup of coffee I had been dreaming about since Thursday morning, and saw an esophagectomy. The surgeon removed the esophagus (the patient had Barrett esophagus which strongly predisposed her to esophageal cancer), then formed a tube out of the stomach and brought it up through her chest and attached it to the remaining cranial portion of her esophagus….I just got paged—I have to go back in for an emergent heart procedure—I guess I’m really not meant to study for the exam on Tuesday—to be continued, likely with an explanation of why I will never be a cardiac surgeon...


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