Trauma

Family medicine ended Thursday. It was a good rotation, and also the last of my third year:). Yesterday I began my final year of medical school with my surgical sub-i, trauma surgery. Sub-internships are rotations for fourth years in which one theoretically acts as a "highly supervised intern" but without having any actual authority or order-writing ability--I say theoretically because on this particular rotation there are few and scarcely detectable differences between the duties of the sub-i and the regular third year student (both of whose jobs can be summarized succinctly in the word "scutmonkey"). So far the only difference has been that in the two days of clinic per week, the sub-i sees the patient and staffs directly with the attending, while the third year supposedly staffs first with the resident though in reality they also usually staff immediately with the attending. Another difference is that the sub-i's carry a special pager for nursing questions, though as of yet it has never been paged, no doubt because the nurses find it pointless to page someone who doesn't have the authority to act on the problem--but again, it's only been a day, so this could change.

My team consists of three interns, three senior residents, multiple nursing practitioners, three third year students, and one other sub-i besides me. And of course the group of attendings who supervise. Blurring the distinction between third year and sub-i even more is the fact that the third years are in my class and therefore have as much patient experience as I. My school's third year schedule provides one month of vacation--I was fortunate enough to have mine be June, which gave me the ability to postpone my vacation month until next year, and start 4th year early, which means I am doing the rotation with third years who had their vacation months earlier in the year and therefore are still finishing their third years and will not be fourth years until July.

Students' duties primarily consist, as I alluded to before, of scutwork (scutwork by the way for those not familiar with the term [is it used outside of medicine?] is work that is very necessary, but falls to the bottom person on the totem pole and provides absolutely no educational value or benefit whatsoever to the person performing it, and usually is something which could be done easily by a drunken chimpanzee) such as keeping the patient list updated (and there can be up to 70 or 80 patients on our team), writing down morning lab values for said patients, and writing down the final radiology reports for all trauma patients for the interns--basically the duties of a glorified (or degraded, I think I could argue it both ways) secretary except we pay them to let us do the work rather than the other way around. Fortunately, I was warned before about this, so I was somewhat prepared for this. The trade-off is that we should be able to see a lot of really neat stuff. In between scutwork yesterday I saw a urology consult--a 60 year old woman who had her bladder removed last year due to transitional cell carcinoma, and now has a urostomy bag for her urine similar to a colostomy bag. She was admitted because an outside hospital had found a large mass in her pelvis by CT scan, and one of their surgeons did an exploratory laparotomy (incision) and found stool in her peritoneal cavity (bad sign as it should be confined to the colon)--a biopsy found recurrent cancer (very, very bad prognosis unfortunately). However, now she has stool literally oozing from her incisional wound. She will need a study to make sure that only her colon is perforated, and if so, she will need a colostomy. After I saw her, the resident and attending apparently re-opened her incision, drained more than a liter of stool, and packed the wound (at this point I was back to scutwork:).

Tuesday will be my first call night (fortunately since we have five students we will be on call only every fifth night instead of ever second or third as has occasionally happened in the past and we get weekends off unless we are on call which means I get two golden weekends which is two more than I had anticipated--unfortunately my last call night is June 30th which means I won't leave until the morning of July 1st), it should be exciting.