Tuesday, July 03, 2007

Coming to a close

Only one more day of trauma surgery left—although it is a call day so I won’t actually be done until the morning of 7/1. We have been really busy the last few days, but I have been in the OR most of the time so have missed most of the traumas that have come in. I haven’t seen many consults either. My last call night I was in the OR from 10:00pm until 4:30am with 5 successive cases. One of the cases was an elderly lady who had not seen a doctor for 30-40 years (she is very into herbals) who had classic cholecystitis. I saw her in the ER in the morning—the residents were swamped, and since this was definitely not an emergency (our initial plan was to not operate) it took a while for them to see her. I got stuck in the ER seeing a couple other consults and every half hour I got paged by the ER resident taking care of the first patient who then tried to harass me into getting things moving faster—it was really annoying, I can see now why there is sometimes tension between different medical services, though I can’t imagine that he would have had the nerve to multipage anyone other than a student. Two of the times he paged me I was in the room talking to the patient, the second time my senior resident was there trying to admit her. We were going to admit her and just give antibiotics then take her gallbladder out next month (since she was old and hadn’t seen a doctor for decades we had no idea what her cardiac status was), but she worsened throughout the day so we had to take it out—we weren’t able to until about three in the morning though.

Today I got to I&D a shoulder abscess by myself—it was pretty fun though I felt bad for the patient. I’m not sure if he was demented or just delirious, but his cognitive function wasn’t all there and he was totally deaf which made it hard to explain what we were going to do. He had an abscess about the size of a golf ball on his right shoulder, so we numbed it up, then I incised it with a scalpel—there was a lot of pus that I had to squeeze out, then I had to stick my finger in the pocket and break apart the loculations. Then I packed it with a strip of sterile packing which will be removed in a couple of days.

Later in the afternoon we had a patient whose small bowel was completely obstructed by a large dermoid tumor on one of her ovaries (dermoid tumors, which I think I have written about before are benign tumors that can be made up of virtually any tissue—hair is a common one). We opened her up, and moved her ovary away from the bowel, then the Ob/Gyn doctors came in to remove the tumor—it was huge—the exact size and shape of a newborn’s head, the operation looked like a c-section. I kept expecting to see a face on the tumor. Once they got it out they cut it open to reveal a matted hairball immersed in gooey yellow liquid—so disgusting. The whole case reinforced that I am not a budding gynecologist.

Last week the senior residents rotated so we now have three new seniors, all female. It has been a big improvement—they are extremely conscientious of their subordinates’ working hours and are extremely good about getting people out of the hospital. We have been going home between 5:00 and 6:00 this week instead of between 7:00 and 8:00, even though we are just as busy as before. It’s amazing how just getting one or two extra hours of free time in the evening can be so beneficial to one’s lifestyle.