Tuesday, August 21, 2007

Clinic

Yesterday and today I was in the breast surgery clinic. Yesterday was all follow-up patients (women who have had surgery anywhere from two weeks to 15 years ago and are just coming back as a precaution). Today was a half day in which I saw a couple follow-up and one new patient. The new patient was a woman in her early eighties who had the first mammogram of her life last month. Aside from having a hysterectomy and radiation for cervical cancer a few years ago, she has not seen a doctor since her last child was born almost 60 years ago. The mammogram unfortunately found a small mass that was biopsied and found to be invasive lobular carcinoma. Fortunately it is very small and very low grade. She will need to have surgery and hormonal therapy, but the prognosis is very good.

We were again running late, so despite the fact that the last patient was scheduled for 11:00 I didn't leave until after 1:00 (yes, I do have a taxing schedule this month:). I then went to the library to update my PDA since the program that lists all the drug dosages I will ever want to look up has been dead for the last month and a half. Since I hate dealing with little things like that, and since "procrastination" might as well be my middle name, I waited until today to get it straightened out. It was as bad as I expected. I spent at least 45 minutes in front of the computer getting the wretched program loaded on.

I've spent most of the afternoon working on my yearbook page and I have come close on several occasions to ripping my hair out from frustration trying to do it on the computer. I think I am going to end up just turning in printed out photos and letting the publishing company deal with the mess.

Tomorrow I will be in the OR. The morning will start with a bilateral mastectomy--to my surprise, my brief perusal of the patient's chart indicated that she had very early stage cancer in one breast which is usually treated with a simple lumpectomy and radiation. Bilateral mastectomy seems like major overkill to me--the only thing I can think of it that she was found to have the BRCA mutation which greatly increases the risk of women (and men) developing breast cancer--I'll have to look through her lab results tomorrow. She will have reconstruction immediately after the mastectomy which plastic surgery will do. A similar case yesterday started at 9:30 am and ended at 11:00 pm (plastic, transplant, and cardiothoracic surgery are all specialties I plan on staying away from based simply on the case length--I like them less than 3 hours--then again, I imagine that time would go by faster if I were actually performing the operation rather than standing for hours with my arms extended at incredibly uncomfortable angles holding tissue back so the surgeon can see what s/he is doing).

3 Comments:

Anonymous Alice said...

I can't really picture how a breast case could last fourteen hours; were there some complications?

Enjoy the hours while they last. :)

6:27 PM  
Blogger Chris Emlyn said...

The bilateral mastectomy apparently went from 9:30 to 2:00, and then the reconstruction went until 11:00. I didn't hear of any complications but there may well have been some.

I am definitely enjoying this schedule! I had to turn in a "hours worked during the week" form to the surgery department and it was really embarrassing since it is the same form all the students on their sub-is are using.

6:43 PM  
Blogger MD Views said...

Assisting on surgery when you've never been the surgeon before, is difficult, strenuous and tedious. But don't judge surgery by the assisting. I nearly did not go into OB/GYN because I assisted on so many vaginal hysterectomies on poorly positioned patients (strains arms, hands, shoulders and especially back) that I hated the operation.

Well, doing a vaginal hysterectomy is on of the most comfortable and least taxing surgeries I now do. And, I have an appreciation for the toll on those assisting, so I position the patient so they don't have to stoop, and takes breaks to rest their hands if needed.

All that is to say that performing an operation is not at all like assisting on an operation. I wouldn't rule out a specialty because of the "crushing" (your word!) tedium of assisting.

9:42 PM  

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