The 15th Floor Overlooking Fenway

The operating comes in spurts on this rotation. However, today was pretty darn good:

06:00 Laparoscopic Appendectomy (for which I was awoken at 03:00)
09:00 Exploratory laparoscopy, incidental laparascopic appendectomy, inguinal hernia repair mesh (which was not as painful as the HOUR long room turnover preceeding it)
10:30 Ventral hernia repair with mesh
12:15 Inguinal hernia repair with mesh

Now can I convince myself to run once I get home?

There have been several times in my residency that I've been struck by the fact that I am at a Harvard (pronounced HA-vaaaard) program. Don't worry, there used to be "oh, shit, I'm at MIT" moments, too. I can specifically remember one of those times was during my intern rotation at Boston's Children's Hospital -- a notoriously hard rotation but also one in which we interact with some amazing faculty who don't think of themselves as amazing faculty. Surgery grand rounds that week was being given by Dr. Judah Folkman. The amazing part however, was that it wasn't really meant to be a special grand rounds -- i.e. there was no visiting professor; it wasn't someone receiving a special annual honor -- it was just normal weekly grand rounds being given by one of the faculty.

BUT, this was Judah Folkman. He gave his usual prepared grand rounds which could easily be entitled "how I discovered angiogenesis". It was fucking amazing. Here I was, tired, sleepy surgery intern. White girl from the 'burbs who went to public high school, who was a freakin' cancer survivor turned Harvard Surgery Intern listening to Judah Folkman give his usual talk "at home".

As Wikipedia so nicely states:

Between 1960 and 1962, Folkman served for the U.S. Navy, where he studied blood vessel growth. In 1971 he published an article in the New England Journal of Medicine, stating that all cancer tumors were angiogenesis-dependent. Though his hypothesis was disregarded by most experts in the field at first, Folkman continued his research. After several years, his theory became widely accepted.

That was the best part of his talk -- about how he had to convince people angiogenesis was a real thing. I had this feeling as if Watson or Crick was personally telling me how no one believed there was DNA.

He died yesterday at age 74, reportedly of a heart attack.

There was always a slide in his presentation of his granddaughter reading angiogenesis journals at a very young age. May she some day fully understand what her grandfather accomplished.

I talked with my sister today and found out that she's having another baby. Her first daughter is THE cutest, and I love her to death. But this will mean that both my brother and sister will have two children. Grrrrr....why does this doctoring stuff have to take so fucking long?

In other news I've officially decided that I will do a vascular surgery fellowship. So in 2012 I should be fully trained....34 years old, $200,000 in debt and fully trained. Great.

I'm still out at our (very) small suburban hospital where I am seemingly always on call. The past week yielded 4 emergent cases:

Tuesday 3am : called in for an acute appendicitis, OR at 6am for laparscopic appendectomy

Wednesday 1am: called in for an acute appendicitis, OR at 7:30am for laparscopic appendectomy

Friday 3pm: called for colonic perforation, OR (finally) at 7pm where we performed an exploratory laparotomy, lysis of adhesions, bowel resection, ileostomy, mucous fistula.

We finished about 11pm (her belly looked much better than the picture). I went home about 1am, ate slept for approximately 90 minutes when I was paged that this lady was not doing well.

Saturday 4:30am: sped back to the hospital to "fix" this lady.

Saturday 9:30am (? I think?): drove home. Call ICU nurse hourly to check on things.

At some point got out of bed and convinced Ben I should order pizza for lunch. I also showered, did my hair and make-up for Benoc's Linden Lab (aka Second Life) Holiday party at the Museum of Science.

Saturday 4:30pm: Drove back to hospital to see sick lady. Came home at 6:30, quickly changed and we left for said party.

Saturday 8pm -- after meeting many people who don't believe I exist given that I never make these functions, get called in for perforated diverticulitis. Stop at home first to take off the high healed boots and skirt. OR at 12m for an exploratory laparotomy, sigmoid colectomy, Hartman's procedure. Finish at 3:30am Sunday.

Sunday 4am: I finally crash in an ICU bed, only get woken once before 7:30a.

Sunday 7:30a: Round, talk with family of perforated colon lady (who is quite ill in the ICU), try to get second patient's pain under better control which includes harrassing the nurse alot.

Sunday 10a: drive back home. Crawl into bed, setting an alarm for 45 minutes later to call at see how second patient is doing -- better. Go back to sleep without need to get up for several hours.

Sunday 1:45p: get out of bed, shower, head to Burton's Grill for Brunch -- VERY yummy french toast and bacon. Ben had some of the best pancakes I've tasted in a very long time.

Sunday 4:30p: drive back to hospital to make my afternoon rounds.

Sunday 6:30p: arrive back home, stopping to get Benoc from mystery hunt. Eat microwave food for dinner.

Sunday 7:15p: PRAY like I've never prayed before that I don't get called in tonight.

The only perk of not really ever sleeping is that 24 hours later my hair still looks almost as good as when I straightened it yesterday afternoon.

(Forgive the constant changing tense -- I've not really slept in several days.)

...like today when I came in to find that my patients were all getting better. The appy from last night had eaten breakfast, shaved, and was reading the newpaper. (Ha, that's probably more than my husband had done by then.) Check. You can go home.

My lady in the ICU is getting better, though I'd love it to be faster.

And my other emergent case from Sat/Sun looks great and gets to eat today.

Plus is wasn't so super cold out today.

Now if only I can get home early enough to run since it's been .... A WEEK since I last ran?! I knew it had been a rough past several days at work, but I didn't think it had been that long.

It's from operating....well, okay, maybe a little from the running I did over the weekend.

Today's cases:
1. Total thyroidectomy

2. Sebaceous cyst removal.
3. Left hemithyroidectomy.

I strongly considered running when I came home especially since Ben wasn't going to be home, but I needed to finish a presentation plus it was already 7pm. Then I strongly considered running when I was finished but it really is my bedtime, and I stayed up late watching some silly football game last night. Nonetheless, I like the fact that it's annoying me that I don't have time to run today.

I can't completely explain today. After my first patient failed to show up for her surgery, I stood for most of 9 hours operating:
1. Exploratory laparotomy, biopsy of mesenteric mass (which, after several hours, we deemed unresectable), bowel resection, hand-sewn bowel anastomosis
2. wide local excision of an arm melanoma
3. umbilical hernia repair

I was leaving about 6:15 when I found out that Ben was stuck at work. I really wanted to lay on the couch until he came home. Instead, I went for a little run. Crazy. Maybe this was just my Lenten sacrifice.

Nothing fancy, and I came upstairs because Ben came home. I should be able to get my 3 runs in this week. My goal is 15 miles this week.

Semi-live blogging:

02/29/08
03:00ish wake up really needing to pee as an effect of eating dinner late. Avoid getting out of bed and fall back to sleep
04:40 alarm goes off the first time. Still need to pee, but don't want to be awake. Go to the bathroom very quickly and get back into bed for 25 minutes, hitting snooze every 4-5 minutes while my two alarms go off.
05:05 Shower
05:32 leave apartment to catch shuttle to work. It might be 4 blocks but it's 5:30 am and it's ass cold outside
05:40 arrive at work
06:00 rounds start

07:30 OR: scalp lipoma excision (not very exciting, but I realize I could do this on my own)
07:51 incision
08:06 close

08:41 OR: incisional hernia repair
08:56 incision
09:21 close. have coughing fit that makes closing take 5 minutes longer than it should

09:59 OR: femoral hernia
10:18 incision
11:06 close

11:20 eat peanut butter crackers and water from recovery room

11:36 OR: inguinal hernia
11:49 incision
12:42 close

13:20 check on patient it recovery room who got reintubated (not my operation)
13:25 discuss above patient with chief resident
13:26 OR: anoscopy and anal condyloma laser excision (don't ask)
13:45 start
14:03 end

14:15 check on patients
14:30 attempt to find lunch
14:35 eat lunch at Super Salad

Hang-out, do some "stuff" including send patient to ICU

16:20 get paged for pm rounds
16:45 pm rounds actually start
17:30 pm rounds end, send intern home, officially start call

18:18 pick up call room key -- have small amount of hope I might sleep tonight
18:20 eat crappy dinner in the cafeteria. smile at the kids who think this is exciting. I think it's a lousy way to spend a Friday night
18:40 check on ICU patient, discuss with nurse, write orders
18:50 check on pt in recovery room -- 80 man who had a gastrectomy. I introduce myself: "Dr. Raven, one of the surgery residents. I know you've met a ton of us." He replies: "Yes and you are all young and beautiful." He closes his eyes again. I start talking to him about how he's feeling. He opens his eyes and tells me what a beautiful shade my skin is. He says he should know because he's a painter -- which he really is. Watercolor.

19:15 return to the floor and field a bunch of little questions because shift change has happened
19:20 check on patient who's pain is not controlled well enough. Chat with her and her mom. (Patient is younger than me.) Her mom spys my MIT ring and asks about it. She is impressed that I went to MIT. She dated a boy in college who went to MIT. She then makes some reference to nursing. Her daughter corrects her before I can. Actually, I'm a doctor. (I'm dressed in scrubs and my BIDMC Dept of Surgery Fleece. My ID is on my lanyard but tucked in my shirt pocket because it gets in the way. I don't have my white coat on because (1) I'm sick, (2) I'm on call, and (3) it's 7pm.)
I'm already aware that the mom is an MD herself (I don't know what kind), and teaches at a prestegious Boston Medical School. I sort of give her a hard time about asuming that I was a nurse especially since SHE is a doctor. She appologizes and then says the MIT thing makes more sense if I went to medical school and not nursing school. Then she appologizes again saying that when she was around MIT (in college) the MIT women then didn't look like me.
I have no idea what that means. I suppose they weren't surgeons and didn't have funky hair. Or maybe they were skinny? Who knows.
I make nice anyway and have my excellent bed-side manner make mom think twice before calling the next woman who walks in "nurse". And, for goodness sake, the patient herself is in vet school.

20:19 Spy the Red Sox on TV. Seriously? If only I had a TV to watch. If only there was "coma guy" like on House.

20:45 Do some evening rounds with myself checking vital signs, urine output and patients in general. Tell one patient who is watching bad TV that the Red Sox are on. He's thrilled.

21:00 Find that a patient from the West Campus was transfered to the East Campus....and is on my service.

22:15 Check on my patient in the ICU. Have a discussion about the fact that my hair still looks this good at this point in the evening is actually a bad sign.
22:18 brush my teeth.

20:56 continue the never-ending scut work.

23:03 Get fed up with the continuous chatter that about the fact that Mrs. S is being transfered back to the floor from the ICU. Hello, *I* am the doctor. Yes, I know she went to the ICU after the OR today. Yes, I know I am transfering her out to the floor tonight (well, hours ago). Yes, I DO know what I'm doing. No, she didn't really need to go the ICU in the first place; she should have stayed in the recovery room longer. No, I won't want her to spend the night in the ICU needlessly.

23:30 Try to answer page and realize I've pretty much lost my voice.

03/01/08
00:05 My patient arrives from the ICU to the floor, doing well.
00:12 Check to see if there are any empty rooms on the floor; there are beds, but no rooms. I'll attempt to retreat to my call room.
00:14 stop and check patient Z's urine output again. It's okay for now.
00:19 Call and say goodnight and I love you to my husband, but not much more because I don't really have a voice
00:22 Remove TED hose 18 hours after putting them on.
00:24 get into bed.

00:45 paged
01:12 paged
02:46 paged
03:00 paged
03:15 paged
03:26 paged
04:15 alarm goes off
04:24 paged
04:26 Get out of bed and start seeing patients before morning rounds.

05:12 see gastrectomy patient who is again happy to see me but asks why I am whispering. I explain I have no voice.
05:20 finish waking up all the patients which can be difficult when you can't talk.
05:22 make sure there are labs ordered for the two patients who "just aren't right"
05:45 finish daily notes for all the patients including exams and plans; not so painful because I started them the night before
05:55 consider going downstairs to brush my teeth, go to the bathroom, and maybe freshen up.
05:56 decide none of that matters
05:57 eat traditional breakfast of graham crackers and peanut butter from the patient kitchen, settle for apple juice because there's no skim milk.
05:58 start telling the intern about the overnight events
06:02 start rounds with the intern and chief resident, which we decide to do sitting because I have no voice and they are huddled around me anyway
07:05 finish sit rounds. get excused to go home since (1) I am done with call, (2) I am done with the rotation, (3) I have no voice and am pretty pathetic. They'll do walk rounds quickly seeing the pertinent people since I've already seen everyone. They at 7:30 the covering attending will come in to round.

07:07 pack up all the important things out of my locker since I'm going out to our community hospital for three months on Monday.
07:12 get all bundled up and schlep all my belongings home in the snow/rain. I am thankful that I at least have an umbrella and that it's not too wicked cold outside
07:25 get home and realize the apartment is still a disaster and wonder who will clean it before people come over tonight
07:27 pour large bowl of cheerios and find out someone has finished all the OJ.
07:28 sit down on couch with cheerios and fresca
07:54 take shower and go to bed.

Overall, it was a pretty average day on call. Not having to be up all night is a huge deal even if it's not that much sleep. Actually being up working between 2 and 4am can be extremely painful.

There usually comes a point on call that one is required to kill some time. This is certainly a late-night phenomenon. If it were the middle of the day, I'd have other things to do while waiting for the radiology resident to read the spinal CT of a lady who fell. Instead, it's 1:07a and I'd like to be "resting".

Were it the middle of the day I might have the motivation to do something productive like log my cases (not a bad idea even now, but my list is in my white coat in my locker), or read something. Alas it's 1:09a.

In my wasting time, I will post the joke on my popsicle stick:

Who does a dog quarterback throw to?
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A golden retriever. Hahahahahahaha.

Com'on, a dog quarterback, that's funny.

I'm post-call tomorrow and off on Tuesday (don't try to figure out my schedule, really). Hopefully there will be less rain and more running.

Review of my 24 hours on call:

v v Hours 27-52 of 78 on call for the weekend
^ v Lap chole this morning -- operating is always nice, but some times annoying for other reasons
^ ^ Sending home 3 people to make the list even smaller
^ ^ Sending home 3 people when the intern did most of the paperwork yesterday
^ v Forgetting that I brought microwave food for lunch and eating salad & chicken fingers from the cafeteria
^ ^ Having a very queit middle of the day with hours to work on my research project
^ ^ So far only 1 consult from the ED, and it was relatively easy
v v Having a patient crash in the ICU who had been doing very well, getting him stablized to have him crash again
^ v Having said patient intubated and almost will all the appropriate tubes and lines such that not much more should happen

I slept for a total of 30 minutes on cal last night, and that was because I crashed and was going to fall asleep wherever I was.

It wasn't a bad general surgery day:
1. incisional hernia
2. vericose vein ligation & radio frequency ablation
3. left 2nd & 3rd toe amputations
4. laparoscopic cholecystectomy
5. laparoscopic appendectomy

I slept from 9a-1p today. I thought I might be able to find some energy to run, at least walk. I was hoping the bustle of Fenway would get me going once I got out side.

Surprizingly I got myself ready and go out side (this used to be the harest part). But I was a block from home when I realized I was physically exhausted and there would be no walking. I couldn't even fathom a little 2 miles walk. Since my eyes are half open I'm going to take a nap until dinner.

Because sometimes my job is cool. Today I did a carotid endarterectomy to clear the stenosis in one of the arteries to the brain.

http://www.facs.org/public_info/operation/brochures/carotid.pdf

Graduation 2008.

I was on call yesterday at Children's and realized the normal world must be taking vacations right now. My day in the ED:

First consult: Intussusception in a kid visiting from Oregon
Second consult: Appendicitis in a kid who was supposed to be on vacation in Maine but his family had to bring him in for this belly pain.
Third consult: Appendicitis is a kid visiting from Illinois

We have a nice hospital, but it isn't vacation.

This rotation seems to be much emotional than adult ones.

She's a beautiful, precious little girl. May she some how be healed some day.