The n00b Files - Week 1 of Transplant Surgery

More things I've learned, some more pleasant than others:

Lesson 1:

One of the best things about being a surgeon is that you get to make people listen to your favorite music when you operate, if you're so inclined.

Lesson 2:

One of the worst things about being on your surgery rotation is that you have to listen to your attendings' favorite music while they operate, if they're so inclined. Sometimes you like their music, and you jam out to Chumbawumba and Third Eye Blind and Hootie and the Blowfish behind your mask. Other times it's lots of Nickelback and Lifehouse and really bad Top 40 and you feel like your ears are bleeding.

On a related note, it's funny when middle-aged white surgeons have club music on their playlists.

Lesson 3:

LUNGS ARE HUGE. I'm talking, each lung is like twice the size of my face. On the real. They're all puffy and somehow remind me of two large-ish Teddy bears. I saw live lungs for the first time last night. Crazy thing.

Lesson 4:

Organ transplantation, when successful, is a wonderful thing, giving recipients a new lease on life. What one often doesn't think about is organ donation, which almost always happens when a patient dies. I came face to face with that part of the equation last night during an organ harvest. It was surprisingly disconcerting to see the patient wheeled into the OR, and then to see the patient's vital organs being removed and the patient's life blood being flushed out. All a part of the circle of life, to be sure, and organ donation is a way to make a senseless death worth something more to others. But all these things being true, it's still a difficult thing to stomach, at least at first.

Lesson 5:

I apparently have a tendency to experience dysphagia (ie, difficulty swallowing) and subsequent throwing-up on mornings after I've had very little sleep the previous night. I've had two such nights in my 5 weeks of the surgery rotation so far, and I've thrown up on both of the following mornings. This has happened to me in the past before, too. This can't be good, as I'm sure residency will put me in this very situation many, many times. Must learn to pace oneself in the morning instead of trying to nom after a long night.

Lesson 6:

If you don't watch sports, it might be smart to start doing so in order to interact with a large number of patients during semi-awkward situations. One of my teammates last month could always talk to patients about sports while changing their bandages in order to distract them from the pain. I usually stood mute, especially when the patient was a man and I was pretty sure we had nothing in common. The talking-about-sports route was much better.

Lesson 7:

When asking questions to attendings, be careful not to ask too many questions that reveal your lack of knowledge. Otherwise you might find yourself being told to research your own question and report back to the attending the next morning. Which is what happened to me today when I asked one too many questions about the steps of a kidney transplant. Drat!

Lesson 8:

Sometimes people are just kind of crabby and prone to snapping at you. That's pretty crummy.

Lesson 9:

You know how on Grey's Anatomy, whenever they're doing a transplant they anxiously wait for the organ to "pink up" while thoughtful music wells up in the background? Yeah, that happens in real life, too. I got a bit of a kick out of that.

Lesson 10:

You'd be amazed how quickly a pink bowel turns white when it's not getting blood flow anymore. Conversely, if you look away for a second after a kidney transplant has been attached to the recipient's blood supply, you'll miss the magic moment when it goes from being white to being a rich purplish-pink. Blood flow is cool.

Things that are bound to make me cry

Taking a leaf out of my new hero Mindy Kaling's book (quite literally), I've decided to list things that inevitably make me cry:

• Watching the movie Up for any 3-6 minute interval. The chubby little boy scout will talk about his absent father, or the adorable, sad old man will remember his deceased wife, or the extremely eager-to-please Dug will show just how much he just wants to be loved, and game over. Doesn't take long for the tears to spill.
• Listening to "Stop This Train" by John Mayer. It's a song about parents getting older and kids becoming adults and life's inexorable march. How can I not cry?
• Thinking about my sister's wedding too much. It makes me too happy/sad. On the real.
• Hearing 3-5 songs by Ingrid Michaelson within a short period of time. Eventually, one of the lines will tug at one of my many, pliable heartstrings, and I'll compare myself to the protagonist in the song ("I don't believe in anything but myself" and so on) and I'm crying while I'm driving. It's always very cathartic.
• Reading good writing.
• Any and every episode of Grey's Anatomy. I'm not even joking.
• Seeing my mom cry (just like Mindy Kaling, except I don't have an amusing anecdote about watching The Help with my mother to illustrate this. In fact, I have just the opposite. Within the first 10 minutes of our watching Up together, I was crying and my mom was looking at me funny wondering why I was such an emotional wreck. She's tough, which is why seeing her cry sets me off uncontrollably.)
• Homeless people. It's so very sad.
• Any time my parents or sister express emotion towards me. We're one of those freakish not-very-expressive families, so any time anything is expressed, my emotions go haywire.
• Belting out Sara Bareilles's Gravity. "Here I am, and I stand so tall, just the way I'm supposed to be" gets me every time.
• Foundations by Kate Nash, Slow Dancing in a Burning Room by John Mayer, and other similarly spot-on breakup songs. Guh.

How is it that Mindy Kaling's list of things that make her cry is so much funnier than mine? I suspect it's all in the execution...maybe....

The n00b Files - Week 4 of General Surgery

More things I'm learning:

Lesson 1:

An NG tube is used to suction/drain fluid that is building up in the stomach. I used to be under the misguided notion that NG tubes were used to feed people. Wrong.

Lesson 2:

When examining a patient with a diabetic foot, make sure to feel for their distal pulses if you don't want to feel totally silly when your upper-level comes in to check up on the patient.

Lesson 3:

It feels pretty darn cool when your team's patients run into you outside of their rooms and address you as "doc." It also feels a little scary; I'm always quick to correct them by saying, "Well, I'm almost a doctor.."

Lesson 4:

Working with a good group of teammates makes all the difference. The other medical students on my team are nice and funny and very accommodating when I need them to cover for me. I'm glad I started out my time in clinics with them. My sister told me that one of her favorite things about clinicals was getting to know many of her classmates much better than before. I'm really grateful for this, too, and I'm off to a good start!

Lesson 5:

Taking time to engage in your interests really improves your quality of life. I've started writing these n00b lessons, and I've also redoubled my efforts to publish my latest essay. Both of these pursuits give me great joy.

Lesson 6:

Finding beauty everywhere makes you pretty happy. I think bowel is beautiful. Weird? Yes. Good for my mental health? Arguably, yes.

The n00b Files- Week 2 of General Surgery

More words of wisdom from a certified n00b:

Lesson 1:

The nicest people during the day become terse and impassive when you're on overnight call with them. It's hard not to take that personally, especially when you're fresh out of pre-clinicals and normally only saw authority figures in the bright light of day (or in the dim light of the lecture hall, as the case may be). However, one should try to keep in mind the simple fact that people are cranky when they're sleep-deprived and/or hungry. Even doctor-people.

Lesson 2:

Planning ahead helps make your life a lot easier/happier when you're on clinicals. For instance, when you're going to take overnight call and know you'll have to sit through boring meetings/lectures the following morning instead of going home before rounds like you wish you could, make some coffee at home and bring it to the hospital with you. That way you don't have to spend an arm and a leg getting coffee to keep your sad little eyelids open. Also, throw an extra granola bar into your lunchbag so you can use it for breakfast the following morning.

Lesson 3:

I can now recognize the smell of dried blood. I'm not sure how I feel about that.

Lesson 4:

Chest tubes, while very important clinically (they're designed to suck out air, fluid, blood, etc out of the cavity around the lung, so that a collapsed lung can reinflate and get back to normal), are really freaking gruesome to put in. They're also pretty unpleasant to remove, but not quite as bad as the insertion process. Shudder.

Lesson 5:

I'm pretty scared of trauma cases, and tend to tense/freeze up when I'm in the shock rooms when a trauma comes in. However, I'm glad to report that I haven't felt nauseous or faint in trauma situations so far, and that's an improvement over some of my previous experiences. Hopefully writing about said improvement won't jinx me.

Lesson 6:

When asked if you're interested in a field in which you have absolutely no interest, a very diplomatic answer would be, "I think it's a great learning experience, but I don't think it's the field for me." Not that I've had the presence of mind to utilize that phrasing so far. Still, it's a good thing to keep tucked away in my brain.

Lesson 7:

Take care of any chronic and/or annoying health issues you may have ASAP. I've had this annoying cough for the last three weeks and it's really cramping my style. I'm pretty sure it's an asthma flare-up, but who knows. Anywho, I have an appointment to get it worked out tomorrow, and I'm very excited about that. Ailments begone!

Lesson 8:

Use an alcohol wipe to clean your trauma shears or stethoscope between patients, especially for the trauma shears. You never know when the dressing you're undoing covers a wound infected with MRSA, and it's best not to spread that from one patient to the next...for obvious reasons.

The n00b Files - Week 1 of General Surgery

I'm now one week into my general surgery rotation, and I've learned a great deal in a short amount of time. Some of the knowledge is clinical, some is more in the life lesson category, and some is simply important knowledge about my own self. In the effort to record what I've learned and perhaps share it with those who might benefit, I've decided to start writing The n00b Files, filled with the edification I gain on clinical rotations. Here's to a great new start.

Lesson 1:

Everyone on the surgery rotation is nicer than the general reputation of surgeons would have you believe. I expected my interns, upper-level residents, and attendings to be much more brusque or impatient with me and my many mistakes, but nearly everyone has been nothing but kind and patient. It's a really nice thing.

Lesson 2:

You're going to mess up at first. It's inevitable. But the nice thing about a month-long rotation is that it gives you ample opportunity to learn from your missteps and do better next time. I think I'm finally starting to be useful to my team, and that feels good.

Lesson 3:

When you're scrubbing into a surgery, you might be asked if you want to double glove. If asked, say yes. Wear a blue pair of gloves as your "under glove," and a white/cream pair over those. The under glove is typically a half-size larger than the over glove, which was somewhat surprising to me, but now makes sense.

Lesson 4:

Being a surgeon basically consists of two main things: actual surgeries and wound care. Nobody becomes a surgeon because they enjoy wound care. Wound care is gross. So basically, if you're not super excited by surgeries, then you probably wouldn't be happy as a surgeon. I'm glad to report that having discovered this, I have confirmed that though surgery is a rotation that's enjoyable and informative, and though I respect surgeons a great deal, I do not want to be a surgeon. It's nice to know that my initial stance was correct.

Lesson 5:

I really, really, really enjoy the clinic setting. Today, during our first day of surgery clinic, I enjoyed myself more than I have throughout the last week. Which isn't to say the entire rotation has been a drag so far. It hasn't. Clinic has just been the highlight. Compare this to my interns' advice to avoid clinic at all costs, and you have further evidence that I am not made to be a surgeon.

Lesson 6:

Shockingly enough, waking up at 4:20 AM isn't all that horrible. It helps that the first few hours after I get to the hospital keep me very busy, so I don't have a chance to get sleepy. It also helps that I go to bed around 9 PM every night now.

Lesson 7:

While free food was the best thing ever during pre-clinicals, free coffee is the best thing ever during clinicals. I probably drink too much coffee now. I should start putting in less sugary creamer so that I don't get fat off of coffee alone...

Lesson 8:

The laparoscopic camera is pretty confusing to drive, and the medical student often has the privilege of driving it during surgeries. You can get some explanation of the camera prior to surgery, but try to ask someone to give you a quick run-down on how it works when you're scrubbed in. The scrub tech is a good resource for this (at least, that was the case in my experience), and knowing how it works will not only make you more useful during the surgery, but also make you feel like your upper-level resident doesn't think you're a total n00b.

Lesson 9:

It is truly a privilege to care for patients. It doesn't always seem that way, and I've found it difficult to interact with some of my sicker patients because I simply don't know what to say or how to act when they seem to be in such pain or so badly damaged. But when I finally did start talking to some of them (while changing their wound dressings, for instance), I felt like I was making my own small contribution towards their healing process. It's a nice thing.

Lesson 10:

Life is good when you're doing what you want to do. Weekends are wonderful for seeing friends you're not rotating with. There are always challenges to overcome and more mistakes to be made, but there's little to complain about.

Joke

Descartes walks into a bar. Bartender says, "Will you have a margarita?" Descartes says, "I think not." Poof! He vanishes.

The Truth Is, I'm a Man.

A few days ago in one of our Behavioral Science lectures (psychosexual development, ie how people grow to "act" like their gender), the lecturer spoke briefly about a study that explored the difference between how men and women attempt to understand themselves and others...essentially, how do the two sexes approach relationships? The study concluded that while men feel that by understanding themselves, they can understand others, women go about things in the opposite way: by understanding others, they can understand themselves.

Funny thing is, I take the male approach much, much more than I do the female one. I am a personal essayist. I take a lot of pride in, and derive a lot of joy from, the fact that people think I know myself well. I am confident in who I am; I love holding forth on my beliefs and past and the way that I see things. I guess that sounds a little narcissistic..but all that is to say that I really do place a lot of value on understanding myself, and I think that by knowing myself well, I can manage my world, and my life, more effectively. Sadly, I've found that life doesn't quite work that way. I used to think that as long as I could regulate myself and my actions, I could deliberately and carefully guard and nurture my relationships with the people I care about. If I can control myself, why wouldn't the things that I call mine--that is, my relationships--also be in my control, right? But alas, I may have to modify my approach.

Other girls I've talked to have said that they really are the opposite way: they love to understand what makes other people tick, to people-watch and hear about others' backgrounds. I suppose I enjoy that, too. I like a good personal essay as much as the next girl. But I suspect that I don't actively unravel and engage the things I learn about others, don't come to understand how others' pasts and beliefs and experiences will color and inform their actions, their prejudices, their weaknesses. It's an interesting dilemma.

In short, though, turns out I'm kind of man-like. Maybe I should try being more of a woman and see if that wouldn't make things better. I hate to break it to myself, but I suspect it's never quite that simple...