Estoy sin un jefe.

Our chief is out of town.  He left Wednesday morning, and will be gone through the end of the month. This leaves Rachelle (a 2nd year) and myself the Vascular Team for the last 5 days of the month of May.

What this means for Rachelle and myself...
The chief, in addition to leading the team, gets to spend the whole day in the operating room, or as the case load allows him/her to be. Once the chiefs take cases the rest get filtered down through the ranks 4th, then 3rd, then 2nd years and finally to the 1st years.  So without a chief on our team, Rachelle and I get all those extra cases. (When the chief's away, the juniors will play!) ;)

For example, yesterday I got to assist an endovascular repair of bilateral iliac aneurysms with aorto-uni-iliac graft to the L iliac. Coil embolization of the R hypogastric and R CIA.  Ligation of the R EIA. and finish it all off with a Fem-Fem bypass. Super cool stuff.

Drawing compliments of Dr. Babu

It also means longer days for myself.  Just because I'm able to spend more time in the OR, does not mean that I am excused from what normally fills my day. While scrubbed in, I give my pager to the nurse who either asks me the question or takes a message for me. And then in between cases I can get to what they had each needed.  Dr. Babu told me to eat some lunch in between our cases the other day.  I think he's too far removed from residency... I showed up to the second case having finished my floor patient notes, responded to the entire list of pager messages. Discharged two patients. Made about 15 phone calls. Saw a consult and wrote up that note with a cherry on top.

I was only able to do that though, because I was aware of what I was going to have to be able to perform and prepared the night before. I was up late working from home getting those discharges ready.  And then to the hospital even earlier than usual so I could get patients seen and as many notes done as possible before even heading to the OR.

It's never a matter of "I don't know how I'm going to do this", but rather simply an "Okay!  Let's Do This!"

Much Love.

Estoy buscando razon.

Hiked a bit of the Appalachian Trail this Memorial Day. After I got home from the hospital I changed and headed up to Bear Mountain. It's only about 30 minutes from me, and I thought it about time I took advantage of its proximity.

I ended up not staying very long. A holiday really isn't the best time to go hiking by yourself.  Most times, the only nature I could actually hear were the cobwebs that would blow into my face and get stuck to the hairs on my arm.

Hiking the Appalachian Trail through Bear Mountain NY

 

Love the eclectic contents of this photo!

 

Much Love.

Estoy buascando peces.

I think something has happened to me over the past year. Something along the lines that only a Psychiatrist could put their finger on and say this... this is what has happened.  You see, I got home last night and had this most glorious feeling.  It came from the knowledge that I was going to be able to sleep, and sleep until I woke up without an alarm. And realization hit me, that is not a normal place for "glorious feelings" to come from. Why do I perseverate so much on this subject?  Sleep. When do I get to sleep next? How long can I sleep? When should I set the alarms? Some could say there's an obvious answer to all of this.  But I suppose it just made me a little sensitive to the topic when I realized just how excited I really was at the prospect of getting to sleep last night.

Due to the holiday weekend, the master schedule has me working Sunday with Saturday and Monday off. My chief did a little rearranging and gave me today (Friday) off and instead I am to round on Saturday and Monday. "rounding" supposedly being 6hr days hence why having Friday off I should come out equal.  However, everyone knows that when you get to work at 5am and the Attending doesn't show up till 1pm and rounds last 2 hours, your 6hr day of rounding has been, well...  not 6 hours. One thing I've learned about all my co-residents: Even the laziest surgery resident is not afraid to work long and hard.

This now being the second month that I have been on the Vascular surgery service I'm starting to realize that pathologies tend to come in groups on this service.  Currently there are two that we are seeing a lot of. 1) My Attendings have been doing multiple Carotid Endarterectomies a week.  (Carotid = arteries supplying blood to the brain, Endarterectomy = surgical removal of plaque causing obstruction of the vessel).  I unfortunately do not get to help with any of these cases as my chief takes them all.  2) There have been multiple admits to the hospital of individuals that have been found in their apartments having been down for days. They come in completely out of their minds, sick as dogs, and legs necrotic and festering. We amputate. We remove the immediate threat to life.  We remove the foot, the feet, the leg... whatever it happens to be for that particular case.  Why are there so many this month? No clue, but something is up.

Much Love.

Estoy cansada.

My chief was going to have me work this past Saturday.  And then literally 3 minutes before I was to walk out the door, he texted saying I didn't have to.  I didn't look for a reason why I just said 'thank you so much' and jumped back into bed until it was time to head to CT. There were visitors this past weekend, and I was to grab every minute with them I could.  You see, there were 'Gridley' visitors.  None of us actually live in Gridley any more.  But... We all know what Jed Ball is. We've all built boats out of ply wood and caulk and then took them for a spin on Lake Bloomington. We all know when Mr. Maubach liked best to vaccum the rugs.  Just to give a few examples.

Gridley Girls in Rockville

L to R: me, Amber M. Kristin Z. Callie P.

Fox Hill

 This photographer was fired.

and replaced with this one!

Much Love.

Estoy asustando los estudiantes.

We have enclosed spaces in our bodies, often delineated by groups of muscles, for example in the arm or leg.  When excessive pressure builds up inside one of these enclosed spaces it can cause pain. Should the pressure continue to build reaching dangerous heights any vessels traversing that particular compartment can collapse impeding flow of blood to and from affected tissues.  When you put too much air in a balloon what happens?

pop...

So how do you prevent a body compartment from going the way of a balloon?  Open it up and relieve the pressure. And then leave the compartment open until whatever was causing the increased pressure has been removed as an insult to the livelihood of the affected tissues. 

Compartment syndrome is seen often in Vascular Surgery. One patient currently has their leg open.  Well...open again.  It was opened and then the incisions stapled closed.  A few days later (long enough for the skin of those incisions to heal closed), and placed on high dose anticoagulation, there was obvious swelling and tension surrounding the incision sites when we rounded.  Within minutes the staples had been removed and the skin physically reopened by pulling it apart. The patient had been bleeding into their compartments and that blood, finally finding an escape route and fueled by the high pressures, shot out of the leg farther than you could spit a watermelon seed.

Just one example of what Vascular Surgery has to offer our medical students in the way of education. This Friday was the last day for our current med students.  Monday we get new ones.  But it was the first time I wanted to apologize to our students.  If they weren't in the OR, they were with me running around the floors.  Friday evening I was finishing up a late case with one of them.  Afterwards, walking back up to the floor I had asked his opinion about something and he responded that he couldn't know because his brain hadn't been functioning for the past three hours. I felt so bad.  The poor kid is going to be a Pediatrician. He's going to sit and tell stories to little kiddies, not perform chest compressions as the patient on the OR table bleeds out. I fear his two weeks with us has left him with memories he won't be able to shake and yet wish nothing more than the ability to do so. And even his co-student. Not openly decided as to which career path he wanted to take and initially undecided about surgery.  Was able to quite decidedly say that 'No! No he was not going to do surgery' by the end of his two weeks with us.

I guess this is the point of med student rotations.  Give them experience, a taste of what the field has to offer and what its respective residency would be like. Honestly, I'm sure that neither of them regrets their weeks with Vascular.  But without a doubt, they walked out of the hospital Friday night with exhaustion causing their eyes to glass over.  And I felt more than a little responsible. 

Much Love.

Estoy comiendo chocolate.

There's a unit clerk at one of the nurse's stations in the hospital. She's a large African American woman.  She likes to give me a hard time, which is okay because I like to give her a hard time right back. In the weeks leading up to my vacation she had been commenting frequently on how tired I looked.  So on my first day back, when she found out I had been on vacation she said, "Ahhh that's why you don't look tired anymore!" 

Today when she arrived to work she happened upon me at a time when I was holding my head in my hands having had just received the third call from my chief in the span of about 5 minutes. (You try getting any work done like that!) She exclaimed something to the effect that it hadn't even been a week yet, what was I doing looking so stressed, and I'd just have to go back to vacation that's all there was to do! 

I guess that made it official!  I'm officially back in the groove of things. I'm back on Vascular Surgery this month. Difference this time though is the fact that our team is smaller yet the patient list is larger than last time. This is not the proper situation in which to have such a reverse relationship!! But it is what it is.  It makes me appreciate having longer legs, although the med/PA students that run after me up and down the stairs and around and between floors may not be so appreciative. 

Much Love.