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.