An exciting day! (with explanatory pictures)

So, I stayed up until 1:15am doing laundry last night, which ended up being a poor decision because my preceptor called me at 8:45am to say she was already on her way to the hospital. A quick shower and some cereal later, I too was on my way to Northern Montana Hospital.

The first stop was ICU, where we had 3 patients: a man in his sixties in atrial fibrillation with fluid in his lungs, an adult woman who needed her gallbladder out (but we had to stabilize her blood sugars first) and a woman in her 70's on a ventilator for pneumonia on top of emphysema. Two of these patients required a surgical consult, one for a thoracentesis (putting a big needle in the chest wall to draw out fluid from around the lungs) and one for a lap chole (laparoscopic gallbladder removal). Thus, I met the surgeon on call, a new doc to this hospital who is a general surgeon nearing the end of his career. I asked him if I could observe him when he did the thoracentesis and he said yes, to meet him in the ICU at 2pm.

So up to the medical floor we went to round on all of the internal med patients (ten of them!). Nothing quite as exciting as in the ICU, but we discharged 3 patients which is always nice. We finished up there around 1:45pm, so I quickly headed down to the ICU to observe the thoracentesis.

THORACENTESIS:

The surgeon was really cool, explaining to me why he was doing everything as he did it, and we ended up pulling out 750mL of yellowish looking fluid from the patient's chest cavity. It was very cool to see, and it was just bedside with the patient awake and everything (he had local anesthesia). The surgeon and I then went to radiology to look at the chest x-ray taken right after the procedure to see how much fluid was still in there, and to make sure we hadn't collapsed his lung on accident. All looked great, even though it seems we only got about 1/2 the fluid out (surgeon says that is par for the course). I thank him for allowing me to observe, and I happened to mention, "so, you have a chole today too?" (the gallbladder surgery). He casually says "yeah, do you want to watch that?"

The right answer to that question is ALWAYS yes, even if you have already been at the hospital for 6 hours and haven't eaten lunch. Luckily there was enough time to sneak off to the doctor's lounge and sneak a sandwich from the fridge.

I got all dressed up in the hospital-provided scrubs, put on the disposable booties over my shoes, a mask on my face and a cap over my hair. There weren't any mirrors in the dressing room, but I'm willing to bet I looked pretty sharp.

I didn't need to scrub in because I was just watching, so I took my place in the corner and watched the surgery on the two TV screens. About 15 minutes into it the anesthesiologist came over to me and I scooted back, assuming he needed to pass by me. Instead he grabbed my shoulder and told me not to be so scared. He asked me to spell the surgeon's name for him, so he could record it properly...then invited me to stand by him at the head of the surgical table so I could get a better view. In the world of medicine, it isn't often that someone will stick out their neck to help a student, so I was thrilled.

I watched the rest of the surgery from a fantastic viewpoint, feeling like I was with the "in" crowd. I quickly realized I'll need some more comfortable shoes while I'm on my surgical rotation, but other than that, I actually enjoyed surgery much more than I thought I would. I abdominal cavity is really much prettier than one might think.

CHOLECYSTECTOMY: (the cartoon version, as to not completely gross out the non-medical personnel reading this)


Anyway, so I finally got out of the hospital around 6pm, and just as I was writing this, my doc just called to say we have 2 more admissions. Before I could say anything she told me that I didn't have to come if I was tired...I told her that I had stayed for the surgery so, for once, I was going to pass on the admits and just stay home. She was perfectly happy with that and told me to go sleep.

Instead, I'm going to pack up all my belongings because tomorrow I switch apartments. I'll actually be moving into the apartment of the nurse anesthetist who was so nice to me today. He is a traveling nurse and his stint here in Havre is over tomorrow. Funny how things work out.

Jen