Week 3

Week 3 had a few interesting OR cases. A young woman with previous abdominal surgery presented with a supraumbilical soft tissue mass which turned out to be a stitch granuloma (a foreign body reaction). Our complex case was a gastrectomy (removal of the stomach) for an unfortunate gastric cancer. That was an intense surgery, lasting 8+ hours. It was a good learning case though. After taking out the stomach, we called the surgical pathologist to take a look. I got to see how frozen sections were done and examined under a microscope. Unfortunately, the margins were not clear of cancer so the surgeons had to keep making wider cuts to get a cancer-free section. In the end, we made an anastamosis (connection) between the esophagus and the jejunum. The other OR case I had was a split-thickness skin graft for a patient with peri-anal hidradenitis, a severe dermatologic condition. Seeing how autologous skin grafts are harvested from the thigh and then implanted was very interesting.

When I was taking overnight call, I got to suture up a pretty severe finger laceration and put in a radial arterial line (my first one!). That was fun; it went smoothly and I really like using my hands.

At the end of week three, though, I'm feeling exhausted and sleep-deprived. No matter how early I go to bed, 4:45am is painful (at least it's 7am on weekends) and I am wiped after the 14 hour days. When I get home, I push myself hard to study. I don't have time for myself or for others; I can't explain how the blogging happens. Call kills me; on post-call afternoons after being up 30+ hours, I collapse in the student lounge. I think I've had a couple incoherent conversations with classmates who've walked in while I was napping. But during post-call mornings when I have fewer clinical duties, I feel strongly that my extra time should be used to do things we don't have time otherwise allocated for; I spent my last post-call morning talking to a patient with cancer and doing mostly psych-type conversation about mood, guilt, understanding, etc. And it's also tough that even post-call, we get grilled on difficult questions (what are the 11 Ranson criteria for pancreatitis?) and fatigue is not an excuse (to surgeons at least). It's good training but I don't think it's very sustainable.

I should say that I can't complain too much; one of my best friends at Johns Hopkins is doing her surgery rotation and she gets up at 3:30am every morning/night (it's even too early to be morning).