This isn't mine, but I wish it were...
Apr 28, 2010
Apr 21, 2010
It's drawing near...
The end of surgery! (and third year)
Surgery's kind of a mixed bag in that we have a pretty slack rotation as far as surgery rotations go, but apparently an even *more* slackass group, so we keep getting in massive amounts of trouble with no conceivable way to end it since as the slackers keep slacking, eventually everyone sort of gets a "f- it; why am I doing the scutwork of two people when you're at home doing nothing" sort of attitude which compounds the slacking which compounds the trouble.
I feel the students' guide to slacking is to not slack in ways that screw over other students or sticks them with excessive amounts of work in your absence. Otherwise, slack at your own risk. If not, the whole group dynamic changes and people get angry, bitter, and defensive. I feel a lot of this is also a function of simply having too many students on this rotation. The statistical likelihood of shameless slackery goes up simply with the number of people, plus since there is an overflow of students that lessens the workload, it creates an impression that you can do *nothing* and others will pick up the slack. This is partially true, but creates a tremendous amount of resentment.
If you are going to slack, the worst way to do it is the slack-and-schmooze. This is a brilliant technique wherein your colleagues are left with thankless scutwork while you flash the glistening smile at the attendings of someone that's racked up an adequate amount of sleep. To be fair, this technique seems to frequently pay off gradewise (leading to a similar phenomenon observed in residents), but your classmates will want to kill you even more than if you were the simple shameless slacker that could not be less interested in ________ rotation, and has no problem showing it. Be advised.
Lest anyone get the idea that I'm claiming to be a good little worker bee when half this blog has been dedicated to my various non-medicine related exploits, I'm not. I tend to refer to myself as a lazy buttmunch with frequency, but moderation people; jesus.
Anyway, so that's that bit. Otherwise, surgery's mixed on its own because as a lazy buttmunch, I detest long hours, and in particular, early mornings, which surgery has in abundance. I'm also fidgety and get hot easily, both of which are not fantastic qualities when you're scrubbed into surgery leaning over a heated air cushion and not allowed to touch your face. On the other hand, you get to do what I generally associate with "medicine" such as "Hear patient's complaint. Use prohibitively expensive education (or Wikipedia) to diagnose complaint. Remove complaint. Hope removal of complaint doesn't lead to minor complications such as wound site irritation or massive blood loss. Discharge happier patient sans complaint. Make bed of money and roll around in it."
Okay, not that last part. For anyone reading this that thinks becoming an MD is an efficient, effective way to make money, that is the same logic as deciding to get a piece of cake by working your way up at Duncan Hines starting as a janitor and eventually buying stock in the company fifteen years later so you can sell it to buy cake.
I'm also finding kind of a mixed bag on the whole surgeon personality thing, which I was initially warned about and expected to be far worse than it was. I've found surgery people more prone to tantrums than your average other-doc and during conference, they're absolutely brutal to each other, but they also seem to possess far less soul-crushing existential angst than other branches of medicine indicating a certain level of happiness. On an individual basis too, I've found most of them to be fairly friendly and nice to students (with a few rather drastic exceptions). So that's cool. Procedures are also interesting. I'm also learning a surprising amount of real medicine because diagnosis is key when screwing up leads to the definitive "uh oh" moment of opening the wrong thing. So they aren't the mindless scalpel jockeys of legend either.
Surgery possesses some amazing gadgetry too, even at county hospital level, which I assume is largely around based on surgeon-tantrums so maybe they have a purpose. For every engineering inconvenience in the human body, there is a tool that's made to deal with it. Wanna remove a section of cancerous bowel and snap the healthy ends back together in such a way that gets you out in time for lunch AND keeps the patient from having to carry their waste in a bag for the rest of their life? There's an app for that. Wanna see where that obstruction is without having to saw through that large important artery? No problemo. So far the only drawback other than the huge cost of manufacturing the most specific articles on the planet (this tool is made to see around gallbladders!) is that then you have to learn the names of all of it. Or if you're a med student, the suture scissors, since that's generally what your tool is. And we take it seriously too.
I'm on ENT now, which is particularly nice, and am almost comfortable enough with the staff to ask them to clean my ears, since after a few patients and the standard procedures of doing a standard ear exam on people without significant symptoms, going "hmm", and still pulling out giant disgusting gobs of crap, I'm paranoid. Though I suspect the root of my gradual hearing loss is far more likely embedded in the fact that I'm in physical and emotional connection with my ipod every second that I'm not at the hospital or asleep, as it protects me from having to talk to people on the subway.
ENT is also proving more interesting than I expected. Lots of allergies and sinus infections naturally, but also some crazy frigging tumors.
Still, pathology calls. There was some downtime in SICU last week that coincided with helping out in the gross lab and an autopsy so I got to make productive use of the time and got to practice some suturing where I can't do damage, which enhances my confidence greatly. When I wasn't fixing the computer.
Lemme just take this opportunity to again rail at frigging virus makers, since the SICU computer got hit with an almost exact variant of the virus I had, which is the only reason I knew half where to start with it having dedicated an entire Saturday to it previously (thanks, jackasses!). So not only are they stealing your credit card information, they're also trying to hinder medical care to your loved ones. Please remember that the next time you happen to catch yourself in a dark alley with one of them.
Speaking of peaceful hippie love, I went to Woodstock and the nearby lighthouse this past weekend so I could give my mom an urban escape for her birthday. I would highly recommend that for anyone who needs a break. What I would not recommend is what I did last year, which is using Woodstock as a staging ground to get lost in the Catskills at night, but I managed to refrain from doing so this time around.
Bedtime. Tonsillectomy in the morning, so I can finally see what was done to me as a child...
Surgery's kind of a mixed bag in that we have a pretty slack rotation as far as surgery rotations go, but apparently an even *more* slackass group, so we keep getting in massive amounts of trouble with no conceivable way to end it since as the slackers keep slacking, eventually everyone sort of gets a "f- it; why am I doing the scutwork of two people when you're at home doing nothing" sort of attitude which compounds the slacking which compounds the trouble.
I feel the students' guide to slacking is to not slack in ways that screw over other students or sticks them with excessive amounts of work in your absence. Otherwise, slack at your own risk. If not, the whole group dynamic changes and people get angry, bitter, and defensive. I feel a lot of this is also a function of simply having too many students on this rotation. The statistical likelihood of shameless slackery goes up simply with the number of people, plus since there is an overflow of students that lessens the workload, it creates an impression that you can do *nothing* and others will pick up the slack. This is partially true, but creates a tremendous amount of resentment.
If you are going to slack, the worst way to do it is the slack-and-schmooze. This is a brilliant technique wherein your colleagues are left with thankless scutwork while you flash the glistening smile at the attendings of someone that's racked up an adequate amount of sleep. To be fair, this technique seems to frequently pay off gradewise (leading to a similar phenomenon observed in residents), but your classmates will want to kill you even more than if you were the simple shameless slacker that could not be less interested in ________ rotation, and has no problem showing it. Be advised.
Lest anyone get the idea that I'm claiming to be a good little worker bee when half this blog has been dedicated to my various non-medicine related exploits, I'm not. I tend to refer to myself as a lazy buttmunch with frequency, but moderation people; jesus.
Anyway, so that's that bit. Otherwise, surgery's mixed on its own because as a lazy buttmunch, I detest long hours, and in particular, early mornings, which surgery has in abundance. I'm also fidgety and get hot easily, both of which are not fantastic qualities when you're scrubbed into surgery leaning over a heated air cushion and not allowed to touch your face. On the other hand, you get to do what I generally associate with "medicine" such as "Hear patient's complaint. Use prohibitively expensive education (or Wikipedia) to diagnose complaint. Remove complaint. Hope removal of complaint doesn't lead to minor complications such as wound site irritation or massive blood loss. Discharge happier patient sans complaint. Make bed of money and roll around in it."
Okay, not that last part. For anyone reading this that thinks becoming an MD is an efficient, effective way to make money, that is the same logic as deciding to get a piece of cake by working your way up at Duncan Hines starting as a janitor and eventually buying stock in the company fifteen years later so you can sell it to buy cake.
I'm also finding kind of a mixed bag on the whole surgeon personality thing, which I was initially warned about and expected to be far worse than it was. I've found surgery people more prone to tantrums than your average other-doc and during conference, they're absolutely brutal to each other, but they also seem to possess far less soul-crushing existential angst than other branches of medicine indicating a certain level of happiness. On an individual basis too, I've found most of them to be fairly friendly and nice to students (with a few rather drastic exceptions). So that's cool. Procedures are also interesting. I'm also learning a surprising amount of real medicine because diagnosis is key when screwing up leads to the definitive "uh oh" moment of opening the wrong thing. So they aren't the mindless scalpel jockeys of legend either.
Surgery possesses some amazing gadgetry too, even at county hospital level, which I assume is largely around based on surgeon-tantrums so maybe they have a purpose. For every engineering inconvenience in the human body, there is a tool that's made to deal with it. Wanna remove a section of cancerous bowel and snap the healthy ends back together in such a way that gets you out in time for lunch AND keeps the patient from having to carry their waste in a bag for the rest of their life? There's an app for that. Wanna see where that obstruction is without having to saw through that large important artery? No problemo. So far the only drawback other than the huge cost of manufacturing the most specific articles on the planet (this tool is made to see around gallbladders!) is that then you have to learn the names of all of it. Or if you're a med student, the suture scissors, since that's generally what your tool is. And we take it seriously too.
I'm on ENT now, which is particularly nice, and am almost comfortable enough with the staff to ask them to clean my ears, since after a few patients and the standard procedures of doing a standard ear exam on people without significant symptoms, going "hmm", and still pulling out giant disgusting gobs of crap, I'm paranoid. Though I suspect the root of my gradual hearing loss is far more likely embedded in the fact that I'm in physical and emotional connection with my ipod every second that I'm not at the hospital or asleep, as it protects me from having to talk to people on the subway.
ENT is also proving more interesting than I expected. Lots of allergies and sinus infections naturally, but also some crazy frigging tumors.
Still, pathology calls. There was some downtime in SICU last week that coincided with helping out in the gross lab and an autopsy so I got to make productive use of the time and got to practice some suturing where I can't do damage, which enhances my confidence greatly. When I wasn't fixing the computer.
Lemme just take this opportunity to again rail at frigging virus makers, since the SICU computer got hit with an almost exact variant of the virus I had, which is the only reason I knew half where to start with it having dedicated an entire Saturday to it previously (thanks, jackasses!). So not only are they stealing your credit card information, they're also trying to hinder medical care to your loved ones. Please remember that the next time you happen to catch yourself in a dark alley with one of them.
Speaking of peaceful hippie love, I went to Woodstock and the nearby lighthouse this past weekend so I could give my mom an urban escape for her birthday. I would highly recommend that for anyone who needs a break. What I would not recommend is what I did last year, which is using Woodstock as a staging ground to get lost in the Catskills at night, but I managed to refrain from doing so this time around.
Bedtime. Tonsillectomy in the morning, so I can finally see what was done to me as a child...
Apr 8, 2010
Anesthesia is sweet...
Though I suck at pulmonary physiology and pharmacology, so I think I'll keep on towards path. Plus path makes me really gloriously happy, which causes me (and others) to doubt my sanity.
So in surgery, we have several weeks of 6 AM rising and cranky residents interrupted by anesthesia, which seems to be a specialty that was licked into existence by unicorns. They leave early; they're chill (getting to sleep does that to you) and given the long periods where there is virtually nothing to do, they enjoy talking and teaching, and periodically, dismissing med students to take long lunches mid surgery, because hey, what the hell.
We still tend to have late lectures, which has often left me several hours at the hospital, forced to do something productive like (gasp) study for Step 2. I actually have a date for the CS, which I decided to take in Houston so I could finally see my family again, to whom I've been a distant memory since before I left for Grenada. I'm also studying for the CK, whose date is "sometime in August", doing the delicate balance between giving myself time off to study and rock boards while being well aware through the entire time that our loan distribution is contingent on our actual enrollment in rotations, so eek. Studying or working, I still need rent, people!
But I'm being oddly productive lately because I've started to run out of creative ways to procrastinate. I'm trying to save money by not... oh, going out to bars and overpaying for drinks, but I still like to get out of the house, so I'm running a ton, including a 6.7 mile double loop through Prospect Park today. So my days are largely consumed by working, studying, and exercising. I'm so ashamed.
It's also gotten hot recently, rather abruptly, so we went from snow on the ground to "Holy crap, it's time for me to buy an air conditioner" weather, which is actually really fantastic. I hit the Brooklyn Botanic Gardens last weekend where everything is threatening to bloom, the cherry trees are all opening up and I feel a strange emotion that was probably, oh, licked on by unicorns. I also got Easter off at the last minute when I was *supposed* to be working a 24 hour call by myself, so I'm feeling pretty good. Except my last run is leaving me acutely aware of what "lactic acidosis" feels like.
In other school news, through anesthesia, I finally got in on my first fresh frozen specimen. This and autopsies are really the only thing most pathologists are on "call" for. Essentially, you're in a surgery and you need the results on something to decide how to proceed. In this case, it was lymph node. The pathologist flash freezes it, shaves off pieces in something that looks remarkably like a miniature deli slicer, throws it through the H&E stain, and in minutes, determines whether it's malignant or not. This determines whether the surgeon will close up the patient or perform a multi-hour axillary dissection. While they were dissecting out, I was doing mature things like shifting from foot to foot excitedly and going "When they take it out, do you mind if I follow it to the lab? Pathologists are also a cool lot who seem unused to students giving half a crap about what they do, so ours readily explained it to me while moving at the speed of sound. And I got to run the papers back to the room with the results. I resisted kicking the door open like Batman and shouting "CLOSE HER UP, DOC! IT'S BENIGN!" but only just.
Also, I'm such a dork that finally seeing the H&E staining process was like meeting a rock star. "Oh my gosh... I've heard about you since histology... I love your work in the gallbladder. I never thought I'd actually see you in person. Can I have your autograph?"
Yeah, so I think it's official. It's even so official that I've stopped giving the flip-flop craven med school response of "Oh, I'm keeping my options open, but I really like surgery" and just blurt out "I like pathology". This usually invites a sort of "Um... oh. Well, someone needs to do it!" response, or the haters, who just think I want sweet hours so I can occupy my time making babies, or something. The rest just go with the general assumption that I wasn't hugged enough as a child.
So in surgery, we have several weeks of 6 AM rising and cranky residents interrupted by anesthesia, which seems to be a specialty that was licked into existence by unicorns. They leave early; they're chill (getting to sleep does that to you) and given the long periods where there is virtually nothing to do, they enjoy talking and teaching, and periodically, dismissing med students to take long lunches mid surgery, because hey, what the hell.
We still tend to have late lectures, which has often left me several hours at the hospital, forced to do something productive like (gasp) study for Step 2. I actually have a date for the CS, which I decided to take in Houston so I could finally see my family again, to whom I've been a distant memory since before I left for Grenada. I'm also studying for the CK, whose date is "sometime in August", doing the delicate balance between giving myself time off to study and rock boards while being well aware through the entire time that our loan distribution is contingent on our actual enrollment in rotations, so eek. Studying or working, I still need rent, people!
But I'm being oddly productive lately because I've started to run out of creative ways to procrastinate. I'm trying to save money by not... oh, going out to bars and overpaying for drinks, but I still like to get out of the house, so I'm running a ton, including a 6.7 mile double loop through Prospect Park today. So my days are largely consumed by working, studying, and exercising. I'm so ashamed.
It's also gotten hot recently, rather abruptly, so we went from snow on the ground to "Holy crap, it's time for me to buy an air conditioner" weather, which is actually really fantastic. I hit the Brooklyn Botanic Gardens last weekend where everything is threatening to bloom, the cherry trees are all opening up and I feel a strange emotion that was probably, oh, licked on by unicorns. I also got Easter off at the last minute when I was *supposed* to be working a 24 hour call by myself, so I'm feeling pretty good. Except my last run is leaving me acutely aware of what "lactic acidosis" feels like.
In other school news, through anesthesia, I finally got in on my first fresh frozen specimen. This and autopsies are really the only thing most pathologists are on "call" for. Essentially, you're in a surgery and you need the results on something to decide how to proceed. In this case, it was lymph node. The pathologist flash freezes it, shaves off pieces in something that looks remarkably like a miniature deli slicer, throws it through the H&E stain, and in minutes, determines whether it's malignant or not. This determines whether the surgeon will close up the patient or perform a multi-hour axillary dissection. While they were dissecting out, I was doing mature things like shifting from foot to foot excitedly and going "When they take it out, do you mind if I follow it to the lab? Pathologists are also a cool lot who seem unused to students giving half a crap about what they do, so ours readily explained it to me while moving at the speed of sound. And I got to run the papers back to the room with the results. I resisted kicking the door open like Batman and shouting "CLOSE HER UP, DOC! IT'S BENIGN!" but only just.
Also, I'm such a dork that finally seeing the H&E staining process was like meeting a rock star. "Oh my gosh... I've heard about you since histology... I love your work in the gallbladder. I never thought I'd actually see you in person. Can I have your autograph?"
Yeah, so I think it's official. It's even so official that I've stopped giving the flip-flop craven med school response of "Oh, I'm keeping my options open, but I really like surgery" and just blurt out "I like pathology". This usually invites a sort of "Um... oh. Well, someone needs to do it!" response, or the haters, who just think I want sweet hours so I can occupy my time making babies, or something. The rest just go with the general assumption that I wasn't hugged enough as a child.
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