Welcome to Surgery...Now Grab Your Ankles!

Perhaps this is not what was said to us during our orientation session, but it should have been!

I didn't expect rainbows and unicorns on this rotation by any means, but it was certainly "more intense" than even I had imagined.

I was warned by other students that the On-Call** phenomenon begins on Day One so I was not entirely surprised to find out that yours truly was not going home after his "entirely adequate" orientation. No, the Pajama Posse had big plans for this medical student.

My day began Monday at 9am for orientation and didn't end until 8am this morning (Tuesday).

To say that my first day with the fine folks of the surgery department was a baptism by fire would be a rather large understatement. By the end of my shift this morning,

I:

• Responded to 5 of the 8 trauma alerts (I was in the OR during the other 3)
• Scrubbed-in on 2 surgeries: a fairly simple skin-graft, and a pretty cool pericardial window surgery. For those who don't know, this procedure involves cutting the membrane that encases the heart to drain blood or fluid from the space surrounding the heart. Scalpels only millimeters away from beating hearts, yeah, pretty cool.
  
• Put in a couple of IVs
• Drew an ABG
• Stapled a head laceration closed
• Saved a man's life.
  

Now before you think that I have already assumed the pajama posse's infamous God Complex, allow me to explain: I was assisting a resident in placing a chest tube(see picture below) in a patient who had developed a spontaneous pneumothorax. During the procedure the resident was being very accommodating and teaching every step of the way. There was a point in the procedure when the patient (understandably so) began moaning from the pain. Out of habit, I happened to look at his cardiac monitor and noticed the patient's heart rate was now 47 (a bit on the slow side if you are keeping score) I mentioned to the resident that his heart rate was now 47 and I think he was having a vaso-vagal response to the pain. As I was saying this, his heart rate dropped to 43....38....34....20....then single digit badness. I think I scored major brownie points with this particular resident because I not only "noticed" that the patient was attempting to join the choir invisible, but I remained calm and jumped into action calling for a code cart, grabbing my own medication, and administering Atropine in the span of seconds. After a brief run of CPR the patient's pulse returned and would soon be awake and thanking us. Afterward, I apologized to the resident for what may have been seen as 'over-stepping' my role as a medical student, but she was very appreciative and thanked me repeatedly for stepping up. I think I made a friend.

Not bad for my first day!







** For the uninitiated, On-Call is what the hospitals now impose on its residents in the aftermath of other, more colorful, draconian methods of torture having fallen out of favor or having been campaigned against by Amnesty International. There is no good reason that medical students need to be On-Call, by the way. I suppose it is just a combination of initiation/hazing to, you know, get us acclimated to the suffering; and a brief respite for the beleaguered residents to have eager students around to help them complete the endless list of doctor-ry things they are required to do every night that the On-Call demons have them chained to the grindstone. Misery, that promiscuous whore, loves company I suppose.