S/P Trauma

One aspect of the surgery rotation I have neglected to mention elsewhere is Trauma. On weekends during the 2 month surgery rotation, we med students take 12 hour shifts in the trauma bay. For me, it was a dreadful part of the week.

My first Trauma shift took place on Sunday night after my first week of surgery. That means I went into the hospital at 7pm on Sunday, worked through the night, and then joined my primary surgery team at 5am and worked an entire work day--almost 24 hours total. Those who know me well know that I am far from a night owl. I like to be tucked in bed no later than 10 or 11pm. On surgery I regularly went to bed at 9pm or earlier given the early wake-up calls, sometimes as early as 4:30am.

That first night on trauma was perhaps one of the busiest of my 2 months. Students typically take turns "gowning" for traumas, meaning only one person actually needs to dawn the blue surgical gown, hair cap, mask and gloves. That person's primary objectives are to cut the clothes off the incoming trauma patient, get them warm blankets, and help the team roll the patient during the physical exam.

If you've seen medical shows on TV, you more or less know what the scene looks like. About 10 people are crammed around the patient trying to establish an airway, IV access, draw blood for labs, and assess the extent of the patient's injuries. It's an intimidating situation to say the least, especially for someone new to medical training. It wasn't uncommon to simply get pushed aside because you were taking too long. Nothing personal, it's just that it could be a life or death situation and things need to happen quickly.

After the airway is established and the initial assessments are done, the room clears out. Often the patients were then left alone, waiting for X-ray or the CT scanner to open up , or for a bed in the hospital to become available. Some needed lacerations sutured or bones reset. Needless to say, the trauma bay isn't a very warm and friendly place. Get in, establish diagnosis, get out.

My first patient was a "delta" meaning a more critically injured patient (as opposed to an "echo"). He was a young man out riding his motorcycle on a rainy evening and flipped over his handlebars, leaving him a quadriplegic. It was clear early on that this man had a severe spinal cord injury; he couldn't feel a bad break in his femur and even gentle touch on his arms caused him shooting pains.

The reason I struggled to like trauma began with that first trauma case. Although I cared that this young man was seriously injured and wanted to see an end to his suffering, it's hard to connect with patients in such a high speed environment. Since I never got to "know" patients like I have time to do in most other situations, I struggled to see them as more than a case or a procedure. Of course the point of trauma is to quickly direct patients to where they need to go, either to surgery or to be admitted for observation, not to bond and share warm fuzzies.

This is in stark contrast to how I see myself practicing medicine though. If I find myself in the trauma bay again, I think I will at least have more confidence and a larger skill set to help me function more effectively, but I think the pace and atmosphere are just not for me.

S/P Neurosurgery

Yesterday was my last day on Neurosurgery, but more importantly it was the last day of my Surgery rotation!

Neurosurgery is not likely a field I'll be considering when it comes time to decide, but I signed up based on my previous work/interest in neuroscience and for the chance to see living, breathing neuroanatomy.

The work neurosurgeons do is indeed incredible, handling pathology of the brain, spinal cord and surrounding structures. I saw procedures to relieve chronic back or neck pain, to remove brain tumors, to decrease tremors and rigidity in Parkinson's patients, and even a vascular surgery to remove plaque from the carotid artery.

I'm just not sure my personality is a good fit for neurosurgery. It takes a certain kind of person to be confident about operating on such delicate anatomy.

Next up, Neurology.

S/P: Urology

Another rotation down.

I spent the last 2 weeks learning about Urology, a field I have professed interest in since day 1 of medical school when I casually announced to my anatomy dissection group on our first meeting that I would love to handle the dissection of our cadaver's nether region. When the day came, I wielded my scalpel with a degree of avidity that no one who was nearby has forgotten (no really, they remind me whenever the topic re-surfaces). I then spent a few mornings of the following summer shadowing a urologist in a community hospital back home. Though I only saw the clinical side of her practice (urology is in fact a surgical field), my interest was still piqued and I sought out the Urology rotation as my Number 1 (and No. 2, actually, to reinforce the seriousness of my choice!) preference for the surgery rotation.

Skip ahead to approximately 2 weeks ago. Reviews from my classmates who had done the Urology rotation prior to me gave mediocre reviews of their experience and I had just come off of a rather excellent month of Surg Onc (though admittedly, my mood had sunk considerably by the end of the month too). Maybe we are all just tired. Let's face it, surgery is pretty physically demanding from the long hours to the standing around an operating table to the not peeing or drinking fluids or eating on a regular schedule (or sometimes at all) to the not exercising...It's easy to see how one's spirits might be crushed by this sort of lifestyle. Anyhow, I found myself less enthusiastic than I anticipated going into the Urology rotation.

At the start of my rotation I quickly learned that I had chosen a bad time to be on urology. Several attendings would be on vacation and the service was slow as molasses. Good for hours. Bad for urologic experience. The majority of my first week was spent in clinic seeing kids with voiding dysfunction (a general condition of irregular bowel and bladder emptying) or vesicoureteral reflux (the back flow of urine from the bladder into the ureters or kidneys, predisposing the kiddos to urinary tract infections) and adults with kidney stones, benign prostatic hypertrophy (BPH) and prostate cancer. Not to complain too much, but I did come here to see surgery! On the bright side, I did get to improve my clinical skills somewhat.

Week 2 had a bit more surgery on the schedule so I spent much less time in clinic. However, the majority of the cases I saw were "under water" (aka cystoscopy, where the surgery is performed through a rigid scope inserted into the urethra) or robotic (where the surgeon operates at a console that controls laparoscopic instruments inside the patient). Not much for a lowly medical student to do but sit in the corner on a stool and watch the monitors. Since I was not standing at the operating table, I was generally forgotten and not much teaching happened during these cases as is typically done during an open surgery. Dare I say, this was a tad boring.

I am hesitant to discount Urology as a potential career, even though I didn't have an ideal experience. The residents and attendings were extremely like-able, the patient population is varied (male/female, young/old), and there is a good balance of clinic and procedures. I guess we'll just have to see how the rest of this year goes!