Thursday, September 25, 2008

"Picture a white sandy beach and a pina colada in your left hand..."

A peek inside the operating room. (Started a few weeks ago, finally finished today.)

Last week of OB. It's been quite an experience. Lately I've been doing a lot of benign gynecological surgery cases. I'm still getting used to the idea of it, and am fascinated with the process of putting someone to sleep and then tormenting them without their knowledge. Here's how it goes at UW Hospital:

0700- If you're scheduled for an 8:30am slot, you'd typically arrive at the hospital around 7:00 and be assigned to a small booth just big enough for your bed, where a nurse comes to do one last pre-op physical, put in your IV, the surgeon (and assistants, me and a resident) meets you and answers any last questions, and an anesthesiologist gives you a sedative to calm you down (an alcohol-like effect). You're then wheeled back to the OR where the scrub nurse and float nurse are preparing the sterile tables full of tools, exactly the way the surgeon wants them. There's stainless steel everywhere. Large trays (fresh from the steam autoclave) full of stacks and stacks of scissors, clamps, tags, needle drivers, foreceps, scalpels, retractors, staplers, and other specialized tools with notable surgeons' names attached to them (e.g. the DeBakey foreceps) are all laid out in a specific manner so that the scrub nurse can find exactly what is needed.

0800- Due to the sedative effect of the benzodiazepine, you probably won't remember the trip down the long, long hallways, zigzagging, through multiple double doors, and then down to one of 22 large OR "suites." They seem more like garages to me. Everything is cold. Cold colors, cold steel, cold bed. The nurse removes your gown and covers you with fresh warm blankets from the blanket warmer. And then they tell you to shuffle over to the OR bed, which looks like a narrow black bench. Many of our patients overflow the sides of the bed, but we strap them in so it's okay. 

Suddenly there's ten people on you at once, the nurse putting compression boots on your legs to prevent clots, the anesthetist is hooking up cardiac leads, a pulse oximeter, IV medications, and then comes the oxygen mask. The resident approaches and asks for a "time out" to verify that we've got the right person in the right room, on the right date, for the right procedure. 

You might see a medical student staring at you, trying to stay out of the way, getting yelled at by the scrub nurse for standing too close to the sterile tables, tripping on all the cords that snake from various machines to you, the center of attention. You might notice the three 3-foot diameter Halogen lamps all pointed at you, or the large, dusty stereo speakers perched atop the anesthesia machinery in a corner. And then someone tells you your IV might burn and sting, but to ignore it and think of a white sandy beach...

0820- The patient, just before being paralyzed instantly and completely from head to toe as they drift off to neverland, is told to take a big, deep breath through the oxygen mask. This is because the anesthesiologist is about to administer a big dose of induction anesthetic (fentanyl) as well as a paralytic that totally shuts off your breathing. He/she then has a couple of minutes to intubate - first visualize the vocal cords, then thread the tube between them, inflate the air bubble that lodges it in place, tape it to the face, listen to each lung to make sure the lungs, not stomach, are inflating by hand-squeezing a football-shaped bag. Then the mechanical ventilator takes over. The eyelids are taped closed to protect the eyes from drying out. 

Now under general anesthesia, the doctors and nurses are free to do whatever they need. Drapes on windows are pulled for privacy, and all clothing is removed as the body is placed in the appropriate surgical position. The scrub nurse turns on the radio if the surgeon didn't bring his/her iPod. Heels together - Foley catheter inserted. For gynecological surgery, this is the time we do our last physical exam to estimate uterus size and get an idea of whether we can, for example, remove a uterus through the vagina, or the abdomen. 

The float nurse does the surgical prep with big iodine-soaked sponges, creating a brown-yellow mess that extends 1-2 feet beyond the surgical site. The pre-packaged surgical drapes come next, custom-made by 3M for whatever surgery the patient may be having and usually large enough to cover a king-size bed. If the adhesive surgical window doesn't stay on well, it may be stapled to the skin. 

0830- Meanwhile, the resident and medical student have pulled their glove size and type (the doctor's are prepared by the scrub nurse along with all special tools as indicated on the Doctor Preference Card) and the surgeon is being paged. The medical student and resident scrub in, using a disposable brush and sponge, a plastic toothpick for fingernails, and going all the way up to the elbows. Rinse from hands to elbows, then raise your hands up in front of your chest and keep them between shoulders and waist for the entire surgery. The scrub nurse then hands you a sterile towel to dry your hands, and a sterile gown and gloves. It's like a carefully choreographed dance, scrutinized by the scrub nurse. Student and resident discuss the surgical plan while nurses catch up on the latest gossip.

0840- The surgeon(s) enter and the atmosphere of the room changes instantly -- now under full control of the surgeon. Music might be turned up, or changed, or turned off. Things may need to be adjusted - bed raised, tilted, step stools for the shorties, lights repositioned, thermostat adjusted, monitors and machine settings tweaked, new tools found if the appropriate ones aren't available, etc. etc. The personality and nuances of the surgeon's style command the attention, or ease the stress, of everyone in the room. The anesthesiologist sits back in a chair comfortably, but must remain alert and ready to act on any verbal orders from the surgeon. He usually ends up crawling on hands and knees at various times during surgery to enter the patient's un-sterile world under the drapes, and adjust the pulse-ox monitor, or cardiac leads, or breathing tube. He uses a large mirror at the end of a flexible pole (like a dentist's mirror) to peek under the surgical drapes as needed.

0850- Incision is made. The patient may jump, quiver, and shake, indicating that the level of anesthesia is insufficient. Despite this, surgery continues while anesthesia is adjusted. Theoretically, you remember nothing and feel nothing. The smell of burnt flesh fills the room as the electric scalpel cauterizes off any bleeding vessels, little plumes of smoke rising up and scattering the bright halogen lights. And the surgeon is totally in his element.

1130- The first thing you see is the medical student's smiling face as you're rudely awakened from a deep, groggy sleep by the anesthesiologist barking at you to wake up and take a deep breath. You reach for your face... your IV... your arms are restrained gently. You'll probably forget the tube suctioning your stomach contents and saliva and the gagging sensation of the tube pulled out of your mouth. In fact, you'll probably groggily try to yank your IV and roll out of bed to "get up in the morning." We'll gently remind you, over and over, that your surgery is finished and that (most likely) all went well.


Tuesday, June 10, 2008

Side income

The iStock thing is starting to work out for me. I was approved as an illustrator in early May and made $50 last month and am on target for about $100 a month, without even having to put any more time into it! It's kinda like making investments in the stock market, but you're investing time, not money, and the proceeds just keep on trickling in, a few dollars a day. There are always a couple of files that really sell well and others that just don't. So far, my big winners are these two:





Wednesday, April 2, 2008

One of my many diversions

I have always enjoyed photography and design, and used it as a creative outlet. I took a photography class in high-school, and I have a tendency to drool out of the left corner of my mouth every time I see a digital SLR. If you add up all of the pocket digital cameras I've gone through (three -- two stolen, one off my body... long story) I could've easily bought one nice DSLR and a lens or two as well!

With all the places I've been and photos I've taken, I have always thought I'd be able to make some money off of it somehow but I have been somewhat unsuccessful. I make an average of $3 to $4 per month on iStockPhoto (see my portfolio here). Due to their new, more stringent quality standards, the vast majority of my photography isn't iStock quality. There are subtle effects created by the smaller lenses and in-camera processing of my compact digital that I can only avoid by purchasing a digital SLR camera, which, at this time isn't practical as I wouldn't really have time to benefit from it.

Recently, since we purchased a Mac (we "needed" it-- first computer I've purchased since my old 486!) and got the Adobe Creative Suite, I've spent some free time doodling (and dawdling) on Illustrator and have applied to submit some of my creations for resale on iStock. Not sure why, but having a creative outlet is something I seem to really benefit from, maybe it's because I have recently been bombarded by a frightful amount of scientific information, virtually all of which is "left-brained thinking" and the right half of my brain is feeling left out? Anyway, here are a few things I've worked on: hand-tracing and stylizing an Arches National Park photo I took a long time ago, and creating my own versions of the famous Caduceus medical logo:

Tuesday, April 1, 2008

My 3rd Year Rotation Schedule

"Starting Third Year is like going to a foreign country. You don't speak the language, you don't understand the customs, and the natives are not necessarily friendly."
--The New Physician, 1982

We just received our schedules for 3rd year after much anticipation and debate. It's a lottery system and this is what I got. The latter half of my third year will be considerably more difficult than the first half. I will be in one of the four big hospitals in Madison most of the time, or travelling up to an hour's drive outside of the city for certain clinic-based rotations.

My Schedule:

7/7 to 8/15 -- Pediatrics
8/18 to 9/26 -- OB
9/29 to 11/7 -- Neurology (includes Ophthalmology)
11/10 to 11/21 -- BREAK
11/24 to 12/19 -- Psychiatry
12/19 to 1/4 -- CHRISTMAS BREAK
1/5 to 2/27 -- Primary Care
3/2 to 4/24 -- Medicine
4/27 to 6/19 -- Surgery

Classes end May 14th, and I'm already well into my studying for Step 1 of the U.S. Medical Licensing Exam. I'm signed up to take it on June 20th, but it's quite tempting to push that date back and have more time to study! Heather and I look forward to an amazing vacation some time in late June because just two weeks after the big Step 1, I'm on the wards.

Friday, February 15, 2008

Green Power


Heather and I are now officially consumers of green energy. Our electricity provider has invested in wind and solar power and we decided to support this investment by paying an average additional $1.77 per month to allocate all of our electricity usage to these environmentally friendly sources. Go green!

Thursday, February 14, 2008

Too familiar?

Today, I became a bit more familiar with the human body, perhaps a little more familiar than I wanted. I had been worrying about this all week! We spent four hours delving into the intricate details of the female pelvic exam, and practicing the various skills until we mastered them. We practiced the breast exam, the bimanual pelvic, the speculum and pap exam, and the rectovaginal exam. I'm relieved it's over, and pleased with how much I learned and how effective it was to have the teaching assistants (who also play the role of patient) help us with the techniques. It's hard to believe, looking at that cervix, that a baby has passed through it when all you can fit into it is the tip of the pap-smear sampling brush. The female reproductive system is a complex system of organs whose communications and interactions are quite mysterious even to the best experts. I fear that section of pathophysiology more than any other! For now, I can merely appreciate, and observe, and understand the basic skills necessary to detect abnormal findings. And, be extremely grateful that there are women in this world who are brave enough to volunteer themselves to the hands of young, naive speculum-wielding medical students. 

Tuesday, February 5, 2008

Miss. Obesity Bill Stepping on Toes, As Intended

A bill proposed by a Mississippi lawmaker to ban restaurants from serving food to obese customers has no chance of being approved - but this was never the lawmaker's goal in the first place.

Republican Rep. John Read of Gautier filed a bill asking that it be illegal for restaurants with more than five seats to serve people who are obese. Restaurants that failed to abide by the new law would have their permits revoked.

The real purpose of the bill: "I was trying to shed a little light on the number one problem in Mississippi." Read the rest of the article...

I agree with the direction this bill is headed, although denying people of their food would be like banning cigarettes from smokers, or alcohol from alcoholics. We need to shed light on obesity, much like we did on smoking when we learned that smoking causes cancer. A shift in our attitude toward obesity would help more people realize they need help to get over their addiction to food. 


Sunday, January 20, 2008

Exercising in sub-zero weather- it's good for you!

Now that we've settled into the coldest winter months with a high of FOUR BELOW and a low of -14 today, I am shocked and amazed to see people still running outside on the trails. I always thought that breathing all that frigid air could damage your lungs, or give you frostbite! Then I came across this article in the New York Times about an environmental physiologist who has done extensive research on the risks of exercising in the cold. Here's what he says:

It doesn't hurt your lungs to breathe such cold air, even up to -50, because by the time it reaches your lungs, it's near body temperature.  The cold air doesn't usually cause frostbite unless, say, you're running in subzero temperatures without a hat covering your ears. Your skin goes numb at about 50 degrees, and doesn't get frostbite until about 27 degrees, so it's gotta be a LOT colder than 27 degrees before you'll get frostbite, and as long as you're moving you can get by with not much more than a track suit, gloves, and a hat! Read the whole article here:


There were two different road races in Wisconsin over the weekend, which happened to be the coldest day of the winter by far, and they still had a good turnout, raising over $2000 for charity at "Freeze for Food" (left: the starting line). 

People are also still commuting to work on their bicycles here. I'm still trying to figure out how to handle the extreme cold, and for now I try to avoid being out in it longer than a minute or two. I feel like my eye
balls are going to freeze solid, and my nose hairs and eyelashes get stuck together with ice crystals after just a few minutes in the cold. After reading that article, though, I'm encouraged to try running outside, or biking. Maybe we'll run across frozen Lake Mendota this week!

Friday, January 11, 2008

paradise.



Heather and I had the most amazing time snowshoeing from Paradise parking lot at 5400' up to Panorama Point (7200') on Mt. Rainier on New Year's Eve. This was our "date/vacation" for the holidays, made possible by borrowing my brother Jeff's 4-runner and Dallin's snowshoes for Heather (thanks!). The only day without precip on the forecast, it was just perfect. If we had gotten there earlier (roads weren't open until 1pm due to heavy snowfall), we would have made it a ways up the Muir Snowfield. Next time, we'll bring snowboards or skis for the way down! 

"I'm just wasting time"

To be honest, I spent the last hour reading the news, catching up on others' blogs, and sending out a few e-mails. It's 2:30, I have tons of reading I need to do, and Heather and I have plans for the weekend. Our first test is already coming up a week from today, and I need to do a 3-hour Medical Boards practice test this weekend so that I can get into a Boards study group. I was just thinking, "did I just waste that last hour? What is the definition of wasted time?" Every day, I only have 4 to 6 of my 24 hours scheduled; the rest is free time for me to use as I please. Time is a gift, isn't it? It seems to be a hot commodity these days. I have realized that the more I value my time, the more others will value my time. And, the better I use my time, the more time I have to spend. It seems like more than ever, with the medical boards approaching, every moment counts (I just shelled out $480 to pay the registration fees for this 350-question, 7-hour test I'll be taking in late June, step 1 of 3 on the road to achieving my MD degree). Even as I type this though, I value the time seemingly "wasted" as I follow the presidential campaign and catch up on the happenings in the lives of those I love, because it gives my mind a chance to breathe, to wander, to escape the drudgery of 2nd year. Now it's 2:45... I'd better go!