Second week on surgery

Another week of fun surgeries such as bowel resections, big hernia repairs and breast lumpectomies. It definitely felt more routine, even though the learning curve is still quite steep. I wasn't allowed to much more in the OR, but got scrubbed in on most of the good cases and did a decent job holding retractors, guiding cameras and closing up with sutures and staples. It's getting easier to anticipate the surgeons needs and they aren't jumping on us as much for not catching on to their intentions.

Rounding is getting easier. I'm getting more efficient at the brief physical exam and progress note. I still miss knowing the whole picture on patients, but I only have time to check on GI and surgery-related issues. Plus, there's usually other specialists or primary care docs on board to address everything else.

Our third student is a decent guy, but I sure started the week miffed about giving up a third of the cases. We'll see how this works out, but so far I only feel like he's taken some office visits - which is just fine.

Our intern and Chief resident (since he's the only resident in this new program) went away for the weekend so I house sat for him. It was a wonderful break from the "cell". I played with his boxer Griffin, got to use his Saab and slept on a real bed. Of course I stayed up too late on Friday enjoying cable TV again.

Rounding this weekend with our Surgeon on call as rewarding. Jason and I scrubbed in on a morning X lap (exploratory bowel surg) since the Chief was gone. We also had the opportunity to share everything we'd been assigned to read. Both of did very well according the surgeon and scrub tech. Jason didn't feel great, so he went home early. This gave me a lot of face time with my Attending. She spent a lot of time teaching and explaining things. It was SO much different than the classic arrogant surgeon-student relationship or the Medicine Attendings with God complexes I met at the VA. Now I have to read up on C. difficile and breast pathology.

One case is worth highlighting because it's so disturbing. We have a women who is an illegal alien getting an incredible amount of taxpayer funded care for no good reason other than her family isn't ready to let her go. The woman is a vegatable from a CVA, has a trach, and can't speak English anyway. Moreover, her kidneys, heart, liver and circulatory systems are collapsing. Finally she has ALL the superbugs: VRE, MRSA and the scary new Actinobacter buneii from the Iraq war. I saw here the first day in full chemical warfare gear, but have been told since that students aren't supposed to expose themselves and risk spreading it around.

It is a travesty that she's getting every antibiotic, imaging study and specialty consult available. The family, I assume for some cultural reason, won't unplug her and let her pass even though there's no where but down to go from here. And can you believe I was called in on this case to disimpact her!! At this hospital Medicine turfs those fun jobs over to surgery. I wonder if we're at this point because they are also avoiding the heart-to-heart conversation with the patient's family (through an interpreter).

From what I've been told, none of the family speaks English or is here legally either, so the whole thing certainly leaves an anti-immigration taste in my mouth. It also highlights some of the huge problems in our medical-legal system. As one of the Indian Attendings said, the only country in the world this could happen is the USA.