Wednesday, June 30, 2010

A Journey of a Thousand Miles...

usually starts with a flat tire and a broken fan belt.

Well it's official. We just had our orientation for our R2 year of neurosurgery. Amongst all the other info we received today, we got our business cards, loupes (those fancy OR glasses with telescopes in the lenses), call schedule, team assignments, and a whole lot of "good luck, you're going to need it."

This year was the reason for which this blog was created. It's purportedly the hardest year of residency we could ever imagine. Listening to the instructions from our attendings in regards to the "back up" we'll have during our first few weeks on call made it sound like we were preparing for war or some great natural disaster. The way the more experienced nurses are heading off to vacation and how the attending surgeons have ceased operating silently reaffirms the huge white elephant in the room: new interns, new R2s - don't get sick, because all around the US during the month of July in academic institutions people die. It's a well known fact that everyone gets promoted during this time. The residents that only months earlier were marching to the beat of a seasoned chief resident now are asked to call their own cadence. The residents who only days before, separated by a week of debauchery and drunkeness, were mindless work horses known as interns, are now expected to make clinical decisions and perform surgery - albeit under close supervision. And the medical students who only weeks before were still strictly book learned and green, are now scrambling around the hospital with their heads cut off like chickens, but still trusted and referred to as "doctor." Yea, now's not the time to be ill.

That being said, if you do find yourself in the hospital at this time, be assured that everyone is hypervigilant. Everyone's work will be checked, rechecked, and checked once more over as no one exactly trusts anyone to do their job completely right. They say that Christmas is a bad time to be in the hospital as that's when residents get overconfident and too big for their britches, making decisions they can't support or correct when things go wrong. So that elective surgery you were thinking about? Yea, I'd shoot for sometime in October.

But I digress. Back to neurosurgery. 337 days, 48 weeks, 116 overnight calls, 200 operative cases, and one soul to preserve throughout the whole ordeal. It's exciting, but let's face it, it's scary. Although all medicine/surgery has its risks, neurosurgery is one of those fields where if you get lazy, sloppy, or lose focus for even a second, someone could die. Perhaps a little melodramatic, but unfortunately true. But hey, it keeps things interesting.

Tuesday, June 22, 2010

Tripped at the finish line

Two days left in intern year, post call, and I start getting fevers and chills in the cafeteria. No biggie, probably just a flu or whatever. I get home and then ensues the worst 24 hours of my life. Fevers, chills, rigors, nausea, vomiting, intolerance of oral intake more than 10cc. I seriously thought death was upon me, but if it wasn't I seriously wished it would come.

That being said it was a pretty disappointing way to end intern year. My senior residents tell me about how they get through residency without a single sick day, and I land one right at the finish line before my first year. I feel pretty weak, but honestly, I think projectile vomiting is where I draw the line.

Still, last day of intern year coming up. Hurrah hurrah!

Friday, June 18, 2010

always remember, and never forget

I used to be a fairly sentimental guy. I'd listen to the slow jams, be able to turn any spoken word into prose, and mentated little phrases and speeches on friendship, love, loyalty, etc... I was a humanist in some sense, an anthrope if you will. But the more I isolated myself in my books and labs, the more I lost touch with people, obviously. But I guess the thing that bothers me upon reflection is that it doesn't really bother me at all. Well at least until today. I forgot my best friend's birthday, second year running. Last year it was because I was in the middle of intern year orientation, and the days were a frenzy of new people and information. This year I'm actually an intern, and being on call running around the hospital isn't the most conducive setting to allow for reflection on the people in your life. Not that she's an all star best friend either (yes you know what I'm talking about), having forgotten my birthday as well last year. Though I'm convinced she just pretended to to make me feel better about forgetting hers... she would be that kind of friend if she were smart enough to remember things, but she's pretty dumb actually, so more likely than not she just forgot (:

With sleep deprivation comes memory consolidation problems. I don't remember much of anything anymore. If it's not on my patient list sheet with my boxes of tasks to do, labs to follow up on, radiology studies to get reads on, patients to discharge, notes to write, orders to order... if it's not there, I don't "remember". This piece of paper is my brain, it's the only thing with information worth keeping throughout the day. My life utterly reduced to check boxes of people I do not know, nor will ever meet again once they leave this place. And yet there's no check box for calling my best friend on her birthday. I wonder if being a great doctor means you suck as a person outside the hospital? People say it can be done... but I obviously have a ways to go.

Clearly, I'm not fit for human consumption.

Wednesday, June 16, 2010

sleep psychosis

You know there's something wrong with your life when you're excited to get 2 hours to sleep. Well that's where I am. Sunday night, 30 minutes. Monday night, 30 minutes. Tuesday night, 2 hours... hurray.

And yet, I'm blogging... to be continued, must get some z's.

Wednesday, June 09, 2010

Last Supper

The neurosurgery seniors took the incoming R2s to a really nice steak dinner today at Mastro's. Although the premise was that of indoctrination and forewarning of the responsibilities of the upcoming year, my fellow R2s and I saw it for what it really was - a last supper for those on death row. Listening to my seniors talk about their experiences as the neurosurgery R2 over the past years was simultaneously comforting and disconcerting. Hearing that there's layers of back up, that they'll be there to answer every simple question in the first few months, that we essentially weren't allowed to make any management decision on our own initially... those things were of great comfort. That we'll undoubtedly fall asleep in the OR (which I've already done multiple times), screw up, upset attendings, etc. Fine, whatever. "You will kill people"... almost in jest, but with enough preceding sincerity that you know they're being truthful... that was kind of sickening.

I've heard the stories (none of these from UCLA btw): elective spine cases where one wrong slip leads to quadriplegia in an otherwise healthy gentleman; plunging into the aorta in a lumbar fusion case causing the patient to bleed out on the table; taking too much tissue in a epilepsy case that results in hemiparesis - these are the catastrophes one never thinks will happen to him, but invariably WILL happen if you're in practice long enough. In poker they say you don't always remember all your great wins, but you definitely remember the terrible losses, the bad beats, the hands that leave your pockets empty and hearts cavernous as you get up to leave the table. It's only natural for surgeons, at least the good ones, to remember the tragedies, as they're hopefully few and far between.

After being an intern in the hospital for a year, sure, I've seen people die, often in front of my own eyes. Good people, healthy people, the ones you expected to walk out of the hospital the next day. But no one's died yet because I screwed up. And to be honest I don't think I'd be able to post such a complication if it did happen. I guess that's the problem with medical writing, especially when speaking from a resident's point of view. Next year I'll probably more likely than not violate work hours, be involved in cases where devastating complications occur, and maybe even get to a point where I'm given enough responsibility to cause some of my own. But these are probably the things not written in this blog. How do we report that to the general public and expect them to understand, rather than litigiously hunt our heads? But make no mistake, for the most part in our profession, the patients that come our way would die without our intervention. Brain tumors, intracerebral aneurysms, intracranial bleeds and abscesses... these are dead men walking, their fates already written without neurosurgical intervention. But maybe this line of thinking is to justify my own existence and absolve my mistakes... we'll see.

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About Me

I'm a quixotic idealist that's readjusting to the reality of the world around him. An aesthetic at heart, willing to not shower a week at a time to go camping, exploring, hiking, etc. I love food, poker, and anything that can be turned into a competition.