Mile 17935: Surgical Adventures of Dr. Shortcoat

Above: I was living "on the air" in Cincinnati. At the Cleopatra exhibit. March 2011.

SURGERY IS AN EXPERIENCE THAT CAN BE LEARNED

THROUGH EXPERIENCES.

On Monday, I began my 12 week adventure into Surgery. Operating room observation, follow-ups on patients on the floors, going to clinics to do more follow-ups and consults, and the list keeps going, but its something I'm looking forward to. I had talked about the operating room in Dominica when I first came onto the island, but I'm glad to be finally writing about it again.

This week, I experienced the longest of surgeries (at least according to one of the nurses) that I'll be experiencing. It was the Laparascopic Nissen Fundoplication procedure (basically wrapping a portion of the stomach around the esophagus as one of the treatments for GERD - layman, acid reflux - not responding to medication). Five hours standing, and assisting by basically handling instruments in an upright position for multiple hours. I'm a bit sore, admittedly, after holding up some of the instruments after a while. However, it felt good to scrub in and afterwards getting my first shot of real stitching after the surgery was over. I used to complain about my ability to scrub into a gown, but with this rotation, I feel I'm getting better.

The operation was rather interesting, as at a point during the operation, there were multiple plasma screens that I could look at, with one camera looking down the esophagus from the mouth and the laparascopic scope looking at the stomach from inside the abdomen. I'll have to say that doing surgery is sometimes like a concert... the lights are on, you have the best view when scrubbed in, and your attention is definitely on the person in the spotlight. Now I know where the term "Operating Theater" came from in Dominica.

My first real scrubbed in surgery was quite an experience. I'm looking forward to the next 12 weeks not just to experience what the profession can offer, but also to learn a few tricks from surgeons that may be applicable to my life in primary care (we still have to do procedures!). Over the next few weeks, I may be also reflecting a little bit more on my last roadtrip... as much as I'm missed Chicago, I'm now missing the road.

Dr. Shortcoat was a name I had earned from one of the nurses when I was in Decatur. More about how I got the name later.

Dry Bones

"ORGANIZE YOUR THOUGHTS... THINK SYSTEMATICALLY."

Week 2. Right now, I’m typing this entry on the our hour-long ride back to Portsmouth. I usually spend my morning ride looking over some board material, while on my way back I usually end up falling asleep after a long day at the hospital... thus, risking my head falling over and plopping on top of one of my friends shoulders. However, I got some stuff on my mind, so I decided to take the time out to pre-blog.

On my mind this week are our rotations in Anesthesiology. Right now, the job seems to be exactly as I had painted in my head: come in during the beginning of a surgery, do some needle poking, talk to a few nurses, check that the patient is responsive to the treatment, and then head out the door to perform the treatment on another set of patients… Perhaps its just the Dominican way of doing things?

Remember that picture I painted of Princess Margaret Hospital last time? Little did I know that beginning my work in the Operating Room department would be so completely… different. The operating room facility is located in the same building where we have our fifth semester lectures, but on the second floor. Outside, it’s a giant cold-looking white colored building, with a tin-sheetmetal roof. To get to the operating room, we need to enter two glass doors, with their glass panes painted over in white. However, after entering, it literally is a different world. The décor features modern pastels, modular plastic cabinets, a standard glistening white floor, and most importantly updated and modern equipment. According to the poster located in the hallway to the three different operating rooms, the site was remodeled in 2001 (in fact the ICU I visited last week was in the old set of operating rooms).

Anyway, back to what I was thinking. Our rotation group was standing in our scrubs, gowns and caps in front of a patient about to undergo an obturator nerve block in preparation for removal of his medial meniscus ligament in the knee (The Dominican's looove their Cricket). Our attending Doctor looked me directly in the eye and asked me, "Tell me everything you know about Propofol." So I started saying, "Well its quick acting, and used to initiate anesthesia, and its better than Thiopental..." and he stops me saying:

"That's right, but ORGANIZE YOUR THOUGHTS... THINK SYSTEMATICALLY."

Remember that childhoold song, Dry Bones, which goes: "The toebone is connected to the anklebone..." and so on and so forth? I remember singing - and annoying the hell out of my classmates -with that song all the time. Well, medicine - even the hardest stuff - can be thought of in that manner. A good example in Anesthesiology goes like... "The Haloflurane goes with the Succinylcholine to make 'Malignant Hyperthermia' which results in Metabolic Acidosis, Accelerated Muscle Contraction, Tachycardia & Hyperthermia."

(Now try to sing it to the tune of the aforementioned song!)

Okay, medical blabber to some of you, but to me it makes complete sense because the logic is there! The point is Everything in medicine links together. I believe that's one of the best parts of medicine, its a never-ending web, but the essence of it can actually be captured by categorized, systematic thinking... Organized thought makes going through the "files and files" of thoughts in your head easily accessible in one sweep. Imagine disorganized thinking: it's like trying to find a needle in the haystack... Well, I still need to get acquainted with this way of thinking, but I see this as the reason why your doctor can just look at you and tell you what's wrong with you with the snap of two fingers.

Now don't be amazed if I shoot medical thought blabber at you next time I see you... you can always shoot the lyrics to Dry Bones in return back at me... We'll call it even.