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Surgery
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here's your bupdate
(bobby update)
rating: pg-13, mildly graphic; running time: long (unless you're a fast reader)
(and i tried to use normal words to describe stuff, so sorry if there is any
doctor jargon thrown in)
i'm now 3 days into the 1st 1/2 of the 1st 1/3 of the 1st 1/4 of the 2nd 1/2
of my medical school career. for you non math majors, i've got a long way
to go. i'll be doing pediatric surgery for these first two weeks. it's been
pretty cool so far. unfortunately, i've been doing stuff for a while now and
still feel totally lost, but i do know how to get to the alumni center (which
is a special place for a&m people where i get free dr. pepper and m&ms).
it has been kind of sad too, we've had some really messed up kids and some
that may not make it, mostly gut related stuff. yesterday we took out about
2/3 of a 16 year old's small intestine which was just dead inside of him.
but i did learn about the greatest surgical invention ever: he had recently
eaten and when we got inside, the dead intestine started rupturing and liquid
poo-poo (technical term) started flowing out everywhere, atleast a liter or
two of it. needless to say, it smelled incredibly super very bad. anyways,
then the nurse brought by the great invention, some sort of peppermint solution
which she rubbed on my face mask, and that was all i smelled the rest of the
time.
and the nicu (neonatal icu) is kind of difficult to be around. we've got two
kids about 3 weeks old who have already had one or more surgeries. it's pretty
sad watching their tiny little bodies fighting to live. and it's got to be
10 times worse for the parents.
that's pretty much the experience so far. today was really cool for many reasons.
1) we (me and this other girl who are working together) got to go home at
4ish, and sadly, a 12 hr work day is super exciting 2) for lunch i had some
sort of mexican thing, and the bowl it came in was made of taco shell!!!!
and if you didn't know, nothing brings a smile to my face more then being
able to eat the containers or silverware that come with the food (i.e. ice
cream in cones, the white stick with FunDip, etc)
prayer stuff: k, this is how you can pray for me
1) that i may walk in a manner worthy of the Lord, to please Him in all respects,
bearing fruit in every good work, and increasing in the knowledge of God--
obviously my schedule has changed and i don't have as much time as i used
to for prayer and bible study, but pray that i would be diligent to use the
time i have (not just at home, but also when i'm walking around the hospital
or just standing around waiting). also that i would develop relationships
with those around me and lovingly share truth with them. it's kind of hard
with this rotation b/c the dr.s i work with i'll only see for a few more days
and the patients are all either babies, asleep (i round on them at 5ish),
or anesthetized.
2) that i could get involved with the body of Christ here, in bible study,
fellowship and serving. and that includes the church i'm going to and fellow
believers at the hospital. we have a dr. bible study, but it won't start until
september, and the two other med students i used to meet with are both in
corpus for 3 weeks. but on the bright side, i am helping out with kindergarten
sunday school this week, so that'll be cool. i just think it'll be hard to
get really involved (which i'm kind of used to after my time at central) with
my schedule
3) that i would accept that this is a season of my life where i will have
less time for prayer and bible study and scripture memory and serving and
all that. it's hard to feel so constrained time-wise. or if that isn't a biblical
concept, that i would work around it and make sure to pursue eternal things
and not temporal. i don't know if i expressed that clearly, but it's been
one of the hardest things i've been dealing with
thanks for praying. may God get glory as we see His faithfulness to Himself
and His word (and because of that, to His children) in all these things
bobby
bupdate: (fyi, kind of long, and i won't send another for a week or so, so you might want to break it into more digestible bites)
so i've been doing pediatric surgery for a couple weeks now and i'm pretty close to getting my god-complex. i don't feel like i have the power of life and death, but i do think i'm better than everybody. ok, that's not true (although i am surrounded by some of those guys and it's not cool). luckily i am daily humbled by my complete lack of knowledge, not only medical but also with the hospital layout and procedures. i have literally been on about 20 different elevators and that's just the tip of the iceberg. and one time i was on the 4th floor and went up on the left elevator of a pair (as in two next to eachother) to the 6th floor, then came down on the right one back to the 4th floor, and wound up on a totally different area. so somehow they either go diagonally or i went through a wormhole or something freaky like that. and sadly, now that i know how to get around all the places for peds (pedi floors, PICU, NICU, OR), i'm starting a new rotation tuesday. the only time i ever felt competent is thursday when the new residents started, and the first years (or "interns" in doctor-speak) were even more confused than us, and i was able to help my guy (who happens to be a fellow LSU guy, geaux tigers). anyways, if you're wondering what a typical day is like, it usually involves getting up at 4, getting pretty (i have to wear a tie everyday :( , rounding on patients, then surgery or clinic through the morning, a couple hours of lecture from 1-3, more rounding in the afternoon, then hopefully home between 6 and 8, doing stuff, then bed by midnight, rinse and repeat. waking up is difficult, but it's not too bad once i get up and going. the worst part is changing clothes many times per day. apparently it offends 3 month olds if, when i check on them at 5am, i'm not wearing a white coat and tie. so then i have to change into scrubs for surgery, and back out and then back in if there's some emergency surgery in the afternoon, etc. if i didn't look so good in scrubs, it would be a real burden :) oh, and the shaving. i hate shaving. i can get by with only doing it every other day, but i have sensitive skin like a baby (assuming the baby bleeds profusely out their neck) and it's no fun.
here's some medical stories for those who
are interested. the first is the greatest story i've had since i've been here.
we have a precious little 6 year old girl here who's been through so much
crap (pardon that word if it's not allowed in your house) her whole life,
multiple surgeries, she's got cerebral palsy, genetic dysmorphic syndrome,
retinopathy of prematurity, seizures, spastic bladder, VUR, interventricular
hemorrhages, and a repaired VSD and cleft palate (you can look those up on
google if you don't know what they are, but basically she's blind, mildly
retarded, physically handicapped, and has had heart, brain, and kidney problems),
not to mention multiple custody changes between parents, grandma and aunt.
anyways, she came in with stomache pains and we did a CT scan and found 3
large masses, 2 in her lower abdomen and 1 in her pancreas. so we were thinking
'not good', probably a lymphoma that metastasized. and this little fighter
is gonna have to go through more stuff (plus it was even sadder b/c she looks
like one of my cousins). so we went in (to her belly) monday, and the masses
turned out to be a large, twisted off ovary, an enlarged ovary, and an extra
spleen. all normal tissue, so she won't have to worry about chemo and radiation
and all that junk. it was so great to be able to tell her family that (there
were about 12 in the waiting room) and see their relief, but
also to see her now, happy and playing, with no complications to worry about.
after seeing a 1 month old in the NICU every morning who we're just kind of
waiting on to die (she was a premie with necrotizing enterocolitis and lost
most of her intestines, now she only lives b/c of a respirator and just looks
worse and more pitiful every day), it was a refreshing change to actually
see good things happen to the kids. another good story, we had a 13 year old
girl with scoliosis (sideways bent spine) who was really
twisted. her spine on x-ray looked like a question mark, with her spine bowing
out to under her shoulder blade. the angle was about 85 degrees (you know
how your spine goes straight down? hers was almost a right angle). on a side
note, this situation reminds me of when we used to see pictures in class of
people with little squamous cell carcinomas on their cheek that wind up eating
off half of their face, and my question is, how can you let things get that
bad before getting help? at what point of your back
twisting completely out of shape do you say, ok, i guess it won't stop, now
i need help. it's messed up stuff. but anyways, we were able to get in and
cut some stuff out and straighten her out about 40 degrees. i was in there
with her for about 6 hours for the first surgery, but (luckily) not for the
second part with the orthopedists, which wound up being around 13 hours. so,
to sum up, it is nice to see the kids getting better and going home. as for
the more glamorous side of my job, i spend a lot of time asking people
if they've passed gas. whenever we go in someone's tummy and touch their bowels,
they stop working for a little while, so we have to know when they start again
(and one way is when they have flatus) before they can eat.
things have been good as far as time with the Lord. i'm thankful to God for all of you and your prayers and i am seeing the fruit of them. besides being able to read and pray at night (and even read a little cs lewis), i have lots of little breaks in the action at the hospital (between surgeries, waiting for docs, etc) and have been able to use them to meditate on scripture (one of the many benefits of scripture memory) and to pray (most of which has been joyfully for you all (Phil 1:3-5) and also for the patients and other people around me). and that is obviously not of me, because i am a great time waster by nature. just pray that this will continue and that my lack of lots of block free time will be replaced with diligence to make the most of the bits of free time i do have.
this past sunday i was able to go to church
and to help out with the pre-k sunday school class (don't worry, in my heart
they are uncute heathens compared to your kids). the church seems to be biblically
grounded and missions/ministry oriented, and the staff seem humble and loving,
so i think it'll be a good place. i really can't get too involved at this
point (i'd love to join a home group to fellowship and study the word with),
but probably can't do that for the next 10 weeks until the surgery rotation
is over. but, thankfully, from what i've seen of the other rotations, the
hours will get a lot better. some people don't start til 8am, and some have
told me they were done by lunch time. but for now, i'm thankful that you all
are still, even by email, filling the role of the body of Christ in my life
and encouraging/exhorting me with your words.
oh, and i was also wanting to build relationships with patients, but that might have to wait for another rotation too, because i only get a few minutes a day with them. i spent the most time with a 2 year old little boy (who wasn't even one of my patients) who was awake one morning at 5:30 and just hanging out at the nurses' station. another sad case, but he had leukemia and was getting treatment (i think we got along so well because of our similar hair styles). i really do want my time at the hospital not to be just wasted time between episodes of worshiping Jesus, but to be an offering in itself. just like i learned from kevin euckert many years ago (back in my college days), wherever you are and whatever you're doing is a vehicle for the gospel. i have had some good talks with anesthesiologists and nurses in the OR while waiting for patients, but other than that i don't have much time with most people.
k, i'll end it there because that's probably
way too much anyways. but here 's a little word to hopefully encourage you,
from 2 Cor 9:10-15 (if you have your bibles, you can turn there). i see a
parallel between y'all and the corinthians (and hopefully you will too) paul
is telling the corinthians how their gift (monetary in this case, prayer and
love :) in yours) to the saints in macedonia (me) are not only supplying all
of their needs, but also producing thanksgiving and glory to God from the
macedonians (me) because
they see the obedience of the corinthians (you) in their gift, and it also
causes the macedonians (me) to pray for the corinthians (you) as they (i)
see the surpassing grace of God in them (you). and the best part in v.15,
so we don't get proud or boastful, thinking we're good for what we're doing,
thanks be to God for HIS indescribable gift. i guess i shouldn't have said
i was gonna end this and then go on for another long paragraph, sorry. and
now i guess i could just erase that and you'd never know, but that wouldn't
be keepin' it real. k, seriously, the end
end transmission
bobby out
bupdate:
now for the quiz: there are 14 punctuation marks in the english language.
which one did i not use in this email? (hint: it's not the ellipsis . . .
i used 2 of those (3, counting that one), and definitely not parentheses)
bupdate:
answer to last week's puzzle: the bracket [ ]. thanks for playing.
well, another week has gone by up at ol' temple.
it is starting to feel a little more home-y. it'll probably be more so once
i stop spending 3/4 of my day at scott & white. on the bright side, i've
saved a lot of money on gas. i don't drive much, and when i do it's to the
hospital (< 1 mile away), or church/gym (2ish miles), so i wind up driving
less than 40 miles per week.
as far as medical stuff, i just finished up my first 4 weeks of surgery with
the private service. not much exciting stuff, mainly hernias and gall bladders.
i did get to talk to a nice lady, 50ish (medical history: month ago had a
gastric bypass-i.e. they took her stomach and reduced the food holding part
to a couple tablespoons- and came back because of anemia) and she and her
husband go around doing bible study/skit/music stuff for children, so we had
a lot to talk about. she was one of those types that called me "sugar"
and "honey" all the time (obviously she knew how sweet i was :)
this weekend was fabulous, because i didn't have to work. i only had class
for a few hours on saturday, and i was able to sleep for 19 out of 24 hours
after work friday (which for me is like 5 days worth of sleep at once). i
was already a big fan of sleep before, but this was super beyond words. now
i'm rested up, and starting at the VA (veterans' administration) hospital,
spending 4 weeks there doing surgery on military-type people. luckily, the
hours are a little better, and i won't have to get there until 6:30ish. i
finally got to go to this weekly bible study that a local pediatrician hosts
(dr. blevins). it's two docs, med students, nurses, and my-age-type singles
from temple bible church (where all of us go). we're spending a while in john
(and no, that's not a surgery/proctology joke, we're in the book of john :)
it was really good to be together with the body of Christ, studying His word
and praying together. and i actually felt really comfortable with the whole
group. as you may or may not know, i'm very socially awkward and not good
at all at meeting new people, especially when it's a new group that all know
eachother. but i can tell that these are going to be people that i'll love
by the time i leave here (especially the two doctors and their families (and
actually, i already know one from our spring break mission trip)). oh, and
the people own this really freaky looking dog. it's some type of shelty (related
to lassie but with a slightly different look). anyways, try to picture this
dog in your head, white, with fur all over the sides and legs, and a shaved
rectangular area from the top of the head down to the tail. it kind of reminded
me of mr. t's hair, except inverted. i seriously haven't laughed at a dog
that much since "snoopy, come home". it just looked so silly. (here
comes the foot-in-the-mouth part) so i asked, jokingly, if they ran out of
money for the dog groomer or were just messing around with the dog, and found
out that apparently he was supposed to look that way. that's the fancy way
they look if they go to the westminster dog show or whatever. hopefully i
didn't offend them (it's not like asking a non-pregnant lady how far along
she is), but every time he came in the room through the night i just couldn't
stop chuckling.
speaking of pride (and i'm full of it), it reared its ugly head again at the
bible study. dr. blevins, the host, was kind of explaining what the study
was about, and he was saying how the main goal was to help us learn how to
study the word on our own (kind of like the logos groups with the college
ministry). so the first thing that pops into my head is: i don't need this.
i've taught other people how to study, i've taught this and that bible study,
etc. i need to use big words tonight and make my spirituality known to these
new people so they can have a high opinion of me and on and on. thankfully,
the Holy Spirit brought to mind 1 Cor 4:7 (again, scripture memory paying
off) "For who regards you as superior? What do you have that you did
not receive? And if you did receive it, why do you boast as if you had not
received it?" everything i have/know (including how to rightly divide
the word and understand scripture and a love for its inerrancy) i was taught
by precious other people who poured themselves into my life and all of it
was worked out in my life through the Holy Spirit. and the same goes with
any gifts, talents, abilities (including my incredible crossword puzzle skills)
or whatever that i have, all was given. and if i did receive that, why do
i boast like i hadn't received it, like i achieved all of it myself. so that
restrained and humbled me, and the rest of the night was good. there were
times during the discussion later where the pride tried to pop out again,
but thankfully truth won out. and to further cement it in my head, while reading
through some proverbs a couple days later, the Lord showed my 18:2: a fool
does not delight in understanding, but only in revealing his own mind. and
that was (and is often) totally me. trying to make sure people know that i'm
wise, rather than just seeking to gain understanding and insight into truth
so that i can be changed by it. i just realized that these last couple of
emails have included some failures in my life, and my hope through that is
not just for you to have a lesser opinion of me, but for you to consider your
own life and obedience and see if it lines up with scripture, or to learn
from my shortcomings, or to see that all scripture is profitable for teaching,
reproof, correction, and training in righteousness so that we may be adequate
and equipped for every good work.
lastly, church has been great. i'm really encouraged by the emphasis on missions
and prayer. every sunday morning i can hear about how we're involved with
missions and how to pray for them, and then we actually do for a while. and
i'm still loving the pre-k sunday school class. i've finally gotten to the
place where i know most of the kids, and even get a few that run up and hug
me when i come in (which is great, because after being spoiled with the kids
at central for so long, i really missed that)
k, that's me in a nutshell
i'll try to have a little more excitment this week
if you're getting this, know that i'm praying for you often. let me know of
any specifics so i can do it better.
have a great week
bobby
bupdate:
the good stuff first: i started at the VA hospital doing vascular surgery
(basically fixing up all of the clogged blood vessels, mainly in the neck
(carotid arteries), belly (aorta), and legs (femoral arteries)). and all of
the old veterans here (we're talking vietnam and before) have mucho vascular
disease, along with heart disease and diabetes, mostly from smoking and "unwise"
dietary habits. they're lucky to be on under 12 medicines. and seriously,
i have never seen so many amputees in my life. i think there is a 3 limbs
or less requirement to get in (and it's not because of shrapnel, but mostly
because their arteries are so clogged that blood can't get to the end of their
arms or legs and their hands/feet died). so lots of action for the vascular
doc. mainly it involves scraping out the plaques (atherosclerosis :) and/or
putting in grafts. and i've never been bled on so much. especially when we're
up in the carotids (in the neck); those puppies have quite a bit of pressure
behind them and can spray pretty far. funny story (not funny "ha ha",
but funny coincidentally): during one surgery, the doc tells us how surgeons
are more likely to die from hepatitis C (from the patient) than in car accidents
or something like that. next patient we're scraping out the carotid and i
get hep C blood all up on me (and it was the one time i didn't put shoe covers
on, so my new balances got splattered. i put them in the washing machine with
mucho bleach, but the stain is still there, so feel free to send me suggestions
on getting rid of blood stains. maybe club soda?). for this rotation, us med
students are paired up again, and i'm with the same girl i've been with for
the past 4 weeks (and yes she has a boyfriend). we get along well, and after
being together for many hours, she still doesn't annoy me yet (which happens
with most people after a while).. we also have a cool resident in charge of
us, and she is also from louisiana/LSU, to add to the list. the per capita
rate of louisianians is pretty high here. oh, and i guess i should explain
the hierarchy system for those who aren't familiar. residents are official
doctors who are still in training. 1st year residents are called interns,
and the rest are just called by their year (3rd year resident, etc.) fellows
are doctors past residency who are specializing a little more. attendings
are the actual docs in charge of the rest of us. so in order of decreasing
importance, we have attendings > fellows > residents > interns >
4th year med students > nurses > social workers > custodians >
visitors > 3rd year med students (me). but everyone is really nice to us
and understanding of our ignorance.
so i finally came across the most un-understandable lecturer ever (and that's
saying a lot coming from a&m :). he was a fast-talking chinese lisper
with a little slurring. dude was definitely not hooked on phonics. no consonant
that came out of his mouth retained its natural sound. from the chinese, W
and L became R, T and Th became D, and from the lisp, S became T. basically
i needed a decoder ring to translate. and worst of all it was just 6 of us,
so it was interactive with lots of questioning. so i couldn't just space out.
on a sadder note, i lost my first patient ever. and it wasn't just like i
got to the hospital the next morning and he'd past away, he died right in
front of me on the operating table. it was kind of a surreal experience. i've
only had a few experiences with death in the past (a handful of older relatives,
and a friend my age) and this was way different because i talked with the
guy, then a couple hours later he dies. he was in his late 60s and had (among
other things) chronic lymphocytic leukemia (CLL) and an abdominal aortic aneurysm
(aka AAA or a "triple A"). we were supposed to fix the AAA before
the oncologists would start treating him for the CLL. the AAA is basically
a defect in the wall (aneurysm) of the large artery that comes off the heart
(the aorta, about the size of a garden hose) in the abdomen (just behind the
belly button). they're normally around 2cm, his was about 5cm. the plaque
and junk in his aorta caused it to weaken and balloon out. there is usually
a 90% mortality rate if they rupture, and the surgery to fix it isn't exactly
cake either. we were supposed to get in there, clamp it off, cut out the aneurysm,
put in a graft, and then wrap it up with the leftover aorta (to prevent rejection-type
problems). well, without getting into too many details, it tore and tons of
blood came out. we had a cell-saver (a suction device that takes up the patients
blood and kind of recycles it for him so we don't have to use any/much donor
blood) and i saw it fill up by about 4 liters in a couple of minutes, meaning
he lost about 2/3 of his blood that quickly. there were a couple other complications
due to his anatomy which i won't get into, and we did give him a few units
of blood and lots of IV saline solution, but he went too long without a high
enough blood pressure to perfuse his brain. you know how normally your blood
pressure is around 120/80? his was about 20-30 (over nothing; no diastolic
pressure) for almost half an hour. i don't really know how to describe the
whole situation emotionally. during it, i was just in doctor-mode and thinking
about what needs to be done to try and save his life. then afterwards, it
was just a strange feeling. there used to be a man and now it was just a body.
we went to talk to his sister, but she had left, so i don't know what that
conversation was like for the doctor. i spent some time thinking how i'd respond
if that happened to me and i lost someone unexpectedly and what it should
look like biblically. because i think the first thought tends to be anger
and questioning. so the first scripture that popped up for me was Job - "the
Lord gave and the Lord has taken away, blessed be the name of the Lord."
and "shall we indeed accept good from God and not accept adversity?"
God is still inherently worthy to be praised no matter how i might perceive
some situation. it seems like i only hear "God answers prayer" "i
thank God" "God was watching over us" and all that kind of
stuff when "good" things happen, but no mention of it with bad stuff.
He is still all of that when someone dies, we just tend not to see it as we
look towards ourself and "our" loss and how we're affected. i don't
know anything about this guy, but he was either a believer or not. if he was,
then death takes on a whole new meaning and is just the beginning of an eternity
with Jesus. paul considered it "gain" and "very much better".
if he wasn't, then the fact that he lived at all is grace from God. even those
who are by nature children of wrath (and remain that way) and only deserve
death, still see God's mercy in the sun and rain (matt 5:45, acts 14:17).
and that mercy of being able to experience God's good gifts on earth came
through the cross; Jesus' death so clearly demonstrated God's righteousness,
that He was/is able to pass over sins(rom 3:25) (i.e. no one can say "God
isn't fair/righteous, He doesn't keep His own law about sin deserving death"
because He let forth all of His wrath on His Son in order to be able to hold
off His judgment). anyways, all that is to say that God is good, even when
people die right in front of you. and i'm not one of those who think i'm letting
God off the hook by saying "He didn't cause it, He just allowed it to
happen", because scripture is clear that He does cause it: "see
now that I, I am He, and there is no God besides Me; it is I who put to death
and give life. I have wounded and it is I who heal; and there is no one who
can deliver from my hand."(deut 32:39). but it isn't random or meaningless,
it's purposeful. but i am not infinite or all-knowing and have no idea what
His purposes are, "He also is wise and will bring disaster"(isaiah
31:2), and "how unsearchable are His judgments and unfathomable His ways?
for who has known the Lord or who became His counselor?" (rom 11:33-34).
i couldn't see why joseph was thrown into a well and enslaved and then imprisoned,
until he was put in position to save all of egypt from famine. and i couldn't
see why Jesus was beaten and crucified, until i learned that without shedding
of blood there is no forgiveness, and by His wounds we are healed. and even
if that weren't true, and there wasn't an overriding purpose, i think that
if we ever stopped to notice all of the infinite good we (undeservingly) receive
and take for granted day by day, the not-so-good would pale in comparison.
but what do i know?
b
k, i don't have much this
week, and i wasn't here this weekend (which is when i usually write these),
but i did want to send something out just for continuity's sake. and sorry
that it's all bulk this week, i'm back to surgery hours and don't have time
for individual pleasantries (but i'll get back to you next week)
toodles,
bobby
bupdate:
not much exciting stuff this week, but it has been really restful. i was on
an anesthesiology elective (instead of doing surgery at the VA), and on electives
they treat you like 4th year students (i.e. if they see you at 11:30am, they
ask "why are you still here?", very laid back, very nice). unfortunately
we had our usual lectures in the afternoon, so i was still at the hospital
for a good 8 hours, but i did get to wake up after the sun, and that's mucho
sweet for me. as far as the elective itself, i really enjoyed it. and actually,
anesthesiology is now up high on my list of "what i'm gonna be when i
grow up". for some reason, i thoroughly enjoy putting things into people.
this week was mostly intubating and starting IVs and an epidural (and side
note: if you ever want a needle stuck in you for whatever reason, let me know,
no questions asked). but there are so many things that are cool about it-
all the little procedures you can do; good hours; when you leave, you don't
have to worry about patients; and of course the substance abuse (just kidding
about that part, but it is funny that 1.25% of the US population has a drug
problem, and 2% of anesthesiologists do-i guess it's just easier access to
lots of wicked cool drugs). i also spent a day at our pain clinic, basically
where people who can't suck it up and deal with the pain get needles put into
their spine and get some lidocaine injected in. it's probably nice for them,
but not something i'd like to do full time. and that's all.
bupdate:
quick rant before i get started: so i'm at the grocery store tonight and i
realize that i am the unluckiest line picker in the world. no matter how short
the line looks or whether or not it's an express, i always manage to find
the one where someone has a broken item and has to get another or needs a
price check or wants cigarettes from the faraway shelf or has some problem
with their credit card/checks or any other possible problem. if you see the
light blinking to call the manager, chances are i'm underneath it. now usually
it's not a big deal, because i'm a pretty patient guy, but tonight i had ice
cream. and the sad thing is, i had already pre-looked for the ice cream i
wanted and planned out the quickest route from the freezer to the cashier
and parked near the cart-return area to ensure the least possible TAFF (time
away from freezer). well, "the best laid plans. . ." and all that.
oh, and furthermore, the bagger put the ice cream in the bag upside down!
we all know that the only time ice cream should be upside down is when it's
a blizzard, and then only in the hands of a professionally trained dairy queen
employee.
now here's something we hope you'll really like (anybody catch that reference?):
well, another week has gone by at the VA. the hours were a little worse than
the last time there, because i had a 2nd year resident who, i think, feels
like she has something to prove. i don't know, either way i've had to be there
at 5am. oh how i keep dreaming of being done with surgery in 5 weeks, especially
when i talk to other students and here about when they go in and leave each
day. ahhhhh (that was a sigh, not a scream)
this week has been with a colorectal surgeon, which basically deals with the
end of the GI tract (the part where number two comes out, and up about 5 feet).
now as someone with "refined" eating habits, i've often heard "how
do you know you don't like it until you try it?" which can be true, but
i think there are some things, like haggis (or any other scottish food) that
i can never eat and honestly say are very very yucky. well, colorectal surgery
is my haggis. not so much the "colo", but the "rectal".
i won't go into details, for all of your sakes, and i know it's an important
job (colon cancer is the 3rd leading cancer killer in the US, in men and women),
but ewwww. and i can't imagine how uncomfortable it is for the patient when
we stick all of these looking devices up there. some roads were meant to stay
one-way. but the doc was pretty cool, and supposedly most colorectal guys
have pretty good personalities; i guess you have to in order to make people
feel comfortable in those circumstances.
and the patients are all great at the VA. they are the most grateful and kind
patients. i don't know if it's military respect or what, but they're polite,
and thankful for everything you do, and have great stories. so i've gotten
to know some of them pretty well. plus i've been inside of them, so that creates
a special bond. call me old fashioned, but i don't think you can really know
someone til you run your hands along their entire small intestine.
speaking of crazy patient stories, i finally got one. there's was this guy
this week that we didn't operate on, but got consulted about (warning: grown-up
story, skip below if you're too young/modest/squeamish, but it's too great
not to tell :). anyways, he had come to his doctor a while back requesting
a penile implant to help with certain physical acts. there was no medical
reason for it, so the doctors wouldn't do it. but he was pretty adamant about
wanting it, and they say "necessity is the mother of invention".
so this guy goes home, gets a razor blade, and cuts himself open, and inserts
a broken off drumstick (the musical instrument type of drumstick, not chicken
bone or icecream) into it and then sews it up with some thread (all of this
without any anesthetic, mind you). as you can imagine, some complications
developed (the least of which was 2 inches of the handle still sticking out
of his skin. there's a little more to this story, but i won't go into for
the sake of mixed company reading this (but it's pretty stinkin' funny, so
email me if you want to hear it).
now i thought i'd take this time, since i'm a little over halfway through
with surgery, to explain the concept of "pimping" to all of you.
i think we're all familiar with the common meaning of "pimp" (let
me just take time in the middle of this sentence to formally apologize to
everyone, this email seems to get dirtier and dirtier, but it's really not),
and if you're cool (or have a youth-age child), you know that it means "-adj
1. very good, excellent; COOL, AWESOME" (i.e. 'John is such a pimp',
'that car is pimped out', etc). medically, it describes the process whereby
upper-level docs ask lower-level docs/students questions, normally while seeing
a patient or in the operating room. now the purpose is to ask medically relevant
questions, about treatment, or about the anatomy you're seeing while operating,
and it's meant to be a learning experience. the reasoning is that you learn
better when answering questions with a little fear, on the spot in front of
other people. luckily, everyone here does it pretty well, and it's beneficial.
at other institutions, alot of the docs are jerks and just try to embarass
and ridicule you in front of your peers (and the patients). some of you might
have seen this type of thing in tv/movies. i think it is helpful, plus it
ensures that you study before going into the OR. there are some docs i've
worked with that like to pimp us on totally random stuff, from medical history/trivia/statistics
(e.g. the drug protamine comes from sturgeon sperm), to classical music, to
animal anatomy (e.g. giraffes do not have a gall bladder and have a blood
pressure of about 280/180 to get blood up to their head). i've done pretty
well so far. the key, especially if you don't know the answer, is to repeat
the question to stall for time (like those annoying spelling bee kids that
keep asking for definition/origin/can you say the word again?) and initially
be vague to try to get them to give some kind of clue. anyways, that's "pimping".
for more information, visit your local library, or you can check out http://www.neonatology.org/pearls/pimping.html
for a funny, interesting look at this time-honored tradition.
k, so what have i learned (and hopefully begun to practice) these past couple
of weeks? well there was one topic that the Lord hit me with repeatedly, at
church, in my own Bible study, with friends, and just reading. call it what
you want, hypocrisy, "fronting", being outwardly what you're not
inwardly, whatever. it first came up at church two sundays ago. we're going
through luke and talked about the pharisees, "be on your guard against
the yeast of the pharisees, which is hypocrisy. there is nothing concealed
that will not be disclosed, or hidden that will not be made known" and
how in matthew they're called "whitewashed tombs" - beautiful on
the outside but bones and unclean things on the inside. and then in reading
a c.s. lewis book, i came across "not to be, but to seem, virtuous --
it is a formula whose utility we all discovered in the nursery." and
i started thinking how that is totally me. my whole life i've been driven
by the desire to please people and be thought well of by them, and consequently
i always worried more about looking "good" than being so, and doing
what was expected without caring why i did it. this seemed to make sense,
since people can't see the inside and i can take care of that later. but the
thing i'm usually too hard-headed to realize is that i serve a God who weighs
men's motives and looks at the heart, and the actions aren't as important
as (nor meaningful apart from) the motivation behind them. and besides, it's
usually harder to just dress up the outside than it would be to spend some
time on the inside. it's like when i was a kid and used to have to make my
bed (for some unexplainable reason that only mothers know, since no one would
go into my room between the time i'd wake up and go back to sleep. but i'm
not bitter :), and i'd just throw the comforter on top without tucking the
sheet in. it looked made, but i knew it wasn't, and it took just as long as
doing it right, plus if my mom found out i'd be in trouble. the perceived
benefits are really no benefit at all. then i was reading "the imitation
of Christ" by thomas a kempis on my palm pilot during some free time
at the hospital, and came across "praise adds nothing to your holiness,
nor does blame take anything from it. you are what you are, and you cannot
be said to be better than you are in God's sight. if you consider well what
you are within, you will not care what men say about you. they look to appearances
but God looks to the heart. they consider the deed but God weighs the motive."
the last bit of the barrage of truth was from studying malachi, and realizing
that i've been like the priests in there, i go through the motions and bring
the offering, but it's a defiled offering, it's lame and sick and blind and
blemished, because it's not backed by true affections. like it says in joel,"rend
your hearts and not your garments." it's easy to go through the motions
and "be religious". i know there were times when i taught the youth
or college kids back in the day, and came into it with a totally wrong heart,
wanting praise or to be thought of as cool or "spiritual" and now
i shudder to think what the effects of that were or how many fell away when
they saw through the facade of this leader who was supposed to genuinely love
them and teach them truth. anyways, that's what i've been learning/struggling
with, trying to change the heart and watching the motives for my actions,
and letting that be dictated not by what others will think, but by the character
of Jesus. it's one of those qualities that everyone, even the world, looks
for in people, someone who's real, or down-to-earth. it's so difficult because
it reveals weaknesses and makes us vulnerable and can lead to rejection, but
it's the only way to freedom (from having to live up to others' expectations)
and peace (in not having to strive to maintain the outer candy shell which
is at odds with the chocolate in the middle (sorry, had to throw in an m&m
reference :)), and besides, all of those hidden secrets will be exposed some
day anyways.
alright, i'm outtie
have a great week
bobby
bupdate:
last week at the VA for me. this week was with the thoracic surgeon, but we
really did more general surgery stuff than thoracic. the coolest surgery we
got to do this week was an esophagectomy (and note, when i say "cool",
i mean for me, not for the patient with esophageal cancer. it's one of those
weird things where i enjoy/learn by getting to see lots of different things,
but that means that someone has to be bad enough where they need it done.
that's the ironic part of medicine: i want people to be healthy, but my livelihood
depends on them being sick). anyways, so we took out most of the guy's esophagus,
and pulled his stomach up to the leftover top of the esophagus. not very fun
for him, but really neat for me. it wasn't a curative procedure, just palliative,
to help him eat during whatever time he has left. he'll still have to get
radiation/chemo, and i think the prognosis is like a 23% 5-year survival rate
(i.e. in 5 years, a quarter of the people in his position are alive). kind
of sad, but hopefully we were able to improve his quality of life.
this week i found a new place to stick a needle :) i got to put in 3 central
lines and i think it's now my favoritest procedure. it's basically an IV put
into the subclavian vein (just below your clavicle) that we use if we're going
to need IV access for long periods or have to put in heavier stuff (like TPN-total
parenteral nutrition, where we feed them without using their GI tract, or
what the vets refer to as a t-bone through your arm). it's really fun because
of the challenge; you're blindly sticking in a needle, and you're next to
a big artery and the lung. and for those interested in the technical aspects
(if not, skip to the next paragraph), you shove in a needle til you get lots
of blood flowing back, then you push through a guidewire which actually goes
into the heart (and you can see the effects on the EKG), then you put a piece
of plastic on around the wire to make the hole a little bigger, then you pull
that out and run the catheter in over the wire, pull out the wire, sew the
catheter to the skin, and boom, you're done. seriously, so sweet :)
well, it's kind of sad leaving the VA after being there 4 weeks. i will miss
some of our patients. there was a guy who i saw all this week (and hopefully
he's home by now) who, for some reason, really took a shine to me, and invited
me to his house next time i'm in college station (and to his farm where he
raises chickens). he mentioned it the last 3 days i saw him, so i really feel
like i should show up. he gave me his number and told me his wife would cook
for me and i could borrow his boat to go fishing and all this stuff.
i'm also gonna miss the doctors we had, really nice and helpful and all that.
especially dr. mehta, the head general surgery guy. he's an indian fellow
(american-indian, not native-american. i.e. from india) and says my name in
a funny way. it's hard to communicate over email, but if you can picture me
saying "what do you want to do, bobby" with an indian accent, you'll
get the idea. i'll try to phonetically spell it: bow-bee (and the bow is the
long-o sound, like hair bow, not bow and curtsy). i don't know about you,
but for some reason i get a kick out of hearing my name in different ways
(as long as they don't call me 'robert'). i used to have a friend with a british
mom and she called me "buh-bee". my old boss, joe, used to call
me "boo-bay". and all spanish speaking people have a great way of
saying 'bobby' that i can't even describe. sorry to waste your life on that
paragraph, but these are things that matter to me. and that's the nice thing
about this emailing; i can get my thoughts out. it's like having a diary,
except i'm still able to feel like a man (just kidding and sorry to offend
any guys out there who do have a diary, but hopefully you call it a journal
or your memoirs or something). as some of you know, i'm not normally one for
volunteering information (unless, as a only couple of you know, you ask specific
questions) for many different reasons. but for some reason this feels different
psychologically and is a nice place for my brain juices to drool out.
at bible study this wednesday i got to meet a guy who's been serving as a
missionary in iraq over the past year. his group is on furlough and he's been
hanging out in the US waiting to go back. it was cool (as always) to get out
of my american bubble and to hear about how the Lord is working in other places,
and now, to be a part of that by praying for them. he said that most villages
they were in now have only 1 or 2 believers, but they are staying faithful
and his team is still in contact with them. i'm excited to see the growth
and fruit that come out of there.
i had a little attitude change this past week. i realized after i sent the
email last week that i mentioned how i couldn't wait til surgery was over
in a few weeks and how things would get better after that (and that's the
feeling i've had for a while). but it's so futile to put my hope/joy in things.
i say "i'll be happy/better once this rotation or test or week is over",
but then once it's over, the happiness is short-lived and a new event replaces
it and it's "i'll be happy when thanksgiving break is here" and
so on. and besides just being fleeting, what does it say about my life now?
if i'm always looking forward to something else, right now becomes pretty
crappy and just wasted time until the next point is reached. besides, i don't
know what my life will be like tomorrow; i'm just a vapor that appears for
a little while and then vanishes away. and that applies to stuff too. i want
m&m's to satisfy me, then once i get them and eat, the pleasure is gone
and i don't desire them, or i get a new toy that i've been dying for (not
now, when i was a kid, mostly), then i play with it a while and it goes to
the back of the closet. luckily scripture has an answer for my problem- psalm
37:4 "delight yourself in the Lord; and He will give you the desires
of your heart." and 1 timothy 6:17 "instruct those who are rich
in this present world not to be conceited or to fix their hope on the uncertainty
of riches, but on God, who richly supplies us with all things to enjoy".
not only does my joy come from delighting in an infinite God, but when i do,
my desires will change so that they will be right desires and good desires.
when my goal is to delight in some thing, it meets its purpose (or sometimes
doesn't) and is gone and has to be replaced by something else. when my goal
is to delight in Him, it goes on infinitely and everything else i do becomes
delightful. in case that doesn't make sense, here's a little illustration
(i tend to always think of metaphors/analogies for stuff i'm learning. the
youth used to make fun of me for it, but i like them. i think it's due to
the teaching in my genes). anyways, say i have a girlfriend (big stretch,
i know), and we're gonna go out to dinner, some girl movie, and then ice skating
(at the galleria). i personally like to eat, but not chick-flicks and not
ice skating. so if i'm setting my happiness on things, i look forward to dinner,
then it's gone, then i look forward to the end of the night and just getting
through the other stuff. but if i'm delighting in my girlfriend, i know that
doing all of that (and the attitude i have while doing it) pleases her, so
i can enjoy all of it knowing it makes her happy, and my enjoyment goes on
throughout the night as i seek her happiness in everything (including the
car ride and conversation, etc). so to bring it back, as i delight in the
Lord, everything i do is to please Him, which in turn pleases me (nice how
that works out). so hopefully you won't hear me talking like that anymore.
there are so many variables in life that i don't even know if i'll make it
to the end of this rotation. but i do know that right now i'm studying for
my surgery board exam, and tomorrow, Lord willing, i'll be at scott &
white somehow impacting other people, and it is good. :)
bupdate:
well, due to scheduling changes, instead of starting with the emergency trauma
service this past week, i did another elective, this time with orthopedics.
it worked out really well for me, because i've been muy sick since sunday:
sore throat, headache and general yuckiness (i think it was just a viral thing
but i'm no doctor, so what do i know?) if i would've had to work the 24-32
hour shifts, i don't think i would've made it. but with the elective, i was
able to come home at 3 or 4 each afternoon and get some rest. the worst part
is that i'm a big time salivator (my dentist said so), and so i have to swallow
often and it's been like razor blades going down (life is pain, anyone who
says differently is selling something). i did have some old vicodin to take,
which helped for a couple hours at a time. Vicodin is a nice opiate with tylenol,
except mine expired two years ago; probably safe, and effective if for nothing
more than the placebo effect). it probably wasn't that bad, but i don't get
sick that often so i don't have much to compare it to. plus i'm a guy, and
obviously we are babies about pain because of the whole not-going-through-childbirth
thing and because we like to milk the sympathy (except i have no wife or mother
to baby me :( i guess it was inevitable that i get sick, though, because i'm
constantly surrounded by sick people, plus i always put things in my mouth
(fingers (mine), keys, pens, etc). i'm somewhat better now (thanks for asking),
but it still hurts to swallow and to not be asleep.
i also came down with another illness this week, but one i enjoyed: olympic
fever (i know, corny joke, but thanks for your slight snicker or chuckle).
olympics are cool because they're the only time that i get excited about swimming
(did you see the men's 4X200 relay??). and the only time when watching gymnastics
is cool. i swear those romanian chicks must be born on a balance beam. i have
no idea how they can do back flips and land on that thing. but that's why
i like the olympics, not so much because i like the events, but i just like
to see excellence in anything. when people do stuff well, whatever that stuff
is, i enjoy it. that's why i can spend 30 minutes watching synchronized diving
or women's judo and not feel like i wasted my time. i also really like to
hear russian names. they sound so cool. if it were socially acceptable, my
first daughter would be katya or yelena, or svetlana. oh, and if you want
some excitement, at 2am on thursday and friday, you can check out the pentathlon:
shooting, fencing, swimming, show jumping, and running. i don't know where
they come up with the combo of events for these things, i guess it's kind
of "knightly" things, with horses and fighting and stuff. whatever
it is, it makes more sense than the biathlon in the winter olympics: skiing
and target shooting??? and while we're on sports, let me just take a moment
to say that although i've been against the designated hitter rule in baseball
for most of my life, i'm now starting to see the use. as an astros fan, i've
discovered that pitchers are just too fragile to hit: andy pettitte hurts
his elbow on a check swing at the beginning of the season and is now out,
and roger clemens strains his calf running to first?? that's just ridiculous
(but not as ridiculous as being 20 games out of first place). but i digress.
actually, while i'm on random topics, let me just say that i had a delicious
seedless watermelon this past week. if you're like me, you're wondering how
they grow seedless watermelon (you know, because how would you plant one?),
and interestingly they use a drug that we give people for gout to genetically
mutate them. and when they say seedless, they mean the black seeds, not the
white ones (which, luckily, don't ruin the texture too much). although there
were 2 or 3 black ones in there, which is kind of weird.
i got to know my apartment a little better this week. i've only been here
a couple months, so i'm still discovering new things all the time. well, i
learned that my fire alarm can't tell the difference between smoke and steam
from the shower. and conversely, my fire alarm learned that i don't like loud
noises (he's now sans battery :) luckily i was out when it went off, so i
was able to quickly pull it off and disarm it.
oh, like i said way earlier, work this week was with orthopedics docs. those
are basically the bone guys. i got to see a bunch of cool stuff, lots of things
with scopes, a large rod inserted into the femur (big thigh bone), and a total
knee and a total hip replacement. and the thing i've discovered is that orthopedists
are basically just glorified carpenters. they use saws, hammers, cordless
drills, nails, screws, cement; basically everything in your garage. they even
had a pair of pliers that were just like a pair i have. the only difference
is that i pay a couple dollars for mine, they pay a couple hundred. and bone
is just like wood to them. the knee replacement was just like putting a hinge
on a door: shave the bone to make it flat, screw and cement on the pieces
and close up. now obviously there is some attention paid to proper alignment,
lengths, angles,etc (measure twice, cut once, and all that). and it's funny,
but everyone, every single one of the doctors and residents are male and ex-jocks.
i think it's required to get your license that you have a y-chromosome and
old football stories. and without going into details, let me just say that
the operating room is just like a locker room, as far as conversation content
and general attitude.
i really don't have much else to say this week. i did take my first test of
the 3rd year today (radiology), and it probably went well. the best part is
that we no longer have a mandatory saturday morning class (whoop!)
oh, and since i am starting up on trauma this week, don't be surprised if
you don't get an email form me next week. i'll be just a tad busy, but i'll
keep track of the cool stuff and get back to y'all in a couple weeks. if you
have any signs of withdrawal (fevers, chills, tremors, palpitations) you can
eat some m&ms and read over some of the old emails.
have a super rest of august.
swarthily,
bobby
bupdate:
ok, so i had time to get one out after all. different format this week, i'm
going with a daily entry type thing because i have more time if i do it in
short bursts. let me know what you think.
Monday, 8/23:
first day on the emergency trauma service (ETS). it was kind of hard waking
up today, but not too bad once i got going. the hardest part was going a full
work day before lunch (breakfast at 3:45, lunch at 12:45). my tummy no likey
:(
first trauma today. A 45 year old oriental female in an mva (motor vehicle
accident), car vs. fence. as you can imagine, our good friend ethanol played
a crucial role (seriously, who gets drunk 6am monday mornings?) anyways, you
can all pretty much imagine the scene from your tv experience; they wheel
her in, slide her onto the bed, then 9 people are around her all doing things
and talking at the same time in a controlled chaos. the prestigious job of
the 3rd year med student is to write down everything they say (as far as the
history, physical exam, what they put in/took out, etc). i really like the
order of trauma though, everything has a set protocol that you run through
every time. you repeat the same procedure for every patient, so nothing is
overlooked. the primary survey consists of the ABCs (and DE too) (some of
you CPR certified people are probably familiar): Airway, Breathing (to make
sure they're getting oxygen), Circulation (to make sure the oxygen is moving
around), Disability (checking for neurological problems), and Exposure (that's
the part where we cut off all your clothes and check every area of skin to
make sure there aren't hidden injuries). This covers all of the immediate
life threatening things, then we go slowly from head to toe checking everything.
the way the trauma service is here, we don't just see the patients emergently
then pass them on to another service, we keep them their whole stay in the
hospital. so we have tons of patients (34ish) compared to the other teams,
which means rounding takes up a large part of the day. some stay for months,
and there are another handful added each day. the residents joke about practicing
the DABCs, Discharge, Airway, Breathing, Circulation, meaning that getting
rid of the people is the first priority. funny, but true. the first thing
that goes into the chart is the discharge summary. we also had another inebriated
fellow today, who was found unconscious in a parking lot, but nothing too
exciting.
here's the latest on my ongoing health issues, since many of you were kindly
offering advice and concern. on sunday, when it seemed i was just on the verge
of recovery, i suddenly felt the icy hand of death upon me. some loser bacteria
piggy-backed on my pharyngitis, so now i'm majorly congested, with a little
cough, plus the previous sore throat (not as sore). and i still have my lovely
raspy speaking voice which has been around the past couple of days. it's hard
to communicate when i sound so nasty, but on the bright side, when i talk
to myself it seems like another person. back in the day, i used to be able
to drink carbonated beverages and it seemed to "bubble away" the
sore throat for a while, but this thing is refractory to it (i had 5 dr peppers
today with no result). and i don't think it makes the patients feel very good
when the guy in the white coat is coughing up a lung in front of them. i can
sympathize better with all of our patients who have respiratory problems,
because breathing is one of those things that i rather enjoy doing- you really
don't know what you've got til it's gone. if i use afrin nasal spray, i can
usually breathe pretty good, but i had to stop today before i got addicted.
if you use it more than a couple days, you can get rhinitis medicamentosa.
the medicine constricts the blood vessels in your nose to stop fluid from
coming out, but if you do it too long, the body compensates by dilating them
to get back to the status quo. so then it takes more medicine to stop the
drip, and the body responds more, and the vicious cycle goes on. then it takes
steroids and a couple months to get back to normal. not fun. but neither is
blowing your nose every 5 minutes. anyways, i'm through being mr. nice guy
and just sucking it up. i went to HEB tonight and bought enough drugs to stun
a small bolivian village. well, actually just tylenol cold, with 3 ingredients
for pain, congestion, and coughing, plus vicks vaporub (they make it in easy
to snort stick form now, for the aspiring cocaine enthusiasts), and some strawberry
flavored lozenges. all that plus i can add the afrin back tomorrow, and we'll
see how it goes.
tuesday/wednesday, 8/24-25: (i was on call, so they kind of run together)
this actually starts with a comical story on monday night/tuesday morning.
so it's about midnight and i'm about to go to sleep, thinking that 4 hours
will be good rest because i have to be up all night tomorrow. so i take some
medicine, and do 4 snorts of the vaporub and lay down. 2am rolls around and
i'm still just laying there, wide awake. i thought the problem was the coughing
or not being able to breathe, then i looked at my vaporub, and apparently
the active ingredient is called "levmetamfetamine", a relative of
good old amphetamines (speed, uppers, etc.). so finally at 2:30/3 i fall asleep.
i wake up, and the sickness is just as bad as ever, but now with nausea and
general achiness. most of the day tuesday was spent in the OR (when you're
on call, you get to operate). i was wearing a mask the whole time (part of
the wardrobe), which was nice because it filtered the cough, but not nice
because it held in everything that dripped from my nose (kind of like skiing
with a mask on, then taking it off and seeing all the frozen snot on it).
i'm feeling pretty horrible, the medicine sometimes last for a couple hours,
and i get some relief from the congestion and cough, but everything else is
still raging. so i finally caved. i usually just suck it up with sickness,
and trust my body to fight it off, but this time he failed and i had to call
in the big guns - i got one of the residents to write me a prescription for
azithromycin (antibiotic), sadly i couldn't fill it til wednesday due to not
leaving the hospital. but atleast now i have hope. tuesday night was pretty
good as far as action; staying up isn't nearly as hard if you're doing things
and i was busy til 3, and with no traumas coming in. first, i ran into a resident
on the transplant service (kandie, who you may remember from a previous email),
and she let me scrub in with her on a kidney transplant. really cool. we put
a 13 year old's (cadaver, from dallas) kidney into a 37 year old guy. the
new kidney actually goes just above the right hip next to the belly button,
and gets connected to a blood supply and the bladder. it's a pretty good feeling
when you take the clips off of the artery/vein and watch the little brown
organ fill with blood and turn pink, and then start making some urine. so
that took about 3 hours. then we had a couple of late night surgeries, a ruptured
appendix and small bowel obstruction. then i went around doing some consult
stuff with another resident, dr. bordelon. he's another LSU guy from near
where my parents grew up, and he's got a real thick cajun accent and sounds
like my cousins. it made me kind of lonesome from my family hearing him talk.
he let me put a chest tube in a lady in the icu. that's another cool procedure.
you cut a little hole in the side, about 5 ribs down. then you stick your
finger in and feel for the bone, then put a pair of kind of blunt scissors
in their and push in til you pop through the outer lining of the lungs (that
was the best part, because she had a pneumothorax (air around the outside
of the lungs compressing them) and once i got in this huge rush of air came
out), then you shove a tube up there so you can suck out any fluid/air. while
i was doing that,at about midnight, bordelon got called away on a code blue
(a little background, that's when someone is unresponsive- i.e. not breathing
or heart has stopped. just fyi in case you're ever at scott & white, they
announce it over the intercom as "dr blue", i guess so they won't
scare people. so if you ever here "paging dr blue, to STC 5, room 590",
that means something not good is happening) so he's called away to that and
tells me to finish up (which was a little scary, since this was my first time
and i'm touching this lady's lungs), but with code blues all the responding
docs/nurses drop everything and go to it (plus this was one of our patients).
so i finish and go to meet them, and it's your typical tv scene, about 12
people in the room giving cpr, pushing in some drugs to get her heart going,
and shocking her. she's an 80ish year old lady who had been in a car wreck
and was doing better, but that night had aspirated some of her tube feed (she
regurgitated some of it up and it went into her lungs). they worked on her
for about 20 minutes on the floor, and were able to get her heart beating
weakly, and then they brought her down to the icu for closer care, but when
we got there, she coded again, and after another 40 minutes of trying, we
finally gave up. she was actually the mother of one of the ladies that work
for our med school, so going to talk to her was really sad, but she kind of
knew it was coming and had said goodbye, so she took it pretty well. so after
all of that, it's around 2, and me and the other 3 residents on-call go down
to the cafeteria for some food. we hang out a bit then get called down to
the ER for a rectal prolapse. basically, that's when the inside rectum pops
outside, so this old woman had internal pink mucosa (about the size of a baseball)
popped outside of her bum. one of the residents gently pushed it back in,
and we're done for the night. now it's about 3 and i'm pretty awake, but then
i have about an hour down time until i have to round on patients. i don't
want to sleep, because i know i won't be able to wake up, so i take a shower
and watch some olympics. after a few hours of our usual morning rounds, i'm
finally done at 11am. then i go get my prescription filled, take it, and sleep.
i've never been more tired in my entire life. from 3:30am monday til noon
wednesday, i've had like 2 hours of sleep (because of stupid vaporub), which
is a record for me. the funny thing is that as a kid i thought staying up
long periods of time was cool. my friends and i actually had a goal at one
point of staying up for three days straight. i don't know if it's true or
not, but we had heard that in texas, if you are up for more than 72 hours,
you're declared legally insane. i don't know why that appealed to us, but
we always wanted to get to that point. i don't think we ever made it past
an allnighter though. kids are so stupid.
Thursday, 8/26:
One dose of antibiotics, plus sleep, and i finally think i'm on the downslope.
there were intermittent periods today where i could actually breathe through
my nose (but still blowing it every 5 minutes). and i think i'm gonna drop
out of med school and sell a new workout video. it's called "cough til
you wretch: hack your way to great abs. get a six-pack at home or at work"
but seriously, very sore in my belly from all the expectorating. and now i'm
out of synonyms for coughing, so i'll stop talking about that.
work was ok, nothing big to report. i am really enjoying ETS though. the work
itself is fun, but the big bonus is that all of the residents are really awesome,
especially the interns (who we hang around the most). very funny guys.
time in the word has been good (and existent, thankfully, even with the schedule).
i started studying/memorizing 2 peter a couple weeks ago, so let me know if
you want to discuss. and while i have the conch (lord of the flies reference
:), let me just take the time to plug large passage scripture memorization.
hopefully i don't have to sell you on the value of memorization itself (read
psalm 119, deut 6 to know why it's good to know it, meditate on it, hide it
in your heart, etc), but i think there's great value in doing chapters and
even books. i'm glad some roommates of mine encouraged me in this many years
ago. one big reason is that it helps you keep the verse in context (which
is a big pet peeve of mine), so that you understand it better and you're not
just throwing things around that sound like what you want them to say. plus
you always know what all is in the book, so you have a reference in your head
for future study. and it's great to be able to "read" in your head
when you're walking around or driving or laying in bed. and i've noticed that
it's so much easier to study a book when i'm memorizing/meditating on it and
likewise it's much easier to memorize when i'm also studying it. it sounds
hard, but it's really not, and there's no set speed or anything you have to
go at. obviously, for whatever reason, some stuff sticks in your brain easier
than others (for instance, i still remember things from 10 or 15 years ago,
like the prologue to the canterbury tales (in old english), the words to "it's
the end of the world as we know it" (REM song) and "the raven"
(poe), and the combination to my bike lock from 5th grade (4639-don't try
to steal my bike, i have a different lock now!)), but whatever work you put
in is well worth it. and that's always a prayer request for me. that i would
be diligent to know His word, and not for the purpose of knowing such and
such amount of verses, but to know Him and to be conformed to His image through
it.
ich gehe jetzt schlafen
Friday 8/27:
another not too exciting day (except that it's friday and i don't have to
work tomorrow!!) i still had some coughing fits today, but my nose is a lot
less full of stuff, and there were isolated times where it was actually all
clear. we're almost there, people. i got to eat a real breakfast today, and
that was good (i usually just eat dry cereal before work). we had some time
in the morning and went down to the cafeteria. i had some eggs, and a biscuit,
and a hash brown (the long kind, ala mcdonald's, not the cut up kind. my favorite
way to make a potato) -editor's note: bobby's favorite style of potato is
actually the tater tot, but hash brown is like a large tater tot to him--
, and a bear claw (my favorite donut). one of my patients, an 80 year old
woman who had half of her colon taken out due to cancer, had a scary period
of unresponsiveness last night. we transfused a couple units of blood. when
i went see her this afternoon, she was up in her chair and talked my ear off
about her childhood (as a 5 year old, she worked picking cotton for $0.05/bag;
kids today are such slackers). but it was great to see her doing well and
hopefully she'll go home soon.
tomorrow off then on call again sunday.
have a fabulous weekend
bobby
ok, here's some highlights
from the past couple of weeks.
there were a few notable traumas. we had one guy in a car accident, not many
problems, just a pneumothorax (which we discussed last week i think, when
i got to put the chest tube in). anyways, this time i got to see a chest tube
put into a patient who was awake (mine was in a coma). apparently, if you're
awake, it's very painful to have your chest cut open and a large tube shoved
next to your lung. who knew? the doc put some local anesthetic in, put when
he got down to the bone the guy was just yelling obscenities. plus it took
him a little to get it in. again, that's the beauty of anesthesiology- the
patient is totally out of it. we had another trauma victim who was a lady
who had passed out at home after hitting her head while out drinking. her
friends came to check on her the next day and she was unresponsive. she came
in and had a big bleed in her brain and needed an immediate craniotomy (hole
in head), and luckily i knew the resident working with neurosurgery and got
to scrub in for that (networking rules; it's all about who you know). that
was really cool. the neurosurgeon who was doing this is a total nut. he makes
everyone call him "daddy". literally everyone. so it's not uncommon
to hear "page daddy", "daddy's in the OR", etc. that kills
me. i guess you can do whatever you want when you're a neurosurgeon. and the
best part of this whole thing is that now whenever people say "well it's
not exactly brain surgery", i have a point of reference (that's pretty
much the only reason i came to med school. now i can drop out and join nasa
to get an idea of what rocket science is all about). anyways, they have a
special drill that bores down through the skull and stops spinning once you
get through (a safety feature to avoid brain drilling). then he used a saw
to cut out a wedge the size of a credit card and there was just tons of clot
all around the brain. then he basically cleaned all that out and stopped all
the bleeders and closed up. she still didn't do too good (i think she passed
away a couple days ago), which was sad, because i had taken her daughters
into the er to see her before the surgery and talked with them for a bit.
the last big trauma was a 40ish year old guy who had shot himself in the head
with a .22. we found out later that his wife had died in january, then his
girlfriend had broken up with him in july and he had shot himself then. but
that time (also using a .22) the bullet had not penetrated his skull and he
evidently just stayed home and bled. then he did it again this time, and the
bullet went in one side of his head without coming out the other and kind
of shattered in his brain. even with all that he still wasn't dead (although
he was vegetable-ish) and survived a few days in the icu. now like most doctors,
we did make some jokes about how you'd think after the first time he would've
used a bigger gun and that kind of stuff (which probably seems cold/callous
to outsiders, but with all the junk we see, you kind of have to make light
of it or you'll constantly be depressed-it's kind of a fine line), but it
was a pretty pitiful sight looking at him lying there in the er with a hole
in his head. i saw his driver's license and he was just a normal looking guy,
could be anyone you know. but for whatever reason he got to a point where
he just had no hope and death seemed better than life. i guess i just don't
understand how things can get that bad. and the sad part is that he must have
known someone who knows the One who gives hope (romans 15:13: may the God
of hope fill you with all joy and peace as you trust in him, so that you may
overflow with hope by the power of the Holy Spirit), but for whatever reason
he never saw the gift or the Son as valuable. to kind of correlate this with
what i'm studying in 2 peter (since knowledge is useless without application),
i was just encouraged to be all the more diligent to be obedient and Christ-like.
1:3-8à because i'm someone who has, by His divine power, received knowledge
of Him and precious and magnificent promises. and for this very reason, i
desire (and am able) to make every effort to add to my faith goodness; and
to goodness, knowledge; and to knowledge, self-control; and to self-control,
perseverance; and to perseverance, godliness; and to godliness, brotherly
kindness; and to brotherly kindness, love. and through that to be fruitful
and productive. i'm not obedient to earn salvation or merit favor, i'm only
obedient because i already have been saved and have received favor.
my last night of call was pretty uneventful. i got to watch the first 90 seconds
of the a&m game, then (thankfully, if you watched it) i was called away
by the residents to go to dinner at mcallisters- which is kind of a no-no,
because technically all of the trauma surgery people are supposed to be on
campus when on call, but luckily no traumas came in. after that we had a handful
of consults, but nothing big. i actually wound up sleeping for about 4 hours.
it wasn't great sleep though; i had the automatic wakeup call service call
me every 30 minutes because i was afraid i'd sleep through a trauma page.
and thanks to great scheduling, i was done with call friday morning at 11,
so got to go home, plus i had the weekend and labor day off; pretty much a
4 day weekend.
i went down to matagorda bay and hung out on the beach saturday with a group
of friends. great times. i hadn't been to the beach (in the water) since i
was a kid. there's something about not being able to see what's swimming around
me that creeps me out. luckily i was able to overcome that. there was this
nasty stuff in the water though (seaweed or seashrubberies or something) that
kept rubbing up against me. that was freaky, but i got used to it after a
while. and it was neat to see a different aspect of creation for a while.
waves are fun to watch, and it's salty, and there's lots of it. plus at night
it was really dark out there and there were mucho stars around. then sunday
we had a surprise 50th birthday party for my dad in houston. that was great.
he totally didn't expect it, and his family came down from louisiana. and
it was fabulous to see all of them (and i'm not just saying that because they
read this :). also, i found out sunday that 2 of my friends were proposing
to their lady-friends. and i got to go to the after party for one of them
and see some old kingwood friends.
this week has been pretty slow because of tests. i took the oral exam yesterday
and can i just say "boo-yah" to that (that's good, for those not
familiar with the boo-yah). i nailed both questions (not so much because i'm
smart, but because they asked stuff i knew). the basic format is "a 45
year old female comes into the er with epigastric abdominal pain" and
then you have to do all the doctor stuff (get a history, do a physical, order
labs/xrays) to figure out what's going on and then say how to treat it. one
was gallstone pancreatitis with ascending cholangitis. cake. the other started
off as just an uncomplicated hernia, which seemed too easy, so i got suspicious.
basically the doctor doing it wanted to make sure i did a digital rectal exam
(aka DRE, basically a finger up the caboose) which found some blood which
led to a cancer diagnosis. the funny thing is that all of the docs stress
always doing the DRE as part of a complete physical exam, and then none ever
actually do it. that's one of the hard things about academic vs practical
medicine. some of the stuff we learn either doesn't apply at all or is never
used. for instance, for a lot of diseases, there are features that go with
specific diseases (i.e. painless jaundice=pancreatic cancer, right upper quadrant
pain after fatty meals=inflamed gall bladder), but in real medicine we learn
that most of those things sometimes only occur 10% of the time or something
like that, and are totally useless. the same goes with physical exam stuff.
for appendicitis, we learn for 2 years that we should always look for rebound
tenderness (push in on the belly, then let go quickly and see if the pain
is worse when the belly bounces back out), then we learn in real medicine
that it's barbaric to do that to someone with appendicitis. the only really
important use of all of that info is for the standardized tests where they
like to ask all of the "classical" signs/symptoms. i digress. the
point being that the oral exam went really well. and i'm starting to feel
somewhat competent (atleast as far as dealing with surgery related things)
as an almost-doctor. i learn so much better when actually doing things. oh,
and one of the most important things i learned, that will help you out if
you ever become blind and need to get on an elevator, when they open up, the
make one "bing" if they're going up, and two-"bing, bing"-
if they're going down. one more test tomorrow then i'm done with surgery forever.
i'm glad the hours will get nicer, but i'm afraid that after all of this excitement
the other rotations will seem boring. next up is ob/gyn. hopefully i'll have
some sweet baby stories to share.
until then,
bobby