Thursday, October 25, 2007

The long season of Appys and ghost tumors

So the last 48 hours have been pretty much the longest of my life. I got a good taste of what is in store for me post-graduation (I hear the internship screaming my name). It went a little something like this....

Wednesday was going to be a great day, we had some really interesting surgeries planned for the day. Wednesday is the big surgery day for the surgeon I've been working with for the past month. Since this was going to be my last surgery day on this rotation we scheduled 4 surgeries for the morning; one retrograde cystoscopy/pelvic mass removal, one neck and thyroid exploration, one hernia repair and ONE lap appy (laparoscopic appendectomy). The first surgery was scheduled to begin at 0730, so I was there at a little after 0700. The patient came in the surgery proceeded and of course went over the time we had planned. No problem, we only had THREE more surgeries and it was only 1015. It was only downhill from there.....

The neck exploration was supposed to be so we could find some recurrent thyroid cancer......4 1/2 hours later and no mass to be found we finally gave up and finished the rest of the surgery. Ok NOW we were running a bit late, it was 1530 and we had only finished our second case. Mostly we were upset because it meant that the following two patients who were supposed to be done by early afternoon had not had anything to eat since last night and they were still going to have to wait. We were so behind we got right into the next case, a simple hernia repair. Luckily it was just that, simple. We got this person done and got moving on our "last" patient of the day an inflamed nasty case of appendicitis. It was at this point that our day took a turn for the long....

You see, we were operating at one of the two hospitals in Logan, and simultaneously we were on call at the other hospital. Seeing that it was now after 5pm the emergency room called the operating room and informed us that there was possible two more cases of appendicitis waiting for us. We had them admitted and they were told to hang tight until we got over there. Oh yeah, the ER also had a pneumothorax (dropped lung) for us to consult on and admit when we got there. We finished lap appy #1 around 6pm and headed over to the ER at the other hospital. We took care of the pneumo guy and go him admitted to the surgery floor. We evaluated the two people waiting for the appendix treatment and decided they both needed surgery. Off to the OR we went. We got going on appys #2 and #3 as soon as we could. Both cases were relatively straight forward and went off with out a hitch, so they went pretty fast. Around 20 minutes from incision to closure. Closing did take a little longer since we decided to suture them (for my practice) instead of skin staples. But we got done with the surgeries and the heaps of paperwork around 2230. Ok, I was exhausted. I had been on my feet for 15 hours holding retractors, driving the scope, sewing and trying to learn. I rode home, crawled into bed with Eugena and crashed. Less than 2 hours later Eugena wakes me up telling me someone called me. Although my phone was right next to my head it didn't even stir me. I checked who it was and sure enough it was the Doc.....we were on call all night and one more of the appendixes in the world decided to call it quits. So around 1am I'm back in the ER evaluating this patient and sure enough she needs surgery. 2am...back to the OR. We get the patient in the OR, quick induction of anesthesia (the anesthesiologist let me intubate!), and we're back in the belly for appy #4 since 5pm. We get it out, close em up, finish the paperwork and stop by the ER to make sure nothing else is there before we get back in warm beds. There must be some weird alignment of the moon or stars cause this little organ was going bad left and right here.....yeah appy #5 had just walked into the ER. Most of the OR staff (Anesthesiologist, scrub nurse, circulating nurse, recovery nurse) had gone home. Once we rounded everyone back up again we were back in the OR taking out #5 in the space of 11 hours. Needless to say my eyes were screaming out for sleep by the time we finished around 430 AM. I drove home very carefully, luckily we don't live far from the hospital.

I had to be back at the hospital at 0730 Thursday morning to round on the the heap of patients we admitted post-op.

Final count:
20 hours either in the OR, in the ER or on the floor.
4 hours of "sleep"
9 surgeries included the pneumothorax (we placed a chest tube which is a minor surgery)
15 trocar port sites closed by me (3 per appy patient)
1 intubation
and I'm pretty sure I ate some food somewhere in there.

I think the worst part about this is that I had not mentally prepared for this long of a day. I've done 20+ work shifts before and I've gotten through them. But this was unexpected. I know I can expect days like this during internship, so in that sense it was a good look into what is to come.

Today (Thursday) after getting home at 0430 sleeping for 3 hours I went to the hospital to round. This morning a patient asked the doc about the role of the appendix, he replied "It's there so it can go bad and they can wake us up in the middle of the night."After rounds, we had a full day of follow-ups and consults in the office. I did get to remove a couple lipomas from a patients arm on my own, which was cool. Oh, then we had an emergent bilateral hernia repair this evening after the clinic at 5pm. Yeah, long days, but I've had a good time on this surgery rotation, it's fun to be in the OR, working with your hands, cutting, sewing, stapling, taking stuff out....not quite sure I want to spend this much time in the operating room though.

I'm going to bed....stupid appendix...

1 comment:

Cycling Phun said...

So that's what an appendix gone bad looks like? I hear a little Kosher Salt and some Pepper, stir fried, not too bad. In all seriousness though, I don't know how the heck you guys do it.