Feeling kinda quiet today. Have lots of studying to do anyway. Hopefully I'll be able to sort myself out before the Angels game tonight with Daniel. The gym should help a lot.
I've been to a couple of yoga classes this week and was re-acquainted with something I had forgotten from my previous, limited experience with yoga.
Several days ago, I wrote a post that prompted a lot of comments about butt pus, which reminded me of a story of when I was a medical student. So today, on my last day of residency, I'll re-tell the tale that happened when I just started out on this long journey to becoming a surgeon seven years ago.
My surgery rotation was the last of my third year. After being on the service for a mere four days, I had decided I could do nothing else except be a surgeon; these were the people with whom I was meant to be and this was what I was meant to be doing. I told my residents as much and they could see my enthusiasm. They let me do more than other medical students because, let's face it, if you're going into radiology, you're not going to need to know how to tie.
One of the calls that had come in during the day was a perianal abscess that had come into the emergency room. We had just finished one of our weekly conferences, where we were all supposed to dress professionally and not just in scrubs. I went down with the chief resident, also named Nicole (note the lack of an "h"), who told me she was going to walk me through the incision and drainage of the abscess. The butt pus, if you will. From what I can remember, it was a young man, not many medical problems except the painful, giant, pus-filled pockets around his anus. (Again, I'm rolling my eyes at the google hits I'm going to get with this word, but what are my choices?)
Before we went into do the procedure, she explained how she was going to numb the area and the kind of incision I was going to have to make to adequtely drain the area. I was nervous, but excited. I couldn't get into any real trouble... I was with my chief.
We warned the patient the prick of the needle that would deliver the anesthetic was coming. After a few seconds elapsed to let it take effect, she motioned over the abscess where I was going to make my incision. I grabbed the scalpel and make the ellipcial incision and removed a little piece of skin. (We take out a bit because if you just make a linear incision, the skin could heal before the abscess cavity and you can have a re-accumulation of pus which would require another drainage procedure.) But there was no pus there. She had warned me about this. That it might be a little bit deeper and I would have to probe with an instrument and break up separate cavities.
She handed me an instrument and I started to dig a little. Well, dig gingerly. She kept frowning. "Where the hell was the pus?" she communicated nonverbally.
"Let me try something," she tells me. Fine by me, I really didn't know what I was doing anyway. She digs now, albeit a little more agressively.
"Sorry, sir," she apologized, which was more an acknowledgement of the pain that we were causing him and less of an assurance that we were close to being done.
She put down the instrument and begins to squeeze the affected area. Yeah, squeese like a giant zit. After all, that's what it was.
The pesky little bastard gave. We found the motherlode of pus. It came flying across the table... and landed on the hair that was draped over my right shoulder and on my silk sweater.
My eyes got really big and I stepped back from the gurney. "Oh my God, did it get me?" I whispered.
"Let me see," she said. I walked over and she inspected my shirt. "No, I don't see anything."
"But I smell something," I insisted. "Are you sure?"
She looked a little harder. There was a small intake of breath. "Oh... yeah. It's right there," she said as she pointed at my right clavicle.
If you've never smelled butt pus, let me assure you, you only need a few tiny little drops to know it's there. And these were small drops... like condensation on a flower in the morning. Except it wasn't dew on a rose. It was butt pus. On my hair and sweater.
"Why don't you go get cleaned up? Go home and shower and come back." Even as a young medical student, I knew the magnitude of this gesture. Surgeons don't leave the hospital if they get blood on them. They clean it with a little soap and water, change their scrubs, and keep going. Most of the time, they don't even miss a step. But I was being sent home. Which was a good thing, because I think I might have eventually thrown up at my own stench.
The news of my misadventure in the ER spread like wildfire. Actually quicker than wildfire, because one of the interns ran around the surgical floor spreading the story. When he was done there, he went to the OR and told each and every operating room team what had transpired.
When I returned to the hospital, people were asking me how I got my hair to be so shiny and smooth. Was it the butt pus conditioner I was using? Ha ha, very funny.
And from then on, I was known as the butt pus girl.
This is my penultimate day of work. As such, I thought I'd share a couple of funny stories about my embarrassing experiences I had on my road to becoming a surgeon. No, this isn't the butt pus story; that's tomorrow. Promise.
This is a story of when I was an intern on trauma... naive and scared of everything. During a trauma run, it is the intern's responsibility to do the primary survey and then the secondary survey. The primary survey covers A, B, C, D, and E: A - airway, B - breathing, C - circulation, D - disability (like a gross neurologic defecit), and E - exposure (remove clothing and keep warm with blankets). These are examined first because if there is an injury in any of these areas, you can die pretty quickly. Once the primary survey is completed and those areas are secured, we move onto the secondary survey, which is to complete the rest of the physcial exam.
This particular trauma started out like most others. It was a moderate trauma involving someone who was involved in a car accident. The EMS personnel arrive with the paient; sometimes, they come in about 30 seconds before the arrival of the patient, especially if there is something the team needs to know but they don't want the patient to hear us talking about.
The fireman arrived and stated that our patient was an obese male. He said it like that... emphasis on the word male. A few seconds later, we knew why. Yes, he was obese. But his facial features were very effeminate... long eyelashes, high cheekbones, etc. But we went with it. Focusing on the ABC's, which are all well above the waist. While I do that, a trauma tech begins cutting off the clothing, usually while the patient is covered by a blanket.
I proceeded with the secondary survey. I went to look... down there... and make sure there was no blood or bruising which might be concerning for a pelvic fracture. (Yes, I know that's not the medical term for it, but I don't relish the idea of all the random google hits I'd get if I did use the proper term.) But I didn't see his male parts. Nothing. I remembered the fireman emphasizing the word male in their report. Ok, then, where is it? Not hard to miss. No family jewels either. Fine. Then the girly parts should be there, too. But they weren't. It was just... nothing.
Sh*t. Now what? I moved onto another area to examine while I contemplated my dilemma. What could cause a complete lack of organs there? What if he were making the big jump to womanhood? Possibly. But he still needs to pee. That's not it. The only thing I could think of was some genetic abnormality. That was it. Well, even if it wasn't, I was just going to have to ask.
"Excuse me," I tentatively began, realizing the perils frought with such a line of questioning. "Do you have some kind of... congenital defect?"
"What?"
It was either that he didn't understand my medical mumbo-jumbo or s/he couldn't actually belive the question was being asked.
I tried again. "Were you born with some kind of... anomaly?"
"NO."
It was at that point that room had become hushed and all eyes were amusedly fixed on me and my interviewee. A male ER nurse, with years of experience both in medicine and seeing all kinds of bodies in men's locker rooms, took his two gloved fingers and pushed down on the mountain of fat where is male business should have been. When the fat was pushed down, what looked like a little turtle head popped out.
I apologized quickly. Assured that I had given this guy at least a short-term complex, I recognized that my job was done there and moved onto my next task.
I have 22 days left of being a resident. And only now am I fully understanding the level of sacrifice five years of residency plus four years of medical school has demanded from my family.
So now it's time for the world to stop revolving around me. It's time for life to be normal. It's time for me to stop bringing drama into everyone's lives. It's time for me to fill the simple roles of a daughter... a sister... a wife. And to fill those roles without people having to use an adjective beforehand that will help people understand why I'm not fulfilling those roles.
"There's this person in my head. She is brilliant, capable. She can do chest tubes and craniotomies. She can run a code without freaking out. She's a really good surgeon. Maybe even a great surgeon. She's me... only so much better.
It was a good day. Maybe even a great day. I was a good doctor. Even when it was hard. I was the me in my head. There was a moment when I thought, 'I can't do this. I can't do this alone.' But I closed my eyes and imagined myself doing it. And I did. I blocked out the fear and I did it."
--Meredith Gray, from Grey's Anatomy
I was on call last night and didn't sleep much. It could have been worse (it can always be worse), but I only got about 3 hours. And since I was on call over the weekend, I had slated this afternoon for doing some errands that I should have gotten done this weekend but was on-call. And that was worse, so Sunday afternoon was scratched as well.
One of the things on my very important to do list was to get a pedicure. Yeah, yeah, big necessity. But seriously, I stand all day. I have got to take care of my feet. I don't want hag feet by the time I reach the tender age of 35. Because Lord knows I'm going to have hag hands -- I've got to protect something.
The problem of me being sleep deprived when I run errands is that I can't make a freaking decision. I make them all the time, but when I'm coming of a night of work, I can't make a call. About anything. Not a good place to be in when you have to pick a color from about 300 different bottles of nail polish. That took me about 10 minutes. I was still unhappy with my decision when I sat down in the chair and proceeded to have a discussion with the little Vietnamese girl about the color. We talked about a paler color, but she said she liked the one that I picked because it would go well with my skin tone. She was right.
Then she asked me if I wanted a flower. Only $5. At first I said no. Then I started thinking. Why the hell not? I'm not going to be able to pull off flowers on my toes when I'm old and haggy, so I'd better enjoy it now. So I told her I did want a flower. She giggled.
If any of you have ever been to one of those all Vietnamese nail salons, this youtube clip is a must. Hilarious. Because you know they talk about you.
I am so blessed in this life. Time to list just some of the many things I have to be thankful for.
I'm not sure if any (three) of you noticed, but I added this thing called Twitter to my right side bar. Your right, not the computer's right. ;-)
I must say, I'm totally loving this silly diversion. I can update from my cell phone and track some of my other friends who use it, too. The whole "snapshot into your brain" thing is very intriguiging to me... If anyone who comes here joins, let me know so I can follow along!
If they had a punkymood of "murderous," I would totally pick that right now. Nearly every inten I have come across today I have wanted to kill. Can they stop telling me half-truths and remember to tell me about a consult you did for my service last night? Can I not take a day off without everything getting negletcted??
It's not that hard. If you don't know for sure, say "I don't know." Stop pulling sh*t out of your ass. If you do a consult because no one from my service is here, thank you. But you have to tell me about the patient so I can follow up on it. Please. I can't take it anymore.
So I'm going to settle for a "cold" punkymood because it's wet and rainy here. But now you all know how I really feel.
