Friday, September 24, 2010

A Day of Pus (and also, Failure to Launch)

I am now on my surgery rotation. Yesterday-into-today was my first surgery call...yippee! The main feature of the last 30 hours was two trips to the operating room to drain abscesses. (You may wish to stop reading now if you are a non-medical person who is eating, and return later on an empty stomach.)

"Incision and drainage," the technical term for sticking a scalpel into an abscess and squeezing out the pus, is a actually a non-technical enough procedure that I actually get to handle the knife. As I poked a giant swelling last night and pus just came pouring out, the supervising surgeon exclaimed, "Isn't that just the most satisfying thing you've ever done?"

Well, maybe not the most satisfying thing ever, but pretty darn satisfying (and also downright disgusting). I was very pleased to get to repeat the experience again this morning. As far as operating room experiences go, abscess draining fits all my criteria for a favorite procedure: short, hands-on, satisfying, and very very helpful for the patient.

Following pus-drainage experience #2, I decided that it was about time for me to leave the hospital, since there were no operations to scrub in on that would be done by 1 PM, when I had to leave after 30 hours on call. It was then that I experienced perhaps the most profound failure to launch of any end-of-shift experience thus far in residency.

11:37: sign postop orders for incision and drainage patient
11:39: one last check of electronic desktop for any patient care issues
11:42: reach car, start driving off hospital campus
11:43: pager goes off while at stoplight. Pull over, answer page from post-op care area. Apparently I failed to sign a needed form. Well, at least now I know that this form exists. Turn around, return to previous parking spot, return to OR
11:53: sign the magic form
11:55: talk with one of my fellow residents to update them on the surgery and on the postop orders
11:58: another final check of electronic desktop
12:00: return to parking garage. Sit down in car. Pick up keys and start to put them into the ignition. Get paged. Curse. Realize that it is the attending surgeon on call today.
12:01: walk back into hospital, answer page. Surgeon asks if I am "in the middle of anything." I state that I am not, but that I am only available for another hour since I am post-call. But yes, of course, I am happy to see the brand new consult!
12:04: power-walk to patient care unit, interview patient, examine patient, review labs and CT scans
12:38: page on-call surgeon to discuss case
12:40: receive call back. Surgeon is in operating room. Can I come down and talk to her there?
12:41: power-walk downstairs to operating room.
12:42: Present case. Get pimped (asked lots of questions) about medical vs surgical treatment of diverticulitis, the surgery options, etc. Hold my own reasonably well.
12:53: Surgeon agrees with my assessment that pt does not seem to need surgery at this point, and can I write a note in the chart? She will see patient once out of OR.
12:54: agonized glance at the clock. Power-walk back up to patient care floor and write consult note. Curse at the fact that I am constitutionally unable to write a note that does not approach the length of a Dostoevsky novel.
1:08: Slam chart shut. Power-walk (really approaching a jog) back to car. Successfully start car, leave hospital grounds, and make it all the way home.
1:28: hear pager go off while getting lunch. Non urgent issue...ignore.
1:40: pager goes off again, another non urgent issue. Finally get smart and turn pager off.

Now for an afternoon of peace, before another day on call tomorrow.

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