Wednesday, July 27, 2011

Loooong Day

Well today was extremely long. Kinda surprised it didn't FEEL longer. Got to the clinic at 8:30am, expecting a short clinic day getting out around 12:30 or 1:00 - instead, the doctor was about 20 minutes late so we had a lot of catch up most of the day, and I didn't have the PA student with me so I had more patients to see than usual. I also did some injections and assisted with a skin nodule extraction - outpatient minor surgery at the clinic. Mostly stressful just because I wasn't sure how to do any of it, not that it was difficult. By the time the patients were gone it was probably 1:30, and I was trying to finish up my SOAP notes. In the meantime, the doctor was trying to get a bed in the OR for a patient with an ulceration in his intestines and was having trouble. Eventually it was scheduled for 3:00 PM, so we drove over to the other hospital around 2:15pm, I got dressed, checked the OR list of procedures to see how on time they were, and then rushed to the physician lounge to get something to eat or drink. Found an energy drink, elected to use the zero carb one, downed that while I waited for 3:00 to roll around, around 4:00 maybe the surgery started.

Today we cut into the first patient's abdomen, and pulled the intestines out of the abdomen and onto the patient's belly so we could look for any perforations that were causing the patient to lose fluid into her peritoneal space. This consisted of cutting away the connective tissue holding the intestines coiled and going through it at length to find stuff. It really looked like an evisceration. Got to see a bunch of new anatomy, and it was an interesting exploration - didn't find a perforation and the fluid was all clear, so it was probably from the pleural space. After that, the doctor had to do ANOTHER one, except this time the guy almost certainly had a perforation in his gut somewhere - he was in a lot of pain. We did the same thing as for the first patient, except we found the hole in the guy's sigmoid colon and the fluid in his abdomen was brownish. Yeah, pleasant. Anyhow, I got to see how you cut out a segment of colon and reconnect it. There are a lot of specialty clipping tools and ways of doing it that I hadn't thought of - it was very interesting. I mean, when you think about it, how do you get a piece of large intestine out and connect the tubes without spilling fecal matter all over the place? With lots of nifty tools and tricks, that's how.

Anyway, got through all that, by the time all this was over and the patient was back in his hospital gurney, it was 8:00pm. SO..... basically a 12 hour day. A few pluses: Saw some new procedures, assisted in new procedures, talked more with the surgeon, and people (including the surgeon) were addressing me by name for the first time. Guess they're starting to get more used to me.

As an aside, for anyone who has played RPGs, I started feeling like a total NPC today - following him around, if I lingered and he got away from me a bit I would jog to catch up, I'd be stuck in doorways or be hindering things (but honestly mostly helpful). When I got that thought in my head it was hard to not laugh. Another day of surgeries tomorrow, hopefully just the three that I know are scheduled. Time to take some ibuprofen for my aching feet - I didn't know we'd have surgery so I stayed in my dress shoes all day and my feet are KILLING me!

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