An arm and a leg

So...as of this afternoon, there are eleven patients on the vascular surgery service at UWHC (Univ of WI Hospital & Clinics), and only 55 toes between them. Considering that an anatomically correct count would be 110, we're running a bit short, largely as a result of my own hand, I might add (amputations are an "intern case"). It's amazing how many people neglect and/or abuse themselves to the point where an amputation is the only solution, and quite sad, really. One of my patients last week was only 32...that's barely older than me! She ended up with a TMA (transmetatarsal amputation - basically, you remove the toes and a small portion of the forefoot), which wasn't so bad considering how she'd neglected her health (for those of you in medicine, her Hgb A1c was 16!!!). She will remain very functional with her current amputation, but will no doubt lose more of her limb(s) in the future, since she voiced no intention of getting better control of her diabetes or quitting smoking.

Medicine, for me, is really a battle between trying to win my patients to my way of thinking (i.e., take better care of yourself and things will go better for you), and allowing them to make their own decisions (they're grown people...they know the consequences...they can decide for themselves). I like to think that most people are capable of running their own lives, but everyday I see the consequences of their actions, and oftentimes, they seem ill-prepared for what they've gotten themselves into...as if they didn't see it coming.

At any rate, enough of that business. So, I'm just about to start week four of my surgical residency. My current "rotation-mate", Jason, an intern from the orthopedic surgery service who is spending his first four weeks on vascular surgery with me, will leave at the end of this week. We've gotten along beautifully...he's smart, a hard worker, and a really good guy. It's been really nice to have someone to vent to, not to mention share the workload with. I just had dinner with he and his fiance tonight, and enjoyed it a great deal. Hopefully, we'll keep in touch as we move on to other rotations. It's always nice to have someone to call when you just want to let your hair down for awhile.

Last, but not least, my latest source of dissatisfaction with my life as a surgical resident is my nearly complete inability to do anything even remotely functional in the operating room. Despite the many hours I've spent tying knots at home and nearly everywhere else outside of the OR, it's as if I've never laid eyes on a suture before when I'm handed one during a case. The other day, the vascular fellow waited, seemingly patiently, for at least 15 seconds while I fumbled daftly with a silk tie in a vain attempt to ligate (cut off the flow from) a briskly bleeding artery we had encountered during our dissection. After taking the suture from me and effortlessly tying off the offending vessel, he mumbled something about it being July and not expecting much from the "new crop". I know it's still early, but I can't help but feel as if I'll never get the hang of all of this. As I mentioned before, it's been nice to have Jason around to lament to. He's had a number of similar experiences, and there's something to be said for feeling like you're in the same boat with a peer.

Well, it's getting treacherously close to my witching hour...tomorrow's another day of fun and frolic beginning bright and early at 0600! I hope all is well with everyone and that you're all getting a chance to get out and enjoy the summer. Until next time, I am, as always...

Yours sincerely,
~AC

231 Years Today

Happy Fourth of July! I hope many, if not all, of you are enjoying our nation's birthday with friends and/or family. As expected, I spent the better part of the morning in the hospital and will be on call starting at 5:00PM tonight. Ah, the life of an intern.

All in all though, I have to say I'm really enjoying being a resident despite the long hours and nearly continuous sensation of being out of my element. It's great to finally be someone's doctor, even if much of what I do is carry out orders from the guys with the big brains.

The vascular service has been interesting. Patients with vascular disease are some of the sickest in the hospital, since just about every other system depends on good blood flow to do its job. Thankfully, the nursing staff is, for the most part, very experienced and helpful. The more senior residents and fellows on the service are also a good group, as are the staff surgeons. We have two vascular fellows (fellows are residents who have finished their residency training in general surgery and are pursuing additional training in a surgical sub-specialty), one third year general surgery resident, and two interns (me and an orthopedic surgery intern). The other intern, Jason, is a graduate of the University of Wisconsin Medical School and knows his way around the hospital quite well. He's been a great asset to have on the service starting out...we've relied a lot on each other during these first few days and it's worked out quite nicely.

Regarding the patient population, much of what we do involves repairing aneurysms that occur in various blood vessels: most commonly, the aorta and its immediate branches. Depending on how the patients are treated (usually with either open or endovascular [stents and wires] surgery), their post-operative care can get pretty complex. They typically do quite well though, and it's rewarding to watch them improve from "circling the drain" to walking out of the hospital under their own power. We also treat several patients with sequelae of long-standing vascular disease (e.g., non-healing ulcers and bone infections). Despite the...well, let's just say interesting...smell and frequently gut-wrenching appearance of the feet and are therefore commonly slightly less eloquent than those of the aneurysm crowd, one kind or another (e.g., above or below and knee), and I firmly believe you haven't lived until you've handed a circulating nurse the lion's share of a severed human leg and legs of these patients, I actually enjoy them more because their operations are "intern cases" (this means I get to operate). Most of these cases are amputations of covered in betadine as routinely as if you were passing her the mashed potatoes at Christmas Dinner.

At any rate, I should really get some other things done here before my pager goes off again. Hope all is well with everyone, and I look forward to putting up another post again soon. Until then, take care and remember to live clean and fight dirty!

~AC