Yes...I'm still alive

For those of you who were wondering if I gave up and went home or suffered some other horrible misfortune rendering me unable to type, I am actually doing well and still able to post to my blog (although you wouldn't know it from the number of updates I've put up during the past few months). Everyone realizes I'm busy and it's really a cop-out to use a cliched phrase like that anyway. Truth is, I just haven't taken the time to write. Nevertheless, I'm writing now and I've got a good deal to cover, so here goes.


Currently, I'm on Pediatric Surgery at the American Family (yes, the insurance company...first our magazines, then our stadiums, and now our hospitals...is nothing safe from the ever-tightening grip of corporate America?) Children's Hospital, the new children's hospital attached to the main UW Hospital. It's a well-equipped hospital in my opinion; although, those with more experience with Pediatric Surgery tell me the program here is really somewhat inadequate. We have only two Peds surgeons, both of whom are good surgeons and teachers. But with only two, our service volume is arguably small. This is nice from an intern standpoint (i.e., my workload is much more manageable than it has been on past rotations), but might leave something to be desired in the way of exposure to Peds Surgery. All in all, I'm enjoying myself. I don't have much interest in a career in Peds Surgery, but kids are fun to take care of in that they are very resilient and almost always get better, often in spite of what we do to/for them. Also, the team is currently led by a terrific chief resident, Ben Mandel. He has led a rather interesting life, the details of which I'll hopefully relate in a subsequent post.

I've also had a whole host of interesting experiences away from my work at the hospital. I'm fortunate to get along very well with all of the other five members of my intern class, as well as the other interns from outside specialties (e.g., Anesthesia, Ortho, Neurosurgery, Plastics, ENT) and General Surgery residents in the program. Particular activities of interest over the past few months include: 2 UW Badger football games (one in the student section [I'm getting too old for that craziness] and one in the "good seats"), one Green Bay Packers game at Lambeau Field (just this past weekend...a great time), the Madison Symphony, several 30+ mile bike rides through the Wisconsin countryside in the fall (usually failing at desperate attempts to keep up with my riding partners...more about them later also...for now, all I need to describe them is one word - triathletes), and a number of recent attempts at improving my luck at cross-country skiing. All of this has helped keep me somewhat sane despite the mounting demands of residency, and I'm obviously thankful for that.

I also was fortunate to get a week of vacation around the Thanksgiving holiday, which allowed me to make the trip out to CA to spend time with my family. My grandmother has a home in Morgan Hill, a couple of hours south of San Francisco, and my folks and sister (and her family) made the trip out as well. It was great to see everyone and I benefited enormously from the break. I spent the first couple of days traveling up north into the Redwoods and camping out with my dad. It was an excellent time, despite some rain.

Regarding the other rotations I've completed since my last post, I've rotated through both Orange and Blue Surgery. These are two of the busiest rotation and are considered the "core General Surgery rotations" during the intern year. Orange is the colorectal and minimally invasive service, which largely entails operating on various parts of the gastrointestinal tract, often through small incisions with the aid of a laparoscope. This was an extremely busy rotation, as our census (with me as the only intern) was often in the mid to upper 30s (meaning we were caring for 30 or more patients in the hospital). The cases were largely bread-and-butter General Surgery, which was nice. However, the amount of paperwork and daily chores on the floor were often overwhelming and led to a significant amount of stress. Furthermore, operating became something to be dreaded rather than eagerly anticipated since all of the floor work (by the way, when I say "floor" I'm referring to the inpatient hospital unit(s) where all of our hospitalized patients are residing and being cared for. This is in contrast to the ICU ["the unit"], the recovery room [PACU, pronounced pack-you], operating room [OR], etc.) was waiting for me after my time in the OR (i.e., there was no one else to do my work for me, so operating made the days very hectic and long). All told, it was a good rotation and I increased my comfort level and surgical knowledge base a great deal.

After Orange came Blue, the hepatobiliary, pancreas, endocrine, and surgical oncology service (translation: liver, bile ducts/gallbladder, pancreas, thyroid/parathyroid/adrenal glands, and cancer surgery service...probably not much of a translation for the non-clinical members in the crowd, I realize). All of that aside, the important thing about the Blue service is that it is "The Chairman's Service", meaning that all of the politically important people in the residency program are part of it (e.g., the Chairman of the Dept. of Surgery, the Residency Program Director, the Chief of Surgery at the Veterans Admin. Hospital). Needless to say, this was another stressful rotation, albeit for different reasons. This was a less busy service, but the patients were considerably more ill as a general rule, and the pressure to perform at my peak often felt crushing. A particularly anxiety-provoking aspect of this rotation was the conference held each Tuesday morning after rounds. Basically, the faculty assembled in a shallow arc of high-backed wooden chairs at the end of a long hallway on the 6th floor with a gigantic plate-glass window behind them (and remember, this group included the Department's movers and shakers). We, the lowly residents and medical students, gathered in small chairs before them, facing the giant window. The real kicker here was that the window faced east and inevitably, the sun seemed to be perpetually rising behind the the assembled faculty blinding us and adding to our sense of ineptitude and anxiety. I won't bore you with the painful details. In short, every week the faculty expected us to have a better command of the topic being discussed than we actually did. It was a stout weekly brow-beating, but I will say this: I learned a lot during that conference, anxiety or not. Again, overall it was a good rotation and one during which I got into the operating room a fair amount, mostly on Friday mornings to do parathyroidectomies with Dr. Chen, the Chief of Endocrine Surgery.

At any rate, this is getting ridiculous and I've spent over an hour at this point. Note to self: write more often and it won't be as painful. With that, I hope life is treating all of you well and that you're looking forward to a great Holiday Season. I'll try and write again soon. Until then here's wishing you, as always...

All the best,
AC

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

The final hours of freedom

Tomorrow is the first day of my life as a resident. My first six weeks will be spent on the vascular surgery service at the University of Wisconsin Hospital (UWH), along with another intern from the Orthopaedics program and a third-year from the general surgery program. I'm nervous to be sure, but also excited. I just hope I don't let my colleagues, or my patients, down.

It's nerve-wracking to think that so many other people are going to be depending on me to do my job well. Some may even be dependent on me helping keep them alive! Well, enough of that...you get the picture, "great weight, long road, uphill, both ways, and so forth".

We (the other five incoming interns and I) played softball with the faculty and current residents today. It was beautiful outside (this seems to be par for the course in Madison), and we had a real good time. Everyone seems very friendly, and I think I'm going to enjoy both my fellow interns and most of the upper levels (second through seventh year residents) as well. The program director, Dr. Mahvi, is a particularly enjoyable person. He seems very approachable and is the kind of person you can see yourself sitting around, drinking a beer, and telling it like it is with. Overall, it seems like the residents work hard while they're at the hospital and have a lot of fun when they're not.

Anyway, I should really do a bit more reading on the patients I have to round on tomorrow morning. I'll be back to let you in on how things are going as the week progresses. Until then, I hope all is well with everyone and remember, live clean and fight dirty.

~AC