Surgery is my FAVORITE!

So far this is my favorite rotation and I knew it would be, simply because I get to see, cut on, suction out and sew up patient's insides. You all know what a freak I am about doing the gross stuff and this rotation is maxing out the gross factor for me, today I had poo on my shoe... and I couldn't be happier :)

The surgeons and PA I'm working with are all extremely friendly, nice, helpful and informative, answer all my questions (even the dumb ones) without making me feel like an idiot. What's even better is the OR nurses are super nice too! In the OR the scrub nurse is the boss, if you touch, move, turn wrong and become "unsterile" she's all over you. Luckily I haven't done anything that has warranted a chastising. One of the nurses even said I "look comfortable in the OR" I was so proud that I fake it so well ;)

During surgery on my first day I developed a tickle in the back of my throat (fortunately we had discussed what to do in this situation during our practice day in school). So I stepped back from the table to cough and as I did everyone in the room stopped and turned to look at me. I'm sure they were watching to see if I was going to faint or vomit or something. So when I coughed they all turned back to what they were doing, it was funny and at the same time extremely unsettling to have the eyes of the entire OR staring at you waiting for you to crash and burn.

I also did "rounds" for the first time on Friday, I was supposed to be in the office observing post-op appointments but the Dr. decided I wasn't going to learn anything from a few patients with no complications, so sent me over to the hospital to "pre round" on the patients that had been admitted. Now I've never done rounds before, the rounds in Browning were...... let's just say extremely informal, so I wasn't exactly sure what to do, so I figured I'd just wing it. Lucky for me at least one of my presentations was "good" so I'm going to consider that an overall win. :)

At the end of my first week I've seen a Laproscopic cholecystectomy (gall bladder removal with cameras) Breast cancer lumpectomy, Hernia repairs (inguinal and umbilical - groin/belly button) Hemicolectomy (small section of colon removed) Sigmoid colectomy (last part of the colon before the rectum) and a couple skin lesion's removed. I've gotten to feel tumors, colon, small bowel, gall bladder, gall stones, nerves, lymph nodes, and liver. The last surgery today I got to suture up the three holes made for the "ports" used during the laproscopic portion of the sigmoid colon resection. I've been told by all the surgeons and the PA that pretty soon I'll be doing closing, writing the post op orders for in-patient and outpatient surgical procedures. I'm pretty excited and I can't wait to do more. For now I'll continue to practice my subcuticular suturing technique, so when the time finally comes I'll be ready to roll.

Aaaaaand I'm OUT!

last day of work at Blackfeet community hospital today and it was fantastic! Spent the day with ENT/craniofacial/Plastic surgeon Dr. Santin, doing surgeries and seeing all the most interesting/difficult ENT cases Browning has to offer. I learned a ton of new things and Dr. Santin helped polish my OR etiquette so I don't look like an idiot in my next rotation.

After I finished my day with Dr. Santin I made my rounds saying goodbye and thanking all the Doc's and staff members that have made this rotation such a wonderful experience. I even got a little choked up during my goodbyes to a few of the the Doc's and a couple MA's that were really good to me during my time here. I will miss the people, the beautiful views and lelou the stray dog who walked me home everyday, Goodbye Montana, goodbye Blackfeet Indian Reservation, goodbye Browning, I AM SO EXCITED TO GO HOME!!!!!

A little preview

Today I spent the entire day in the OR, I figure this is a wonderful little preview of how my surgery rotation is gonna go, and man oh man do my feet hurt! 5 hrs standing, I even wore my most padded, comfy, old lady, easy spirit walking shoes and they still ache. Despite the ache in my feet and back I LOVED it today. This morning I watched the podiatrist debried a mid-tarsal amputation that developed a giant "hema-tomato". This is the 3rd surgery on this patients foot in 1month and I've got to say, I honestly think this guy has some kind of death wish. He's way beyond being "non-compliant" he's a nightmare to treat. He sneaks out of the hospital to go and get drunk, pulls out the drain and then walks close to a mile on his freshly amputated foot. Then when they put him in a room next to the nurses station to better monitor him, he unhinges his window and sneaks out again, so it's no surprise he ended up with osteomyelitis and a giant hematoma! It's hard to watch because he's really a nice guy, he's just an alcoholic and keeps making horrible decisions.

Anyway back to my day...

So I watched the pretty blood foot surgery, got to hold the debris bucket and work the suction tube. Then what was supposed to be a quick Lap Chole I was just going to observe became the highlight of my day! The other Doctor who was supposed to assist the general surgeon couldn't make it so I got to be the 1st assist!! I ran the endoscope camera and one of the grabbers holding up the liver and the fundus of the gall bladder. Unfortunately the super inflammed gall bladder was being tricky and we were having a hard time keeping ahold of it. The general surgeon decided it wasn't going to work laproscopicly so we went in Old School and did an Open Chole!! Giant almost 12" incision across the right side of the abdomen and I held the retractors and ran the suction, while he cut and cauterized the bleeders. The toughest part was standing for 3 1/2hours and pulling on the retractor for 1hr. My feet were killing me and my arms and hands got so tired. But getting to sick my entire hand in the patients abdomen was totally worth all the pain. After we finished he suture closed the facia layers and I stapled the entire incision and then a suture into the two smaller incisions where the ports were from the laproscopic attempt. Today rocked, can't wait for surgery to start in 12 days!!!!

Halfway through

So I've reached the halfway point for this rotation and still can't believe how fast it's gone and how much I learned in such a short period. Today I spent the day with the ENT (Ear, Nose and Throat) Nurse Practioner Mr. McDivit. He is fantastic, funny, super knowledgeable and a great teacher. I watched him do a layrngoscope exam and watched the vocal cords move as the patient said "eeeeeeee" and "aaaaaaaaaa" it was very, very cool. I also learned how to do the Dix hall-pike maneuver for BPPV (Benign Paroxysmal Positional Vertigo) which started a long and interesting conversation about dizziness and nystagmus (eye bouncing) and all the different kinds of things you can tell from putting people in certain positions and watching their eyes.... AMAZING!!! I also will be getting the opportunity to watch tonsil/adenoidectomy, ear tube and cleft palate surgery right before I leave because the ENT surgeon who volunteers to come up here and do ENT surgeries 2x year (FOR FREE) will be here the day before and the day I leave. So I am extremely excited about that!

Well better get back to studying, I was given a book and 4 articles to read tonight about "practical management of the dizzy patient" so tomorrow I will be better informed on the subject and ask some more "good questions". Here is what I got to see in person (this is however NOT the actual exam I witnessed, I just thought it was a good example to see what I saw )

How I spend my days

There are a great many things I love about this rotation, but I think the top 2 have to be my freedom at the hospital and the Native American culture I've been immersed in.

1. I have, at my disposal, every department in the hospital, virtually no student competition (Hugh, the medical student spends all his time in the ER) and everyone has been extremely willing to have me come by and hangout for a few days, take their time and teach me. I'm taking this new found freedom for all it's worth and trying to spend my time where I think I would not otherwise have the chance to see at all. For example I got to hang with the podiatrist last week and next week I'm going to spend 2 days with the amazing ENT NP and the Optometrist as well as some OR time with the OB/GYN Doc's. We have rotations in major/general fields of medicine but not much time to spend with the specialties and I'm trying to get as much of that as I can while I'm here.

I have spent most of time with OB/GYN outpatient doing ultrasounds, prenatal checks, pap's and some IUD insertions and removals and I know what your thinking... yes going out onto rotations when asked what area I would like to focus on and practice in I stated with confidence "anything but OB/GYN or Pediatrics" and yet as you can see I have spent quite a bit of my time in the very department I so adamantly denied interest in. Well to ease your suspense, the answer is NO I have not changed my mind about this. I do think it's an important area to understand and so I am forcing myself to spend some time there. What I have learned is a great deal because the Doc's are wonderful and also it's not as bad as I thought... but I still don't want to do it :)

2. Last night I went to my first Pow Wow! It was really a very moving experience actually. Hugh and a friend from the pharmacy went down to the local high school where people were all dressed up in elaborate traditional/not so traditional Indian garb singing and dancing. Another friend I've made from the pharmacy was actually dancing later on but he sat with us and explained the history of the dances and some of the outfits, about the singing and Pow Wow's in general. It was fascinating and really enjoyable to watch. It's so heart warming to see some of the younger kids embracing their roots and learning some of the traditions of their culture. One of the nurses is going to bead my stethoscope as a memento of my time here and I have enjoyed every second of it.

Life on Le Rez...

is interesting to say the least, be it the packs of stray dogs and wild horses, the long abandoned boarded up houses and stores or the ER escapee patients carrying their IV bags, the Rez is like no place I've ever been before.

First things first let's break down my living arrangements

I live in a trailer or mobile home on hospital property it is 656 steps door to door ( I know this because I counted them... why you ask, I guess because I was curious, moving on) The trailer itself is much more spacious than I had thought it was going to be, it is on the other hand not the cleanest of places, but livable (there is no housekeeping staff so it is up to the rotating students who cycle through here monthly to keep it clean). There are 6 bedrooms and a common living room and kitchen space. When I first arrived there were 3 Pharmacy students and a Dental student all of whom have now left, a 4th year Medical student from Israel arrived the same day as I did and will be here for 4 weeks.

I walk to the hospital every morning and so far the weather has been really nice, I don't even need a jacket. Although I'm told this is really unusual weather, it's apparently something to do with the warm "Chinook winds" that come down from Canada. Speaking of wind it is really very windy here everyday all day long the wind blows, it's like living in the gorge, and according to the locals this is MILD wind. Anyway I get to watch the sun come up over the plains to the east and looking to the west I see the giant mountains of Glacier Park. It's the best commute I've ever had :)

Even though the hospital is pretty small it took me about two days of scavenger hunting to find all the different departments and be able to navigate from one side to the other without getting lost. It's mostly one level but there are a 3 main corridors with different places off each one, once you get those down your golden.

Every one has been very friendly (aside from the podiatrist, who really isn't even that bad, he just makes a horrible first impression) Dr. Obied (FM) and Dr. Masterton (OB/GYN) have been the best right from the start. It was difficult to get going at first because this is really a self directed rotation as in it's supposed to be my Primary Care rotation but I can go to any department I want. This is a wonderful opportunity but could also be it's downfall, when they say "self directed" they mean it, from start to finish! Granted the orientation is good and they give you a schedule for every practitioner in the hospital but the leg work is all up to you. There is no one to check in with, no one keeps track of your hours, who you work with, what time you leave ect.... you could work 80hrs/wk or 15hr/wk and I doubt anyone would know the difference. So it's completely up to me to make my own schedule with the different Doc's each week. I've watched/assisted in a few surgeries and done some clinic work in FP, Peds, OB/GYN, Rhumatology. That's the coolest and hardest thing about this rotation, just setting up my schedule.

This is my first weekend here and I'm trying to take advantage of the nice weather while it lasts. Today I drove around to the other side (west) of Glacier National Park to drive on the "Going to the Sun" road through the middle of the park but it's closed 16 miles in and it was 25$ entry so I turned around and did some fishing instead. Even though I didn't catch anything it was still very rewarding to spend an hour or two by the side of the Flathead river, breath in that crisp fall mountain air and relax. Tomorrow the medical student and I are driving up to St. Mary's on the east side of "Going to the Sun" road so we can drive up to Logan Pass and hike up to hidden lake.

On the Res

So I have just arrived on "the Res" set up my room and figured out how to use my phone as a hotspot so I have internet while I'm here, otherwise I think I'd have to drive over to the library for internet. Although I'm not sure how the charges work, I'll have to figure that out soon before I rack up a hellatious phone bill.