Staffing shortage

This week we opened a new building... brand new operating rooms, new offices, etc. beautiful place. Still some growing pains as we are somewhat short staffed.

Yesterday, we had an urgent case to start. No residents or CRNAs were available since it was a lecture day and the available people were giving breaks so other people could go to their lectures.

Anyway they had an available OR, and I myself was giving lunch breaks....

So I just went ahead a did the case myself.

I know this doesn't sound too strange to most of you. It's probably the norm in most places. But being at an academic institution I haven't done a case by myself, well ever. In the few years I've been staffing, I always work with a resident or CRNA. Before then I was a resident so I worked with a faculty member supervising me.

It's nice knowing you have your stuff together well enough that you can do a case by yourself at a moments notice.

Yay me.

Preop Hijinks

So I'm in clinic today and I'm talking to a patient about his health problems for some surgery or another. All of a sudden he stands up, unbuckles his belt buckle, unzips his pants and starts tucking his shirt in.

Now I've done this before too, but usually it's in my bedroom before I go to work or if I'm in the bathroom or if I'm alone somewhere with no hope of someone walking in.

Weird and unsettling.

I just acted like nothing was happening and averted my gaze.

Condolences

As you no doubt have heard by now. A plane with an organ transplant team crashed into Lake Michigan on Monday. All six aboard were lost.

Condolences to the families of the two doctors, two organ donation specialists, and two pilots.

They perished in the quest to save the life of another.

Tragedy

I don't really want to talk about it now but do me a favor.

Go home, kiss your wife or husband, boyfriend or girlfriend, hug your children.
You never know when it's the last time.

More later... maybe

Tuberculosis

Everyone knows the name of Andrew Speaker. If you don't he's the person carrying the multidrug resistant tuberculosis(TB) stain all over the world.

First, Tuberculosis. It's a difficult disease to treat... months of antibiotics are required in most instances, and usually more than one type of antibiotic. Because people generally feel fine when they have this diagnosis they often quit taking the medication. This leads to more drug resistance.

I find a few things very funny about the case.

1. He's a personal injury lawyer. If someone else had done this I bet he'd be on TV advertising for people to call him to get their "rightful settlement"

2. His new father-in-law... works for the Centers for Disease Control. Speciality -- tuberculosis. You can't make this stuff up.

3. His name came up when he crossed the border from Canada. "including instructions to hold the traveler, don a protective mask in dealing with him, and telephone health authorities." The border inspector ignored these warnings because they appeared discretionary and the man appeared healthy. Good to know the system works. Good thing he's wasn't a terrorist. I imagine if he had been of middle eastern ethnicity he would have been face down handcuffed in a ditch in twelve seconds.

I'll give the guy some credit. He's probably not extremely infective from what I know about TB. He wasn't coughing, he probably didn't have an acute infection. He also picked it up somewhere long ago. And it was just recently found on an xray for something unrelated.

But also some problems.

1. He states he didn't know the risk of what he was doing, but when he was told not to come home he went to extreme pains to get home. He flew from Atlanta to Greece for his wedding, warned not to travel. Then flew to Rome, Italy. Warned again not travel. Then got to Prague, Hungary flew to Montreal, Canada then drove across the border to avoid authorities. Sounds like someone deliberately trying to skirt the system.

2. I'd hate to miss my wedding and honeymoon. But questions are now arising to whether a wedding took place. One article states "There was no wedding. They came for a marriage but they did not have the required papers." Good planning on his part. If I was the prospective bride I'd be pissed off.

Keywords

So I've realized for the last few posts that you can add keywords to each post and people can read those posts with those keywords only.

I'm anal enough that I'm going back and adding keywords to all my old posts. Hope this makes reading more enjoyable.

(I'm assuming people are reading)

Random walls

Image from freefoto.com

I'm walking out of work late yesterday. I'm tired. I'm on cardiac call i've been here for 12 hours. Not bad hour-wise but i've had to work with one of the stressful surgeons and just finished helping code a patient in the operating room.

I just want to go home and put up my feet...

All of a sudden there's a wall along the corridor where I usually walk out. It was open this morning

"Detour -->" I guess they're finally connecting the new building to the old one.
Now I wander through the basement and finally get to my car.

Perfect ending to a long day. Hope I don't get called back in.

Yay!

I got a page from a friend today saying oral board results were posted.

I passed!

It's about a week and half earlier then they said scores would be up, but I'm glad.
Relief.

Oral Boards - Done

I've been back from DC. Oral boards are done.
Yay!

Topics were anticipated. Did I study enough, hard to say... would studying more been more helpful... doubtful.

I think I did okay... but who knows for sure. I'll find out at the end of May.

At least it's over, for now.

Transvaginal Cholecystecytomy

In a word -- Yuk!

These words together mean removal of the gallbladder through the vagina.

Yuk yuk yuk.
If I had a vagina, you're not removing my gallbladder through it.

And to boot there's a Natural Orifice Surgery Consortium for Assessment and Research.

You can leave my natural orifices alone... I mean look what great scientific advances there are in this decade.

New York Times online via Book of Joe

DC in the spring

Ah to be in Washington DC in the spring.



Blossoms on the trees.

Spring is in the air...

NO!

I'm in DC for anesthesia oral board exams

Its 40 degrees outside.

There's a wind advisory...
The plane was shaking like a laundry dryer as we were landing... and I swear we were going sideways for several seconds.

AND I'm taking oral boards tomorrow.

I'm a little stressed

I'm back to the books for last minute cramming... maybe a short nap.

More later.

Drug interactions

A friend called and asked me: "Are there any drug interactions between Darvocet and albuterol?" Her friend had just had surgery and was on pain killers (Darvocet - acetominophen/proproxyphene) and wanted to take a puff on her inhaler (Ventolin- albuterol).

I said I didn't think so. The narcotic has lots of interations, but not likely with albuterol. "Why?" I asked.

"Well she saw this Law and Order where this girl poisoned her mom with darvocet and albuterol."

Hmm... Law and order? "You sure that wasn't darvocet and ALCOHol not ALBUTERol?"

"Hmm... yeah probably, see ya bye!"

I guess it's all in the details.

Clinic

Been in clinic a lot the last few weeks. Almost half my work time. By now i'm almost suicidal... I didn't go into anesthesia to do so much clinic

(no offense to those who are actually suicidal)

Room temperature

It's important to keep the patient in warm in most cases. Most cardiac cases this is not an issue much because the heart-lung bypass machine has a heat exchanger on it which allows the perfusionist to warm or cool the (patient's) blood as it goes through it.

We were doing a big cardiac case under left heart bypass -- where part of the blood is taken after it gets passed through the lungs, and rerouted to the femoral artery in the groin so that work can be done to the descending aorta with most of the blood flow being perserved. This is nice so that damage to important organs like the kidneys and intestines can be limited.

Since we have less control over temperature because it's only partial bypass, we had the room temperature way up. It was warm for me, but must have been killer for the surgeons who were wearing waterproof gowns, etc.

On of the attending surgeons was scrubbed in and asked for temperature to be turned down. He's generally very expressive. "Turn down the temperature or I'll vomit in the wound and the patient will get septic and die!" I just about died laughing...

(For those not in the know... sepsis in a severe systemic infection caused by bacteria. If you vomited into a patient surely this would happen but it's not a scenario you contemplate ... well ever.)

Working too hard?

Imagine my suprise to get my schedule this month to find that I have 3 random vacation days this week. Apparently I'm not using my vacation fast enough. I got some Christmas shopping done, and put up some decorations.

Brr.

Sexily dressed doctors may be dangerous

My resident in clinic showed me this article today from the ABC news web site
Sexily dressed doctors may be dangerous

First of all, it must be a slow news day. Second of all the first paragraph mentions Grey's anatomy. And we know that all hospitals are like the hospitals on TV.

Sad.

A day

Been gone for a while, busy at work, vacation (wasted nothing too fun), then busy at work sorry there's been not much posting.

Put in a LVAD (left ventricular assist device) in a patient, which is an assist device to help the left side of the heart. Another patient had an RVAD which was a device to help the right side of the heart which we took out. Stressful day though... now doing some general cases while the overnight guy does a heart... what a way to make a living.

high glucose

my fasting glucose this am was high, 167 usually it's been running high but only in the one-teens to 120s 3 confounding factors.
1)I was up all night teeing up a heart transplant
2)I'm using a different glucometer, the one at work, rather than my usual at home
3)I had Chinese takeout for dinner.

Sadly i suspect It's number three.

Being a patient

So apparently I have diabetes. I went innocently enough to the doctor's office to ask about getting a sleep study for sleep apnea (which I probably have). So he's asking all these questions and running all these tests because it's the first time I've gone to the doctor's in years. My Hemoglobin A1c was through the roof. The hemoglobin A1c measures the average blood sugar over the last 120 days or so in your blood. Also I had a pretty high blood pressure in the office.

Now I'm checking my glucose (almost) every morning, supposed to be checking my blood pressure regularly so he can decide if I need an anti-hypertensive medication. My sleep study is scheduled, and I'm making calls to the insurance company to see if things are covered.

I guess I'm a set up for this. Even though I'm in my early 30s, I'm overweight, I eat poorly, diabetes and hypertension run in the family ... let me continue.

I don't think I'll like being a patient.

Black Cloud

(Sorry that postings have been so sparse. I'll fit in more time)

Some say that I have a black cloud. They're wrong. I have a storm cloud following me.

Let me clarify. In the medical profession, (I don't know if this concept exists in other fields) if you attract all the worst, bad, complicated cases, or when you're on call everyone and their mother has to come to the hospital, then you have a black cloud. It's possible to have a white cloud. And sometimes the white cloud cancels out the black cloud.

Anyway, I think the origin of my black cloud was my first day of residency. To sum it up... out of the 2 patients I took care of that day, half of them did not live to see the next day. Not that I was responsible, but it was still traumatic nonetheless. I had patients die the first two times I was on call as an attending physician.

Friday night, this continued. When I came in during the afternoon, here's a partial list of what was left to start -- 3 liver transplants, a heart transplant, and 2 endovascular thoracoabdomical aortic aneurysm repairs in addition to a myriad of other smaller cases. Also on the table was a facial reconstruction that had been going 8 hours so far, an open thoracoabominal aortic aneurysm repair, and liver resection that had lost six liters of blood.

Needless to say I was up all night. Two liver transplants had been finished (I was not responsible for this) the heart transplant also (not me as well, yay) The thoracoabdominal aneurysm finished after 15 hours of work, the facial reconstruction had been going 24 hours with no end in sight, and another ENT reconstruction case had not only finished, but had gone back to the OR 3 times in addition because things didn't look well. At least I was working with good residents and colleagues. It makes things a bit more manageable.