Cholesectomies, Cholecystectomies, and Poop

Surgery is a language. This first week and a half has been a challenge trying to figure out this particular dialect of medicine, but I've loved almost every minute of it. I mean that. I've worked a variety of cases: from emergent laparoscopic appendectomies to breast tumor resections, as well as colectomies for chronic distal diverticulitis. I've gotten the opportunity to round on patients in the Surgical Intensive Care Unit (SICU), writing notes and presenting my peeps to an attending; I've gotten time in the operating room (OR) closing incisions and maneuvering the laparoscopic camera. Some days are long, but it's amazing how quickly 14 hours go when you're on your feet all day running from rounds in the hospital, then to the clinic, then to the OR. I've also met some really inspiring patients; some have dealt with very tough procedures, bounce back a couple days later, ready to be discharged and recover at home.

Of course there have been many mishaps: not filling out a "history and physical" on a preoperative patient because I didn't know I was allowed to write on official documents (I am, but an attending has to co-sign after reading it... don't worry!), answering at least 75% of "pimp" questions incorrectly (maybe closer to all), or the time I wrote on the preoperative note that we were going to do a "cholesectomy" instead of a "cholecystectomy" (my surgeon promptly corrected my spelling, and queried me about which procedure I was planning to do on the patient). So when I say that surgery is a whole new language, it is... and perhaps my first goal should be to figure out how to spell its more common words and phrases.

Everything is a learning curve, and I have already taken home some very important lessons. Here's what I think I know:

1. Poop is very important. I need to know if you've pooped, when you've pooped, and where you've pooped. What is the consistency of your poop? How many times have you pooped? Did it hurt when you pooped? What does your poop look like? What color is it? Have you passed gas? How many times have you passed gas? Are you passing more gas than you were yesterday? All joking aside, it is imperative to assess bowel function in the hospital post-op. Many things related to surgery can cause "ileus" or disruption of your normal bowel motility, and this can be a serious complication. So we have to get those bowels flowing!
2. Be ready for any type of question. When you're in surgery or on this clerkship, you have to be ready for questions, questions, questions! And, you can't get tripped up by the ones that come out of left field. I've had two favorites so far. First, while operating the camera for a laparoscopic choleCYStecomy (removal of the gallbladder), I was asked to point out the "cystic vein." Given that there is a cystic artery that the surgeon must clamp off during the procedure, the vein must be nearby. Fortunately I had gotten a little help earlier in the day (thanks, Steve!) and reviewed some of the anatomy... there is no cystic vein. Apparently that one gets students all the time. However, my favorite favorite was when I was asked during nursing rounds what the Latin word for hiccups was (the answer is singultio according to Google Translate). I didn't know it. Thanks for nothing St. Anselm's Abbey School. It's not all fun and games though. After doing a thorough H and P (history and physical) on a patient for an appendectomy, my attending asked me how many previous children the patient had. I knew she had one. When asked what her daughter's name was, I couldn't answer. It was Abigail. Lesson: patients are people, so get to know them. It is a privilege to be a part of their medical care team, so show that you do indeed care. Lesson learned.
3. If you don't think you should touch it, DON'T. I have yet to break scrub during this clerkship (meaning I haven't contaminated the surgical field by touching anything in the room that either isn't blue and between my waist and shoulders, or isn't an instrument dedicated to that specific surgery), but I'm knocking on wood as we speak. I did it once in college and it is a feeling I will never forget. Move slowly and purposefully; keep your hands locked in a praying position; and, don't touch anything! I must thank Dr. Fullum over and over again for hammering this into me.
4. You might be confused with being an actual real live surgeon. As I walked in to see a patient in the ER and pulled back the drape, the man started stuttering into the phone, "Mom? Mom? Mom. My surgeon just walked in so I'm gonna have to call you back. Okay okay. Bye." Admittedly I was wearing scrubs, a white coat, a surgical cap, and surgical "shoe-socks," and had my stethoscope draped around my neck, but come on. I still don't look a day over 18, even in a surgeon's uniform. I politely told the gentleman that I was a medical student who was part of his team. It'll be a while before he needs to get off the phone to speak with me...
5. I don't know anything. Pretty much nothing. Every day is an adventure, just trying to hold on to as many pieces of knowledge as possible. It's a very slow process for my thick skull, but I do think I'm learning at least a little something each day.

More lessons to come, but this is a start. It's a lot of work, but it's a great way to begin third year.

I eat when I can, sleep when I can, and maybe I do "cholesectomies" in my spare time.