Thursday, December 6, 2012


I don't care what surgery service you're on, even if it's not trauma - it's ALL trauma.

Seriously?  Surgery is trauma for everyone involved.  Even an uncomplicated, routine case involves fairly significant trauma for the patient.  Don't be fooled into thinking otherwise - it is very carefully controlled trauma, but trauma nonetheless.  Minimally invasive?  I mean, sure, you end up with three or four tiny little neatly-closed incisions around the belly, but have you ever seen the whole process?  The way those trocars get maneuvered around in their ports, the shoving things around, tearing things down, cauterizing whole swaths of tissue... man.  I love watching surgeries.  I think it's the coolest thing, and it is super easy to become desensitized to the violence of it.  But yikes.  Surgery is no joke. 

It is also trauma for the residents and the med students.  At least for me it is... the whole time you're standing there during the surgery, the attending can pimp you at will - basically, he or she can just ask you anything they want to ask, related to the surgery or not - and I never feel totally confident about my answers.  It can happen at any time and without warning... you're never free to just relax, you always have to be on guard for random flying tricky questions smacking you in the face and making you look like a total idiot.  It can be trauma for the nursing staff and the scrub techs - some attendings have notorious temper control issues, and all attendings have very different, nuanced personal preferences about how they like things set up, what they like to use, etc, and they are not shy about letting someone know when they don't get it right.

Surgery is trauma physically and emotionally, too.  Being on your feet all day is less than ideal for your back.  The crazy hours lend themselves to terrible self-care.  I have literally not worked out in three weeks now and am starting to feel totally nuts mentally and super crappy physically.  Nutrition has mostly gone to pot - remember the cookie party on Sunday night?  Yeah, it has basically sustained me all week.  Only I have long-since finished the actual cookies and have now started in on the huge batch of gingerbread cookiedough that never made it to the baking stage on Sunday.  That was my dinner tonight.  Not kidding.  Trauma regarding my personal life - today, my attending asked me if I had kids.  When the answer was no, the question was, well, are you married?  No?  Ok, well, what about someone special, then?  I said no, absolutely nothing, nothing at all going on my life.  And his response was wellllll.... at least... at least you can do what you want whenever you want...?

It's even trauma for the floor nurses. Ok, so this incident didn't actually have anything to do with surgery, and I don't even know if it was one of our patients that was involved, but when I got to work a couple of mornings ago, some of the nurses were shaking their heads and muttering in disgust.  When I asked, one nurse told me that everyone was all in a tizzy because one of the patient's parents had been, shall we say, getting amorous in the patient's hospital room.  Not only that, but it was happening while the patient, a young baby, was crying the entire time.  And not only that, but the nurses knew this because they could hear it from out in the hall!  Ugh, really?  Gross.

~ ~ ~

And then there is the actual trauma.  The awful, horrible, heart-pounding, life-flight bloody trauma, that, when you are in a pediatric hospital, can just be too much to bear.  

Last night there was one of those.  

It came in just as I was about to leave at a decent time in the afternoon, and it was absolutely horrific.  There are really no words for when something like that happens to a small child.  But one of the worst,  sickest aspects of the whole experience?  The truth is that a part of me was thrilled to be there for this case.  It feels horrible to admit that.  It was such a hideous tragedy.  I think I was mostly just so happy to finally be helping, to finally be useful, to finally be able to use skills that I actually do have and to feel like I actually did know what to do and how to do it and then actually be able to do it.  I love being in the operating room when I am getting to participate. 

We operated for probably close to seven hours, sewing and sewing, trying to put this little girl back together.  

When we finished around midnight, I went home and slept for roughly about three hours before I got up to go back in this morning.  We rounded, went to grand rounds, had lecture, went to clinic, went back to the school for a lab on advanced vascular access.  

It was sort of a shitty, blah daze of a day.  A reminder that I have not even started to do a fraction of the studying I need to do for the exam that is fast approaching.  No breakfast food left, no coffee made, not even any crappy energy bars left to grab on my way out the door.  A text from my landlord letting me know that hey, fyi, your rent check bounced, again.  Oh yeah, my financial situation is still so far down the shitter that it is actually in the water-treatment facility an hour down the highway.  Half a dozen more automated phone calls from my credit card company telling me that my payment is late, again.  Which was then followed by a voicemail informing me that my precious doggie has finally figured out that she can clear the fence and so now, even though we have finally bullet-proofed the gate that she had continuously, ingeniously found a way to foil until very recently, she is still escaping.  And when she was put back in the yard and tethered to a line set up on her leash, she chewed straight through her leash and severed it completely.  Her dog walker has apparently not been showing up and she has also somehow destroyed the latch on her crate door, so now I have zero good options for her while I am gone for 14-hour days.  

I wore heels today.  My feet were killing me.  When I left the school, it was dark already.  I walked to the parking garage in the dark, drove home in the dark, got home to a completely dark house.  Not a single car in the driveway, not a single person at home.  And I just burst into tears and proceeded to have a small breakdown.  My first cry on surgery.  My first cry in a good long while, actually.  My roommates got home a little while later and walked in and said "hi" to me and I started crying again.  I took a long, hot shower and sobbed.  I am crying right now, sitting in bed and typing.  

I don't really know how to deal with this stuff.  When I started this post a couple of days ago, I meant for it to be sort of a funny "wow, this is super tiring and intense and ridiculous and how about those inappropriate parents?!" post, but then last night happened, and I was mostly really put-together about it until a couple of hours ago.  Now I just feel drained and exhausted beyond belief and I can't think about last night at all without crying.

If you are a pray-er, maybe say some extra-special ones for a little girl in an intensive care unit tonight.  She has a really hard road ahead. 

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