serendipti's Diaryland Diary

10:24 a.m. - Thursday, Jul. 14, 2005

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so a couple things I am learning about myself in this rotation....important things, because learning what you do not like and what is unsuited for your temperament, is, in my estimation, just as important at learning what is.

1. I do not like physical discomfort.
Well, easy enough, you say, who does? Okay, in the context of surgery, I think I know enough people (Grace, Amy, Phyllis, Laurel..to name a few), that may also dislike the physical discomfort, but think it is outweighed by the satisfaction/excitement/intellectual challenge of this field. I scrubbed in on a surgery on tuesday---it was called a carotid endarterectomy.....they slice open your neck, right where the carotid pulse is (put your fingers sort of underneath the angle of your jaw....somewhere around there you can feel a pulse, that is your carotid artery, pulsing with blood flow...your main flow to your brain)...so this carotid artery is in this little bundle alone with your internal jugular vein and one of your most important nerves, the vagus. So in this surgery, they go in and cut through your skin and the overlying muscles and through the outside of the bundle and then parse through and find the carotid. Then, we sliced it open (I saw 'we' in the loosest of definitions...yes, I was technically on the team....it was only 3 of us....and yes, at the end of the day, I did retract and move some things here and there, and hold suture while the surgeon was doing stuff....but at the end of the day, there was no slicing done by me, per se....but if we got sued, i would be named in the suit, most likely, so for the time being, I think the 'we' part of the sliced open sentence is just fine) and then there was all the gunk in the lumen of the carotid...that slice of cheese pizza you ate yesterday...yup, that was there....those fries you ate when you turned 20...check, right there......nice, calcified yellow plaques of gunkerooni....that was what was in the right carotid of this 72 year old woman....and yes, this is me at my most technical.

So yes, it was a really cool surgery, i am sure we helped this woman a lot, and no, miraculously, I did not pass out (a huge feat, in and of itself, I feel), although that might have had to do with the fact that I did MAD MAD carb overload before going in (two servings of hashbrowns, an asiago oregano bagel with cream cheese, a biscuit, orange juice, and then for lunch quesdillas and this yummy ass salad with Grace...I won't mention the breach of professionalism that enabled me to have lunch with gracie...) and maybe it was all that food that kept me on my feet, but honestly guys, back to point number one in this entry, i do not like physical discomfort. The standing for 2 to 3 hours, the shifting of your weight back and forth, shift right, shift left, right, left, shrug your shoulder, do isometric contractions of your calves....surgery requires you to be motionless for the most part, and when you do have motion, the motion has to be so precisely controlled....and oh, you have an itch on your nose, oh floggin well, you can't contaminate the sterile field and so maybe you can try to blow some air up past your nose into your mask, but there is nothing to do about that itch....and oh, it is so hot, there is salty sweat rolling into your eyeball....oh well, mind over matter, pretend it doesn't burn, because you are scrubbed in and sterile...nothing to do about that.....oh you want to move, you feel like you want to run around....pacify yourself with cleching your gluteal musles...clech, realease...clench...release....oh, what, did that not satisfy your urge for movement....well too bad, pretend it did, because we have 2 hours left of this thing.

I don't have fun being motionless. It feels like torture. And as a result, I get TIRED after surgery. And that night, we had a consult in the ER, and so once again, i was exhausted by my on call experience, and when I crawled into bed at 130 am, i felt so tired that I was nauseated by my tiredness. And I remember thinking, I do not want to feel like this voluntarily. I talked to Amy about this the other night, and i was saying how there are enough times in my life where I am forced, by circumstances of my illness, to spend hours or days with extreme fatigue, physical pain, and discomfort. And i hate those days, or months, depending, because I have no control over feeling exhausted and achy. Then for me to feel sort of that way, except this time it is VOLUNTARILY INFLICTED....it seems very counterintuitive. there is no part of me that feels proud or satisfied at having worked and powered through my exhaustion and physical discomfort...in fact, the only thing I think is, why the hell am I doing something that makes me feel sort of in the ball park of how I feel when my immune system is raging against itself???

I have not fallen in love with surgery. And I thank the stars. because had I, knowing me, I would have wanted to prove to myself that my illness does not dictate the course of my life, and I would have taken it as this huge challenge that I must undertake.....and my friends who did fall in love with surgery, every day, are stressed out about applying, where will I end up, how will I get in, will I ever have a life, will I always be tired, will my ovaries back stab me and be too old.....I feel awful saying this, but I am so glad I am not plagued by those thoughts, at least not in the context they are, and the more days pass and I have not been enamored of this field, and the more feelings of gratitude I have towards the universe, that I am not likely going to choose this field, the more I realize what a tough tough courageous decision these women i know are faced with, and how deep runs my respect of them, how visceral is my admiration for them following their heart.

back to point one. I dislike physical discomfort.
Nuff said.

2. And I say this tentatively, because maybe internal medicine will prove me wrong: i do not like hospitals.

I know, I know, why the hell are you in medicine? Because not all docs have to be inpatient hospital docs. I find the inpatient environment to be kind of stagnant and sort of boring to me. Following patients over the course of days or weeks, checking on their Potassium values, seeing how many liters of fluid have been draining from their chest tube....the changes in urine output....there is something about that sort of step by step, plodding, intellectual challenge the bores the living bejezus out of me. (have never used that word....looked it up at dic.com....i spelled it wrong:

be·je·sus ( P ) Pronunciation Key (b-jzs, -j-)
n. Slang
Used as an intensive: The bear scared the bejesus out of us.

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[Alteration of by Jesus.]

So anyway, the inpatient setting is boring to me. Like way way way way way way boring. And i get impatient on inpatient.
HA.
But it is true, i do. there is a lot of sitting around and waiting for labs and waiting for the patient to come back from CT and somehow, that makes me restless and I would rather be DOING something...the waiting kills me. that is why I like the clinic setting so much....movement movement, in and out and go and send and do and incise and drain and pack and biopsy and cut and suture and look and hear and palpate and talk and talk and ask and listen....so much more ME, than inpatient feels like. And maybe I look at all of this because I have already loved family medicine, and everytime I am in any service, I love clinic days (which are Amy's BANE), but that is more who I am, and the pace at which I like to work. And although you would think you have more time to hang out with patients becaue, well, where are they going on inpatient, I feel like I have better patient interaction on outpatient (i.e. in clinic) because so much of the time in the hospital, you are running around from here to there, that you rarely have time to actually sit for ten minutes and actually TALK to your patients....nurses are the ones who get to do that, that is why patients will ask a nurse to be in the room to hold their hand when you do a procedure, because the nurses actually have the space to nurture a connection....these doctors are all running around, headcutoff chickens, and they scarcely ever sit down to day, hello. how are you?

I feel like I am able to have that space in clinic, and though it might not be more than 5 minutes, I feel like 5 minutes well spent in clinic can actually have a greater effect on quality of life than 5 days in the hospital.
But this is all premature, because I have not been on medicine, but from what I understand of internal medicine (which starts sept 27th for me....3 months of medicine)--it seems like a whole lot of inpatient-impatient sort of stuff that I will not like. From what I know of the medicine folks, they love being the Sherlock Holmes of medicine....always trying to think up an exotic diagnosis that could feasibly fit the constellation of symptoms.....oooooh....we still don't know the diagnosis....maybe I can be the one to come up with it....they seem to get off on the intellectual challenge of it....and they can sit and talk about a case for hours, even if every knows the diagnosis, but JUST IN CASE there is some outlier chance that it is not a bleeding ulcer, let us go through the differential diagnosis of all the possible other diagnoses it *could* feasibly be (while the whole time everyone knows that it is, indeed, an ulcer)......internal medicine seems to be a whole lot of intellectual masturbation....and don't get me wrong, there is absolutely a need for that....because if i were the patient with the mysterious constellation of symptoms, I hope that they all sit around the table and go back and forth and someone brings up the possibility of my having been bitten by a reduviid bug in south america and maybe i have trypanosomiasis.......
okay, just got paged, let me rant later

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