serendipti's Diaryland Diary

1:35 p.m. - Tuesday, Aug. 09, 2005

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valsalva, fight dragging, crippy hands, my scrumpet, and my new crush!

I just finished up with a 2-3 hour ventral hernia repair....the woman had had her abdominal hernia repaired a few months ago, and got in a car accident 3 days later and it POPpped right back out. So this time, we put this huge mesh thingymambobber that was like the size of a sheet of paper....we did it all laparascopically, which means that we did it through tiny incisions using a camera, which was tricky since this patchymambob was so huge. So I got to be in control of the camera, which is rather stressful because sometimes you just don't know when up is down and down is up, and the attending is moving around with this little chomper, chomp chomp chompin all about, with this little pacman mouthed metal chomper, and you are supposed to keep him in the center of the screen with your camera, but then there is blood and abdominal adhesion, as well as your innate lack of direction.....I made it through, as did the patient, more importantly.
Yesterday I saw this total nephrectomy....that means we removed an entire kidney. that was one of the coolest ones yet. The other cool one I saw a few weeks back was one where we did a lung biopsy, and we had to go past the heart, and I was like, jesus, there, right there, is this huge beating heart, and the attending was like (sarcastically), what structure is that....and though it was SO CLEARLY the heart, I am so used to messing everything up and not knowing what is what, that I almost whispered out...the heeaaarrtt??? Sad, but true, I doubted my own knowledge that the huge, fist shaped, thumping structure in the left side of the chest we had opened up, was indeed, the heart.
My self confidence has really needed a boost of late.
But aside from that, I have been really starting to get comfortable in the OR. Now I can go 2 hours, no prob, and I don't pass out. I have been doing the over-hydrate carb-overload technique right before scrubbing in, which has been working for me, give or take 1 or 2 times. I scrubbed out yesterday during the nephrectomy, after 2 hours and something, because I started to get woozy and sweaty (diaphoretic if you want to use a bourgie med word), and I actually FARTED in the sterile field before leaving.....I had been controlling the passage of gas, as well as the propensity to feel woozy, but sometime past the 2 hour mark, as we kept digging and digging for the renal artery, and I kept retracting and retracting, I knew I had to scrub out before it was too late, and *fart*, I let one, and once I had done the valsalva maneuver, there was little blood left to go to the ole brain. The valsalva maneuver is what we do when we poo----increase abdominal pressure....happens when we cough or lift heavy things too.....so then blood is being used in those muscles, so gets shunted away from the brain for a sec....that is why a lot of times people pass out when they are pooing and stuff.....anyway, what is so funny is that one of our patients, who had a bowel obstruction, was trying to say how it hurt when he pooed, and so my resident was like, it hurts when you make a valsalva? And she was serious, like he should understand what the hell that means....I had never heard of that before med school....how the hell is a pt. supposed to know what that means?
He nodded and was like, yeah....
oh, here I looked it up for you:

Definition

The Valsalva maneuver is performed by attempting to forcibly exhale while keeping the mouth and nose closed. It is used as a diagnostic tool to evaluate the condition of the heart and is sometimes done as a treatment to correct abnormal heart rhythms or relieve chest pain.

Purpose

The Valsalva maneuver is used with patients who have suspected heart abnormalities, often in conjunction with echocardiography. The maneuver is based on the fact that when a patient forcibly exhales against a closed nose and mouth while bearing down, as if having a bowel movement, specific changes occur in blood pressure and the rate and volume of blood returning to the heart.

ME AGAIN---so anyway, I scrubbed out of the nephrectomy, went to the patient recovery room and made sure that my BP was okay (90/50....normal for me), downed 2 apple juices and 4 krispy crackers while the nurses came in and out and gave me dirty looks as if to say, I can't believe dat bitch is stealing patient food....then I went back to the OR, scrubbed right back in, and made it another 2 hours till the end of the nephrectomy. My resident (who never says much of anything that is nice, except that she thinks I have great hands....booyah!) was like, good job, your stamina has increased.....I was like, why don't you just say, I am shocked you no longer pass out in the first ten minutes....
Anyway, i would so rather be in the OR that doing rounds in the hospital....any freakin day of the week....I can't stand being in the hospital, doing stupid errand like crap....i god, i am so dreading my 3 months of internal medicine...you have no idea....shudder shudder.

In other news, as I was dissecting a particularly unpleasant encounter with someone I love, I realized that I have a propensity to drag fights out about a day longer than I should. Basically, I have had this very stern little window of time, where I would like to have it out with the person, and if they choose not to engage during that window, then I get hurt and take a day to get over it. I have seen this pattern recur in two of my closest relationships, and I don't like it one bit, so i need to work through it. I like dissecting my personality. Then you have fun new challenges to pose to yourself and work on.
Yaay self-improvement.
I know, i have a problem.
But this whole set time frame for conflict resolution thing I have needs to change. For real.
What sucks is any time I work hard with my hands, I have to pay for it for a few days. We have been moving Amy into her apt, and I have been in charge of the anal-cleaning, like the fridge and the kitchen floor. So I cleaned the floor, tile for tile, hard, on Sunday, and I was still paying for it during the hernia repair today, as I was holding instruments. It sucks. I mean, at least I don't have a manual labor job, but at the same time, I hate having my hands get cripped out after just a bit of work. that is crap.
I need to pst some Rohun pictures. I have a bunch. I wish diaryland let me post pics. I tried starting a blogspot journal a while ago, and had one raelly depressing journal entry I had written the hour before getting my round III Board scores, but I could not let go of the 360 some odd journal entries I have on here. What to do? Is there a way to transfer them over? I had my 4 year diaryland anniversary a few weeks ago, and I realized that, on average, I have one entry for every four days out of the past 4 years. Crazy, no? i mean, we know I have taken long periods off, but still, about a years worth of entries over a four year period. I was stoked on it. So how am I supposed to let that go for a flashy blogspot, free picture upload journal? if only diaryland didn't charge for pictures....anyway, but my point is, I still want you guys to see some Rohun pics, so I will upload then there, and put the link here.
Have i told you I spend at least an hour a week on the webcam with him? I know, that is absurd, but it is the only way I can get through this whole missing out on his childhood thing I am doing. I was there when he learned how to roll over from back to stomach (about 6 weeks ago)....they zoomed in on his first little nubbin tooth that popped out 3 weeks ago (now there are two!).....I was there to watch them give him a bath while my bhabhi made scary faces into the camera every once and again.....the webcam has made my separation from my little scrumpet much less painful.
I MISS MY SCRUMPET!!!
anyway, I think there is prolly another surgery I need to scrub into, so let me check.
miss you!
sorry I have not been writing. sometimes I don't write when I am an a funk. I have been in a sort of med school angsty-I suck-at-everything funk.
I need to get over it.
OH! I found a brand spanking new obssession last Friday. I am very excited about him. he is amazing. Only problem? He is famous. Damn him. Why does he have to be famous? It is really friggin cramping my style...because he is cute and smart and righteous and artistic.....arrrghhhh.....I am firing up all my hollywood contacts to see if I can figure out a way to cross paths with him so that he can understand that we are meant to be....
I'll keep you in suspense until we have our babies!

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