ER Shadowing

As you know I've been shadowing in the ER for the past few weeks.  Until this week, there wasn't anything to special to talk about.  There isn't a lot to write about this week either, but this week I got to DO something.  It wasn't anything major, but it was still kinda cool to do it, versus watching it.  A patient fell and hit their head on cement.  They had a cut on their forehead that required stitches, but since they came in by ambulance, they were on a stretcher with neck brace.  The staff had to make sure she didn't brake anything before they could remove all the braces, and in order to do that, they have to roll the patient on their side so they can check their spine.  One person is at the head, and two to three people are on each side.  The person on the head counts to three and they roll the patient on their side so the doc and feel along the spine to make sure nothing is sore.  Well I got to be at the head.  :o)  Of course there was nothing wrong with the patient, aside from a gash that needed three stitches, but it was still kinda neat to do.  I also got to watch them stitch up the gash, but that is nothing new really, considering I've had my fair share of stitches! There were some interesting cases - abdominal pain, chest pain, pneumonia,  and some really neat people working that night, so it made it more enjoyable.  Last week was pretty slow and the staff wasn't as interested in showing me around.

I can't believe that it has been 4 weeks since I started shadowing in the ER!

ER Shadowing

Since I didn't make the cut into med school this year, I have been trying to find some more opportunities to shadow and keep involved in medicine. I am interested in doing emergency medicine, and a friend of mine actually shadowed in an ER.  She was able to give me the contact information and help set it up so I could start shadowing there too!  Awesome!  Yesterday was my first day, well night, and it was very interesting.    It's a smaller ER, so most of the major traumas get shipped over to the bigger hospitals, but it was still very steady.  The staff was very laid back and fun, and due to the way they change shifts, I got to shadow two different Dr.'s.  The cases I sat in on were very similar to what you would see at a primary care/family practice, which I find kinda funny, and of course i got to see a couple drug seeker cases.  I think I was more interested in the drug seekers than the primary care cases because of the wonderful acting.  :o) The sad thing was the patients were only in their early 20's! What a waste.

Another sad case was a 90 yo diabetic patient with gangrene in both feet/legs.  They were in pretty bad shape, and the patient was refusing surgery, which meant he was going to die. The family understood the patient's wishes, and they all seemed to understand what was going to happen, and they were fine with that.  The patient was admitted and another physician was coming in to talk over some other options, but there was no guarantee the other options were going to work either.


I really enjoyed seeing the cases that came in, and I really enjoyed the chance to talk to the ER doc's.  After talking to Dr. F. and hearing how he went from family practice to emergency med, and the reasons he changed,  I am thinking that emergency med is a good fit for me.  I know I will have a lot of experiences in medical school and something else might come along, but right now emergency med is really calling to me.  The variety of cases, the calm before the storm, the storm, the eye of the storm, and then the calm again.  I find that I do really well under pressure and I like to be busy.  Yes, it is nice to be able to sit down for a breather, but being busy keeps me focused.  I think I am really going to enjoy this experience and hopefully I can get a letter of recommendation out of it!  Oh, and Dr. F went to KU too, plus he has family in Bozeman, MT. :o)   He was pretty cool and I really liked his doctoring style, so I hope I get to shadow him some more.  I'll keep ya'll updated!

Another Surgery

I had the pleasure of watching another open heart surgery -this time it was a bypass surgery. Here is an explanation, http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery,  compliments of Wikipedia. I have to admit the valve replacement surgery was pretty awesome compared to this one. Don't get me wrong, open heart surgery is pretty amazing, but there is a different level of "awe." The valve replacement (I put a picture up to give some perspective) seemed to be a little more extensive and time consuming because the valve had to be sewn all the way around the base to the heart, 48 stitches to be exact.

The bypass surgery consisted of veins being removed from the leg and then sewn onto the heart before the area of blockage and after to “bypass” the blockage and allow blood to get through.

http://www.answers.com/topic/coronary-bypass-surgery

During a coronary artery bypass graft (CABG), the chest is opened to visualize the heart (A). A heart-lung machine takes over the function of the heart during the procedure. A portion of the saphenous vein of the leg is removed (B). This vessel is used to bypass a blockage of the coronary artery. It is attached from the aorta past the point of blockage (C). Another option is to bypass a blockage with the mammary artery (D). The bypass increases blood flow to the area served by the coronary artery (E). (Illustration by Argosy.)

It was amazing at how the surgeons made this look so simple. I know that years of performing this procedure is the reason for this, but it was still pretty impressive to watch.

Tests/Shadowing/More Tests

So yesterday I took my second Organic Chemistry II test, and of course I thought I did well on it when I turned it in, but now I am doubting some of my answers to some of the questions and I have been comparing them with my good friend Tammie. I feel a little better knowing that we put some of the same answers down, but then there are the answer's we disagreed on. ARGH! The waiting is the hardest part as he probably won't have the tests graded and ready to turn back till Monday. That means I get to worry all weekend. Yay! As Brad would say, “whatever, you did fine.” And I'm sure I did, but the anticipation of KNOWING! is killer. :o)

Yesterday I got to shadow the pathologist that I was assigned to for the semester. He seems to be a really nice guy, pretty chatty compared to the surgeon I'm shadowing. We looked at a few slides yesterday - that's what most pathologists do- and it was pretty interesting. I'm still undecided if that is what I would want to do every day, but the good thing is I know there is a lot about medicine that I haven’t seen yet and will get to experience.

I also realized that November 2 is the first day of registering for the MCAT. Wow! It made me realize that this time is flying by and how real everything is. The test isn't until March, but the seats fill up fast. The bad part is that it costs $225 and if you want to change the date of your test, they charge you $50 on top of that. I'm sure they are raking in the dough with this test. They offer 10 retired MCAT tests to use as practice, but they charge $25 per test, which is kinda bs considering they could still make a big profit charging $10 per test. This isn't even anything compared to the cost of the tests you have to take once you are in medical school or to take to get your certifications. I believe some of them start out at $1000, which again is total crap considering you are a poor med student/resident. Boy, I’m sure looking forward to those bills.



 

Surgery

Ok, I know it has been over a week since I did my shadowing and you are just dying to know how it went. :o) The surgery was an open heart surgery to replace an aortic valve with a pig valve – similar details according to wikipedia.org are below.


Aortic valve replacement is most frequently done through a median sternotomy, meaning the incision is made by cutting through the sternum. Once the pericardium has been opened, the patient is placed on cardiopulmonary bypass machine, also referred to as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.

Once the patient is on bypass, an incision is made in the aorta and a crossclamp applied. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. Once the valve is in place and the aorta has been closed, the patient is taken off the heart-lung machine. Transesophageal echocardiogram (TEE, an ultra-sound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital.

I was standing in the room at the patients head looking down at the heart. I have to say that it was pretty amazing to see a human heart beating right there in front of me. The surgeons were also amazing and made everything seem so easy. I’m still in awe.

Shadowing

Tomorrow I get to watch an open heart surgery - standing right next to the surgeon in my scrubs and everything! I will actually get to see a heart beating inside a chest and be close enough to touch it. How cool is that? I’ve been to the school’s cadaver lab and actually had the opportunity to hold a heart, and yes it may sounds kinda gross, it was really neat. I didn’t realize how big the aorta really was until I looked into it. This one was about the size of a fifty-cent piece. Tomorrow will be a long day, but I promise to tell you all about it. (I’m sure some of you are thrilled and can hardly wait…Brad.)

Shadowing – what is this? Shadowing is something you have to do to show to the medical admissions committee that you know what you are getting yourself into – that you know what a dr. does. Most of the ones around here are pretty cool about letting you follow them around for a day to see what life as a dr. is really like. So far I’ve shadowed my family physician that is really wonderful, and every time I shadowed at least one of his patients complimented him. He is also kind enough to offer to write me a letter of recommendation. I have also shadowed a pathologist for a couple hours and will get the opportunity to shadow another one on Wednesday for an hour, and every Wednesday until the end of December.

Well, I’m off to study for my psychology test that is in two hours. Hopefully I won’t do too bad on it. :o)