So before I jump into talking about myself, which I tend to do I should talk about Shawn and life - since it is our blog although I am pretty sure he forgot about it and will never contribute directly to it. Shawn's working nights, but he's finished his FTO which is awesome, so now he can alternate pts with his partner. He's not too fond of nights, although he picked up a day shift yesterday and thought nights were better - no traffic, although the clientele seemed to be a bit different. He's had 2 field tubes and given lots of meds. The protocols up here are advanced and the area they cover is massive which means very little downtime and lots of calls - 11 the other night in just 12 hours!
Cubs and Wrigs are good, this mini heat wave of 90 degree days are rough on both of them - thank goodness for our floor fan. Wrigs is recovering great from surgery, her scar looks much better. They've adjusted well to the new place and even scoped out the park not too far from us which is really big and hilly - lots of room to run but that means we have farther to trek to keep an eye on them.
So it's day 4 of week 1 of rotation 1. I was with the ortho doc today - we saw 45 pts, holy cow; in one room out another. For school I am required to log all the pts I see and I could hardly keep up writing the basic info down so I can log them - whew. This guy is crazy, in and out in and out in and out over and over. On one hand I think wow, this guy is doing great, he started 30 min late due to a scheduling error and manages to finish only 25 min behind and on the other hand I think holy cow, I would feel so ripped off if this were my doc. $45 for an office visit - or more depending if you are new or established and if the visit is focused, detailed or expanded (stupid level of service charges) and he's only in the room for a couple minutes - but he says all he needs to and answers questions - so he is really good to the patients. Today, we were too busy to for him to actually explain much or let me do anything but put a bandaid on injection sites - but on the other hand I found I listened well today when I got pimped at a "business lunch" by a (7th day adventist) family practice doc in his 60s (he made it a point to let me know his religious affiliation). He asked me what the operative options are for a MCL tear and what I would do if my patient had a lateral collateral ligament tear and why. Anyway, I do feel confidant in locating the ligaments, cartilage, bone, tendons, arteries and muscles of the knee in an MRI, so hurray!
Yesterday I spent half a day in surgery with a huge case - a total revision of a TKA (total knee arthroplasty). It was an awesome case! We started at 7:45 and finished right around 11:30, wow. So this pt had a new knee placed a while back, but it wasn't really placed quite right so Dr. H (the doc I'm following) had to take out the old knee and figure out a way to put in a new one. It seems simple enough but it's really quite complicated. First there's the cement which must be cut out, then there's the bone and tissue breakdown that occurred because of the poor placement, this breakdown means there is no sturdy bone in some areas to adhere the new prosthesis. So all in all there was a lot of leveling out bone, building up bone with cadaver bone chips, and lots of hammering, and drilling to perfectly place a new knee which unfortunately had to have "stems" (pieces that go into the shaft of the bone to hold them in place) but I think the patient will be good as new! While this was great, I don' think it compares to my first day of surgery experience on Tuesday...
The morning started with a TKA (total knee) then a Rotator cuff repair (really wicked tear), then off to another hospital to finish out the day starting with another rotator cuff repair, followed by two knee arthroscopes. Morning went without a hitch and with me staying on my two feet the entire time (no face planting today!) I have to add that the doc and PA were already a little peeved knowing they had such a full surgery day - which wouldn't have been too bad if we didn't have to go from Portland to another city about 20min away, and to add to this insult they hate doing surgery at this other hospital due to the poor medical staff and help available. First case is the shoulder - a 600 lb man who didn't fit on the surgical table. Well the patient wasn't prepped the way he should have been (he was super hairy and they had all the important medical bracelets on his operative arm), then one thing after another seemed to be just a little off - which I have to say is not good for a doc who hates change. The doc and PA went to scrub and the doc says, Jen, have you scrubbed before? I said yes (yeah in a OR during school, once, but no pts were involved) then he said I'm going to need to to scrub in on this case. What?!?!?! I thought, I'm only supposed to be observing.... so he finishes scrubbing and the PA says, as I begin to scrub - you don't need to do the whole 20 scrubs on each plane, just get each plane and hurray up, we are all waiting for you. So I scrub - and as thoroughly as possible, Candy Randolph and Gietzen would be proud and I tromp into the OR waiting for the grumpy scrub nurse to hand me a towel - you know a lady is grumpy when the doc asks for a new scrub nurse. Then I find out my job: I am the arm girl - my job is to hold this ginormous arm (and no I am not exaggerating - it was bigger than my highs together) in downward traction - if I let up just a little bit, the sutures won't be tight and he has to start over, plus I have to rotate the arm medial and lateral on queue with the same parameters. So I'm feeling pretty good, all I have to do is focus on the arm - no big deal...which was all good until about 15min into it when my arms began to shake. My biceps burned as did my forearms. Then I'm told to hold the arm up - above my head - but careful don't contaminate yourself (the sterile field can be a real pain to maintain), so the next 15min involve me holding this huge arm steady above my head. Then back to out and down traction (apparently the position is the same as if you were water skiing - bent knees, fairly straight arms, pulling back with your weight). Sweat dripping and arms trembling I manage to do my job - fairly well (my arms hit fatigue and the doc had to reposition the pt a couple times - but oh well). So for my first time scrubbing in I was actually incredibly useful.
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