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Surgery Thoughts

1) It's taking over my life.  I don't HAVE a life anymore.  I have time that I spend sleeping (limited), and time that I spend in the hospital, and maybe two to three hours that are mine for the day.  For some reason, three hours to do errands, cook food, eat food, see the boyfriend, relax, read news, and take a bath seems much shorter than three hours standing and retracting someone's skin flaps.  I just get so disoriented...I lay in bed last night and heard something that sounded like distant fireworks and thought, "Oh, have we had the fourth of July yet?"  When I am standing freezing in the OR, I think, "I wonder if it's almost Christmas".  I just have no perception of anything anymore.  I am frighteningly isolated.  I see other people on surgery and my boyfriend.  That's about it.

2) Today was really horrible because I was literally just coming upstairs to the team room with a much-needed cup of coffee and painful painful feet after five hours spent doing two thyroids, and the resident who I hadn't been working with caught me in the hall and really excitedly said, "Hey!  Chang!  We've just gotten a new surgery that you can scrub in on!  It's now!"  So I put the coffee down and scrubbed back in.  During that surgery, I...
             2a) realized that I don't really like huge huge gobs of blood.  During the other surgeries, when something is bleeding on me (a little vessel that has been cut shooting blood drops up into the air and spattering my gown and gloves), I've sort of been very blase about it.  It gets fixed.  I don't really mind.  But this surgery, we were re-opening this woman because a huge hematoma (blood and blood clot) had formed where we did her surgery yesterday and it was A HUGE amount and really disgusting, especially the gigantic clots.  The attending wasn't even bothering to use suction or tools or whatever; she was scooping up handfuls of blood and clot and dumping it into a basin and that was quite disgusting.  I had thought that the only body fluid I really minded was vomit, but apparently I don't like 750 mL of blood clots either.
            2b) was in so much pain!!  In the first place, I was in this stupid surgery that I didn't want to be in and had already done five hours that day.  And yes, it might not be a lot for people in some programs, but for me, it is very tiring and painful, especially to the feet and back.  And then, the attending didn't really seem to want me there.  She said, "Oh, I'm sorry, Chang; this might not be very interesting because there's not a lot for you to do."  Alas, then she found something for me to do.  I had to retract from across the table with my arms outstretched and raised pulling hard to pull up the skin flap.  I felt like my shoulder blade was driving directly into my spine.  My back started spasming.  Thankfully, the scrub nurse was SO nice and kept asking if I was okay because he knew I was in a really awkward position.  I tried to hold on, but after ten minutes or so I was in so much pain that it was all I could do not to moan.  So he asked me if I was okay and I said no and started crying.  In surgery.  Everyone was really nice and the circulating nurse led me out of the room and calmed me down a little and I scrubbed out, but I am so ashamed....I have to work with this attending again tomorrow, and she's kind of scary...and also, my back and shoulders REALLY hurt.

3)  Surgeons do have a reputation for being really sort of mean and intense, but they do say that they are intense because what they're doing is so important.  And that is true.  It is really easy to screw someone up pretty badly.  So I suppose you can't have a lot of latitude for mistakes, because mistakes actually matter.  Surgeons (at least many of the ones I've talked to) do also seem to have a lot of insight into what I guess is the humanitarian aspect of surgery.  They do feel both proud and honored that people allow them to cut open their bodies.  I understand this feeling--I feel it about asking personal questions, that I can ask a patient about their sex life or drug use or whatever without any reciprocal information, without really any relationship with the patient, and the social contract suggests that they are supposed to give me an honest answer.   I guess I would feel the same way about cutting someone open if I were actually in charge of anything besides retracting or if I were interested in it.  Though, as a corollary, I learned that my name goes on the note of the operation under "Assistants".  It says in the note, "Surgery Assistants:  Russian Lady, PGY-3;  Chang, JMS"!  What?  I'm assisting?  No, I'm not assisting anything--I'm really just like a machine.  You move me to a position; I hold the position.  But regardless--I am generally impressed with surgeons' feelings re: the trust that patients place into them.  If I may be anti-surgeon for a moment, I didn't think that surgeons thought that way...I thought they were just all muscleheads who liked cutting and chopping.  Maybe that's ortho.

Given that I need to go to bed in an hour, I will go take my bath soon and jot down more surgery-related thoughts when I have them.  I am in so much pain.  OW.


Elle panique!

Have just (3.5 hrs ago) begun my surgery rotation, and good lord am I very overwhelmed.  I do not think I will enjoy this experience at all, although I am trying to keep an open mind and be optimistic.

The resident in charge is this very scary Russian lady.  She greets us--the JMSs--and almost immediately says, "By the way, make sure you write the post-op notes for all of the patients you take to the OR.  Don't ask me whether you need to do it or wait for me to do it."   Now I am sure that this is good advice, and I intend to follow it, but there are some basic issues that we need to take care of first!  For example, what is a post-op note?  Yes, obviously it is a note one writes following an operation.  But what goes in it?  When do we write it??  For that matter, let's address some more basic things, such as "When am I supposed to get here?" and "What am I supposed to do during the day?"  and "Am I expected to take call?"  Thus far, the sole guidance I have from the resident is that I need to write post-op notes, that if my patients have had skin flaps put in, I need to defer to plastics about making a plan, and that the attendings in clinic like it if I read about their clinic patients before seeing them.  (Note: I have no idea when my attendings HAVE clinics or what my responsibilities are re: clinics...)

I'm just a little frustrated.  I did behave appropriately assertively though, and I asked her if the other JMS and I could meet with her at her convenience today to discuss expectations for this clerkship more fully, and mentioned casually that both of us have just come off of two months on medicine and have never had surgical experience and need guidance.  So perhaps all of these issues will be addressed, but it was just a hell of way to start out...

We also had an orientation to the clerkship today.  The clerkship director is this funny, seems-laid-back-but-really-isn't sort of man who very casually said that if were consistently coming in to work before 5 AM, that might be a problem, but 5 or 5:30 is a pretty good time to start the day.  The problem with coming in before 5 AM is that, if we do so, and stay until 8 PM each night, we'll have difficulty staying within the work hour rules, which state that we are supposed to "only" work 80 hours a week and be out 10 hours between shifts.  The clerkship director also discussed that we should eat breakfast, because sometimes one gets hungry otherwise when one is in surgery straight through lunch and dinner...

I will never see my boyfriend again because I will be sleeping between 9 PM and 4 AM for the next two months.

On the positive side, they gave me a meal card so I can eat for free for those times when I am not standing unmoving in an operating room.

And, on a last note, hi, LiveJournal.  I am told that I have been absent from it for 14 weeks.  In that time: I took my boards.  I passed.  My sister went to the hospital for treatment, got better (!), and went home again.  I started my medicine rotation.  I completed my medicine rotation.  I learned that I do not like hospital wards that smell like feces.  My grandfather died.  The boyfriend and I had a weekend vacation.  I got sick on the weekend vacation but recovered.  I visited my parents for a weekend and saw my grandmother.  I think those are the significant events that require documentation.

Chang, going to read some surgery stuff now.


Really surpisingly awake for this time of the night.  Usually by now I am exhausted and beginning to plan going to bed.  I wonder if it was going to the gym today at 5:30 (after a LONG gym-less hiatus) that has made me so perky?

So, today I studied for 7.5 hours, and if this is what I am supposed to be doing every day before the boards (and I am told that it is), I will be dead long before June 13th ever gets here.  Because SO BORING!  SO MIND-ACHINGLY BRAIN-FILLINGLY HEADACHE-PRODUCINGLY boring!  Tomorrow I will have to bring NSAIDs.

Today I did more of my biochem review.  I feel much more confident about it.  I really learned some things that I don't think we ever did learn in actual biochem class, but which seem to have been given places of prominence in the review materials.  The various types of homocysteinuria, for example, as well as all of the different glycogen storage disease and the different sphingolipidoses.  For the latter two, I do remember being told that these various diseases existed, but always with a caveat of, "You don't need to memorize those".  Well, now I DO need to memorize them.

I would really like to spend a few more hours on biochem, but I think I need to move on.  So tomorrow I will study anatomy/embryology.  It may cause me to tear my hair out in frustration, because it is seriously the subject I like least.

I went to see the boyfriend this evening.  He requested more cake (when I had visited his dog last night, I brought him some cake for when he came home today from call.)  So I brought him more cake.  I am glad that I do not have to eat this entire cake by myself...baking for an appreciative audience is always nice.  We chatted for a while, and he gave me a very nice neck massage.  And then he fell asleep at 9 PM because he was post-call.  And then I went home.  I do completely understand, incidentally, and am sure that one day, when I am cool and take call too, I will also fall asleep tres early.

I am re-reading Love in a Cold Climate.  I think I would still like to have been a Mitford sister, specifically Deborah, the Dowager Duchess of Devonshire.

Chang, the Charming C(h)ountess of Cheshire?

still alive

Hello, world!

I am still here.  I did my pharm final, which was a horrible nightmare.  I haven't gotten the grade for it yet, but somehow I don't think it's one that I will wish to record for posterity.  Sadly, because I had been doing relatively well in pharm, everyone (my parents) continues to ask, "Did you get your pharm grade yet?"  People!  Forget it!  Pretend that the pharm class had no final.

I also took my path final on Friday.  It was really not as bad as it could have been.  I knew going in that I needed to get above a 47% to keep a High Pass in the class.  I got substantially above a 47%, but less than a 92%, which I would have needed for an Honors.  Whatever.  Sic semper pathology, I suppose.

To celebrate my finishing finals and the class-taking part of second year, I got sick and/or extremely allergic on Saturday.  (The boyfriend and I did go to listen to blues on Friday, but the guitarist was sick and not very high-energy.  But it was good.)  I moped around on Saturday and prayed for someone to come into my house miraculously, arrange the covers nicely around me, turn the pillow over to the cool side, and bring me tea and cinnamon toast in bed.  It did not happen. 

As of today, I am still moderately sick/allergic, but it is more responsive to antihistamines now.  Hurrah.

I have started studying for my USMLE step 1 exam, which will occur on June 13th, A Day That Will Live In Infamy (or hopefully just in Famy).  Today I started biochemistry.  It was disgusting.  I had far too many books.  I will document my reference materials for today and tomorrow in this space:

1. Kaplan Step 1 Qbook
2. Kaplan Step 1 Biochemistry and Medical Genetics
3. High Yield Biochemistry
4. Underground Clinical Vignettes: Biochemistry
5. Deja Review Biochemistry
6. First Aid for Step 1: Guide
7. First Aid for Step 1: Cases
8. Deja Review USMLE Step 1
9. Buzzwords for the Boards: USMLE Step 1

This is way too many books! 

I also made a chocolate cake and dog-sat for the boyfriend's dog.  I miss having a dog...


I Am Losing It.

Pharm studying is going badly.  My workout is again going badly.  I am so frustrated with a friend that I just want to grab her by the shoulders and shake some tact/sense/manners into her.

It just seems like nothing is going efficiently into my brain anymore.  I think I might be Ellen Wilson in the Malory Towers books and on my way to brain fever or a nervous breakdown of some sort that will require a Miss Grayling to sort it out and why why WHY can I keep the plot details of five million Enid Blyton books straight in my head but not absorb more drug facts?  Surely there ought to be some way to exchange one for the other...I can always read Enid Blyton again, and probably will do so, many times.  But I have a limited amount of time to get all of this pharm stuff into my head before I take the test, take the other test, and promptly forget all of it because you can look it all up on the iPod anyway.

I did talk to the boyfriend and to a friend to express my frustrations, and I feel a little better, but I just feel so overwhelmed! and exhausted!  and potentially dehydrated!  Drugs drugs drugs drugs.  Brain hurts.  No wit or amusing commentary issuing forth from within.

Yes, see above.  Because when I am old and gray and reading these entries in order to tell my grandchildren about what life was like in the 2000s, I will probably remember that time when A was sick, and I won't necessarily remember that time I studied so hard for my pharm final.

About A:  She is out of the hospital as of today.  She'll go the residential program in about a month; they've finally accepted her.  She is getting very nervous about the whole thing.  It's a little strange: she wasn't apparently afraid to die, but she is very scared about the idea of spending two to three months away from home.  Poor baby.  I think adolescence is like that to an extent...on one hand, you are making these really complex decisions, but on the other hand, you are still very much a kid in some ways and have very little life experience.  She seems happy to be out.  She was able to tell the doctor without prompting that she wants to live.  I am so glad.  And yet--I am so scared, because, although I knew that she was depressed, she called me the day before she tried to kill herself and sounded so normal, and didn't mention being depressed at all.  So I just worry that she's so very fragile and I want to make sure that I'm able to tune into what's going on.  For all that I do believe that my parents minimized her illness, I don't think that I would have done anything different on the day before she tried to kill herself based on what she was saying and how she was acting.  I am just so scared it will happen again.  Anyway, she called and wanted to know about the residential program.  I tried to emphasize the good things about it, that the kids there will be more or less like her, and not drug addicts or foster kids with nowhere else to go.  I explained that when I went to summer camp for two months when I was 14--not the same thing, I know, but I think similar enough--I spent the first three nights being tremendously homesick, but that it passed and I was able to get into being there at the camp.  I just hope she won't get too much anticipatory anxiety and start getting depressed again.

About studying for the pharm final: I am a little mad at myself, because I'm really not getting enough done during the days.  Today I did cut short my anticipated study time by one hour because a) I was losing my mind, and b) I wanted to see the boyfriend.  I don't think this is really a case of boyfriend interfering with schoolwork.  It's more of a case of I don't want to do schoolwork and have lost my ability to concentrate for many hours at a time on a bunch of minutiae.  I feel like I know nothing.

About the boyfriend:  I saw him this afternoon/evening.  He was post-call, so he was very tired, and also not feeling well.  So we went and bought him a zillion bottles of Gatorade so he can stay hydrated and go back to work tomorrow.  We just hung out, watched TV, ate some of the leftovers that we (I will say we, because I did chop the potatoes and add them to the dish, and I also cooked the rice) cooked on Sunday.  It was really nice; I was very happy to see him.

About working out: My workout was tons better today.  I mean, I am always disgustingly sweaty and out of breath at the end, and this time was no exception.  But I didn't feel dead like I did last time.  Maybe it's just an off-and-on thing, and the point is that the trend of my being better at exercising is moving in the right direction?  Hopefully.  I just want to be fit...

That's all for this evening.  I bore even myself.  One week from right now, the pharm test will be over.



extremely trivial

A-watching update: She's still in the psych hospital, looking at discharge tomorrow or Wednesday.  She's on a medication that seems to be working well at calming everything down.  I don't think that the medicine will cure anything necessarily, but what it needs to do is make her safe enough and stable enough and lift her mood enough for her to be okay first back in my parents' house and then in residential treatment.   A couple of times today I've gotten a little sad while listening to the radio in the car, because I always hear songs that remind me of her, but otherwise, I've been okay today and able to concentrate on studying.

As opposed to this weekend:  I had actually a very nice weekend with the boyfriend who does not have a catchy moniker.  (I mean, when I date doctors, I really like calling them all Dr Boyfriend, just like Dr Girlfriend on The Venture Brothers, but I called my ex that, and it just seems like bad luck to use it again.  Also, it seems confusing.  Dr Boyfriend the Second?  Unsure.)  Yes.  So I had a really nice weekend with him, but I got almost no studying done, only a few hours each day.  He is so sweet.  I met one of his good friends for the first time, and she seemed really nice.  I really enjoy being around him. 

Other things in addition to studying that are not going so well: My workouts.  I went back to the gym today, and I just had a lot of trouble.  I was able to complete it, but I just felt really disgusting afterwards.  Way too disgusting for the work that I was doing.  I think in some sense I am a little bit fitter than I was before I started working out, but it really feels like I'm not making much progress right now in being able to exercise faster or more intensively or in my weight...I did a little computer calculation that indicated that, given a fairly sedentary liftestyle, if I want to drop a pound a week, I can get where I want to be in a little over a year by eating ~1750 calories each day.  I know that most days I don't go over that, and I think that many days, I am under that.  Why is it not working???  I think that my body is just evil.

Anyway, I will now take a bath and relax my aching leg muscles.


much more trivial

So, let us update about my sister first.  I talked to her yesterday.  She seemed very sad, a little tearful, "hates it" at the hospital, wants to be home.  Although I know that I am trying very hard to see hope in this situation, I do legitimately wonder if it's not a step forward to just admit that she's sad instead of spending all of her time and energy pretending things are okay.  I feel like maybe if she lets go of all that pretense, then she'll actually have some energy to put into getting better.  I think that the fact that she's not going back to school this year probably will help; the only people she needs to be around are her family and doctors, and we her family all love her and don't want her to pretend with us.

Anyway, she started some new medicines yesterday, and, per my mom, they're already helping a bit, making her feel a bit calmer and like she can think more clearly.  So I hope that those will continue to work...

I studied quite a bit today.  Unfortunately, I really needed to have started studying in earnest on Monday, but this past week has been such a rollercaster nightmare that I didn't.  So I was reviewing path this week, and I have a year of path to review and I am only up to October or so.  And tomorrow I start reviewing pharm.  I'll try to do a little bit more path, though, too.

Also, I got my iPod Touch today, courtesy of the med school and the US government (for giving me loans so that I can pay my tuition that includes the bill for the iPod Touch).  It is such a neat toy!  The school had indicated that, although we'd have to put a bunch of medical-ish applications on it, we "might" have some room for our own music.  Might??  I put all of the required apps on it this evening and I still have 15 gigs left.  I could put almost all of my music on it.  I don't have wireless internet here at my house, so I will take it to school sometime this weekend and test it out.

And, in other minor news, I am going to see the Wolverine movie with the boy tomorrow.  He was quite excited about it and indicated that he had not planned to ask me to see it because it was a guy movie and he didn't want to pressure me.  So I suggested it, because I knew he wanted to see it, and I quite honestly wouldn't mind seeing it.  So, tomorrow evening I will turn off my brain and watch a lot of things blow up.

Lastly, 1) I didn't have a very good workout today and feel like a failure, and 2) I just ate many many strawberries, and they were tasty.

And with that, those are all the minor details about my life.


a win

A victory for the forces of good today.  My parents went to court for their hearing.  As we had thought, it was the school who called CPS on A, and the school social worker and the principal were there to testify against my parents.  My mother was appalled.  I haven't gotten the full details yet, but she said, "If I was the person that they described, I would shoot myself."  Apparently they just portrayed her as being very neglectful, very careless, very insouciant about my sister's depression and suicidal ideation, which, they contended, culminated in her attempt.

The judge had apparently written the order even before the hearing (!) committing A to state custody.  The only thing that made him change his mind was that everyone agreed that A needed to go to a specific program for residential treatment because it was the best, BUT the CPS worker indicated that the state, which would be responsible for paying for the program if the state took custody, would not be willing to pay for the best.  So it seems that the judge thought, hmm, place A with her (possibly neglectful) parents who are willing to spend money to send her to the best treatment program available, or place her with the state who will stick her in some hellhole to rot.  And he rewrote his order to give A back to us, and she is ours again and not a ward of the state.  Ha! 

She still did transfer to the inpatient psych unit this evening.  I have realized that I don't understand what is going on in her mind--when she is thinking of hurting herself and when she isn't--but she **seemed** okay with the idea of going over there, if only for a few days.  Because the judge and the insurance people and my parents decided that she didn't have to stay in the psych ward until transferring to residential; she could go home and insurance will pay for a visiting nurse, and she will not be left alone.  Per my mother, she will not go back to school this year.  My poor mother is so mad at the school people...I think especially she felt like she was friendly with the principal before this event...

So, I think that this whole event, as horrible as it was, may have driven my parent to be more serious about A's treatment.  It certainly drove them to commit to sending her to residential treatment, and insurance has even agreed to pay for it!  But I am so glad that this part of it, with the court and all, seems to have resolved...?

I got some studying done today for the first time this week, and I went to the gym, also for the first time this week.  I have been so consumed by all of these problems that it's just been really hard to commit to do anything.  And then this evening, I went to my volunteer refugee English tutoring.  I worked with three Hmong ladies.  I don't know how well I did as a teacher, but I enjoyed it.  I did some talking about culture--what to do in a movie theatre--as well as language stuff.

Thanks so much for all your support over the past few days.  I just hope A will be okay in the inpatient psych ward...


Thanks for all the nice comments.  I am usually somewhat self-contained, but in the past few days I have just been going anywhere and everywhere for support.  I hug the cat brothers a lot...

I spoke to A today; she is up and alert and oriented and no longer sounding drunk.  She sounds a little bit embarassed, like she knows she did something that is going to have consequences but would really prefer that it didn't have consequences.  Poor little girl, she doesn't know any of this stuff that's going on with the state, and she doesn't know that she can't go back home immediately.  No one has told her yet.  But I am so happy that she's awake and herself and that her mind/spirit/soul/essence-of-A, no matter how fragile or stained or shadowed, is still bouncing around in the little-girl-woman body.

My mom, however, is really struggling.  She has been really brave through all of this.  She's always been someone who hates facing unpleasant things and who prefers to distance herself and allow other people to work them out.  But she's really stayed with it.  She hasn't shirked from taking care of A or being involved.  But she's not used to dealing with emotionally difficult things, and I think that, even if you are used to emotional difficulties, this is sort of a big one.  She's getting very overwhelmed.  She was sobbing all the time she was on the phone with me.  She said that she walked around the house just screaming yesterday because all this was happening.  I want to support her, but it's such a huge role-reversal.  It's hard.  (And, as an amusing sidenote, the ad on the right side of my screen right now is from Sprint, saying "If only being a mom were this easy..." and advertising some new phone.  Ha!)  Also, I don't really know how you do cope in this situation...I told her that this will be over soon, and that she will get through it.  But I know the feeling.  It's like that torture they used to do where they piled stones on you....every huge stone that gets placed on to you, you initially think, Oh, I can't do this, and then you adjust a little, but as soon as you adjust, they put another stone on, and eventually your chest gets crushed and you die.  We are all trying to stiff-upper-lip it out over here, but I think my mother has about met with her limit of stones, and I am hoping that they will wait awhile for the next stone, because I'm not sure she could take it.

In other slightly good news, my dad has done an assessment for my sister at a really good child/adolescent residential treatment program near my house, the one where I used to work.  I don't know if it's finalized, but it's looking more and more like she'll go there within the next couple of weeks.  This will be good for a bunch of reasons.  I am really impressed with the program there, and I think it will help her.  I have always been so impressed with even the 'tech' staff, because I think they are wonderful at being consistently caring, firm, and safe.  I would feel safe if I were there.  And of course, I am happy that she will be near me and that I can go visit, and, since it's not a locked ward or anything, I will be able to take her out on weekends to do fun things when she is ready.  So, I hope it works and that she can go to this program.  In the meantime, I hope she is able to hear that she needs to transfer back to the psych unit in my parents' town without breaking down.  Poor little girl...she has been through so much.  Just a little more...I hope she can be strong enough to just go through a little more.

Thanks again for the nice replies.   I think I am taking this morning off and then going into school in the afternoon.  We are getting our iPod touches for next year--we are going to have them in lieu of PDAs and get Epocrates on them and things like that.  We also have to have our pictures taken for next year...I guess I should brush my hair.