Orthopedic surgery, round 1 run-down

Seeing as this is the end of my first orthopedic surgery rotation, it seems fitting that I do a run-down of the past 2 weeks:

Number of weeks in rotation: 2

Number of patients seen: well over 100 (I lost count on day 2)

Number of surgeries: 15

Number of new sutures learned: 1 (the horizontal mattress stitch is pretty awesome if you don't wan't a huge scar when they come out!)

Number of solo intra-joint injections performed: 1!!!  (By far, the most exciting part of my day today!!!)

I wish I could say that being so stubborn and set in my ways will change after such an incredible, eye-opening experience, but due to the fact that I am so stubborn, I don't think that will happen.  But, I can definitely say that this has, by far, been the best 2 weeks of my training thus far!  I was so lucky to have such a fantastic teacher in my preceptor, who took the time that I needed to learn, and gain something from each experience.

I must say that learning about orthopedics in lecture and actually experiencing it first-hand is so different; I always thought that I could never imagine seeking a career in orthopedic surgery, because sitting in lecture, learning about how bone growth happens, and the types of bone pathologies on paper can become very tedious and boring.

However, in the clinic, when I was actually able to see the effects of these pathologies, and how they affect patients' lives, and the evidence of everything as seen on x-rays, MRI and CT imaging studies, in addition to the very hands-on nature of their assessment and treatment, my opinion totally changed.  I loved the balance between seeing patients in clinic, and the ability to scrub into surgery, and have the procedural component included in there.

I am pretty sure that after this experience, I don't know how any other rotations will be able to live up to this one, and how challenging and fun it has been.  I have been so surprised by how the things I have been so enthralled by in the classroom have turned out to not interest me as much in clinic, and the things that I never would have considered beforehand based on my classroom experiences have me thinking about the possibility of long-term career goals.  I can honestly say that this has been the best summer I can remember in my entire life, with the combination of fantastic clinical experiences, wonderful (and much-needed) time off from the world of academia, and the chance to explore my place in medicine.

Beyond the broken bones

Considering my life is currently dominated by all things orthopedic surgery, I felt it appropriate to change the picture on my blog, to that of a post-op. x-ray of someone with total knee replacements, a surgery that is not uncommon in ortho.

For those of you who, at times, know me better than I know myself, you know that I am an EXTREMELY stubborn person, and, sometimes to a fault, I am very set in my opinions, and my feelings on what I like, and what I dislike (or think I dislike).

Such was the case coming into my required surgical rotation for the summer.  Months ago, back in January, we all had to fill out an inquiry form for our surgical rotations, indicating our preferences for surgical specialties (general, GI, urologic, trauma, orthopedic, etc.).  I just remember that, when I did fill out the form, I ranked every other specialty above orthopedic surgery; the idea of ripping apart joints, using tools seemingly better suited for a carpentry shop, and operating on bones really freaked me out.

So, much to my dismay, when we received our assignments for the summer, I saw that not only was I placed in Greeley, but in orthopedic surgery...what, was this the universe showing its hatred toward me?!?!  In the weeks leading up to the one I just completed, I tried fervently to find positive things about my assignment ("well, this should make it easy for me to realize I don't like surgery;" "I'll reinforce what I don't like, which will inevitably help me know what I do like when it's time for me to pick a specialty," etc.)  Seriously, there was no one dreading a rotation more on the planet than me, last Sunday night, as I went to bed before my first day in the ortho. clinic.

I must admit, my first day of the rotation was a little uneventful, since it was a clinic day.  My preceptor operates 2 days out of the week, and sees new consults, pre- and post-operative patients the other 3 days in clinic.  A lot of range of motion testing, special tests, and trying (and failing most of the time) to interpret x-ray and MRI studies to determine what caused pain, swelling, redness, limited motion, etc.  All throughout clinic on Monday, I was thinking about (and dreading) Tuesday, because I knew that would be my first day in surgery, and when I finally had to encounter all of the creepy things that made me think I hated orthopedic surgery.  I was terrified that at the moment I heard the revving of the jigsaw used to remove small pieces of bone, I'd pass out cold on the OR floor.

I didn't sleep a whole lot on Monday night...too nervous to calm down and sleep.  I got to the hospital at 6:30 am for the scheduled 7:30 am start of the first surgery.  I found my way down to the OR, and into the locker room, where I changed from my street clothes into the requisite blue scrubs, my super comfortable tennis shoes, surgical cap, and 2 pairs of shoe covers.  I then entered the OR hallway, and found the main desk, and looked at the scheduling board to see what was up for the day.  My preceptor had 6 procedures scheduled for the day, including a few arthroscopic procedures, and a total knee replacement.  I met up with him in pre-op. to visit the first patient on the schedule with him, and to touch base on what the day was going to look like.  At this point, I could hear my heartbeat inside my ear, and I was shaking beyond belief (and I had no coffee that morning, for fear that I'd get into a long surgery without the opportunity to leave to visit the ladies room).  Once the pre-op visit was done and the patient was under anesthesia and ready to go, I left to go with my preceptor to look at the x-rays, and "scrub in."

Scrubbing in is quite a bizarre practice for anyone not in medicine, and even some of us in medicine.  The ways in which we must move in order to get our gown, gloves, goggles, and other protective gear on without contaminating ourselves, the sterile surgical field, surgical tray, and the other sterile people in the room is quite mind-boggling.  It sort of looks like an awkward, 90s-style club dance, in which you back into the room after scrubbing your hands and forearms, with the scrub nurse coming at you with your gown while you wriggle your arms through the sleeves, and someone comes up behind you to close the velcro enclosure at the neck.  Then the scrub nurse holds your right hand glove out in front of you, and with still partially damp hands, you have to somehow dive your entire hand into the glove, and make sure all of your fingers find the appropriate home.  The process repeats for the left hand, and then for another pair of gloves placed on top.  Then, to tie the gown around the waist, you give one part of the sash on the gown to the scrub nurse, while you grab the other side, and twirl around (what is fondly known as the "surgical pirouette") until you meet on the other side, and you tie the 2 strings securely in a bow.

Seriously, between the process used to get scrubbed in and sterile (by the way, there is probably nothing that makes you feel more stupid as a student than scrubbing in for the first time...there is no way around it...you will look like an idiot, but everyone in medicine has had this rite of passage), and knowing that I was about to see someone's bones, I was proverbially sweating bullets at this point.  And the surgery hadn't even begun yet.  Oy.  I was toast.  But, I figured, as a student that was scrubbing into surgery for the first time ever, my precepting surgeon would probably just have me standing somewhere obscurely in the OR, observing.  Nope.  "Katie, stand right next the table right here; you'll get a better view that way."  So much for obscurity.

Once the surgery had started, and he was down to the bone, my surgeon told me to take my gloved finger and place it into the surgical field, while he flexed the joint.  Apprehensively, I did so, totally freaked out.  But, once he started flexing the joint, I realized just how amazing it was that I was touching someone's actual bone, while it moved!!!  This tiny joint in the foot, that had helped this person move, was the one I was touching right now in surgery!  SO COOL!

Yep, and all of you naysayers out there can probably predict how the rest of the story goes: a few screws and stitches later, and I was hooked!  Seriously, I fell head-over-heels in love with orthopedic surgery!  And that was just with the morning surgery!  A few arthroscopic procedures and a very quick ingestion of lunch later, I was getting ready for the afternoon's total knee replacement.

As a student, I had heard up until now that there is pretty much nothing more violent that we, as healthcare providers, can do ON PURPOSE, than total joint replacements.  I knew that when my surgeon told me that I would need to don the surgical haz-mat suit for this one, complete with booties, gown, and a helmet with it's own personal cooling system, I knew the rumors weren't lying.

Once in there, I was told to again, stand right next to my preceptor, but this time, I was going to get the opportunity to not only observe, but serve as the 2nd assist!  He wasted no time in deconstructing the joint (if you have a morbid curiosity, just look up "total knee replacement" on youtube; there's a plethora of live surgical videos that go through the surgery in detail).  For all of you not in medicine, in a period of just over 2 hours, the knee joint is completely deconstructed, the patella is removed and retracted to the side, small pieces of the tibia and femur, most likely severely affected by arthritic change, are removed using a surgical jigsaw, the artificial end pieces (aka the new knee) are fitted, cemented in, and everything is sewn back and stitched up.  Seriously, when I say violent, it's pretty fitting, although mostly bloodless.

Being a part of the total knee replacement was pretty much the most amazing thing I've done up until now.  I was there to witness, first hand, as a surgeon completely tore apart someone's knee, again, on purpose, and used his skills and a bunch of surgical titanium to build a new knee that would not be riddled with the same arthritic issues as this patient's actual knee had been.  It was SO MUCH FUN!!!!  Again, if you have a strong stomach, watch it on Youtube; it's pretty cool!

After the total knee, there was just one more surgery, and 15.5 hours after I had arrived that morning, I left the hospital for my bed, blissfully knowing I could sleep in a bit the next morning, since the day only involved rounding on the post-op. patients, and checking on their progress.

Wednesday involved rounding, and Thursday was another busy day of seeing patients in clinic.  Surgery, like Diabetes Camp, feels like total immersion.  Orthopedic surgery is a world unto itself, with an entire breadth of terminology, physical exams, pathologies, and techniques, and surgical tools (including to my amusement, an ugly looking tool called a "mother-in-law," most likely named by someone who thought his mother-in-law was scary) to know and master.  Since this is only a 2-week rotation, I cannot possibly learn everything, but I have been fervently studying every night after clinic, in the hopes that some of what I see in clinic and surgery will stay with me.

Next week is another busy week of clinic patients, rounding, and most importantly, SURGERY on Tuesday and Wednesday.  Seriously, if you had talked with me just a week ago, you're probably totally flabbergasted that I'm actually excited for more surgery.  It's kind of addicting, actually...like chocolate, only better.

I am already anticipating scheduling more stints in orthopedic surgery throughout my clinical rotations, including, hopefully, another, longer rotation with this same surgeon.  I have learned so much, and am so grateful to have such a patient teacher, and overall, so far, amazing experience.

Stay tuned for all of the nitty gritty details of orthopedic surgery, week 2.  If it's anything like this past week has been, I'm sure I'll have plenty of fodder for another interesting post.

High-low, high-low, it's off to camp we go...

Wow, it's been WAY too long since I've posted...since like, the end of fall semester of 1st year.  I can definitely say that a ton has happened...enough to deserve more than one blog posting.  Here's just a peek at what I've been up to:

1. I'm officially a 2nd-year PA student (aka, PA-S2).  I must say, I had so much fun changing my email signature from saying PA-S1 to -S2, and being able to have the -S2 on my security badges for the hospitals.  It represents 1 extremely long, arduous year, full of tears, frustration, feeling overwhelmed almost as often as I brush my teeth, completed.  It also represents moments of satisfaction, especially those during my clinical rotations, when I am reminded of WHY I put up with the frustration and feelings of being extremely overwhelmed: I will have the health care needs of my patients in my hands, and will have the knowledge and tools to help them.

Students from previous classes have always said that this summer between 1st and 2nd year is the most glorious summer you'll ever experience in the CU PA program, because it actually somewhat resembles a normal summer.  So far, that has proven to be true.  We finished classes in May, and other than the 2, 2-week clinical rotations that we've had to complete, all of the other time until August 29th is ours.  It's such a great feeling being able to sleep in, and not have to freak out about a nap-time that inadvertently went WAY longer than 30 minutes, as you'd set your alarm for more study time.  I know, that with just over a month until August 29th, I really need to enjoy the time I have remaining, because 2nd year will be just as unforgiving as the first.

Now, onto those clinical rotations.  After spending countless hours in the classroom, there's such immense satisfaction that comes from being in the clinical realm, and having the opportunity to "practice what they preach."  I am surprised at how much more comfortable I feel seeing patients now, as my first time in clinic was nerve-wracking, and an experience in overcoming the feeling of being an idiot.

This summer, I was scheduled for my required surgical rotation (more on that in the next post), and an elective.  For my elective, I chose Pediatric Endocrinology, and was split between the outpatient clinic at the Children's Hospital, and the 2nd part of the rotation was going to Camp Colorado, Diabetes Camp 2011.  My week at TCH was so much fun, as endocrinology is one of my favorite areas of medicine, and the practice environment at Children's is just so much fun, and definitely favorable to students.  All of the providers jumped at the opportunity to have me see the interesting patients that they were treating, and eventually throw me and have me see some on my own.

Diabetes Camp, on the other hand, felt like a foreign language emersion program.  Camp Colorado is one of the many camps that the American Diabetes Association puts on around the country every year, so that kids living with Type I Diabetes have the opportunity to thrive in an environment with other kids dealing with Type I, and to just be kids, doing camp things.  Often times, normal summer camps just don't have the capacity or knowledge to deal with the day-to-day requirements of a camper with diabetes, and therefore, a lot of these kids wouldn't otherwise be able to experience summer camp.

Camp Eagle Lake was absolutely gorgeous!!!  I still can't believe I got credit for my clinical rotations for this!

Beautiful view of Eagle Lake, just after an afternoon rainstorm :)

Beach-front lifeguard chair

Like I said, the week that I spent at Diabetes Camp truly felt like a total immersion program in a foreign language.  I learned more about blood glucose testing, blood sugar highs, blood sugar lows, insulin types (rapid-acting, intermediate-acting, long-acting, Lantus, Humalog, Novolog, etc.), insulin pump therapy, and giving injections than I could have ever learned in the clinic setting, where, when these kids do their follow-up appointments, things are going pretty well for them on the day of their appt.  I also saw first-hand the effects of too much exercise, not enough exercise, crazy teenage hormones, altitude, and 5 pita grilled cheese sandwiches on blood sugar levels.  Let me just say, it was one crazy week, but I learned so much about diabetes management, and will most definitely be returning next summer for another round!  

I was so incredibly humbled by the 268 campers there, and especially by their parents; I was completely exhausted after just 6 days of 24/7 diabetes management for my 7 campers...this exhaustion doesn't even scratch the surface of what the parents of these campers must feel every day, worrying about their child's blood sugar levels, getting up at 2am to test them, and give them a snack if their sugar is too low, and bolus them with insulin if it's too high.  However, I was extremely lucky to have a med-staff partner who not only has done camp before as a staff member, but she has been living with Type I for the past 8 years, and taught me so much, and very willingly answered all of the random questions I had for her!

After briefly recovering from my endeavor in endocrinology, it was off to my required surgical rotation in Orthopedic Surgery, in lovely Greeley, CO (stay tuned).