Lots of suturing

I have definitely neglected updating this blog in awhile; Internal medicine has come and gone (which was the update from my last post; I had just finished my first week of IM, and now it's already done), and I saw and learned a lot.  It was a very nice introduction to full-time clinical rotations, with a wide variety of different patients presenting with different chief complaints, and very complex medical history and allergy lists.  I actually did a happy dance when the rare patient presented with no significant chronic illnesses and no known medication allergies.  However, my ability to use my pharmacology definitely increased dramatically when I was forced to integrate the list of the patient's medication allergies with what was available to me, and I learned the preferred 2nd and 3rd line drugs (especially antibiotics) for common disorders, when a patient was allergic to the 1st line therapy.  I also became confident in when I picked up on an abnormality, because I've already seen/heard so many normals.  It's nice when things start jumping out, like a subtle heart murmur, developing abscess/infection, or difference in a neuro. exam from what is expected.

This month has been with the plastic and reconstructive surgery service.  While I know that it won't be what I pursue professionally, it has been a great time learning about different common procedures used for breast reconstruction post-cancer, reductions, augmentations, and other reconstructive procedures that may be part of my patients' histories.  It has also been a great opportunity to learn different suturing and knot-tying techniques, although I feel like I'm the slowest suturer ever.  I have done (although very slowly) sub-cuticular and deep dermal suturing now, both of which I hadn't done in my previous surgical rotations.  Sub-cuticular is amazing, because they are done with absorbable suture material and buried beneath the skin; the resulting scar is minimized, and you don't end up with the "railroad tracking" appearance from sutures that are superficial.  I hope that with time, I will be able to do more than 4-5 sutures a minute.  It is also difficult that I am left-hand dominant, and many surgical instruments are built for right-handed surgeons/assistants.  I will have to learn many things in a different way.  It's a constant learning experience. 

I have one more week of plastic/reconstructive surgery, and then I start my Ob/Gyn rotation, which I'm very excited about.  It's at a community hospital, away from the academic medical centers that are not as conducive for students and getting individual attention, and less competition.  Hopefully I'll find more time to update things next month!