Friday, July 13, 2018

No scrubs

I don't actually know what that line in the song means, but I thought it a fitting title for a post on finishing Surg.

Surgery has never been particularly appealing to me. I find anatomy tedious, have zero visual-spatial intelligence, and detest 30-seconds-per-patient ward rounds. Sure, Surg had been great as a student - I learned a lot and had no responsibilities. Also, I was only there for six weeks or something. The idea of living the #surglyfe for three whole months as an intern struck fear in my heart, to tell you the truth. I mentally prepared myself for long hours in a rotation that I cared little for, and bade the sun farewell (you're in the hospital well before the sun rises, and only head home after it's set).

There were some positives, though. I had been assigned to Breast and Endocrine, which meant I wouldn't have to be overly invested in patients' bowel habits/stool consistency (sorry, Colorectal). Breast and thyroid surgeries are generally pretty neat and quick, so no standing in theatre for hours on end assisting with complicated bowel resections or Roux-en-Ys. Also, thyroid and parathyroid surgeries meant at least some degree of medical learning, which this medically-inclined intern was grateful for. I'd been talking to a locum Psych reg (originally a Med reg) about starting Surg, and he said it wouldn't be so bad since interns dealt with patients' medical problems on the ward anyway. It had been a random, brief conversation with someone I might not ever meet again, but this was something I held on to throughout my time on Surg.

As the only non-surgically-inclined person on the team, I did my best to take care of the medical side of things. My biggest triumph was figuring out the cause of a pre-op patient's newly-diagnosed AKI after trawling through their drug chart, bloods, records, and taking a history. I would look through patients' histories and read up on the weird and wonderful diseases I encountered, just to get some medical learning in. Pre-op was great in terms of examination -- I learnt to listen for the prolonged expiratory phase in patients with known COPD, and got to examine Grave's patients with exophthalmos and good-going thyroid bruits. I also picked up a loud systolic murmur in a toddler, who went on to have a paediatric echo to look for structural abnormalities in their heart. And all that was just the non-surgical learning!

In terms of Surg itself, I also learnt heaps. A large part of being a Surg intern is managing electrolytes -- potassium and magnesium are the main concerns, but you're also worried about calcium when you're on Breast and Endocrine. Isaac was constantly writing up minibags, and I soon started calling him the electrolyte king. The other thing you get pretty good at is prescribing analgesia. Initially, whatever your boss says is gold and you just chart that, but then you occasionally overhear anaesthetics raging about charting (or not charting) a particular med, so you take that into account and slowly begin to formulate your own approach to analgesia. My two main takeaways: Long-acting analgesia should not be used for acute pain, and tramadol is the one thing that can definitely be used with a PCA. In addition to all that, I got to help out in theatre a bunch, and once did a close-to-perfect subcuticular stitch closure of a breast lump excision wound. It was beautiful and incredibly satisfying, and that was probably my proudest moment on Surg.

My favourite part of Surg, however, was the people. We had a great bunch of regs this term, and also a great bunch of interns. The doctors' office was always abuzz with activity -- paper rounds, general chatter, and everyone teasing/bullying Sarah. (Things got a bit confusing at times with two Sarahs and sometimes two Rachels, but we got over it.) The office was a narrow, stuffy, usually overcrowded room, but I already miss the good times we had in there. Like when an unnamed individual nearly gave himself a concussion. Or when the same unnamed individual somehow mysteriously ended up having his face plastered over the screen of every computer in the room. Or hilariously awkward Shoot Shag Marry sessions. Or 'superstitiously' planning but not planning basketball sessions. Or asking each other why they were still there and why they hadn't gone home yet. Or commiserating with each other because we were both still there and both hadn't gone home yet. Ah, the memories!

Of course, I'll miss my team as well. Isaac and I genuinely worked so well together -- it got to the point where if one of us was scribing and our phone rang, the other would silently reach for the phone to answer it, no prompting required. Jobs were completed quickly and efficiently, which meant we got to spend time in theatre. Our reg was an excellent leader, and I was constantly admiring his patient rapport. Also, thanks to him, we almost never had to come in before 7am, which is a huge blessing in the world of a Surg intern! The big bosses were an absolute pleasure to work for, and continuously showered us with surgical teaching and homemade food. It was such a fantastic team, and I will miss it very much. This is possibly the last Surg rotation I will ever do (woo!), and I'm thankful to have had such a great experience.

I've just started on ED, and found it to be a stark difference from Surg. Far less walking, for one, and also far more snacking in an attempt to stay awake (thanks, shift work). This does not bode well for my weight. However, I will theoretically have more time for gym, so hopefully this will help offset the extra food intake. My first day on the floor was kind of insane; so insane, in fact, that it actually made the news. I've just finished my second day, which went far better. All the bosses have been really lovely and supportive, and I've decided that ED nurses are my favourite nurses in the whole hospital. It's looking to be a good rotation, and I'm looking forward to the rest of it.

It's sort of ironic that I've titled this post 'No scrubs' as a farewell to Surg, but we actually wear scrubs in ED as well. But whatever. I thought it was clever, so I'm running with it.

(Bye, Surg!)

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