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what the HECK.
surgery wk 2, day 8
i started out the day extremely tired, having had 4 hrs of sleep. i was able to choose the OR shift with Dr. Z that was supposed to end early, since i was post-call.
Dr. Z and i had worked together before. by now, i was familiar with his procedures, and was generally on good terms with him. he allowed me to ask questions, and let me do a little more than a typical med student is allowed.
today was a little unusual in that a guest surgeon from a different country (expert in the type of operation we were doing) was visiting to observe, critique, and give suggestions on improvement. we were on track to finish at 3 or so. i was planning to jet home and sleep after the last op. however, the last op became complicated.
first off, anesthesia had trouble intubating the pt. which caused a bloody trach tube, and the patient kept desaturating during the intubation. took up another 20 min, and got Dr. Z already somewhat irritated. then Dr.Z became unsatisfied with my retraction. kept asking me to retract harder, HARDER, HARDER, because harder retraction would help her to see better. i didn't know which way she wanted me to move, so i let the fellow guide my hand. he positioned me, i maintained position. yet she kept complaining, kept asking me to retract harder.
then, midway through the procedure, Dr. Z had apparently nicked a medium sized artery that pulled away, making it very difficult to locate and control. after some time, we eventually found the artery and clamped it.
yet even after suctioning, there was still blood pooling in the abdomen. a more careful survery showed a bleeding spleen. where my retractor had been. Dr.Z cursed. when i put my hand on the retractor to adjust it, he yelled out, "DON'T touch it! look, get out of there, and come behind me."
the next 20 minutes, he worked on fixing it. the normally jovial and light operating room was quiet, and the beeps of the monitors seemed too loud. i felt like a leper.
eventually, the bleeding was contained, and Dr. Z resumed the procedure. quiet still hung in the air. i stood behind Dr. Z, well out of his sight.
Dr. Y, the visiting expert who was standing next to me, bent down and said, "you know that wasn't YOUR fault, right, jacob?"
Dr. Z: "oh! he knows that. you know that wasn't your fault, right jacob?"
my mind was churning. what was i supposed to say? the truth? i squeezed out, "well, NOW i do." laughter. the scrub nurse cracked a joke, and the jovial character of the room was restored. for everyone else, that is. i was still upset. what i really wanted to say was: yeah, i know it wasn't my fault. it was YOUR fault for yelling at me to keep pulling harder and harder on the retractor. but i'm not ballsy like that. my comebacks rise and die in my head.
in retrospect, it wasn't my fault. and both doctors said that the pt would be fine, that it just took a little longer, that's all. but i still felt crummy. crummy that Dr.Z pretty much commanded me to do something, and then blamed me for the negative results. crummy that He told me to not touch anything. crummy that he told me to step away from the table and to stand behind him. if it wasn't my fault, why are you treating me like i screwed up? crummy that i felt like a leper. crummy wondering if Dr. Z was going to report this and demand that i be failed out of the clerkship (not unheard of). most of all, though, i worried that in several days, someone would come up to me and tell me that this patient had died. i couldn't get that out of my mind. it's one thing if a person was going to die, and i couldn't save him. it's quite another for a patient to die because of a mistake, something you did.
i'm terribly grateful for Dr. Y, however. he, the expert, took the time to worry about how i felt, and to reassure me. i think Dr.Z wouldn't have even thought to reassure me.
the craziest thing about all this: even after the stress of getting yelled at, being treated like a leper, being shunned like a leper, worrying like heck about all the issues above, i STILL got really sleepy standing behind him. this is amazing to me. aparently, i can sleep in any situation, however stressful or emergent. should this country go to war, i would fall asleep. should there be an earthquake, i would fall asleep (actually, i have slept through a big earthquake back in LA). should armaggeddon come tomorrow, i will likely be fast asleep.
that was the mood i came home with. then i read about the lakers moving up, kobe being the top candidate for mvp, etc, etc, and order was once again restored.
but what really made me laugh:
Basketball shockers:
the last one reads: Oshkosh player Frank Andresko dribbles overinflated basketball, which explodes and hurls him into gym wall (1929)
i'm chuckling imagining this. oh boy. heehee.
yakob at 6:23 PM
-----------------
surgery wk 2, day 8
i started out the day extremely tired, having had 4 hrs of sleep. i was able to choose the OR shift with Dr. Z that was supposed to end early, since i was post-call.
Dr. Z and i had worked together before. by now, i was familiar with his procedures, and was generally on good terms with him. he allowed me to ask questions, and let me do a little more than a typical med student is allowed.
today was a little unusual in that a guest surgeon from a different country (expert in the type of operation we were doing) was visiting to observe, critique, and give suggestions on improvement. we were on track to finish at 3 or so. i was planning to jet home and sleep after the last op. however, the last op became complicated.
first off, anesthesia had trouble intubating the pt. which caused a bloody trach tube, and the patient kept desaturating during the intubation. took up another 20 min, and got Dr. Z already somewhat irritated. then Dr.Z became unsatisfied with my retraction. kept asking me to retract harder, HARDER, HARDER, because harder retraction would help her to see better. i didn't know which way she wanted me to move, so i let the fellow guide my hand. he positioned me, i maintained position. yet she kept complaining, kept asking me to retract harder.
then, midway through the procedure, Dr. Z had apparently nicked a medium sized artery that pulled away, making it very difficult to locate and control. after some time, we eventually found the artery and clamped it.
yet even after suctioning, there was still blood pooling in the abdomen. a more careful survery showed a bleeding spleen. where my retractor had been. Dr.Z cursed. when i put my hand on the retractor to adjust it, he yelled out, "DON'T touch it! look, get out of there, and come behind me."
the next 20 minutes, he worked on fixing it. the normally jovial and light operating room was quiet, and the beeps of the monitors seemed too loud. i felt like a leper.
eventually, the bleeding was contained, and Dr. Z resumed the procedure. quiet still hung in the air. i stood behind Dr. Z, well out of his sight.
Dr. Y, the visiting expert who was standing next to me, bent down and said, "you know that wasn't YOUR fault, right, jacob?"
Dr. Z: "oh! he knows that. you know that wasn't your fault, right jacob?"
my mind was churning. what was i supposed to say? the truth? i squeezed out, "well, NOW i do." laughter. the scrub nurse cracked a joke, and the jovial character of the room was restored. for everyone else, that is. i was still upset. what i really wanted to say was: yeah, i know it wasn't my fault. it was YOUR fault for yelling at me to keep pulling harder and harder on the retractor. but i'm not ballsy like that. my comebacks rise and die in my head.
in retrospect, it wasn't my fault. and both doctors said that the pt would be fine, that it just took a little longer, that's all. but i still felt crummy. crummy that Dr.Z pretty much commanded me to do something, and then blamed me for the negative results. crummy that He told me to not touch anything. crummy that he told me to step away from the table and to stand behind him. if it wasn't my fault, why are you treating me like i screwed up? crummy that i felt like a leper. crummy wondering if Dr. Z was going to report this and demand that i be failed out of the clerkship (not unheard of). most of all, though, i worried that in several days, someone would come up to me and tell me that this patient had died. i couldn't get that out of my mind. it's one thing if a person was going to die, and i couldn't save him. it's quite another for a patient to die because of a mistake, something you did.
i'm terribly grateful for Dr. Y, however. he, the expert, took the time to worry about how i felt, and to reassure me. i think Dr.Z wouldn't have even thought to reassure me.
the craziest thing about all this: even after the stress of getting yelled at, being treated like a leper, being shunned like a leper, worrying like heck about all the issues above, i STILL got really sleepy standing behind him. this is amazing to me. aparently, i can sleep in any situation, however stressful or emergent. should this country go to war, i would fall asleep. should there be an earthquake, i would fall asleep (actually, i have slept through a big earthquake back in LA). should armaggeddon come tomorrow, i will likely be fast asleep.
that was the mood i came home with. then i read about the lakers moving up, kobe being the top candidate for mvp, etc, etc, and order was once again restored.
but what really made me laugh:
Basketball shockers:
the last one reads: Oshkosh player Frank Andresko dribbles overinflated basketball, which explodes and hurls him into gym wall (1929)
i'm chuckling imagining this. oh boy. heehee.
yakob at 6:23 PM