Why I haven't posted in a while

It's been almost 3 months since I last posted! Wow, time flies.

This time, however, it was not me simply being too busy to write about my experiences. Rather, it was the timing of a JAMA paper that came out with some interesting data on medical students and patient privacy. As I was processing all this, I thought it would be better for me to hold off posting anything on this blog.

Here are some news articles about the paper that was published. (There were plenty more in case anyone is interested in reading them). They should give you an idea of what I am referring to:

Time Magazine
CNN

Soon after this, our medical school issued a statement and I quote a small segment of that statement: "Specifically, students are prohibited from sharing personal expressions, in the form of text, photos or video, that violate patient confidentiality, violate the doctor-patient relationship or depict illegal activities."

My hope is that I haven't violated any patient privacy in my posts during these past 6 months or so. However, I will be getting in touch with the administration to clarify a few things before I fully resume blogging - I have actually missed it quite a bit!

Since my last post - I have completed a month of outpatient medicine, one month of general surgery and 2 weeks of trauma surgery - I have plenty of stories to share and look forward to doing exactly that!

one of THOSE days...

After spending last week at the Coronary Care Unit (more about that experience later), I was very excited to re-join my Internal Medicine team for Week 6/8 of inpatient medicine. I was ready to start following some new patients as today was our call day, which turned out to be a 14+ hour call day.

My first patient was a very nice gentleman who had had a rough time with addiction issues in his middle-aged years but seems to have cleaned up his life quite a bit since then. He has been HIV+ for 20+ years and has been on anti-retrovirals since then. He is doing very well in that aspect of his life. He came in with a very non-specific complaint of some pain in his left arm that bought him a chest x-ray in the Emergency Department. The x-ray results bought him an admission into the hospital - something he was not too happy about, and a CT scan of his chest.

My resident, intern and I walked into the radiologists' office to get a read of his CT scan. Somewhere within us, all three of us knew what to expect. The CT scan confirmed a very high suspicion of a primary lung cancer in my patient. This can't be confirmed until a biopsy of the mass is done, but the radiologist was pretty sure this will turn out to be malignant - Here's hoping he is wrong.

We also wanted the radiologist to read the abdominal CT scan of my fellow medical student's patient. It turns out that that patient had the classic signs of metastatic ovarian cancer on her CT scan.

In a 5 minute visit to the radiologist, we bought ourselves 2 high suspicion scans for malignant cancers.

The universe was not done yet. My second patient was a very nice old lady who came in with some very non-specific complaints that had bought her a chest x-ray at a different urgent care center. The results of that chest x-ray bought her a visit to our Emergency Department, and a CT scan of her chest. I didn't have to go to the radiologist's office this time. The report was already in the system. Our patient had a humongous pleural effusion (fluid in the membranes surrounding her lungs) with a high suspicion that this was caused by metastatic cancer that had spread to her pleura. We will tap the fluid and analyze the cells in the fluid to see if it is malignant or not.

Neither of my two patients have a confirmation of malignancy yet, but if clinical suspicion is anything to go by, that might be changing tomorrow for both of them.

This was definitely one of those days. Yes, one of THOSE days.

List of Gyn Surgeries

The following is a summary of the surgeries I happened to see over the 2 weeks of Gynecology. The number after shows how many of each procedure I saw.

1. Tension Free Vaginal Tape Obturator, Sacrospinous fixation - for urinary incontinence - 2
2. Laparoscopic Bilateral Salpingo-Oophorectemy - Removal of both ovaries and fallopian tubes
3. Laparoscopic Assisted Vaginal Hysterectomy - 2
4. Laparoscopic Right Salpingo-Oophorectemy - The right ovary had a cyst about the size of a human head. We sucked out the fluid and the cyst was very easily removable after that!
5. Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectemy - with staging for cancer - thank goodness, there was no evidence of malignancy!
6. Total Abdominal Hysterectomy - 3
7. Total Vaginal Hysterectomy - 3
8. Laparoscopic Assisted Vaginal Hysterectomy - 2
9. Laparoscopic Assisted Supra-cervial Hysterectomy - You leave the cervix in
10. Exploratory Laporoscopy/Left Salpingo-Oophorectomy
11. Wide Local Excision of Breast Mass - benign mass
12. Partial Left Mastectomy
13. Dilation and Curettage - common diagnostic and therapeutic procedure for uterine bleeding, once for endometrial ablation for heavy menstrual bleeding - 3
14. Large Loop Excision of the Transformation Zone - pap smear had shown high grade abnormal cells in the cervix

Search here for more details of some of these procedures:

2 weeks of GYN surgeries

After a great week of night float on my Ob-Gyn rotation, I was due to spend 2 weeks in the OR helping with gynecological surgeries. I was very excited about this. One of the big decisions you make in medicine is whether you want to go into a "medical" field or a "surgical" field. I have yet to make that decision, mostly because I haven't had enough exposure clinically. The 2 weeks of Gyn would be a sneak peak into surgery.

Despite passing out in the OR during my first C-section, I wasn't too nervous about being in the OR. I had already been in on a few more C-sections and was getting used to that atmosphere. Scrubbing into the OR was becoming more of a habit. This includes scrubbing our hands and arms for 5 minutes to make sure that we are completely clean and maintain sterility in the Operating Room. The harder part is gowning up and gloving up while remaining completely sterile. Thankfully, most of the nurses were very helpful with this, and by the end of the two weeks, I felt more competent with the art of scrubbing. This is not me below but we looked something like this while getting ready for the surgeries:


Most of the surgeries lasted anywhere between 30mins - 2 hours and were really enjoyable! I got an opportunity to scrub in with residents who were accompanied by teaching faculty members as well as private attendings (highest on the totem pole in medicine). I was pleasantly surprised by how much almost each and every one of the surgeons was interested in teaching. They took the time to show me anatomic structures. They took the time to ask me questions about the anatomy. The really good ones took the time to get to know me better and give advice on how to go about the 3rd year of medical school, and how to balance personal lives with careers. I was also very lucky to work with excellent residents who had a wonderful attitude towards their patients and showed great skill.

One of the final year residents especially sticks out in my mind. Her laparoscopic technique was simply brilliant. I would say that her skills were so developed that they would probably rival most attendings' skills. Not only that, but she knew how to make laparoscopic procedures interesting for me as a medical student. We don't get to do the actual procedure so it can sometimes be hard to stay focused looking at a video screen for 2 hours. However, this particular resident described each step as she did it, engaged me throughout the entire time and really made the time fly by. I am very thankful for seeing her teach and hope to emulate some of her techniques once I am on the other side. (of course, that is if I end up going into a surgical field)

As the two weeks went by, I got to see a large variety of cases (listed in the next post). I would be very excited to wake up every morning to be in the OR. I had a lot of fun talking to my patients before the procedures. Although they were nervous and scared, they had this faith. Faith in their surgeons that whatever problem they had would be fixed after the procedure. Faith in their anesthesiologists (whom they only met for a few minutes), that once they went under, the anesthesiologist would take care of their breathing and their basic physiology.

I did not expect this. I absolutely LOVED being in the OR for the 2 weeks. Whether it was the adrenaline of being there and seeing awesome procedures done for the first time, or whether it is a sign that a surgical field is calling my name - only time will tell.