Videos and noses

Yesterday a sales rep for glidescopes came by. The glidescope is a plastic device with a camera on the end designed to replace the standard metal laryngoscope--it was actually pretty neat, but since the anesthesiologists were trying it out it prevented me from intubating people, so I kind of hate it. It is particularly meant for difficult intubations, but apparently some prefer it for even standard intubations since it is gentler on the patient's mouth--one doesn't need to pull upwards on it like one would a laryngoscope.

The highlight of the day was when I successfully intubated a patient nasally. An oral surgeon comes on Fridays, and since he obviously needs to have access to the patient's mouth he can't have a tube sticking out of it. There were two patients, the first I did not succeed on, but I got the second. To intubate someone nasally, you first dilate one of the nares with a series of progressively larger rubber tubes, then you have someone assist by advancing the endotracheal tube through the nose. Then, you use a laryngoscope in the standard fashion to visualize the vocal cords and guide the tube between the cords with a pair of McGill forceps while the assistant advances or withdraws the tube per your instructions. I was very happy, I didn't think that I would even get to try nasally intubating someone, much less succeed.

The nice thing about this rotation is that I feel like a normal person. I don't have to worry about studying when I get home (though that needs to change this week as we do have an exam at the end of the month), and weekends are totally free. Yesterday evening I was going to meet some friends at a park by the lake, and I still had time to spend an hour going through Barnes and Noble beforehand. I bought John Piper's "Desiring God" which looks very good, as well as a collection of some of Bram Stoker's books. I have always wanted to read "Dracula" but never have. I was also trying to find "The Language of God" which apparently is a book by the man who ran the human genome project defending faith in God, though I believe he is a theistic evolutionist and not a creationist. I couldn't find it, but did find lots of books in the theme of "The God Delusion" by Dawkins. I started paging through one to see what the author's arguments were, but had to put it down as I was beginning to visibly shake my head in disgust and was on the brink of actually making loud uncomplimentary comments and as I was standing by myself in the middle of the store I didn't want people to think I was high on something. Also in that vein for a lark I went by the alternative health section and picked up a book by Kevin Trudeau who essentially claims that the government is covering up the fact that all human illness and suffering can be solved by taking an herb--and he does it in the most irritating informercial-style possible. Again, I did not look at the book too long since another minute would have resulted in my flinging it across the store.

I found out my fourth year schedule yesterday. I'm quite happy with it, I got pretty much everything I wanted when I wanted it. The sequence will be: trauma surgery sub-i, vacation/step 2, breast disease (with surgery program director), nephrology consults, away rotation (which I still need to set up), ER (in November, so hopefully I can schedule shifts around interviews), two months of vacation/interviewing, then pediatric sub-i (we had the option of internal medicine, peds, or family; if I could have done internal medicine at the VA I probably would have ranked that first, but since I was at the VA last year my sub-i would be at the school's main hospital, and as sub-is we have much more autonomy at Children's where we really are treated as interns). My last serious rotation will be inpatient cardiology in March, then in April I will have radiology (also known as radiholiday--we have to show up, but have no actual responsibilities), and May will be "Preparing for internship".

More intubations

So far I have done 20 intubations and still have a week and a day left. Much as I enjoy this opportunity and like the people at this hospital, I think another week of this is really unneccessary. I'm getting a little tired of having no responsibility other than putting a tube down someone's throat four times a day and sitting around playing games on my PDA during the in-between times. On the bright side one of my attendings quickly became my favorite person of the month after telling me that I should not be at the hospital any later than noon on any given day. I can live with that. This week we had lecture every afternoon anyway, but next week we have no lectures. I'm not sure what I'm going to do with all the extra time.

Intubate

Today was a good day--I stayed busy and held off boredom. I intubated four patients, the last three I did entirely by myself. Last week I couldn't find the vocal cords on my own so the anesthesiologists had to position the blades for me. This afternoon we had three very crummy lectures. The good news though is that I was able to wear a short sleeve shirt outside today! (as opposed to having to trudge through almost a foot a snow and icy winds like last week).

Procedures

Not much going on. This month I am on a clinical procedures rotation. The first week and a half consisted completely of lectures (some of the days we didn't have to show up until ten!o!clock!!!) sponsored by the emergency and trauma surgery departments on resuscitation and advanced cardiac life support. Now, theoretically, should someone go into asystole, vfib, or vtach right in front of me I'll be able to do something about it. I'm still working on recognizing orthodromic reentrant tachycardias and other such things though.

The last two and a half weeks of the rotation consist of following an anesthesiologist around. Most students go to the main school hospital and are assigned a resident they are with everyday, and are supposed to remain in a case beginning through end. I have the advantage of being at a community hospital where there are no residents and I am the only student, and I am encouraged by the staff to "procedure hop", which means jumping in at the start of a case, intubating the patient, then jumping to another case to maximize the number of intubations I can do. Once I get the swing of things I think it will be beneficial and I should get to do lots more intubations than most of the other students. Right now though it just feels very weird to intubate someone I've never met, then leave before the operation starts. The problem with this rotation is that in between intubations it is unbelievably boring. After two hours I feel like I have worked a full day. Most days next week we will thankfully have lecture in the afternoons, but Friday there was no lecture and I stayed til 3:00. By the end of the day that was the most miserable I have felt this year, I don't know if I could have handled staying another minute longer. But fortunately everyone is very nice at this hospital, and everything just seems so much more relaxed than at the academic hospital. It definitely confirms my desire to be a community surgeon rather than an academic.

In May I will start family medicine in one of the rural areas "near" where I live. It will be the last rotation of my third year! In June I will do my trauma surgery sub-i, from which I will hopefully gain a couple letters of recommendation. I'm going to take July off and will take both the written and (grrr) clinical portions of Step II. Then I'll have to start applying for residencies.