Lightning rounds

July 8, 2007 at 10:04 pm (Clinical rotations)

Since my malignant attending has been out of town this week, his partner, an equally malignant surgeon has served as our attending. Rounding with him in the afternoons is a sight to behold. These trips are nicknamed “lightning rounds” because he runs through the patients so quickly. On Thursday, he saw 14 patients in four minutes. A typical encounter might go something to the effect of…

Attending: How are you feeling today?
Patient: Well doctor, I’ve got this pain…
Attending: change her dressing twice a day. What are her labs?
Me: (fumbling through the chart) Her creatinine value was…
Attending: Whatever. Who’s next?

The internal medicine crowd could learn something from him. I scrubbed in on a whipple he was performing earlier this week. He apparently hates teaching students as much as he hates talking to patients. I stood for four hours in total silence with my hands resting on the surgical tray. When time for class came around, I asked if I could leave early so that I could eat lunch before attending lecture. At that point, he finally acknowledged my presence by yelling at me that I should stay on the case until the moment class begins. Leaving early for lunch was “unacceptable.” I don’t know what good I was doing there at 2 in the afternoon if I wasn’t at least going to hold retractors.

Speaking of retractors, at least one of our attendings is eager to have student involvement during cases. I scrubbed into a total thyroidectomy with central neck dissection the following day. When the surgeon saw me enter the room, she immediately removed the mechanical retractor that was automatically holding open the patient’s neck, handed me two manual retractors, and made me keep the surgical site open. If you’ve never seen retractors, they look like shoe horns and serve the purpose of reminding everyone in the OR that the medical student is the surgeon’s bitch.

That procedure lasted nine hours. Imagine standing in place for an entire work day, not moving your arms, not eating, not peeing, and wondering when they’re going to sew this patient up so you can finally rest. The ophthalmologists are smart enough to perform all of their surgeries sitting down. No wonder getting into ophthalmology is so competitive. If other surgeons were that smart, maybe they’d realize that they don’t need to put every patient on Vancomycin prophylactically.

This particular case involved a rare type of cancer called medullary thyroid cancer. The procedure was going well enough until our non-paralyzed patient started moving during the surgery. Her thyroid was partially hanging out of her neck when she started jumping off of the bed. As I tried to hold her down, the surgeon went right on cutting as if nothing was happening. Later, my attending also hit the jugular and blood went airborne with a perfectly vertical leap. As Old Faithful shot forth, I jumped back to prevent getting showered in HIV and hepatitis. The surgeon replied, “Look at how scared this guy is.” Nice to be the bitch.

At least I finally got into the OR this week. I’m done with doing scutwork and cleaning up after my lazy interns who are here simply because they have to do surgical internships before running off to become radiologists. Next week, the screamer returns.

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5 Comments

  1. LuckMC11 said,

    after those gruesome 9 hours…the patient just died? wow

  2. REO SpeedDealer said,

    Most radiologists are smart enough to do a medicine or transitional internship. Only the masochists do a year of surgery before moving to the promised land of rays.

  3. halfmd said,

    That patient didn’t die. She lived through the procedure just fine and was discharged the following day.

  4. mj said,

    wow. 9 hours for a thyroidectomy? the surgeon must suck. a lot.

  5. halfmd said,

    Not at all. The thyroidectomy involved a central neck dissection and a modified radical neck dissection to remove all of the involved lymph nodes. The patient had medullary thyroid cancer, not a simple goiter.

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