I'm in love with trauma (surgeons)?

I'm in love with trauma surgeons. The most unattractive trauma surgeon is still pretty hot. In fact one of the trauma surgeons told me that the girls always go for the trauma docs. That's why he became one! All of the trauma docs are married but one, and he has a significant other.
You know who else is hot? Neurosurgeons. Not spine surgeons, but bona fide, frontal lobe to cauda equina, neurosurgeons. The ones who can pluck a tumor out of your gray matter and send you home with all your functions still intact. That is power. That is amazing. That is hot. But, I also find it a little bit boring. Too predictable perhaps? Look at me, I'm calling brain surgery predictable. I guess what I mean by that it that it is so controlled. So calculated and mapped out in advance.
What is this deeply embedded desire I have for trauma? Is it about the surgeons themselves? With a trauma surgery you have to be thinking three steps ahead of the procedure. If Action A leads to Consequence B do we have Equipment C in the room? You must realize and admit that if what you just tried to do to control bleeding didn't work, it probably won't work the second time you try it either. You'll have to try something different. That's where plans B, and sometimes C and D come into play. Two eyes and hands are focused on the patient, one ear is tuned into anaesthesia, and the other ear monitors what's going on between the scrub and the circulator. The surgeon has to know when the time is right to do damage control only and get out, or if he has the luxury of being able to do a definitive repair. It's often fast moving, fast thinking, and always requires technical skill. I find the whole process, from the trauma bay (bonus if we get to meet the helicopter on the roof!), to the operating room, to the ICU, very seductive and addictive.
So my conclusion is that it is not the physical attributes of the trauma surgeons themselves that I find so attractive, as much as it is the fact that they have welcomed me into their world, shared with me some of their skill and knowledge, and have appreciated my obsession without taking it personally.

Ski Season

Ahhh, ski season. The season of broken femurs and severe head injuries, sometimes on the same patient. Broken ankles, wrists, pelvic fractures, and broken spines from C2 all the way to the tip of your coccyx. Trees and rocks and cliffs are so unforgiving.
Horses get a bad rap for being DANGEROUS creatures. I've taken more spills off of a horse than I can count on two hands, I know, doesn't say much for my riding ability, but in my defense I've ridden everything from barely broke Mustangs to horses who were just plain clumsy, and I have never had a broken bone or a head injury. Thank goodness.
You may think I look forward to ski season being a surgery junkie and all, but I actually find it to be a rather sad time of year. It's sad when teenage snowboarders come in with a traumatic head injuries, or a 40 something year-old comes in as a quadriplegic and has to be maintained on a vent.
I guess every one's gotta have a hobby, and maybe I am extremely lucky so far, but I think I'll stick to horses and leave the snowy mountains to those of you who don't fear it.

SurgeXperiences 213

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Welcome to SurgeXperiences 213.
We begin our journey as infants, and who better to help busy mothers care for their newborns than a Maternity Nanny as described here on nursery jobs blog. As a maternity nanny, I am sure that you are trained to recognize pregnancy myths and legends, as are ultrasound technologists. But don't be fooled by this story recounted at Baby Lifestyles, it may become legendary but it is no urban legend.
There are many educational toys for children these days. Is your child showing an interest in medicine? Surgery? Well here are not one, but two games to help develop that interest, and all you need is a certain cell phone and a little cash.
As children grow, it seems they need a lot of sleep. Nap time seems to disappear as they enter grade school. Or does it? According to the popular website Slate, nap time seems to return with a graduate education but here's the downside. (While those pesky residents are napping, I'll steal their cases!)
Who better qualified to provide one with the ultimate nap than an anaesthesiologist? Perhaps a stingy one who doesn't like to share their drugs. An unfortunate, and hopefully uncommon occurrence among anaesthesia providers is discussed by our very own, Resident Anesthesiologist Guy, in One Strike You're Out.
Speaking of anaesthesia.....here is a post from a patient from the site, Disabled World. Describing his fears of general anaesthesia from induction to emergence in, My First Experience With Surgery, he offers some constructive criticism for health care providers to make the surgical experience more productive and less stressful for all involved.
Not all procedures require general anaesthesia. In, Live From Surgery Part 3, Robert recounts his third surgical visit for the treatment of varicose veins, complete with photos.
If you like photos of surgery, you're gonna' love the next four submissions from Oystein, a Norwegian medical videographer at The Sterile Eye. It's snowing at his blog but these videos will warm you up. Beware! Not for the faint at heart.....
1. Esophageal dilatation.
2. Gastroscopy.
3. Gastrectomy. (My personal favorite!)
4. Hepatic artery embolization.
Speaking of sites not for the faint of heart, our next story comes from Dr. Cris at Scalpel's Edge. Dr Cris shares her experience of being involved in an organ donation surgery and explains why that experience prompted her to become a registered organ donor.
If you are awaiting an organ transplant, you would hope for the very best surgeon to perform the procedure. Bongi relays to us why being The Best, or at least believing that of yourself as a surgeon, is important. Being the best surgeon also means that you would never perform unnecessary surgery on a patient and you realize that textbooks are meant to be a guide. Still, some aspiring surgeons seem to have never even read a textbook! In Bongi's third submission, Doctors For Africa, we see that standards for doctors vary geographically. At least she got one right, well sorta' . I bet she was thinking, Mama said there'd be days like this. Unfortunately, her mistakes involved people, not sewing machines and quilts.
Speaking of penises, 911 doc at MDOD recounts a story of A Surgeon with a Pair, yet the surgery may never have happened if 911 hadn't followed his instincts and ordered an abdominal CT.
Speaking of pairs......Vijay, aka the scan man, offers us a series on ultrasonography and scrotal swelling. This has gotta hurt no matter what age you are. I will present them here in what I hope is a logical order. Casebook 6-testicular torsion, casebook 7-acute orchitis, mind map-testicular torsion, and casebook 8-hydrocele, hematocele and pyocele.
And now, surgeons in the news.
Barack Obama's consideration for surgeon general.
A retired surgeon wins an Ironman competition.
And the Cleveland Clinic hosts the nations first face transplant.
I believe a face transplant is still considered plastic surgery and not transplant surgery, so here are some more plastics tidbits. The UK says the US is addicted to plastic surgery. It must be true because we even buy plastic surgery for the dead!
So we reach the end of our journey. Our prime behind us, we strive to grow gracefully into old age. Some of us just don't know when enough is enough. Would you let a 100 year old neurosurgeon operate on your brain? That is the age old question. Watch this video then you decide!
"Best of " lists seem to be popular at years end so I leave you with a few "Top 10 (50 and 100) lists."
Top 50 Eastern Medicine Blogs
Top 50 Medical Ethics Blogs
100 Helpful Resources for dealing with Crohn's Disease
and,
Top 10 Incredible Self Surgeries

Thank you for joining me in this edition of SurgeXperiences.
Wishing you all peaceful holidays,
MMT
SurgeXperiences is a blog carnival about surgical blogs, wherein surgical experiences are shared. It is open to all (surgeon, nurse, anesthesia, patient, radiologist, pathologist, etc) who have a surgical blog or article to submit. The next edition of SurgeXperiences (214) will be hosted by Dr. Bruce Campbell at "Reflections in a Head Mirror" on Jan 4, 2 weeks from now. Be sure to submit your post via this form.

The 12 days of Christmas

I was recently invited by Medblog Addict to participate in her latest creative endeavor, The 12 Days of Christmas (I will link you here with the first day if you promise to read the rest!). If you have never visited her blog, you are in for a treat. She is known for her Calendar Doc series and has branched out to include interviews of non-MD medical types, including EMT's, RN's and yes, even Surgical First Assistants, among others, to compliment her voyeuristic addictions. It's a hoot, it's great fun, and it's seasonally festive. Check it out!

Reply to September Email

I am so, so bad. This past September I received this question in my in-box.

"Which do you think is a better choice? Surgical Technology or LPN?

I know that some LPN's are restricted from the hospitals, but there are other areas they can work. In your honest opinion, would it be wiser to stay in surgical technology for the few months of general educations classes I have had, or LPN?

I have been researching & it seems as if surgical technologists are a little more limited . LPN's can scrub also. My school has LPN (15 mos) + add'l 18 mos to become an RN. Which route do you think is wiser. I can not get many other opinions. I just don't want to continue with surgical tech if later I may possibly want to go to nursing school.

What state are you in? What is the difference in pay for LPN & Surgical Technologist?

Thanks again..."

Well, I have finally gotten around to answering. I apologize profusely for the delay and hope my opinion isn't arriving after the fact. Not that I believe my opinion should have a major influence. What is right for me may not be right for others. I can only inform you from my limited experience and knowledge of nursing.
I think the first question you might want to ask yourself is, do I enjoy interacting with people on a very personal level? For myself, I am a sociophobe, well o.k. not quite, but I am much more comfortable caring for someone that is asleep, or at least sedated, than I am caring for someone who is awake, alert, and oriented. Another question may be, do I want to stay in the O.R. and scrub all the time, or would I like to someday work in a doctors office, pain clinic, public health clinic, clinical trial, research facility, emergency room, etc., etc., etc. ? You are correct in your observation that techs are limited. While there are some opportunities to assist as a tech in a doctors clinic with some minor office procedures (vein disease treatments come to mind), surgical technologists are pretty much confined to the surgical setting. You may work at major trauma center where you are required to take call and work occasional holidays and weekends, or a small ambulatory surgery center with weekends off, holidays off, and you never have to be on call ( how boring is that?).
Wages for techs will vary with hospitals and duties. Trauma techs will make more than those who do not scrub trauma. Some hospitals offer techs monetary incentive, say an additional 10%, to be team leaders in the various specialties, such as ortho, neuro, etc. If you take call, you can expect to make anywhere between two (hopefully that has increased) to six dollars an hour just to carry the pager, and then bank time and half if you are called in. Many surgeons are willing to pay nicely for a private scrub. By knowing a surgeons routine and having everything needed for every case, every time, private scrubs can save a surgeon a lot of time and frustration. Given all of these factors, the salary range can be anywhere from $13.00 an hour starting, to as much as $30.00 an hour (so I've been told, but not seen) as a private scrub.
You are also correct in stating that an LPN can scrub. At least as far as I know. I used to work with one who did scrub. I don't know the exact going rate for LPN's but my guess is going to be ballpark range from $20.00 new grad to $30/35.00 an hour top out? Anybody? Wages will probably be higher on both coasts (ie. NYC or SF), in major cities, and through a nurses union perhaps. Again the question is how much do you want to scrub? Is that all you want to do? If you are an LPN, it has been my experience in the O.R. that nurses will be circulating, running the front desk, maybe even helping in pre and post-op when staff is short handed, and usually NOT scrubbing. In effect, nurses will be employed as nurses and not techs. There are some areas and hospitals that are of a mind to use only scrub nurses. However, as you have seen, technologists are generally cheaper.
Let me say this, I have not researched the different scopes of practice for LPN, APN, NP, or RN. I would say that if you are going to go to nursing school, get your RN. Do it all at once and you shouldn't regret it. Take it from me, it is a lot harder to go back and finish something after you've left school than it is to just "get 'er done!" and if you really want to be a nurse, I think RN is probably the way to go.
I don't know what your ST curriculum is, but if you are unsure about scrubbing, maybe you can stay in the program until you begin clinicals. I have mentored my share of students and clinical cases seem to be the make or break point for many. The notion of being in the O.R. may seem very romantic and thrilling until you smell poop from the inside out, or get a strangers blood tattooed across your eye protection or worse yet, soaked through your scrub pants. It is often nothing like they imagined. For others, it is exactly as they imagined and they can't get enough. You may never truly know unless you try it. If clinicals are definitive enough it will make your decision very clear. If you choose RN, hopefully the didactic portion of your tech program will transfer, A & P, microbiology, gen. ed. credits etc. Personally, for me, I have no inclination to become a nurse. I love being in the sterile field and I never want to leave the operating room. As an assist, I am doing exactly what I was meant to do.
If any one else has anything to add, please feel free. I can only speak from my own experience and I am not up on nursing privileges or restrictions and I am too lazy to research it!
Alright, I did look here and see that I was pretty generous with the LPN wage . According to this LPN ranges from $17-21.00 based on a fourty hour work week. I think you can make that as a Surgical Technologist. Seems an RN averages about 58% more in salary. Yeah, I say go for the RN if you don't love scrubbing.

SurgeXperiences

Visit SurgeXperiences 212 hosted by The Sandman at Quietus Leo.
I will be hosting the next edition of SurgeXperiences on December 21st. Deadline for submissions is midnight on Friday, December 19th. Be sure to submit your post via this form.
It has been quite a while since I've done this so I may be a bit rusty, bear with me. I have been lurking regularly enough to know that some hosts like to sport a theme. I am not that clever nor organized so I will not be asking for themed posts. So, post as you are!

Shout Out

Dr. Ramona Bates has combined two of the many things she is excellent at, quilting and compassion, and has created a wonderful quilt which is being auctioned on line to benefit a wonderful charity, The Childhood Brain Tumor Foundation. Please visit Ramona's blog, Suture for a Living to learn more about how you may bid on the quilt or simply make a donation to the Foundation.

Odd, wierd, crazy?

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I have a bit of trouble with dyslexia, at least I think that is what it is. I don't have trouble reading or writing or learning, per se, but on many occasions I will read something a thousand times as one thing and then, all of a sudden, one day, something makes me look at the same printed word just a little bit differently and it takes on a new meaning altogether. Some words will appear as total jibberish and I must concentrate intensely to unscramble it in my brain. This is a big problem with medical terminology. I know what the word means, I can spell it, I can write it, (well except for the letters b, d and p- I always have to pause and think about which way the loop faces on the stem) and more often than not, I can pronounce it correctly with in the confines of my synapses, but when forced to speak it out loud, it will not roll out of my memory and into my mouth correctly. Often times I will resort to a lay term instead, hiding safely behind a simpler pronunciation. I realize that this doesn't exactly project intelligence when conversing with other health care professionals. Lately I have taken to prefacing my sentence with..."I'm not going to pronounce this correctly, but..." when I want to use a grown-up word. Most people on the other end are more than happy to jump in and show off the fact that it is easy for them to say. The saddest part is that hearing someone else pronounce a word doesn't necessarily help me pronounce it. I seem to speak a bit dyslexic also.

I have a worse time with numbers. Once I remember a number, I usually don't forget it (duh) but recite four digits to me and if asked to recall them later, I will invariably transpose one or more of them. Thirteen-fifty-eight (1358), becomes fifteen-thirty-eight (1538), etc.
I also have an interesting thing that happens with colors. Not all colors or even random colors, but specifically red and green. No, I am not color blind. Apparently I am color dyslexic too. If I see a red vehicle and I am asked to recall what color that vehicle was, I will be POSITIVE that it was green. The reverse is true for recalling a green vehicle as red. This isn't specific to vehicles, it could be the color of a sweater or a sticky note or almost anything. Fortunately it doesn't happen with items that known to be a specific color such as grass or blood or traffic lights.

I could write a whole chapter on my food rituals, but I'll spare you. Besides, I don't think it has anything to do with the topic of this post. There was this one incident though that is interesting, well at least to me, this whole post is probably so NOT interesting to the rest of you, but indulge me. So, I had made two pieces of toast with almond butter and blueberry preserves. As is often the case, I was eating it while I paced around the kitchen (don't ask). I had both pieces of toast on a napkin in my hand while wandering around the room entranced in deep thought of some sort. I would take a bite, chew and pace, switch pieces, take a bite, chew and pace. Switch pieces, take a bite, chew and pace. Did I mention I have food rituals? The idea is to eat all of the crust of both pieces first so that your final two savory bites are the heavily laden, softest center of the toast. Somewhere in mid-chew, I looked down at the toast in my hand and the toast in the napkin. I laid both pieces down on the table for a better comparison.
Toast twins! Even though I was not paying attention and was alternating between the two pieces, I had managed to take bites from the exact same locations in the exact same sequence. I know, amazing only to me. It would be more interesting if ...say! Isn't that an image of the Virgin Mary in the piece on the right?!

Just a Matter of Time

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Well, it finally happened. It was just a matter of time before it happened. But it was a Thursday afternoon, a scheduled case. It's not like it was a sultry trauma rendezvous in the middle of the night! Just a simple, standard double incisional hernia repair with mesh. Booked for an hour and a half, but I knew from experience it would take longer. So why did I optimistically fudge the time when *FTS called to have me come meet him at 1530? I knew I would be later but I told him it should be about 1630 before I would be done. "Not a problem." he says. "Just come over when you're done and see where I'm at."

We finally made incision at 1445'ish on our hernia patient. I calculated in my mind that we would not be done before 1700 but I hoped for the best. The clock was on the wall behind me, and while time usually has no bounds for me in the OR, this day I could feel each passing moment. The (other trauma) surgeon even asked me, "What time is he starting his case?"
"Supposed to start at 1530, but you know what that means, start time will probably be closer to 1600." Even as I said it, I didn't feel it to be true. Somehow I was sure they would start on time at the other hospital.
"You'll be done by five, don't you think?" I asked. To which he enthusiastically shook his head yes.
First hernia (at an old ostomy site) reduced, cleaned up, meshed and closed, we moved on to the second, a smaller peri-umbilical, mid-line, incisional hernia. I resisted the urge to look over my right shoulder at the clock. As is often the case, the area of defect was larger than anticipated. Well, I anticipated it, but that's more akin to Murphy's law than medicine.
After placing the mesh, tacking it down in four "corners" and sewing one side of it in, we switched places and moved to the opposite sides of the patient. Although I already had resigned myself to missing the sigmoid resection with my FTS (he was on ER call this day, not trauma), I couldn't resist a peek at the clock. Almost 1700. As was expected, we would finish close to 1730.

As soon as the wound was closed, I broke scrub and called the other hospital. I asked to be put through to the room my FTS was working in. The phone was, as usual, on auto-answer so when I identified myself and asked if he was still working, the room could hear the conversation. While the nurse was trying to explain to me that he was closing, I could hear him in the background. "Tell her she's fired! She missed my case and I'll never, ever work with her again."
This is a running joke with us because he knows that I can't say no, and when, or if I do miss a case or call day, I get anxious fearing that he (or they) will stop asking me to assist. Of course I know that this is not true, especially with him. Still he knows I always have that sliver of doubt so he likes to tease me.
"Tell him not to say that! He knows I'll believe him!" I yell through the phone with a smile.
"Nope, it's too late, she's fired. Well, right after this open appy I have to do next. She can help with that if she wants. Then she's fired."
I tell the nurse I'll be over shortly.

After I arrive and change into scrubs I seek him out in the ER. "I came to beg for my job back!" I tell him.
He almost seems hurt when he asks what took so long on the hernia case and tells me he really could have used my help. I didn't have an answer for him except that the defect was larger than expected. Even as I spoke the words, it felt like a weak excuse. He turned to the chart he had in front of him and I told him I would wait upstairs. Before I turned to go I told him, "It was just a matter of time before I got caught cheating on one trauma surgeon with another!"

*favorite trauma surgeon

Slowly coming back to life.

photo from freephotos.com
I have had an extended vacation it seems from blogging. I've barely been lurking. I do actually feel sort of rested and ready to work my way back into posting. A few things have happened since my last entry.
I did, in fact, take my first assist certification test. I took it over three weeks ago and I still don't have my test score back. I have been told that they had the preliminary results and "I should be
pleased.." I am assuming that it means that at least I passed. I was
told that I would have my certification card in the mail by the end of last week, but that hasn't happened yet either. So here I sit, still waiting.
I bought a BlackBerry. My Razor was dying a prolonged, painful death as the result of one too many falls to the O.R. floor. It was fond of blacking out for no apparent reason and periodically begging me to check it's SIM card. I think it was trying to tell me that it's heart was giving out. I took the hint. I don't have a clue regarding the full extent of BlackBerry capabilities yet, but what I have discovered so far, I like.
I have assisted on 46 cases since my last blog entry.
I missed the last two SurgeXperiences, edition 209 and 210. I was supposed to host 211 but many, many thanks to "M" for stepping up. I was starting to panic because it is due to be published on November 23 and I will be spending November 22 in house and on call for trauma. (Have I mentioned how deadlines make me anxious?) It could always be a mellow night of call but it is Saturday night and the weather has been super mild for this time of year. In fact, I am on call for trauma 6 nights this week. The seventh night is ortho call. I don't know how students and residents can keep up so well with blogging and their careers/studies. I think I am horrible at time management. I know I am great at procrastination. I think that is why I like surgery so much, as an assist, I don't have to plan it, it plans itself and I just show up. I don't decide what time to allot to it and there are no excuses to put it off, they call, I go. Muddling through my billing paperwork is another story.
I have become a 1099 employee (a bit like contract labor) for a large local orthopaedic group. I actually started about two months ago. Sounds like a big deal but I only really work with three of the orthopods there. They were surgeons I already worked with and now it is just a different pay and billing arrangement.
I did a quick peek at what search phrases brought visitors to my blog, and I have discovered that there are some men out there worried about their hand size. "depressed size of hands", "what is a small hand for a man" and "man with small hands" all showed up as keyword searches leading to my post. I hope the size of my hands hasn't pushed anyone over the edge.