None

Nothing exciting to post because nothing exciting has happened! I had the free institutional turkey dinner at the hospital on Thanksgiving and hung out in the lounge 'till midnight waiting for some trauma to come in. There was one pediatric trauma blue which thankfully turned out to be nothing. Other than that, people seemed to be not driving drunk, or at least not crashing, and not assaulting each other. All things to be thankful for in reality.

"If you love what you're doing, why would you go to school to do something different?"

I have come to a dilemma in my career. To PA or not to PA? That is my question. I am currently a Surgical Technologist (certified) and a Surgical First Assistant. I had the notion in my head to go to PA (Physician Assistant) school. For the first time in this life of survival on my own, I will have the financial means to pay for tuition and go to school full time. PA school is very intense and no amount of time can be spared for a j-o-b.

But for those of you who don't know (!). I love surgery. If I go to PA school I will have spent approximately $50,000.00 in tuition and my best bet at a position after graduation will be in a clinic. Maybe an Ortho group or General Surgical group sure, but everyone knows that PA's generate more income in clinic than they ever will in the OR. Of course there will be days that I actually get to assist but most of my time will be filled with H and P's, (physical exams actually touching the outside of patients, argh!) and patient teaching and follow up visits and rounds and fielding phone calls and all sorts of other patient contact chores that I have absolutely no desire to do. The only way cool thing I can think of in this position is diagnosing. I would love the investigative portion of medicine. I even think I have an intuitive aptitude for this, but beyond that, why would I want to change my current situation?

Emergency medicine might be a venue to explore. I am unsure what a PA's duties might be there. The ER is the only other place that intrigues me as much as the OR, but I fear I would constantly be yearning for surgery.

I had originally thought that being a PA in the OR would make me more valuable. Surgeons often have a hard time finding an assistant for Medicare patients. Go figure. Right now, I do it for free because Medicare does not recognize an SFA. Medicare reimbursement is minimal. How long would it take at Medicare pay rates to compensate for 50k in tuition and two years lost income? My guess is a very, very long time. If I don't want to do all of those PA things, why spend the money and "waste" the education?

In the innocent words of my sister, "If you love what you're doing, why would you go to school to do something different?"

Why indeed. I believe that I have the best job in the world right now. It allows me the financial stability to be self employed. I get to do all of the fun stuff and none of the horrible. I don't have a lot of emotional interaction with the patients. I try to be comforting and reassuring when they enter the OR before induction. After the surgery my follow up consists of inquiring about their condition from the surgeon. This is all the patient interaction I care to have. It sounds callous, but I have had to admit that I have come to realize that this is self-defense, protecting me from the emotional roller coaster of being involved with sick and/or dying patients and their families. I cry at Dove soap commercials. I have become softer as I age, I used to only cry over animals.

I have heard legend that there are surgical PA's that only do surgical assisting and related post-op activities. Is this true? Can anyone reading confirm this? Now that might be a dream job.

To all of you ER, or if you insist, ED Docs, are there PA's in your department? If so, in what capacity?

I could sure use some help on this one.

Uncalled Forth

Apparently I have become the white cloud. Even worse, I seem to have turned the Trauma Surgeon with the biggest black cloud into a white cloud also. I'm sure he appreciates it, but I am having physical cravings for some trauma surgery. Hell, I'll even settle for any open general surgery. Nothing laparoscopic thank you, it just doesn't fill the void like actually getting your hands on some organs. (photo credit)

Last week's call for me.

Monday- Ortho.

Tuesday-Trauma and Ortho.

Thursday-Trauma.

Friday-Ortho.

Saturday-Ortho and ER (with the same doc I take trauma call with).

Sunday-Ortho.

Total number of cases, 0, that's zero, zilch, zip.

Last night I was on Ortho call again. Nothing. Tonight I will hopefully have better luck, I'm on ER call again with the trauma surgeon.

Tomorrow I will be available for trauma with a different trauma surgeon, maybe he will be the new black cloud.

This week I assisted one of the general surgeons on Monday morning, three scheduled laparoscopic cases, he mentioned he was on ER call this Friday and Sunday. I volunteered my services. He programmed my number into his phone. A good sign.

Free Cell?

One of the Ortho surgeons had given me a coffee card for all of the free assists I do for him. He's a great guy. Today I had an hour in between cases so I went to Starbucks. As I got out of the truck a street person approached me and asked if I could spare 50 cents. I told him when I came back out I would give him my change. Standing at the counter, I gathered up two one dollar bills as I waited for my hot beverage, with full intentions of giving them to the "dude". As I walked back out to my truck, he was still standing there but his back was to me and his attention seemed to be on a group of three girls approaching the store. I opened my truck door assuming he would hear me there and come to collect his free money. When I looked back at him I realized that he was not soliciting the three girls that had approached but rather he was talking on his cell phone! I got in the truck fully expecting him to tap on my window, but as I started to back out I saw that he had taken off across the street pushing his empty shopping cart ahead of him. Apparently street people are now networking.

Very Superstitious?

I am normally not a superstitious person. A black cat lives with me (the feline variety), the mirror on my locker is broken, and I love the number thirteen. Give me a Friday the 13th and I feel lucky. But in the operating room, there are several superstitions that must be strictly adhered to!

Many OR's have a large magnetic dry erase board on which to display the days schedule. Individual magnetic strips about two feet by two inches are used to write the individual cases. Start time, patient initials, procedure and surgeons name are the typical information written. Then the strips or cases, are arranged on the board by room number in chronological order. Anaesthesiologists, Techs and RN's have their own little magnetic strip with their names on them. When you are assigned to a room your name magnet is placed next to the corresponding case.

When a surgery is complete and the patient is transferred to recovery, the individual strip comes off the board and the information is erased. Different story if a patient dies in the operating room. Should this unfortunate incident occur, the magnetic strip upon which the procedure was written is left in it's place on the board and turned upside down. This informs everyone, especially those who may be wondering why their case to follow is delayed, what has occurred without anyone having to say a word.

What is the superstition, you ask? Never, ever, let someone turn your name magnet upside down! If you see it is so, immediately upright yourself and any of your friends. If you have enemies you may turn their name strip upside down, but I shudder to think what Karma may have in store for you

.

Another strip superstition. If it is the last case of the day, and the patient has long since gone to recovery, maybe even been transported up to their room, under no circumstances should you remove or erase that strip. Unless of course you want to bust open the flood gates and have several add-ons rain down upon you. Typically three at a time.

Emergent procedures come in threes. If you do one lap appy, you can bet two more are to follow in the same evening. Same with hip fractures. Some procedures like Crani's and AAA's may occur once a day for three days. If you exceed five in a consecutive time frame, you just have to plan on doing six.

When you are scrubbing a case all instruments that have been opened for that case MUST remain sterile on your back table. If you are sure that the surgeon won't use a particular instrument, or set of instruments, or any item of any sort, and you hand it off to unsterile territory, the surgeon will immediately request said item.

If your instrument string has an uneven number of like instruments, for instance, three Kochers or seven hemostats, you must either remove or add one Kocher and one hemostat to even up the numbers. If you insist on tempting fate, and remaining unbalanced, your case will not go well for you.

There is no OR number thirteen.

If you are on call and you don't want to work all evening and night until the sun comes up, then never, under any circumstances, utter the words "Quiet" or "Slow." If you use them in a sentence such as, "It sure is quiet tonight." Or, "It's been so slow lately." You will invoke the jinx pixies and you will not see sleep's bliss until tomorrow night.

These are just a few of the superstitions I know of. If anyone out there in the medical world have any I missed, I would love to hear them!

Who Let the Dogs Out?

Wow! What a difference a month makes. Things have accelerated this month like crazy. By tomorrow at days end I will have assisted on 40 cases in the month of October. All this before the winter ski/snowboard/MVA/domestic violence/drunk driving season. You will almost never hear me say this but, "I want a day off!" It's those 0730 starts every day that kill me. I'm a night owl dammit!

Trick? Treat?

It has been a very busy two weeks for me. I have had no time to get claims out or answer emails or lurk much on my fav blogs. I did catch the October Calendar Docs over at Addicted to Medblogs. As I had hoped, Oct. featured the bad boys of M.D.O.D. The badder they are, the better I like 'em! Safety in the annonymity of cyberspace. Etotheipi has given me a new perspective on Pathologists. Actually, my perspective didn't change.....it has just been confirmed. (See my comment in Calendar Docs part one).

M.D.O.D. is by far, the most entertaining compilation of blogging docs. If only there were a way to produce their essence in Hollywood with some high powered sit-com producer like Bright/Kauffman/Crane (Friends), or Castle Rock Entertainment (Seinfeld). I think they would be a hit. They could replace Scrubs , which is sadly in it's last season.

Trauma Hopes and Dreams

Word's finally getting out that I am serious about assisting for the trauma service.

I volunteer to be on call to assist the trauma surgeons anywhere from 5 to 7 nights a week. There are five surgeons who know they can call me whenever they are on. Most traumas that come to the OR, with perhaps the exception of some ortho trauma, are indigent. Victims of the notorious "SumDood" never seem to have health insurance or for that matter, a job. I can't bill Medicare or Medicaid or the (state? county?) indigent health fund. Put it all together and you'll see that my reward is not monetary. I do it because I love it. I do it because every surgery reveals a new technique, another anatomy lesson, a chance to fix or remove what's broken, torn or punctured. I like to participate in restoring a bloody misshapen mess back to neatness and order. My scheduled cases pay the bills, trauma cases are all about the adventure.

About a week ago, just after midnight, I was called in to assist on a stabbing "victim." I had not intended to be available that night, but I could not refuse. Lucky for me, or maybe more appropriately, as fate would have it, the trauma surgeon who was working that night is Chief of Trauma Services. I had expressed my interest in working in some (or any!) capacity with trauma services to him about a year ago. Perhaps a hospital paid position of some sort. My vision includes staying in-house, being the liaison between the ER and OR, relaying accurate information between departments and expediting surgery starts by helping the OR crew get set up and ready, assisting on the operation, whether it be as a first or second assistant, and doing whatever I can to help post-op. I'm sure he had all but forgotten about my year old inquiry. Since that time, there have been indications (from my Favorite Trauma Surgeon, who said he will recommend me) that some sort of position may indeed be forthcoming, and it may well be a position that I qualify for.

"Do you come in a lot?" Asked the Chief, as he explored the first gaping wound to see if the knife had penetrated the peritoneum.

"It depends on the surgeon on call." I replied.

I was able to rattle off the names of three of the five trauma docs who call me on a regular basis before the conversation was interrupted. I wanted to steer the conversation back to the original topic but, I have learned the hard way that sometimes less is more when I want to illustrate a point.

The peritoneum spared, we irrigated and closed one complex abdominal wound, and one not so complex. He thanked me for coming in and we said goodnight.

The next day my scheduled cases were scattered around at three different locations but I ended the day at the trauma center. I was on call with my Favorite Trauma Surgeon (F.T.S.). Around 1830, just as I was about to wrap it up and wander home, the trauma pager went off so I headed up to the trauma bay.

I don't know if this season has begun in other parts of the country, but here the depression is already overflowing. Almost a parallel to the holiday shopping season which seems to begin before Halloween these days, the Winter/holiday blues now start in the Fall. Our trauma is an attempted suicide by shotgun that managed to miss everything vital on that side of the face, but due to the damage intubation is not a viable option and airway is an immediate issue. We need to set up for an emergency tracheostomy. Off I go to the OR where we have bumped an ortho case. The room is already opened because we will use the ortho set up for drapes and sponges. The scrub has added a trach tray. I call the anaesthesia assistant and I drag the difficult intubation cart and the trach cart into the OR. I explain the truth of the situation to the Anaesthesiologist, dispelling the rumors which have made their way to the OR quicker than I could. The circulating RN has everything in place. I go out to the control desk to meet the ER crew and my F.T.S. as they roll in with the patient.

We are underway with the procedure when in walks none other than Chief of Trauma Services. He is here not to scrub in but rather to document the wound. First I think nothing of it but then I realize that he is seeing me with one of the trauma docs that I mentioned to him just the night before. His attention is on the extent of injuries and not on me, but I know that he knows I am there. He knows that I am serious, and he knows that my F.T.S. really does rely on me. And I feel as if I'm one step closer to that rumored trauma services position. All trauma all the time, with compensation! Talk about a dream job.

surgeXperiences 106

Due to time constraints (and perhaps a lack of imagination!) the format of this edition is more practical than clever. Since October is Breast Cancer Awareness Month, I begin with a few posts on the subject, from informative to personal.

Thanks to all contributors. Here's to continuing success.

Much like the wire itself, Mammorable patient, posted by Sid Schwab on his blog in Sept of '06 has migrated to Medscape

Dr. Bates has two very informative posts on breast reconstructon. Part I, and Part II.

Orac of Respectful Insolence shares some of his views about breast cancer awareness month and an article from Time magazine which "...points out that dealing with breast cancer in the rest of the world is a much different affair than it is in the U.S. and Europe"

A personal reflection from MedblogAddict. A touching tribute in memory of her friend who lost the fight against breast cancer. Related in three parts, A Kernel of Corn Beginning, Middle, and End.

Bits and Pieces

DR. J C posts on Brain Blogger and shares why he blogs anonymously .

Doris explains the two types of Plastic Surgery, and the latest from L.A.

Fit Buff has something for everyone. Here is a sampling in Morning Mix.

Plasticized has lot's of short tidbits that are fun to read. This one shows us how to chill after a face lift.

Foreign Affairs

Chris, an American Military Surgeon deployed to Iraq, shares with us his humble abode which he longs to get back to after 18 hours of fixing broken people.

From Dr Bruce Cambell comes a story of a non-traditional patient who shares a wonderful tradition.

Technically Speaking

Someonetc at Orthopaedic-residency shares a technique for sucessful percutaneous pin placement in Think Before you Shoot

Buckeye Surgeon makes a tough decision in a Tough Case

Emergency!

RugbyGirl MD presents a interesting case from the ER with a twist, so to speak.

911Doc shows us why vital signs are vital in Bread and Butter

Doctors in Practice

Here is a great post from T., the Anesthesioboist, about matters of the heart

#1 Dinosaur shares the progression of 18 Years of solo Family Practice

Here's a fun blog from Tommy ,a surgeon in training, featuring a cholangiogram and a special guest....

The Human Factor

A sad yet heartwarming article on Steven E. Kopits , miracle maker. Contributed by Hungarian Med Student ScienceRoll

Meet David as he shares his story of "Brian". A patient's perspective of maximizing control over his complex needs during hospitalizations, making his unavoidable experiences a little more tolerable.

That's Funny!

Karen, from Just Up the Dose, shares perhaps her most embarrassing moment in Tunnel Vision.

From my friend Bongi, here is an offering that is sure to create a visual for all to enjoy in Fashion Statements

Too Late to Classify

And, again from Orac, another visual which still leaves something to the imagination.

Thanks to Jeffrey at Monash for asking me to host. Be sure to participate in surgeXperiences 107 to be hosted by a Canadian medical student at Vitum Medicinus.

It's all fun and games until the election.....

This clip is making it's way around the blogosphere. I found it on Dr Luks orthopaedic blog. It's so funny, I was crying with laughter.

I found this link in my email in box.

Here are my top results.

1. Rudy Giuliani 40 points (What! I despise Republicans!!)

2. Dennis Kucinich 37 points (Who? )

3. Joe Biden 35 points (Are you serious?!)

4. Barack Obama 35 points ( Is he still running?)

5. Hillary Clinton 35 points (Isn't she married to someone famous?)

BTW, doesn't John Edwards look like he's hiding something devious behind that phony smile?