Last week we were hoping that when the new chief came on, there would be more surgeries. But actually, it takes a week or two for him to generate patients in (at least semi-)need of surgery. So this week is also slow. (Note to self, don’t look for action in the OR at the end of the school year.) Tomorrow, not only are there no morning surgeries (and nothing in the afternoon but breast biopsies), but no clinic even. So we will start rounding at the unheard-of hour of 7am. The residents, of course, are tickled. We students are rather disappointed. But, that will at least set me loose to latch on to any of the private surgeons I care to try, without worrying about the residents’ schedule.

This morning we attempted to do a laparoscopic removal of a kidney from a man with polycystic kidney disease. Almost the only things visible on his CT scan were his huge, lobulated kidneys, stretching from the liver to the pelvic brim. (And don’t ask me what gave the attending the idea he could get that out laparoscopically; I think he was counting on the “possible conversion to open” part of the consent form.) He has no other medical problems, but for some reason became irrefractably hypotensive after anesthesia induction. So after spending more than two hours putting in a central line, positioning him, starting the laparoscopy, pushing tons of epi and dopamine, and even having one of the anesthesiologists do an intra-operative echocardiogram. So he was closed up without anything happening, and sent to the ICU for further consideration. This afternoon we did a laparoscopic ventral/incisional hernia repair. The attending and new chief generously let me hold the camera some of the time, even though I think it’s more fun for them to play “video games” when holding two pieces of the equipment. The patient was a very pleasant 70-yr old lady, who even woke up smiling – which is some feat.

Apparently, last Friday – while we were taking that impossible quiz – the OB service consulted surgery for a woman with severe abdominal pain, and fetal distress. The two teams did a stat Csection, and found ruptured appendicitis. Now, I ask you, why did that have to happen while I was in class??

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