This morning my old lady was somewhat better; the face mask oxygen that she finally got yesterday, after the older attending gave in and got an ABG which showed a pO2 of about 40, probably had something to do with her improvement. Now that it’s the end of my two weeks with this team, I finally felt like I knew what to check on all my patients in the morning; just in time to leave, and never hear what happens to them.

One of the big cases for the morning was a lumbar disk fusion. You wouldn’t think vascular surgeons would be involved, but apparently they’re needed to clear the aorta and iliac veins out of the way so the front of the vertebrae can be approached. By some happy conjunction, all the senior residents were busy elsewhere, and when the orthopedic surgeon saw the intern and me following the vascular attending, he didn’t scrub for the first part of the case, and let us assist. Not that there was much assisting to do. The intern got to retract and cut sutures, and I watched – both the surgeon and the scrub tech. The hierarchy of standing towards the head of the table meant that by the time the orthopedic attending and his intern scrubbed in, I was standing much closer to the instrument table than to the incision. The scrub tech was always busy fiddling with the complicated orthopedic equipment, so I helped out by handing things as they were called for. I didn’t see much of the surgery, but I’ve figured out the names of a great many orthopedic things. They mostly sound like a hardware set – screws and applicators and chisels and mallets. (Everyone says you should never touch the mayo stand – where the scrub techs keep the instruments arranged in a precise order – but all the ones at this hospital are friendly to students, and let me pick up scissors and so on if they’re busy somewhere else.)

The orthopedic intern was about six and a half feet tall. The vascular attending and I both came somewhat short of his shoulders. This seems to be a uniform characteristic of the orthopedic residents: they average more than six feet tall. This will be a very interesting two weeks. I always feel very close to the floor when these giants walk by.

The chairman had lunch with the students today. When he asked us to go around and tell something about ourselves, we all cringed, because that’s what we’ve been doing ever since the beginning of medical school. But he had a way of drawing everyone out, to the point of getting the two Yugoslavian students to give an excited account of their grievances against the Serbians, and of the circumstances that led to their immigration. However, things became rather tense when two of the students, speaking of their plans, said some people had advised them that, if there was any specialty they liked nearly as much as surgery, they should do the other thing. The chairman was clearly displeased with the “people,” obviously residents, who had been making these statements, but couldn’t quite say plainly that they had no business to give advice. The two students belatedly developed enough discretion not to further identify who had been giving such heretical warnings.

After his last lecture, I figured it was high time I went and asked him for a letter of recommendation, since surgery programs always want a letter from your chairman. Every time he’s talked to the students, he tells us about letters of recommendation, and says you must ask for a strong letter, not just any letter; otherwise, he says, someone will write you an unhelpful letter. It sounds silly to me, but I made sure to use his exact phraseology, and he laughed. Of course he said yes; I don’t think, as chairman, he could possibly not, unless I basically killed someone; but I can’t help feeling nervous about asking for letters. It seems so presumptuous. Now I just have to write my personal statement, figure out ERAS, finish my resume, accumulate the forms, and get them to the people I’ve asked for letters. And explain myself to some of the other ob/gyn attendings. . .

Well, I’m beginning to have had enough of being enthusiastic. I and another girl are supposed to be at that orthopedic doctor’s office for two weeks. So I made the mistake of saying hello to him before the surgery this morning. He told me to get the other student, and study a bookful of orthopedic terminology, and come to the hospital at 8am Sunday morning so we can get a head start on studying about orthopedics. <jaw on floor> I had the greatest difficulty to persuade the other girl that I was serious that he expected us Sunday morning; moreover I get the impression he already has plans for us for all day next weekend. Serves me right for coming in early the last couple weeks. But, I guess, if I want to do surgery, I better get used to the non-existence of weekends.

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