It feels like I’m living in a series of unconnected episodes. Yesterday evening I was extremely frustrated, starting to worry that this year is going to be just like the last year of medical school, where I never really got to a higher level of learning or practice.

This morning after M&M (which incidentally made me very happy about this institution, as the attendings spent a constructive half hour looking into the systemic causes behind a patient’s unexpected death, trying to find guidelines to prevent future occurrences, rather than trying to pin the blame on any one individual) I went to the OR where the attending from yesterday had a couple of small cases. I asked if I could do anything there, since these cases were obviously more on my level. He smiled and said the only problem would be, the patients wouldn’t think he was doing the surgery. But you never take no for a first answer from a surgeon. I asked again if there was anything I could do, and he said to come around for the last case, which would be with iv sedation.

So I did. The poor fellow had nearly a dozen lesions scattered here and there which needed to be excised or biopsied. The attending let me do two of the more inconspicuous ones. I conclude that although I may have learned something about sewing, I don’t know beans about handling a scalpel. Admittedly, that was the third time I’ve ever had one in my hand, and the first time I’ve tried to do anything other than a straight line. When someone else holds one, it seems to slice through tissue effortlessly. You wouldn’t think you had to put so much effort into each cut. When someone else holds it, the planes of tissue separate in front, like the Red Sea in front of Moses. When I’ve got it, I can barely tell where the dermis is anymore. The attending remarked that I needed to practice some more. . . I do hope that means he’s going to let me practice some more!

Then I went over to the main OR, where our big free flap was in progress. After a couple of hours, the attending sent the med students to get lunch, and I got to assist with a nerve repair under the microscope. Absolutely fascinating view, although so infuriatingly tiny that I’m glad I won’t have to do it much myself. It was also fun to be actually helping this attending, not getting hopelessly quizzed, and having him help me get set up, and then be able to do things right, cut and retract in the microscopic field without making any remarkable mistakes. Then the attending went to get lunch while the fellow finished dissecting the flap; poor guy, he was the only one so irreplaceable that he didn’t get to eat.

 The case ended after about seven hours, and then we started trying to get the patient transferred to the ICU, for careful monitoring of the flap. As we wheeled in his bed, the attending started cursing. Although he can get angry, audible cursing is quite unusual for him, so the whole room jumped. When we understood that he was deploring the absence of an orthopedic traction frame from the bed (as had been requested), we tripped over ourselves to run and detach such a frame from another bed in the hallway (somehow unsuitable for the ICU, I never understood why). The OR started to look like a Keystone Kops or Abbott and Costello set, as six of us staggered in carrying the frame and trying not to knock each other, the patient, or the anesthetist on the head as the metal bars swung around. Just as it began to get stable on the bed, we realized it was on backwards, and had to disassemble the whole thing and run around again. . . Like in any OR, after about 3 o’clock, you have no chance of getting the materials you request brought to the room in any reasonable time period.

Tomorrow I am going to go hunting for a Middle Eastern grocery, so as to get some decent rice. (The stuff they sell in American stores is icky. No wonder Americans don’t like rice, it comes out all mushy.) Then I will see how far my budget and a clearance sale will stretch towards furnishing the kitchen farther. I am a big show-off as far as cooking is concerned. My roommate professes to hate vegetables, so I’ve set myself a private contest to see how nicely I can cook them, as often as possible, to get her to eat them. And then I want to cook some cake for the night float guy who has been so sweetly picking up after my messy days, and putting all the patients in order. Besides, I hate hospital food so much, it’s a very necessary protective mechanism to insist on cooking in the evening whenever possible.

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