Winning the game, more night livers, and moving on...

We won the game last week. In residency, that means we discharged all of our patients on the service and didn't have to come early to round since there was no one to round on. It's a pretty rare event for this to happen, and it was erie. Everyone on the service felt uneasy, like we were supposed to be doing something but there was nothing to do. We gave the intern on the service Friday and Saturday off. I came in on Saturday to round on a consult patient and we actually did get one admission. I almost gave him Sunday off and he said "are you sure?"

In the end, I asked the intern to come in on Sunday and I'm glad I did because we got two admissions for transplant. One kidney transplant and one liver transplant. The liver transplant went first at 1AM on Monday morning, and we finished around 7AM. The patient did well but like all liver patients bled intra-abdominally on the first post-op day. I spent the day resuscitating him and we almost had to take the patient back to the OR for exploration but he stabilized out in the end.

Moving on, I started as Vascular Surgery senior resident on Wednesday. Vascular is the field that I am likely going into, but the service itself is miserable. I love the cases and like the patients themselves, but every day is a 6AM to 10PM affair. We always think that there is an end in sight for the day, but something always comes up, there are unanticipated admissions, extra cases that need to come up, anesthesia delays, oh my.

As a result, I haven't been able to spend much time with my wife who is usually asleep when I get home and waking up as I leave, but I do have this weekend off. I am looking forward to seeing my wife and we are going on a date to see a Tenessee Williams play at a local theater.

Night-time livers

I've been inspired to blog a little more both from my wife, who has a semi-professional blog that she actually gets paid for writing (based on ad-revenue stream of visitors) and another surgery resident whose blog I started following.

I've been meaning to blog on the day after being up all night or after an interesting case. Last Monday night on August 11th, we did a liver transplant. Actually, the case started at 1AM on Tuesday August 12th and finished around 7AM. The guy was a very sick frail gentleman who "appeared much older than his stated age" of 60 years old with end-stage liver disease from hepatitis C. He had around 6 liters of ascites in his belly and the case was pretty bloody. I was a good first assistant in a pretty big case and I sewed half of the portal vein anastamosis and half of the biliary duct anastamosis. I've scrubbed in liver transplants before where I've been able to do more of the case, and I feel pretty comfortable with the case and feel I could do more of it, but working with different attendings I just take what I can get.

More importantly, I think we did a great job of managing a pretty frail old guy post-operatively. We did a gentle management and now one week later he is on the floor and ready to go to rehab.

Not much else is going on. The service is pretty slow right now and we discharged most of the other patients and our census is now 3 patients and one is going home today. I thought we might "win the game" in discharging all of our patients today and thus wouldn't have to come in for rounds on Wednesday, but now I don't think that will happen.

Transplant Surgery

Well, I'm back for a post. We'll see how long this last.

This blog lasted throughout the majority of my intern year and a brief one month period during my third year. Now I'm about 1+ month through my fourth year of training. I started the year on transplant surgery, which is a cool specialty. We basically do two operations: liver transplants and kidney transplants. Kidney transplants are more frequent and are pretty straightforward in terms of the operation itself and the post-op recovery. The liver transplants are less frequent, are almost epic in their scope and post-op recovery.

On Thursday, I came into work a little early. I got paged at around 5 AM that a patient who we were following (on the waiting list for a combined liver-kidney transplant) was in the ER with an incarcerated hernia. I showed up to the hospital at 5:45 AM and scrubbed into the case. We had two scheduled cases that day, a laparoscopic cholecystectomy and a revision of dialysis fistula which I did next. During these cases, I found out that we were posting both a kidney and a liver transplant. We did the kidney transplant and next the liver transplant.

In summary, I scrubbed into a case at 6 AM and didn't finish with surgeries until 7 AM THE NEXT DAY. 25 hours of surgery! I was a little tired during the liver surgery, which was the last one. I was scrubbed in the 2nd assistant position and I actually did a lot from that position as there is a new fellow who is sort-of new at the transplant business, but there were parts of the surgery where I wasn't doing much and I FELL ASLEEP STANDING UP. However, at the end of the day, it was a pretty amazing day of surgery.

Vacation!

Whew. Finally made it to vacation. It's been good so far - going out for dinner at a very nice restaurant post-call to celebrate and spending the day with my wife on Sunday. Unfortunately, I'm not doing very much over the vacation other than catching up on Things That Need To Be Taken Care Of, like taking USMLE Step 3 and finishing cleaning out our old house which finally is under contract after one year on the market.

I had two calls, on Monday, Jan 12th and Friday, Jan 16th. Monday's call was probably easier, with 43 pages, 14 consults, and 4 cases (I&D buttock, lap chole, and 2 lap appy.) Friday's call had 64 pages, 16 consults, and 4 cases (lap chole, washout and closure of knife wounds, a grueling 6 hour long common bile duct exploration, and a lap appy.) Then on Saturday morning, we did a 2 hour long lap chole for acute cholecystitis on someone who came in the day before. The gallbladder was about 8 inches long by 3 inches wide and filled with huge gallstones. Normally, the resident on-call on Saturday is supposed to do the case, but I like doing that case and it was someone who I had admitted, so I scrubbed.

I think I need a vacation - my last one was in July.

Cannot... Wait... For... Vacation...

Well, I made it through two more call nights. The first was Jan 5th and the second was Jan 8th. It was nice having four days off from Jan 1st through 4th, but it seems like all I do is call these days. I'm on vacation after this upcoming week and I can't wait. I have three major goals during vacation: 1) get my life in order 2) study for ABSITE and 3) take my USMLE Step 3 exam. Not necessarily in that order.

I've been keeping stats on the calls, and now it's kind of funny that my co-residents and attendings ask me how many pages I got on the morning after call. I know it's geeky to keep track, but still I keep doing it. I had 72 pages on Jan 5th and 69 pages on Jan 8th. On Jan 5th I had 18 new patients and on Jan 8th I had 12 new patients.

The highlight of the two calls was doing a case at 6:30 AM on Jan 6th for perforated appendicitis. My attending kept thinking we were going to have to open but I managed do the case without attending help and kept it laparoscopic instead of open. The guy left the hospital on post-op day #3 and did very well. I hope he doesn't come back with an abscess.

Next calls: Monday, Jan 12th and Friday, Jan 16th.

Can't wait for vacation.