I, The Retractor

Equals



The retractor is a tool used to spread open body cavities to allow the surgeon better access into dark crevices as the surgeon attempts at legal battery and assualt while he searches for that gall bladder or that tumor in your body.

Surgeons are a strange breed and I won't presume to understand why it is there is such necessity to demean anyone just because, but it happens. There is a surgeon here, whom I shall not name, who likes to throw surgical instruments at Residents and students and cusses out anyone when he feels like it and he is in an ESPECIALLY bad mood when he gets woken up in the middle of the night when a trauma comes in. Maybe he has a miserable life and his wife doesn't give him head when he wants it. Maybe he likes to practice his dart throwing skills to see who he can skewer with a HIV infected scalpel? Who knows. I don't think I would like to sit down and have a conversation with someone quite so volatile. I doubt he is capable of conversation without the expletives.

Back to the question of whether you would rather a good surgeon with no personality or a bad surgeon who cares about people and is nice and not stressful to work with.

Congrats, it's a, uh, it's a....

The wonderful thing about OB anesthesia is that it's fast-paced. I think out of the entire month of anesthesia elective, I had the most wonderful fun in OB. This is also where I got the most hands-on training. I got to stick needles in peoples backs and tubes and shit down their throats and I got to shut them up by strapping a mask onto their faces while I smile gently, upside down, into their eyes and tell them to inhale deeply. This is also where I have been petrified into the conviction that childbirth is the closest a woman gets to base animality, second only to sexual endeavours one can have in certain positions, that may have gotten the woman in the labor room in the first place.

First, there is no shred of modesty in a woman in labor. You are naked, although certain women insist on keeping their bras on during labor, and are basically just dripping. You are so bloated, you can hardly move because your feet are the size of overstuffed pork sausages. And when it comes time to push, well, let's just say that more than the baby's head gets pushed out.

The penultimate OB feature is the C-section. By the time you are on the table, your legs are numb and even paralyzed because either your spinal or your epidural has kicked in full swing or it gets topped up in the OR and people have to move your overstuffed sausage legs into position. You are FULLY naked by this point in time, with 10 strange people you have never met in your life, staring at your protuberant belly, among other things, including the shell shocked medical student. And then, you are filayed open, blood and everything else is all over the place and you're not really looking your best.

After much pushing and shoving, the baby emerges, blue and crinkly, hairy like a little monkey and let's not forget, slippery and smelly. Now, you get sewed up and when surgery is over, the drapes fall and you see yourself, a bloody, brown (from the betadine prep) mess and you can't see your toes because you are in horror after seeing your belly just an expanded, empty sack that's just fallen to one side or the other, depending on where the nurse moves it. And then, because you are now fully paralysed, you are cleaned up by the 2nd year resident, who all happen to be male, who places pressure on your abdomen so as to squeeze out whatever blood is left in your uterus or else it won't contract. You are cleaned up because the blood and the betadine is just bad form and then they stick a sanitary napkin in bewteen your legs, like it's going to help prevent spillage and soiling the bedspreads.

And women want to have children to experience that?! No wonder my mother hates me on a level she is not willing to admit but shows it anyway.

It's a good thing surgical masks are mandatory in the OR.

Things You Wish You Hadn't said to your Attending

My first week in Anesthesia, I get assigned to a hilarious, wry Italian in Cardio Thoracic, who's a bit on the embittered, jaded side. Of course his name is Guiseppe. Well, Guiseppe has been doing anesthesia since the late 80's and completed a Cardiac Fellowship at Harvard. So, it's no surprise that he is not as fascinated as myself with the intricacies of Cardio Thoracic surgery/anesthesia and the Heart-Lung Bypass machine.

Guiseppe is a rare breed. He doesn't pimp* and is not really interested to know if you know what the physiology of a left to right shunt is or how does one calculate the cardiac output from a TEE (TEE: transesophageal echocardiogram) or what the heck are Starling's forces. Instead, he is interested in you. Plain old you, if you weren't a medical student. And along the way, he drops little pearls of anesthesia wisdom, that is hard to come by.

I must admit that it is all very overwhelming at first; anesthesia and Cardiac anesthesia at that. There are 500 million things to do before surgery even starts....central lines, PA catheter, Arterial lines, zeroing transducers, cardiac output sensors, swan ganz.....I could be speaking in Arabic. The anesthesia machines are menacing to the untrained eye and there are many things that beep and scream for attention. Like a sponge, I soak it all, almost to a frenzy.

And then there is the Bypass machine. It was beyond fascinating to know that before heart repair is attempted, a person has to be exanguinated, his blood pumped through a contraption, that for the duration of the operation, will act as lung, heart and to a minimal extent, kidneys. It's a giant test tube where physiology is allowed to happen and "clean" blood is then returned to the patient. Meanwhile, on the monitors, the person flatlines, his arterial pressure is at 60 and monophasic (normal pressures have 2 components to it, hence, biphasic and is usually 120/80). For all intents and purposes, this man's heart has stopped and the only thing keeping him alive is a flip of a switch.

So you can understand how it is that I am utterly enthralled by this entire process and have like 90% of my attention affixed on the flat lined monitors and the bypass machine, a million questions zipping through my head, and only like less then 1% of my attention focused on Guiseppe, who is asking about where I was born, what is it that my husband does for a living, how did I meet him, where is Singapore and what is the Straits of Melecca? (The other 9% of my attention was focused on what I was going to have for lunch, which is unusual for me since I normally spend like 98% of my energy obsessing about what it is I would like to stuff down my gullet.)

In fact, I don't even remember how it is that we came to talking about Swinger's Clubs**, which according to Guiseppe, is quite a rave in Europe and hurls out some French term that sounded like some food item. Of course this is somewhere after I got done telling my story about how I met Mitch, which for the benefit of all who don't know, I will now subject myself to public humiliation by publishing it on the WWW. I told them that I had found it unnecssary, in my youth, to hide behind the modesty of a closed blind as I changed out of the shower. At this time, both the Attending surgeon and his resident have stopped working on the still heart and have now proceeded to stare at me in their google eyes through those vascular glasses they all wear. In my youth...I kept repeating.....in my youth!

Guiseppe now asks if I have participated in any Swinger's clubs here in New York and, not paying much attention, I said: "I wish!" like it had no consequence.

Guiseppe is nonplussed and the CA 2*** is laughing his head off. Meanwhile the monitors go on flat lining, the patient is still in full cardiac arrest. It's Friday and I take my que to leave.

Monday rolls around and I am now with a different attending rotating through ambulatory surgery. Dr M. is rather sparing with his words and doesn't really emit the impression that he is too thrilled with students. But my skin is thick. I want to learn and so introduce myself any way.

"Ah, Edna," Dr M. says, with a sort of knowing look in his eye. The CA 1, whose shirt tale I am tagging along on, grins from ear to ear and says: "It's never a good thing when the attendings know you by name."

Yes, it's Swinger Edna, just in case you don't know and here's my number: 612-IDO-SWNG.



*pimp-ing - used to describe a habit by attendings and residents who wish to test the student's general knowledge of useless medical facts and get very tickled when you know what Epstein's anomaly is or what is Valentino's sign like it makes a whole damn difference to the medical care of patients.

**A place where one goes to wife swap. I swear, on my mother's name, that my knowledge of such places goes as far as Episode 6, Season 5 of CSI.

***denotes an anesthesia resident in his second year of training.

Hello from the Lost World of the Midget they call Edna

Ok. It's almost a year. I've even managed to forget the web address of this Blog, but due to popular demand, I've reinstated my humor, which was somehow lost somewhere between the Upper East Side in New York, armpit New Brunswick, New Jersey, and Hell Hole Bakersfield, California. Life just got too serious for me.

Wilma came and went. I'm still in Turd Year. So far, all is still turd.

Here's what I learned:

Internal Medicine pearl: consult, consult, consult everything you are not comfortable loosing your ass over. There are alogorithms fashioned by others way smarter than you for everything else so you can forgo using your brains. For those who don't have any; don't worry, you don't need them.

Infectious Disease word of wisdom: You are a drug peddler; get used to it. Cocci (Valley Fever) is not a figment of the imagination nor is it a fancy Hebrew word and it gets everywhere in your body imaginable (yes, even the Testicle) and if you are African American, you need all the spiritual help you can get. In other words, tough shit. And, finally, clean and cook everything you come in contact with.

Pulmonary medicine: There are way too many fat people around so you are always gauranteed some type of job security. ("Look, ma, it's Jabba the Hut!")

Psychiatry: Protect yourself from the attendings....they are the ones on the other side of the monkey bars who aren't medicated! And everything you learned about State mental instituitions on TV - lime green walls, bars on every window imaginable, dead bodies hidden in the corridors.....it's ALL true!

Anesthesia blebs: When you get tired of listening to a patient talk, you strap them to their masks and tell them to take deep breaths. Isoflurane smells aweful and when you sniff it deliberately, you get quite silly.
OB Anesthesia blebs: OHMIGOD, I'M NOT HAVING CHILDREN!

That pretty much sums up the past half a year of Turd year. I cried, I laughed, I cracked my crazy little head trying to figure out "medicine", as if it was all that important, especially when the world is about to end anyway when the Isrealis and the Lebanese Shi'ites decide to eradicate the whole world. In the light of all this, does it really matter what I want to be when I grow up??

Decidedly not.

Additionally, we are all going to burn in New York by tomorrow's high of 103, which is the average temperature in Saudi Arabia at 6 o'clock in the morning. Last I heard, Manhanttan is an island, not a vast nothingness of desert.

So, I will just relish my Venti Tangerine Frappucino at the corner Starbucks I have been nursing for the last, oh, 5 hours and forget that I am a medical student for a while and delight in the fact that I was just hit on by an average Jo who asked me if I wanted to "work out" with him. You almost want to feel sorry for him as he fell flat on his face when I said "No, not really, I don't think so" or perhaps he is hinting that I should get rid of those sandbags under my arms as they prepare to flap me off the ground.....

Oh, it's good to be back!