Call Rooms

Being POD 1 from getting my wisdom teeth out, I've been doing a decent amount of sleeping. Some of that's probably due to the vicodin. Overall, there's pretty minimal pain and swelling - which I'm pretty happy about. I figured I'd try out the vicodin or an equivalent narcotic combo since I've given it to scores of postop patients. I feel it's good practice to experience what patients go through, if feasible.

Wisdom teeth aside, all the sleep got me to thinking about how much I like sleeping in a bed I call my own. Then that reminded me of how some were unaware that on-call rooms existed in hospitals outside of TV. Well, here's a rundown of the one's I've been in.

Christ Medical Center, Oak Lawn, IL
Did eight weeks of surgery and was on-call an average of every fourth night. The surgery call rooms are actually a set of four rooms. Two single-bed rooms for the trauma and gen surg chief residents. Then two bunked rooms in the back for the trauma and gen surg junior resident and med student. The rooms are the length of a twin bed and the width of 2.5 twins. The beds were reasonable enough, it was just cold in the call rooms. And I usually like it cold. I didn't mind sharing the room, because it's not like we were ever there anyway.

The food was better than expected. Even better, I never paid for a meal. That's a perk of being in tight with the coordinator for meal tickets. A cool cafeteria lady who charges only $1 for your lunch also helps. And so does grabbing lunch in the OR suites' doctors lounge - both time and cost-efficient.

By far the best part about Christ's food was their hours. And by hours I mean that they were open from 130A-430A for the on call and night staff. Hell yeah. No other hospital's had the common sense (or more likely money) to do that.

Jesse Brown VAMC, Chicago
Did six weeks of psychiatry at the VA and took three nights of call. There's actually a wing in a newer part of the hospital dedicated to on call staff. That said, the rooms were even nicer than I expected. Especially from a federal institution. The rooms were basically converted patient rooms, each with their own bathroom, desk, bed, TV, and window! Oh and the rooms were ridiculously spacious.

Unfortunately, the food at the VA is exceptionally subpar. The chicken strips were okay at best. Between UIH and the VA it's quite the competition for my lowest rating. Making it worse, I had to pay for lunch each day I was on psych. At least my nights on call, meals were free.

MacNeal Hospital, Berwyn, IL
Did six weeks of ob/gyne at MacNeal with a week of night float on OB and took two Friday nights on gyne, for a total of seven nights. There are actually two call rooms for me to use. One is about five seconds from the labor/delivery floor. The other is about five minutes or a block away. The closer one is definitely nicer, newer, better lit, and better furnished. But this room was usually unavailable to me, since there's typically a family practice resident on call with the OB team.

The further one is older, in an empty part of the hospital, less comfortable, poorly lit, and cold. All that said, it's quieter. But it's also apparently for gen surg med students. I only discovered this my last night on call after getting paged to basically move my shit out. Meaning I had no place to sleep. Hell no to that. After talking to the nurses, I ended up sleeping in a patient room on the L&D floor. It was ideal: right in the middle of the action, quiet, comfortable, with a bathroom right there.

The food was reasonable at MacNeal. Paid only for a handful of meals, thanks to meal tickets and the doctor's lounge usually being stocked. Unfortunately, they didn't have late night hours. They do have a bank of vending machines though, from which I've gotten: hard boiled eggs, tuna sandwiches, White Castle burgers, and other assorted fare. Be jealous.

In Queue
I've got three more core rotations my M3 year: pediatrics x 6wks (at Christ again), family medicine x 6wks (Hinsdale, all outpatient), and internal medicine x12wks (Lutheran General). If I remember, or get this bored again, I'll update you on the bed situation for Christ's peds and Lutheran's IM med students.

OB/Gyne & More

Having just taken the shelf exam on Friday, I've closed out my ob/gyne rotation. All jokes aside, I actually enjoyed the rotation. Enough that it's still on my list of possibilities. Along with most other things, as I'll touch on.

Except for the demographic restrictions, the pathologies and scope of practice are pretty diverse. Ob/gyns function as a lot of women's only interaction with the health care system. As such, this provides for a decent amount of primary care and outpatient experience. Outside of usual primary care stuff, there's obstetrics, which encompasses its own breadth of experience including prenatal care, normal births, instrument deliveries, C-sections, and conception/infertility treatment. Entwined in all of those are maternal and fetal conditions and morbidities of pregnancy with appropriate management.

Then there's the gynecological aspect, including birth control, dysfunctional uterine bleeding, cancer screening/biopsies, pelvic organ prolapse, and urinary/fetal incontinence. Gyne is a lot more surgically oriented, e.g. D&Cs, hysterectomies, LEEPs, tubal ligations, and prolapse repairs.

As a specialty, ob/gyn encompasses a lot: decent amount of clinic/primary care, inpatient medicine, and getting to operate. Not many specialties offer that combination. Of course the downers include being on call (though not as bad as gen surg), malpractice insurance (highest risk specialty), and regional litgation (Illinois is one of the worst states). Overall, I was pleasantly surprised by the specialty - especially since I was expecting to hate it and immediately rule it out. I might even say that I'm giving it some consideration.

On the "when I grow up" note, I now officially have no idea what I want to do. The first decision people traditionally make is between surgical or medical fields. I can't even decide between the two and want to do both. I know I want to be in the OR. I thought EM would quell my desire to do procedures. But it's just not the same as being in the OR and getting to operate. That said, I don't want the majority of my medical practice to be based on surgical anatomy - I also enjoy thinking and working through medical problems.

So, I've basically got a few months to realistically decide on a specialty - and I've regressed on that front since M3 year started. Score.

Rotation Highlights

Clinically Sweet Procedures
Translation: things that may not sound so hot to you, but are actually big deals to med students.
1.) D&C: dilation and curettage. Basically an ablation procedure, most commonly applicable to the uterine wall in the context of dysfunctional bleeding. As a lower end operation, why is it a big deal? Because my resident and attending let me do one of them :)

2.) Fascial closure. If you were watching an operation, closing would be the most boring part. That's because it is. Unless you're new to operating and actually get to partake. Closing fascia is basically what keeps your insides inside you. Nobody likes herniating through their incisions. The most suturing action we get is usually closing skin. So closing fascia, fat, and skin was pretty sweet. Especially getting to do it more than once :)

2b.) Digression. My other operative things were from gen surg and have a bit of a better "cool factor."
-Taking a rake out of a foot.
-Washing out a compound comminuted distal tib/fib fracture. Why is it cool? Because you could see the fractured bones outside the skin, and it was basically my hand and some soft tissue keeping the foot attached to the leg.
-Laparoscopically taking out two gall bladders, with an endocatch and a grasper. Basically like playing one of those "claw" stuffed animal games, except with a camera, a lot smaller instruments, and a gall bladder. Harder than the residents make it look, and a pretty sweet opportunity for me.

3.) LMA placement: laryngeal mask airway placement. One of the anesthesiologists and I got along pretty well, so she eventually had me place a few of these airways. I thought it was pretty cool, her letting me place airways. Especially since I'm only a third year, wasn't on an anesthesia rotation, and wasn't an anesthesia resident or CRNA student. The head is suprisingly mobile and taut at the same time when under sedation. As such, I'm a bit tentative to shove things down people's throats. Apparently that's poor technique. Regardless, it was a good learning experience :)

30 y/o G6P2032 sAB @ 16 wks
Translation: 30 y/o with six prior pregnancies, two full term births, three abortions/miscarriages, and two living children. This lady was by far the saddest patient of my six weeks on the service. This lady comes into the ER and we get called because she miscarried her 16 week fetus at home and was still bleeding. The bleeding was secondary to not having delivered the placenta and uterine atony, both of which resolved after she spontaneously delivered the placenta on the bed.

Messed up: she brought the fetus in. We ended up examining it and it was ridiculously disheartening to me. It was a lifeless miniature baby at only a few inches long. Even more fucked up is the fact that this was her fourth miscarriage. I can't imagine the pain and suffering this family has gone through over the past few years. With this many miscarriages, she's long overdue for a workup, i.e. for antiphospholipid syndrome, lupus, or something else systemic. Her lack of insurance keeps her from doing this and four miscarriages is the end result. Poverty's also keeping her from a proper burial for this fetus. She wanted to take the fetus home with her and bury it, but the hospital wouldn't allow it.

Long story short: this patient's story was immensely sad and emotionally draining. Even for someone who's grown somewhat numb to morbidity and mortality. We didn't even speak the same language, but our faces told each other what we were feeling. It was a legitimate downer to that night on call.

NSVD
Translation: normal spontaneous vaginal delivery. As opposed to complicated labor such as failure to progress, asynclitism, breech presentation, or any myriad of indications for C-section. Getting to deliver a baby is considered a rite of passage in med school, and I'd agree with that sentiment. It's not the prettiest thing, but it isn't as disgusting as I'd been led to believe either. That aside, I think it's pretty damn cool to deliver a baby and be part of bringing someone into the world. I only delivered a few babies, but it was legitimately one of the highlights of my clinical career so far.

Lost in Translation
In medicine, there can be a disconnect in communication between providers and patients. Especially when talking gynecological history in younger patients.

"Are you sexually active? Because your pregnancy test came back positive."
-asked of a teen patient with a belly bump complaining of weight gain, nausea, vomiting. And yes, belly bump is the medical term.

"No."

"..."
"How'd you get pregnant then?"

"Oh, I'm not active."
"I just lay there."

Just so not all my anecdotes from my rotation are depressing downers or med student geeky.