Tuesday, September 16, 2008

Drunk Driving Aftermath and Total Knee Replacement

My Saturday call was pretty quiet, so I wound up leaving at 10 PM. I had the same cool senior as last time, and mainly I just ate dinner and hung out with him for a few hours. He had taken some time off before going to med school, and I found out that he had been a chaplain for a few years. That is probably the most interesting thing I have ever heard of someone doing before med school. It's especially interesting that he went from being a chaplain to being a surgeon! Sunday I mainly spent working on the questions for the oral exam. It's going faster now that I've been dividing up the questions with the other surgery students, but sadly I am still not done.

Yesterday, I was in clinic all day with my surgery attending. We spent a couple of hours with one patient who had a very sad story. He was a college kid who was driving drunk on the highway when he lost control of his car and hit a tree at high speed. The airbag deployed and saved his life, but his lower body was crushed. There was a girl riding with him who was killed. We were seeing him because he had become fecally incontinent since the accident. He had to have several tests to measure his anal sphincter function, and at the end, the attending told him that unfortunately, there wasn't anything she could do. The kid didn't say much, but his mom was sobbing. It was really awful on so many levels. Maybe the worst thing is that all of this tragedy was preventable. Now this guy will probably have to spend the rest of his life in a wheelchair, wearing diapers, and living with the knowledge that he killed his girlfriend, all because he made a really dumb decision to get behind the wheel that night.

Today I scrubbed in for an orthopedic surgery. It was a bilateral knee replacement, and it was really cool. The patient couldn't have general anesthesia, so he was awake and talking to the anesthesiologist the whole time. That was kind of weird. But I got to watch a spinal block, which I hadn't ever seen before. It's kind of like a spinal tap, except that instead of withdrawing spinal fluid, the anesthesiologist injected anesthetic. Then the patient was prepped like normal. I mostly watched for the first knee, but I got to do some drilling and cementing for the second knee. At the end, the attending left the intern and me to suture up the patient's knee. It took us a while since neither of us was very experienced, and the anesthesiologist and scrub nurse were kind of getting annoyed with how long we were taking, but we got it done in the end.

I don't really want to be an orthopod, but I can understand the appeal. You get to play with a lot of cool hardware and instruments that don't get used in other surgical fields. It's also very physical work and requires a pretty good understanding of geometry and biomechanics. For any of you readers who ever scrub into an orthopedic surgery, make sure you wear a face shield, because it's messy. Also, you might not want to make a knee replacement the first surgery you see, because it's a lot bloodier than the other surgeries I've scrubbed for. Fair warning!

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