The In-Service

Courtesy of FunPrep.com

If any of you have ever watch any medical TV show in the last decade, whether it's Grey's Anatomy, Scrubs, or Emily Owens MD, etc... then you have probably at seen the residents taking an exam. In surgery, this exam is called the ABSITE, or American Board of Surgery In Training Examination. This exam takes place every year, at the end of January. And it is taken by every surgery resident in the country (or every resident in an accredited program). There are two levels. The Junior Level (for first and second year residents) and the Senior Level (for third through fifth year residents).

This exam, while designed to give diagnostic feedback on the where the resident is weak in knowledge, can cause all sorts of anxiety. The test lasts about 4 hours and covers any and everything that a surgery resident is supposed to know. However, the the anxiety comes with how one performs -- each level of resident is grading against all the other residents in the country at their level (i.e. a second year at Hopkins, UCSF, and U of Miami, are graded against each other). This results in a percentile score and a raw score (not affect by how everyone else does). The one that matters the most... the percentile score, especially if you want to go into a competitive fellowship (i.e. pediatric surgery).

So, this month all my free time is being dedicated to studying... and trying to retain everything that I've forgotten over the past year (and from medical school). Countless hours of reading review books and guides, cramming in questions between seeing patients in the CCA and post-call, while trying not to fall asleep. Caffeinated days off spent at the coffee shop, and anxiety filled nights while trying to remember what was learned. Praying for the days to go by slowly, while anxiously awaiting the day after the test, when there will be a huge burden lifting off the shoulders.

If you happen to run into a exhausted looking surgery resident, which injected eyes and empty cups of coffee in front of them, don't judge them on their haggard appearance, just remember we're striving to be the best doctors we came be, at least in the academic sense.

And now it's time for me to get back to hitting the books...

A Personal Update

Image courtesy of http://www.vascularsurg.wustl.edu/

About a year and a half ago, as I was justing starting my residency, I got a call from my dad. He said that he was on his way to the emergency room because his big toe was cold and blue and his leg hurt. Being in the medical field, I started freaking out, cause I had an idea of what was going on... and I didn't like what has happening at all to my dad -- He had clotted off the artery above his knee and wasn't getting blood flow to his foot. Luckily, the physician taking care of him got him on blood thinners and to an intervention rather quickly. He walked away from the event with all his parts plus a shiny stent in his leg.  However, since that time, he's been hospitalized multiple times and had to have the stent revised more than once.

I was able to get home during the initial event. And although I was grateful that my dad did well and his foot was saved, I really didn't like the care he was getting, or the vascular surgeon taking care of him. I urged my parents to get a second opinion, and after he had been hospitalize two additional times (once cause the stent clotted off, and another time for a hematoma after he was overly anticoagulated), and had another procedure to salvage the stent, they took my advise and transferred his care to the University of Michigan, where he has been taking care of in an exceptional manner.

However, earlier this week I got a call from my dad -- his foot was cold and his leg was tingling and in pain. He emergently went to the ER in our home town and was transferred down to U of M. He had clotted off his stent, again. The surgeons took him to the vascular suite and started him on a clot busting medication, and were able to get blood flow back to his foot over the next couple of hours.

During the conversations I had with my dad, I started prepping him for the fact that he'd likely need a bypass surgery, to bypass the diseased arteries in his leg. On his arrival, the chief resident taking care of him called and voiced the same opinion, and the following day, the attending vascular surgeon said the same thing.

Thankfully, due to the therapy he received, this does not need to be done emergently, but is being planned for the next couple of weeks, on an elective basis. And I will hopefully be able to get home for the couple days surrounding the surgery -- which is a big surgery.

I have to thank the surgeons at University of Michigan, though, for their great care of my father, and for the conversations they were willing to have with me -- and for talking to me as a medical professional who understands what is going on, rather than talking down at me (like dad's previous surgeon, who treated me like someone who didn't understand anything medical, in spite of him knowing I was a surgery resident).

In the meantime, please send up some prayers for my father -- that he does well over the next couple weeks, that he gets through surgery without difficulty, and has a quick recovery -- and for the surgeons taking care of him.

"A cheerful heart is god medicine, but a broken spirit saps a person's strength." - Proverbs 17:22

Shock Trauma, ETA 2 minutes

The Ambulance Bay. Photocredit: M. Ramirez

Welcome to January... And yes, I do realize it's half way through the month already.

This month I found myself back at the trauma center. My program is well known for its trauma -- it's one of the busiest Level 1 Trauma centers in the nation. Which means that it's always a full house, of patients and residents. As the second year I'm basically in charge of running the trauma assessment area. The CCA (or critical care assessment) is where I live every 3rd day for 24 hours -- this area is basically an ER room just for trauma; it's actually completely separated from the level 1 (or medicine) ER, which is located done the hall from us (and about 500 feet away from the ER ambulance bay, whereas they can just roll into "my" ER).

My job is to see, evaluate, and "dispo" all the patients that arrive by ambulance or through triage. And then help run the shock traumas that arrive, with the rest of team. Basically, the second year resident functions as an ER doc for traumatic chief complaints (i.e. "I fell off a ladder and now my ankle hurts" to the "Some dude just shot me in the leg, doc"). What's really good about this rotation is the amount of autonomy... I have a chief resident who is a phone call away should I need help or advice, and I run every patient by the attending (in person or on the phone) before sending them home or admitting them, but for the most part, it's a time for the second year resident to get a lot of experience triaging patients and honing their skills at assessment and treatment.

I was last in the CCA in July -- in fact, I was the resident who got lucky enough to be on call July 1st and 4th... For those of you familiar with the new ACGME duty hour rules, it means that July 1st, as a newly minted second year resident, it was the first day any of the kids in my class could take the 24 hour call. I was there for 7 weeks, and in those 7 weeks I saw and learned a lot.

July is busy, especially in the trauma center. There's a few reasons, but the main reason is that it's warm. And like I said when I lived in Detroit, "It's a lot easier to shot someone in the summer and get away on your bike, then in December, when there's snow on the ground." Down in the south, it may not snow, but people just don't go outside when it's cold. In July, during a 24 hour period, I would see and assess, work up, and dispo about 50 to 60 people. In January, it's about 30-40 people.

That being said, there's a certain air of electricity at any time of the year in the trauma center. You don't stop. Even if there's nothing to do, you find something that needs to be done (even if it means squeezing in a few extra minutes of studying).

Trauma is exciting -- you never know what's going to come through the door. There could be 1 person in the CCA one minute, and 2 minutes later there's 4 s/p MVAs (just had a car accident), a GSW to the LLE (gun shot wound to the leg), a person that has a pneumothorax in need of a chest tube (air outside their lung but inside the chest, causing collapse of the lung) and a shock trauma that's unstable arriving to the shock trauma room.  You are always on alert... it's what makes shows like, Trauma: Life in the ER, popular. Trauma is "sexy" to the general public. But not necessarily when you're the one living it -- then it's just exhausting.

That being said, it's not too bad... and can be a lot of fun.

It's a New Dawn, It's a New Day

Wow... I suck at blogging (even in spite of weekly reminders on my phone).  9 months?! To all those who are still subscribed, please forgive me.  But it's a new year, so I feel I should make a little bit of an effort. And hopefully, I'll get better over the year -- I can make excuses (life is just so busy), but that's not what you need, or what this is about... Let's start again. New year, new start, right? So, all that being said....


Hi, my name is Kate and I am a second year surgery resident at an academic program in the south (too easy to figure out which one if you look at any other social media, but I'll leave that to you). Let me start by saying, I love my job, even on the days that I hate it or just want to stay in bed. I have been blessed with amazing friends and have the best puppy in the whole world (her name is Adson -- and yes, she's named after a surgical instrument, a small pick-up, in fact, because she is my little pick-me-up).

Since it's the beginning of the year, I thought I would share with you all my new years resolutions (which, suprisingly, given the nature of this post, does not include being better about blogging). Anyways, here's my 13 resolutions and goals for 2013:

1. Finish my 1 year Bible (I started it a year ago November... yeah, life is distractingly busy at times) - aka start doing daily devotionals
2. Memorize a new Bible verse every week (this one, and the one above are going to be aided by youversion and shereadstruth) 
3. Be consistent in efforts to exercise (currently on day 5 of Jillian Michaels' 30 day shred, which I will only do if I do it before work... which means I'm jumping around my apartment at 3:30 am right now)
4. Make a new recipe every week (did this in medical school, really liked it, wish I hadn't stopped)
5. Pay off credit card debt (there's not a lot, but I want to get rid of it -- and along with that, build up my savings)
6. Buy a house (yep, gonna be here for another 5 1/2 years, seems like the thing to do)
7. Lose 30 lbs (silly but something I want to do)
8. Clean apartment weekly (I found a 15 minute daily cleaning schedule)
9. Study at least 30 minutes a day (actually doing pretty well on this one so far)
10. 13 miles by the end of '13 (yep, run a half... Maybe the St. Jude Half? Starting goal run is the Pancreas Run at the end of March, with some of my residency friends)
11. Swear less (It's there every year... trying to catch myself, but I'm really bad at it)
12. Publish (or at least finish) one research project (this should be aided by the fact that I'm starting a 2 year clinical research stint starting in July)
13. Cultivate friendships.

Since making that list, a few more things have been added as goals for the year:

• Eat healthy
• Read medical journals more consistently
• Stop texting while driving (I know... I'm horrible)

What are your goals and resolutions for the year of 13?