July - Mike O'Callaghan Federal Hospital (General Surgery)

*Warning, this is a long post, you may want to read it in instalments. :) I don't think there is anything too graphic, although I may use actual anatomical words, so hope that doesn't offend anybody. Other than that, I think it is pretty safe.

I spent the month of July doing General Surgery at the Mike O'Callaghan Federal Hospital. It was a long drive every morning. I live in Henderson, NV (southern Las Vegas Valley) and the hospital was in the North. It tooke me about 45 min each morning to get there. I would get up most mornings at 4:30 am, roll out of bed and shower to try to wake up. After getting ready (professional attire, shirt, pants, tie, white coat), I would then grab a "Kellogg's Cinnobon" bar, (man those are good, throw it in the microwave for 10 seconds and you have a great snack) and wash that down with some OJ or Apple Juice, brush my teeth and head out the door. (Yes, I am going to include small details in this. :) I get away around 5, 5:15 am and turn on my Fox News and get my conservative fix for the day, either that or 94.1, my favorite radio station in Vegas.

When I got to the hospital I had to go through security with my car to get on base. The Hospital is located on the Nellis Air Force base. Upon parking I would go to the third floor and meet with the residents. They would assign me a patient (pt) and I would go interview that pt and see how the night went and if anything of importance had happened. It was a good experience and helped in my pt interviewing skills. I was able to better come to know what is important to ask and what is not, at least for surgery pts. I would then write my SOAP note. (For those not familiar with this terminalogy: S-subjective (what the pt says), O-objective (what I observe and find), A-assessment, and P-plan (what we will be doing with the pt that day)) The residents would then view the note, go and see the pt for themselves, and decide whether or not they agreed or disagreed with what I had put. They would then add their own note. At 7:00 am we would head down to the ICU to start rounds with our attending physicians. We would go from pt to pt and report to the physician. I would present my pt and then hear what the physician thought of my plan. It was an educational and enlightening experience. We would discuss specific cases and illnesses, methods of treatment, both surgical and non-surgical.

*A quick note about the residents. They are awesome, now they do change from time to time, but the ones that I was associated with were very helpful: Drs. Reyna, Swenson, Martin, Hollingsworth, and Moss. All really cool and more than happy to answer any questions. We may have had. They also spent some time teaching lectures. I had a lecture on Acute Pancreatitis, Cholycistitis (gallbladder inflammation), and Appendicitis. These lectures were very helpful in furthing my understanding of stomach pain and were usually presented as a specific pt case and then we had to come up with the differential diagnosis, and the steps to take to pinpoint a specific disease. Kind of like a choose your own adventure book, thrilling!!! :)

*A note about the UNR students (University of Nevada-Reno). The ones that were with me were awesome. Very friendly, and it was great to be able to talk to them about osteopathic medicine and the differences between allopathic and osteopathic. They were very open minded and great to work with. Tuesdays were a great day because the UMC (University Medical Center) students and residents (those associate with UNR) were gone all day for lectures. This meant that I was 1st assist for the doctors operating that day. I also didn't have to get up that early because we didn't have to round, so I just made sure that I was there before 7:30 am when the surgeries usually started.

So about my surgeries. I was in the room for 21 different surgeries, of those, I scrubbed into probably 15. It was great. The OR nurses and staff were awesome. It was like one big family and everybody was working together. Everyone was friendly and watching out for each other. There were a few that were kind of crazy and anal retentive, but for the most part they were all really cool. So here is the list of my surgeries: Open left inguinal hernia (LIH) repair, hemithyroidectomy (removal of half of the thyroid), panniculectomy (pannus removal, google pannus if you want more info), breast lumpectomy, lateral sphincterotomy (surgical repair of an anal fissure, or cut that won't heal in the anus, very painful), laproscopic cholecystiectomy x 3, pilonidal cyst excision, colonoscopy w/biopsy, RIH repair (open), removal of basal cell carcinoma of left leg, teratoma removal (google teratoma, it is pretty cool), total laproscopic assisted vaginal hysterectomy (LAVH), partial LAVH, total thyroidectomy, sigmoidectomy (removal of the cancerous portion of sigmoid colon and then resection or putting the two pieces back together), ventral hernia repair (cutting of small bowel adhesions, joining of small bowel, primary closure w/mesh), gastrocnemisu flap with soft tissue graft (part of the pts calf was flopped over his knee, and then skin was taken from his thigh, really cool, kind of like a cheese slicer, but electric and a little more advanced), and finally an APR (abdominal perineal resection, this pt had rectal cancer and we completely removed his rectum and anus, now the poor guy has a colostomy bag, but hey, better than cancer, right?!). So there you have it, all of my surgeries for the month of July. Like I said, it was fun, the doctors were great: Drs Joffs, Dunn, Lal, and Narciso. They are willing to teach, but won't volunteer a lot of info, you have to show interest and ask. Also, don't be afraid to jump right and and help out with stuff, they will let you, they won't take the time to ask you, but if you are ready and ask, they are cool with it.

So, some of the highlights from my month: definately the Teratoma removal was the best, the doctor cut into the ovary and black hair came out, there was also a tooth in there somewhere, luckily, he was able to preserve 1/3 of her left ovary. Sticking my arm in a guys stomach, that was pretty cool, during the APR, we had to feel the liver for metastatic cancer, after the doctor had done so I stuck my arm into the guys abdomen and felt his liver, very very cool to actually feel a soft warm living liver and not just the dead hard ones from anatomy, the guy was also really thin, so we could see his ureters peristalsing, and his appendix; it was great to see the anatomy. Placement of 2 Folley catheters: okay, so this was interesting placing these 2 catheters in guys before surgery, yes they were out, the resident told me to grab his penis like I meant it (whatever that means) and insert, after inserting one, a nurse was telling the surgery tech that it doesn't hurt, just a wierd sensation (that is a bunch of bull, it does hurt and I will argue with anyone that states otherwise. :). There was also the pt that I went in with the doctor to talk to, she called him Mr and he corrected her and say he was a Dr., I informed the Dr. that the pt had dementia, after we left and were talking to the resident, I found out he was a Dr (oops) PhD in Sociology, guess he wasn't that demented. So anyway, those were some of the highlights, along with seeing some pretty interesting gentlemen. God Bless our veterans, you really feel for some of them, some of the stuff they saw and experienced in combat must have really done something to them.

So that was my month. Post any comments you wish. Sorry it turned into such a long post. I didn't realize I had so much to say. All in all I would recommend this rotation to anybody, it was fun and I got to see and do a lot of stuff, a lot of which I couldn't include in this post, but if anybody has any specific questions, feel free to send them my way.