The Highs: 

• Procedures This Week: 

  • Laparoscopic cholecystectomy

  • Exam Under Anesthesia - Hemorrhoidectomy x2

  • Neck mass excision

  • Tracheostomy + PEG tube placement

  • Ex-lap d/t anastomotic leak in abdomen, R hemicolectomy, middle ilectomy, anastomosis of colon and small bowel 

  • Inferior umbilical hernia repair x2

  • R hemicolectomy 

  • Nissen fundoplication

  • ABRA A-cell placement 

  • Ex-lap (Emergency case) due to confirmed bowel perforation; JP drain placement

  • Ex-lap + EGD due to possible bowel perforation

• Got to see so many different cases this week, a couple of rare ones too! 

• Started my second surgery rotation with Dr. Vickerman

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The Lows: 

• COVID-19 scare 

• Dr. Le's patient that we performed extensive surgery on last week began to deteriorate
   

Overall rating of the week: 7.5/10

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This week marks the start of my rotation with the infamous Dr. Vickerman! What a wild journey. I learned quickly that Dr. Vickerman is one of those doctors who cares deeply about his patients, who is very high energy, all the time, and is someone who is very similar to me. I wasn't sure how well we were going to get along, especially because I know he loved working with my other colleague. I didn't know how I was going to compare, but I knew that I was going to try my best to shine and do well. 

My first day was a clinic day. I was so surprised by how many patients we had to see! It was by far, more than Dr. Le and Dr. Barloco's patients combined in one day. That meant it took me awhile to prepare my patient notes, but also meant I was going to learn so much. We met at 07:15 on Monday morning in the Physician's Lounge for Sign-Out. Once we got through the patient list, Dr. Vickerman refilled his jumbo Kum-n-Go soda cup, and we headed up 4 flights of stairs to the Fourth Floor of the hospital... oh yeah, he never took elevators. I was huffing and puffing by the time we got to the top, and was worried that I was going to have a collapsed lung, haha. Still, it was good to know that I was going to get some exercise while working with Dr. V, because Lord knows I need it. 

I watched Dr. Vickerman say hi to all of his inpatients, in particular, Mr. CM. He was a patient who, after having an abdominal procedure, received a vaccine and unfortunately developed Guillain-Barre. He was slowly recovering from the adverse effects, and looked incredibly cachectic and old, despite his age of 40. He was also suffering from a case of C. difficile, which meant that we had to gown and glove before going into the room (We already had our masks on). Regardless of his frail appearance, I felt a little tug in my heart and knew that I needed to show him all the compassion that I had. Every day of the week, we came to see him in the mornings, and every day, I would say, "Have a great day, Mr. CM". And he would respond in his southern accent, "Thank you, you too miss." I'd get a little smile from him, and it was enough. 

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On Tuesday, after finishing all of my surgical cases for the morning and afternoon, I bumped into Dr. Le, who said he was taking his patient (our 8 hour surgery case) back to the OR today because he started leaking from his anastomosis that we did. He told me that I could scrub in if I wanted to, so I gladly accepted the offer. I got to see an Exploratory Laparotomy, and unfortunately, the patient needed his entire R colon resected, as well as part of his ileum. However, I got to see first-hand what good versus poor bowel looked like, feel the difference in my hands, and watch as Dr. Le expertly fixed this patient's intestines. 

Next day was clinic. I've been really enjoying clinic days with Dr. Vickerman because he allows me to see patients on my own, perform my own physical exam and assessment, and then he'll go in to talk to the patient after I've finished presenting him/her to Dr. V. It felt great to have some autonomy, and to feel like I was doing more than just shadowing him for the entire rotation. I saw a female patient who was recently seen in the ED for RUQ abdominal pain. She had a history of fibromyalgia, but she seemed to have an acute gallbladder. We scheduled her for a laparoscopic cholecystectomy on Friday. 

This week, I scrubbed into another case with Dr. Le on the same patient. We couldn't close the patient's abdomen from the first surgery due to the exorbitant amount of edema and hardening of the abdominal muscles. So, Dr. Le was going to try to place an ABRA device that would stretch the patient's muscles every day. It's not something that's done often, so I took the opportunity to scrub into the procedure and see how it worked. It's honestly a crazy looking device, and after we finished, I had to say a little prayer over the patient, hoping that he would finally heal and not have to be in so much pain. This entire time, they kept him intubated and sedated so that he wouldn't feel anything... I can't even imagine how he must've felt. 

Friday was an absolute hell-hole. The day started out alright; we finished Sign-Out and rounding on patients. Then, Dr. Gibson, a brand new trauma surgeon who was recently hired at NCMC, asked Dr. Vickerman if he would be so kind to scrub into his surgeries just to have an extra set of eyes and hands. That day, Dr. Gibson was expecting a small bowel perforation patient to come in for emergency surgery, so we had time to plan for that one. But then, two full trauma activations were called overhead, and an appy, as well as a sicker-looking small bowel perforation came into the ED. What I thought was going to be an early day turned into chaos! 

We took the sicker-looking perforation patient into the OR first. Despite the Ex-lap, we found no perforation, just a small bleeding ulcer, which we fixed. We even performed an in-operation EGD to confirm no perforation of the duodenum, and to look for other ulcers. The patient was then sent out to PACU. Next, we brought in the first bowel-perforation patient, who, despite not looking as sick, ended up having a real duodenal perforation. We were able to suture it back together, but couldn't perform the EGD because we couldn't get the scope past the stomach. Still, Dr. Gibson wanted to place a JP drain, and he was so kind enough to allow me to sew it in! 

After I left the OR, Dr. Vickerman and I discovered that the patient who we had scheduled a cholecystectomy for that day had tested COVID-positive. I was absolutely stunned. That meant that I had possible been exposed to the virus, and needed to alert my school, my coordinator, and my clinical education director right away. In no time, I had submitted my report to RVU, and spoke with Sandi, my coordinator, on the phone. Dr. Miller called me shortly after that, and we discussed what I needed to do. He thought I would have to quarantine for two weeks, but said that he would leave it up to Banner's Occupational Medicine department to make the final call. I called Occ-Med, and they told me that it sounded as though I wasn't in a high-risk position when I got "exposed". They also said that if I was completely asymptomatic, then I could return to work at the hospital without quarantining. I felt immediate relief! After reporting this to the school and Dr. Miller, I just needed to get a COVID test on the following Monday. If that came back negative, then I could continue with my rotation without taking any time off. Yay! But geez, I was really scared for a second there -- I thought that I was going to lose two weeks of my surgery rotation, thus missing out on a huge learning experience in a field that I had grown to really love. Thank goodness it didn't come down to that! 

On a non-medical school related note, my roomie got into a pretty bad car accident last weekend. It was snowing really bad last Saturday, and she was planning to meet her friend in Loveland for lunch. I got a phone call a little after 1pm from her, saying that she got into a terrible accident. While driving on the country back-roads, she was approaching a traffic light that suddenly turned yellow. She braked too hard, and her car slid into the opposite lane, hit an oncoming car, spun out of control, and went down a steep ditch. Thank GOD she's okay. The passengers in the other car that was involved included a couple, and the woman was pregnant. Luckily, they were extremely understanding, and after a full ED check-up, were completely okay and healthy, including the baby. My roommate's friend was able to come to the scene and drive her back home, but unfortunately my roomie left everything in her totaled car, including our house keys, garage opener, and her hospital ID badge. I ended up having to drop her off and pick her up from her rotation site most days this week, but regardless, I'm just so glad she's okay. Her boyfriend came to visit from Seattle this weekend to take her to get her a new car! She now drives a bright-orange 2019 Subaru crosstrek, and even though the circumstances for obtaining the new car weren't ideal, she's driving a much safer, more reliable vehicle than her old one. 

Be safe, people! Don't drive long distances in a blizzard if you can help it! Also, when in doubt if you should report to your boss that you might have been exposed to COVID, always proceed as though you're taking universal safety precautions. Because I acted quickly and pulled myself out of the OR (I did not go back in to scrub on more cases that afternoon), I was met with a lot of grace and understanding from RVU. I think that's the best approach you can take in these situations. On top of that, I was on my rotation when I got exposed, and not putting myself in harm's way outside of my job. Because of that, RVU handled my case cleanly, and I met no pushback from Clinical Education. I was extremely grateful that Dr. Miller was so understanding and quick to respond to me, so now I just hope I test negative for COVID on Monday!