more of the same

I'm finally starting to feel comfortable with endoscopy. I've done probably 40 or 50 scopes, and about 25 PEG tubes. I'm also starting to get to know other residents, nurses and support staff, which helps when I'm trying to get things done for my patients. I finally feel comfortable finding the answer to any problem that arises, which is great. And I'm consistently getting more scopes done without any attending help. Its still lonely without a team, but the nutritionists are great, and I work with them quite a bit. I'm not sure if I mentioned this part, but I also take care of the nutrition needs of all patients who are on tube feeds and TPN. Its a great way to learn how to use nutrition support in the critically ill.

Being on call in the SICU on the weekends has been very, uh, educational. Its tough to come in and cover for a weekend, because I dont know any of the patients. The residents who normally cover the SICU are not surgery residents, and so they're not as interested in the rotation. For example, the ER resident who signed out to me last week left before rounds last weekend, leaving me to present all these new patients to my attending. Luckily he was somewhat understanding, but the chiefs and the fellows who rounded with me beforehand were not. Anyhow, I dealt with more really sick patients. I'm finally starting to feel comfortable with the controlled chaos that is the SICU. I am starting to figure out that there's no need to get stressed out . . . most things, even emergent ones, happen in slow motion. Even codes happen in slow motion. There's still a lot of standing still and thinking involved. And a lot of procedures. I've gotten to put in chest tubes and central lines and arterial lines.

Several people wanted to know when I did my first real surgery, so here it is: I did a lumpectomy and sentinel lymph node biopsy this past week. There was no one else to cover the case, and I didn't have anything urgent going on, so I agreed to head to the outpatient OR and do it. It was a great chance to work on my (sad) suturing and knot-tying skills, and it helped me remember just why I'm here working my butt off in the hospital. I love all the procedures I do in endoscopy, but I really can't wait until I get to operate more.