Sunday, October 23, 2005

the kids are alright

I did my first awake craniotomy this week. An awake craniotomy isn't quite as dramatic as it sounds--the patient isn't awake like, "Hi, how are you? And what are you doing with that giant bone drill?"--but they're not under general anesthesia. We have them deeply sedated so that they don't complain when their head is pinned and the surgery begins, but they're not intubated, and they don't have any respiratory support except for the little bit of oxygen that we throw at them through the nasal cannula. The trick is to keep them asleep enough that they don't move or react, but awake enough that they don't, you know, STOP BREATHING. It's a little scary to find that balance, especially since, in neurosurgery, the patient is positioned and draped in such a way that you have almost no access to their airway. I mean, yeah, if there was an emergency you could just tell them to stop the damn surgery and rip off the drapes, but...I don't like emergencies. It was cool, though, my first awake crani (and the patient's too), and though I had done some reading about it and had a lecture about the technique just that morning, I just couldn't get over the fact that they were basically sawing into the skull of a lady that was, however sedated, responding to questions just a few seconds ago. Gah!

Anyway, I talked to the patient in the recovery room afterwards, and she said she felt great, no pain, and didn't remember anything from the surgery. Sweet! Another victory for the good guys!

But anyway, that's not what I wanted to talk about. What I wanted to talk about today were med students. So far this year I haven't yet been matched up with any of my own med students--probably because I still have too much learning to do--but from my vantage point behind the blue curtain, I see a lot of medical students rotating through General Surgery, OB-Gyn, Neurosurg, what have you. And oh, it is so painful. And I don't say that in the way that med students are clueless or bad, but in the way it kind of hurts to watch video footage of yourself when you were in the eighth grade, all awkward and spazzy. Med students, I FEEL YOU, because I've been there. I know what that's like, to not know what to do, where to stand, what to touch in the ORs, and I certainly know what it's like to struggle to stay awake during a 7 hour case where, though you're scrubbed in, you still can't see a damn thing because the incision is the size of a walnut. On top of it all, I went to med school at [University Hospital] too, so I know that special brand of [University Hospital] med student pain, all old-skool and crusty. Med students, hold my hand. Breathe with me. It's going to be OK.

[Quasi-tangential aside: I was in the OR the other day and met a first-year med student who was observing during a Neurosurg case. Hi Zach! Or whatever your name was--I'm not good at remembering that kind of thing. Anyway, near the end of the case, the Neurosurg resident was talking to me about something or other, and first-year dude was like, "Michelle? Are you Michelle Au? Of 'Scutmonkey'?" And I said yes, and it was cool, but also a little weird, to be "recognized" at work. Also, I have to say that Zach comported himself very well in the OR, because lord knows, if I had set foot in an OR when I was just a first year, I would have promptly contaminated something sterile upon five minutes of setting foot in the room, and, in the process of backing away in horror, would probably have knocked over and destroyed some five million dollar piece of endowed equipment.]

The most painful thing about watching med students from my safe little perch behind the drapes is how earnest they all are. They are trying, they want to learn, they want to do well. These kids are allllll-right! But oh, it's still painful to watch a med student getting pimped and fumbling, fumbling for answers. Still worse than that is when the attendings or residents are joking around with the med students--asking fake questions, making fun--and the med students are so earnest that THEY DON'T EVEN KNOW THAT IT'S A JOKE. And then they're trying to think of the correct answer to the question, "What ligament is connected to the ass bone?" and the residents and attendings are just looking at each other like, what the hell is wrong with this guy? It is during those moments that I want to swoop down on these tiny, freshly hatched little chickens and shield them under my wing. There there now, little med student. Lighten up. Everything is going to be fine.

I was in the women's locker room a few weeks ago when I heard two medical students discussing the Blue Scrubs Rule. See, where we went to med school, the dean was very strict about scrubs. Med students could wear green scrubs anywhere, but blue scrubs, specifically designated for the ORs, could not be worn anywhere but in the OR area. The dean was so serious about this that she actually threatened to expel any student that she caught wearing blue scrubs outside of the hospital building. She made her point, but honestly, by the end of fourth year, we were all wearing our blue scrubs everywhere (I actually was wearing blue scrubs and walked right into the Dean's office for a meeting--what cheek!), and no one ever, ever got thrown out of school. But still, the threat stood, and the fear lives on.

So anyway, these two med students were changing into their blue scrubs and talking worriedly about the Blue Scrubs Rule. After listening to them fret for a while, I had to intervene. "Actually you guys," I broke in, and basically told them what I just detailed above. "So don't worry. No one has ever gotten expelled for wearing blue scrubs outside of the ORs. I understand the worry, though." I paused, deeply, meaningfully. "I know. I WENT TO MED SCHOOL HERE TOO." I waited to let this latest revelation sink in, fully ready for them to break down weeping, clutching to my bosom with relief because the legends were true, there was life after med school, people did indeed survive. We would set up a beautiful mentor-mentee relationship where I would regale them with tales of my own hapless studenthood, and they would listen with shiny-eyed wonder, and like so many precious heirlooms, I would pass on to them the lessons that I had learned from my own med school days. It would be beautiful.

Well, the reality of it was...I wouldn't say that they couldn't have cared less, but I think the things that they cared less about was short, and included such items as the internal state of affairs of an anthill in Sudan and the brand of fabric softener most favored by a particular housing complex in southeast Michigan. Basically, they just said "Oh," and started walking away, scared and not just a little bit disturbed at the sight of this somewhat disheveled Anesthesia resident, standing in the middle of the women's locker room with her arms spread open for a ready embrace.

Currently eating: Nilla Wafers. I love Nilla Wafers. If given unlimited access, I could probably demolish an entire box of Nilla Wafers in a day. I am the Kobayashi of Nilla. A word to the wise: if given a choice between regular and reduced-fat Nilla, never get the reduced-fat kind, for it is a different cookie altogether, and not nearly as tasty.

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