MIA

Hello gentle readers.
I've been a bit off-the-set lately. We're in "intersession" this week, which is boring besides getting to see all of my classmates and hear how things are going for them. People look tired. We've lost our dewy youthful look, for sure. But people also seem enlivened and engaged, on the whole.

I was inspired yesterday by our talk about providing healthcare to people with disabilities. I want to see this movie "The Sound and the Fury" that has nothing to do with Faulkner and everything to do with cochlear implants for congenitally deaf children. Apparently there are whole intentional communities of deaf people who consider these cochlear implants "a form of cultural genocide," according to our lecturer. Piqued my interest, for sure, in that it's amazing how strongly people identify with a group, and how disabilities can be a primary identity for certain individuals and groups. I also respected the opinion held by some people that there is no such thing as a disability because if the world were resource-rich and accommodating enough, functional limitations could be essentially eliminated.

My reduced posting will probably persist through July, as most of you know that I have the pleasure of revisiting Step 1 of the boards. I'm feeling good about it this time around. I've traded in my "this is a pointless waste-of-time exam" attitude for "I have to do this to realize my dreams." And having seen any patients with any diseases is helping me to care about the material, too. Anyway, as usual, I am deeply grateful for the massive amount of support I enjoy. The TWIGs have been so nice handing over their resources; special thanks to Nicole and Jade for putting the Goljan lectures on to an iPod for me -- what service! And they see my retake as an opportunity to have another done-with-boards celebration. Second time's the charm...

So I won't be in the clinic very much for the next month, but I may have some good stories from the OR and other scattered patient time. In the meantime, send me hardcore study vibes, and I'll resurface after July 25, just in time for Julie and Arturo to arrive.

Fascinating medical fact of the day

At pisces school yesterday, our Ob/Gyn instructor told us that women have been known to conceive when they have one functional tube and one functional ovary on the other side. Meaning that the left ovary pops out an egg, it conceivably falls into the cul-de-sac behind the uterus, and the right tube sweeps down, like a Gumby salpinx, and picks it up. Amazing! I had no idea that tubes are so mobile. I have wondered why the fimbrae of the tube is not firmly attached to the ovary, why we would risk having the egg transverse any area open to outer pelvic space, but maybe this is why! I ran the idea past Papa at mom's birthday dinner, and he was nonplussed. He has totally heard of this and finds it totally plausible. Apparently there are chemotactic factors -- meaning chemicals that attract one thing to another -- that help the tube find the egg. I would really love to see that live, the tube craning over like one of those claw machines that picks up stuffed animal prizes at Chuck E. Cheese.

Speaking of gyn stuff, it was pretty inspiring to see my own uterus on ultrasound for the first time today. We were practicing on each other in the ER. The uterus is very tiny when one is not pregnant! (I was thinking of a potential short story or movie scene in which a medical student not unlike myself finds out she is pregnant in that situation.) I also saw my abdominal aorta, liver, and kidneys, though we couldn't find my gall bladder. Maybe I don't have one. It was surprisingly cool to see my insides. I mean, I know blood is pumping through my abdominal aorta, but seeing it on the screen, having it externalized, it's like a different kind of mirror. The PET/MRI scans I have seen make haunting portraits, too.

I have a 16-hour day tomorrow, so I'm off to sleep. Hugs to all!

Abdomivision

I'm so happy that I'm doing these long surgery shifts during these glorious long near-solstice days. It is already getting light at 5:30 a.m., and here I am in the twilight at almost 9 p.m. My sanity definitely benefits from the rays bookending my days. The birds are very active early morning, too, though my weird bustopmate tells me they will migrate away soon.

Today I was wowed by laparoscopy. This woman had abdominal pain that no one could diagnose, so we stuck a camera in there to take a direct look -- a crazy yet brilliant idea, general anesthesia aside. I saw the appendix for the first time, an innocuous little pinky of bowel. Gall bladder was just chillin', too. So then we turn our scope towards the land of gyn, and what do we see but an inflamed Fallopian tube. Scopes out, sew her up, give her antibiotics, voila.

I've now seen the underside of the diaphragm a few times, and you can clearly watch the heart beating against it from above, which is that typical surgical combination of amazing and spooky. The heart moves around more than I realized, displaces more space.

I am grateful for my Dansko clogs; my back would hurt a lot more without them. But dang, standing for so long is surprisingly hard. I feel like we should have some extra bones from the bottom of our ribcage to the top of our pelvis for structural support. The spine shouldn't have to do it alone.

Sending well wishes to my two surgical patients of the day. May you rest and heal.

Tumors are people too

I'm inspired that people are able to look at their own bodies when they are deformed in some way. These skin grafts for melanoma are not pretty. A rectangle of skin is taken off of your thigh and put through some device that turns it into mesh skin and then slapped on the site where the cancer was resected. And then a ring of staples is put around it. Some of these wounds are 8 - 10 cm in diameter. I flat-out asked this woman today, "Is it strange to see your body look like that?" and she nodded and even smiled, maybe slightly fascinated instead of grossed out. It takes humility, a check of vanity, and a buttload of acceptance.

I was also inspired that even surgery residents are willing to change course. One of the guys is bailing out after year two because he doesn't like being in the OR. Good call, bro! I just like it when med students are willing to step off the track, "waste time," and do what will make them happy.

Nurses, medical assistants, and administrators are my favorite people in the world, my collective guardian angel. There's this "don't bug the doctors" current throughout healthcare, but I have to bug people because I'm clueless, so I bug the non-doctors. They help me generously and gracefully. I was wandering around the ORs today looking for a bonnet when a nurse pretty much tackled me with one before someone could scream at me for not having one on. Thanks, sista!

Speaking of those bouffant surgery head covering things. I saw this woman in the cafeteria the other day wearing one over her epic afro. It filled the volume of the hat precisely, this globe of hair frosted by blue chiffon. By far the best surgical fashion statement I have seen.

i stapled skin and removed staples from skin for the first time today. My neck turned very hot and red when I was removing them in front of a bunch of people. The second time I was removing them, the guy kept wincing/flinching away in pain, which was very unnerving. I hate hurting people!

This tumor they took out today was a gnarly little bastard. Big bastard, I should say. It was the size of like a mini football, larger than a mango, but like a redwood burl, all knobby and irregular and angry looking. These masses totally have a personality. They seem belligerent, maniacal.

Do we acknowledge that everyone must have PTSD to some degree after surgery? As soon as I start feeling like the time I spend on surgery is totally irrelevant to my interests and future practice, I remember that people are going to need some serious somatic work and plant spirit healing before after and during surgery. I start fantasizing about a world in which surgeons and the whole OR staff take a real "time out" before a procedure to set a healing intention for the patient, create a healing field of energy around her, express explicitly that the trauma they are going to inflict has its root in therapeutic intention. If I had another lifetime, i would spend it creating a different kind of medical school with its own hospital. An integrative education, for reals. Not sure I'm going to get around to it this time, though.