Y!IFMBA - Surgery Style

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I understand what you are saying, and I know all to well from personal experience what it is like to be nervous/bad at something around patients and the uncomfortable feelings that ensue. That was just one example that came to mind. There are many times, delivering bad news aside, when I can't help but wonder whether the attending/resident/intern/other med student even realizes that there is a real live patient that has to experience the results of their actions.

A couple weeks ago, we were putting in a permacath. The patient had some versed in but was still totally with it, talking with the anesthesiologist. The resident, mid-conversation, without saying a word, chucked a towel on this guys face (and I do mean chucked). I mean would it have been that hard to tell the guy that you are going to cover his face with a towel?

I know that there is a mix of becoming jaded due to training and simply being an inconsiderate person from the word go, I just wonder how much can be attributed to training, and is hopefully avoidable.

From the sounds of your story WS, this guy is just a jerk and it got me thinking.

Marshmallows can be deliciously toasted over the flame of a gas burner. Somewhat less effective if the stove top is electric. Just wanted to share.

Originally Posted by dpmd

Marshmallows can be deliciously toasted over the flame of a gas burner. Somewhat less effective if the stove top is electric. Just wanted to share.

Originally Posted by dpmd

Marshmallows can be deliciously toasted over the flame of a gas burner. Somewhat less effective if the stove top is electric. Just wanted to share.

I could have used a bunsen burner and bag of marshees this past week! I had an 30 hour roundtrip business engagement turn into getting stuck and or delayed at each plane change in each direction... stuck in the middle flying out and stuck in the middle flying back arrrgh. Not to mention, the one important business trip I wanted to get done has been canceled with the NE storm

I don't think they would travel well.

The day they make a commercial teleportation device will be a happy one indeed.

Is it wrong that I was thinking of going to SAGES this year because Schlitterbahn is just outside of San Antonio, but since I discovered they aren't open that soon I changed my mind (we get to go to one national conference per year paid by the program-as long as it comes to under about 1100)?

Originally Posted by Winged Scapula

I do this everyday and I'd like to think (and have been told) that I'm pretty good at it. But there were a few medical school and residency lectures on the art of breaking bad news; I think I "got it" before those lectures. Others never do (and there probably is some "becoming jaded/hardened" to it as well).

Agreed that breaking bad news never really gets easier. You may become more comfortable at it, but believe me...still leaves you with a terrible feeling in your gut. Some of the worst ones I've been in were telling a (very large) family that their 9-year-old daughter/sister/granddaughter was now brain-dead after being hit by a bus. Or the 2-year-old who coded and died after a terrible scald burn (abuse case). Or the 16-year-old who was paralyzed from C6 down. Or even the 60-year-old transplant patient who came in with a simple SBO, ended up aspirating, coding, being intubated, going to the ICU, developing ARDS, and then died from septic shock and MSOF.

What does Y!IFMBA mean?

Originally Posted by Slack3r

What does Y!IFMBA mean?

It dates back 10 years; in the original version of "The Lounge" on SDN, a guy started a thread that was essentially free association, apropos to nothing - the title was "Yes! I Found My Broken Antenna!" (which, truth be told, was true to the subject matter, so apropos to that).

Then, it evolved into a cult-like thread where people would post banalities that today would be tweeted. You either got it, or you didn't (I didn't). Those of us not "into it" thought there was finally a reprieve when Lee said that mega-threads were straining the servers too much, so it finally got closed. Of course, like symbiotes, other daughter threads (like grafted shoots) sprang up. There's still a descendant "flourishing" (or at least not dead) in The Lounge.

Originally Posted by Apollyon

It dates back 10 years; in the original version of "The Lounge" on SDN, a guy started a thread that was essentially free association, apropos to nothing - the title was "Yes! I Found My Broken Antenna!" (which, truth be told, was true to the subject matter, so apropos to that).

Then, it evolved into a cult-like thread where people would post banalities that today would be tweeted. You either got it, or you didn't (I didn't). Those of us not "into it" thought there was finally a reprieve when Lee said that mega-threads were straining the servers too much, so it finally got closed. Of course, like symbiotes, other daughter threads (like grafted shoots) sprang up. There's still a descendant "flourishing" (or at least not dead) in The Lounge.

That was ten years ago?? Wow, I feel old....was thinking it was only 5-6 yrs old.

Kudos to WS for resurrecting this surgery thread from the brink of death...too bad it was because of crappy patient care for one of her family members

In the spirit of this thread, apropos of nothing, I can't wait until Step 3 is done. I've been studying a bit for it, and I'm on a light rotation, so I want to enjoy my free time and not have to study! I'm taking it on Wednesday...

Also, I really hope the Packers kill the Steelers tomorrow. I want to see BJ Raji use the terrible towel in terrible ways

Ugh - http://www.nytimes.com/2011/02/03/us/03birth.html

This article is about hospitals banning the videotaping of births. The comments are an endless drivel about "WHAT ARE DOCTORS HIDING? WHY CAN'T WE VIDEOTAPE EVERY PROCEDURE??" Because the general population doesn't know what every procedure is supposed to look like, and if we let the jury watch a AAA repair or a CABG, do they have any clue what's supposed to happen?

The analogy is flight recorders for pilots, but that's an automated device, not a psychotic parent/spouse standing there with a video camera in the pilot's face. Here's a great response by a lawyer - http://www.nytimes.com/roomfordebate...0tuteur&st=cse

As a malpractice attorney concentrating in birth trauma, birth videos - where they exist - can be the crucial evidence that makes or breaks a case. Some kinds of injuries, such as Erb's Palsy, are generally believed to be the result of bad obstetrical technique in the moments before delivery when a baby's shoulder gets stuck in the birth canal ("shoulder dystocia"). A videoof the birth will demonstrate whether the baby was really stuck, and if so, for how long, what was done to dis-impact the stuck shoulder, etc. The defense to such cases typically is that the injuries were due to "natural forces of labor," and had nothing to do with obstetrical mismanagement. Objective evidence, in the form of a video, can exonerate the doctor, or inculpate the doctor. Either way, it is better than the typical he said/she said swearing contests that occur in the absence of objective imaging evidence. In this way, it is comparable to red-light traffic cameras that can prove who is at fault in an intersection collision. Nobody would say that such cameras "invade the privacy" of drivers, if they prove or disprove fault.

The stated "privacy" concern that the obstetrical team doesn't want to star in someone else's home movies, is largely disingenuous. Delivery personnel have posed with their smiling patients since the early days of photography; most obstetricians of a wall of pictures of the babies they delivered in their waiting rooms. Videos of a birth are focused on the birth itself, not the faces of the delivery personnel. Nobody takes a home movie that stars the labor nurses. If the delivery personnel are "camera shy," that suggests that they are fearful that some poor quality care will be objectively captured, far more than they are worried about their "privacy."

When my son was delivered 25 years ago at a Manhattan hospital (by C-Section, no less!), our obstetrician - who knew exactly what I did for a living - was so confident of his skills that he invited me to take a video. "I will demonstrate perfect technique," he said, "so you can use the video as a teaching tool." And indeed he did. His confidence inspired confidence. Conversely, reticence inspires the lack of confidence, perhaps for good reason.

Originally Posted by TheProwler

Ugh - http://www.nytimes.com/2011/02/03/us/03birth.html

Don't read too much NYT...it'll rot your brain.

We don't have any prelims at my program, but we get a TY for one month, for a total of four of them for four months. This first one is making us categorical interns look like all-stars. one of our attendings said to her at the end of her first week "Oh, I thought you were one of the students." Then she called in sick today, when she's supposed to be on call. And by "called in sick," I mean she didn't show up, and they called her. Then she said "Oh, I'm sick." Wow.

Originally Posted by TheProwler

We don't have any prelims at my program, but we get a TY for one month, for a total of four of them for four months. This first one is making us categorical interns look like all-stars. one of our attendings said to her at the end of her first week "Oh, I thought you were one of the students." Then she called in sick today, when she's supposed to be on call. And by "called in sick," I mean she didn't show up, and they called her. Then she said "Oh, I'm sick." Wow.

Hey, they are lazy...that's why they went into derm. Haha.

I'm wearing a fleece jacket under my white coat and I'm thinking again of making some fleece lined scrubs. I usually don't wear a white coat-except when I am away from my home program (figure I need to represent us well), and sometimes the fleece jacket isn't appropriate (like in the OR). I'm thinking a fleece lining would be really nice for those times. I think I'm the only person who really enjoyed the temp when operating on burn.

She is going into derm actually. The other TYs are doing stuff like rads and anesthesia.

Originally Posted by TheProwler

She is going into derm actually. The other TYs are doing stuff like rads and anesthesia.

I knew it.

UGH, I'm going to strangle an entire bucket full of kittens if I get one more question on USMLE World about tuberculosis. THIS ISN'T A THIRD WORLD COUNTRY. I don't need 1-3 questions about TB on every single practice test (of 20 questions). There's also way too much derm on there.

Here's how I treat rashes:
1. F/u with your PCP in a week
2. Benadryl
3. Don't give that medication again

If it's a rash on myself, I'll put hydrocortisone cream on it.


I'm taking Step 3 tomorrow.

[QUOTE=TheProwler;10574447]
Here's how I treat rashes:
1. F/u with your PCP in a week
2. Benadryl
3. Don't give that medication again

If it's a rash on myself, I'll put hydrocortisone cream on it.
QUOTE]

This is actually how they treat rashes too. They just charge more for the visit.

Originally Posted by TheProwler

We don't have any prelims at my program, but we get a TY for one month, for a total of four of them for four months. This first one is making us categorical interns look like all-stars. one of our attendings said to her at the end of her first week "Oh, I thought you were one of the students." Then she called in sick today, when she's supposed to be on call. And by "called in sick," I mean she didn't show up, and they called her. Then she said "Oh, I'm sick." Wow.

Originally Posted by TheProwler

She is going into derm actually. The other TYs are doing stuff like rads and anesthesia.

Wow. Derm applicants are usually awesome students. At least ours are at the top. I'm surprised she's still not in gunner mode. I guess after it's in writing most people dial it down (or to "off" in this case).

Originally Posted by Guile

Wow. Derm applicants are usually awesome students. At least ours are at the top. I'm surprised she's still not in gunner mode. I guess after it's in writing most people dial it down (or to "off" in this case).

Derm applicants, yes. Derm residents, not so much. The one's I've met have been less gunnerish, more bitching-when-their-clinic-extends-past-2PM-ish.

Originally Posted by Winged Scapula

And yes we don't really have a university hospital here: Mayo Scottsdale is the closest it comes although we have several hospitals that have surgical residents: Banner Good Sam, Barrows, VA, Maricopa (but I would never send a family member there, please ).

Don't forget St. Joseph's unless you were counting Barrows as St. Joe's... but they're just the neuro guys.

Enjoying what will likely be my last snow day ever. From here on out, snow days mean struggle through the snow to get to work days (unless I end up in Phoenix, in which case it will be struggle through the 115 degree heat to get to work days...which sounds better).

Originally Posted by Jwax

Don't forget St. Joseph's unless you were counting Barrows as St. Joe's... but they're just the neuro guys.

I wasn't actually attempting to list all the programs but let's give St. Joe's surgery program a shout out since you liked it so much.

Enjoying what will likely be my last snow day ever. From here on out, snow days mean struggle through the snow to get to work days (unless I end up in Phoenix, in which case it will be struggle through the 115 degree heat to get to work days...which sounds better).

There's no struggle with the heat - you will leave home before it gets that hot. The max temp usually hits around 5 pm, so you might note it coming home but you will have AC in your car. While you were enjoying your last snow day, I was driving between hospitals with the top down on the car. Let me know how you're ranking programs.

Originally Posted by Winged Scapula

...I was driving between hospitals with the top down on the car. Let me know how you're ranking programs.

Sure, rub it in why don't you.

I just saw more of that evil, white, vile, cold, wet stuff start falling...AGAIN. >.<

OK, WTF is a "nocturalist"?

Well, I can figure it out but I LMAO when reviewing the H&P from the "hospitalist" to see it signed as John Doe, MD Nocturnalist. Really?

And secondly, where do non-surgical consultants get off on recommending surgery vs other treatments? I mean, where does the nocturnalist get his surgical training to determine that removal of implant is the preferred method of treatment over perc drain placement? Where does he get off telling the nursing staff that the patient was going to the OR, before the patient was even seen by a surgeon?

To top it off, while said nocturnalist was spouting off about what procedure this woman need, he neglected to cover her diabetes, hypertension or do anything, ya know...medical. For some reason THIS surgeon had to see that the diabetic patient had gluc checks, some insulin, and noted that she wasn't written for a diet or fluids (ie, fluids were HW and she had no diet, no NPO, nothing mentioned about diet). If the patient is admitted to *you*, you might consider:

1) seeing the patient
2) writing some orders
3) some combination of the above

The topper was actually my realization that since the patient is in the global period I am not getting paid to see her in house but the Nocturalist is...even while I'm doing his job.

</rant over>

Nocturnalists are hospitalists that cover night shifts.

Originally Posted by Golding

Nocturnalists are hospitalists that cover night shifts.

Yeah thanks....I got that.

Its just a ridiculous term. Are those who work in the day time called "dayists?"

Originally Posted by Winged Scapula

Yeah thanks....I got that.

Its just a ridiculous term. Are those who work in the day time called "dayists?"

I kind of like it. Definitely more than the term hospitalist. Maybe I'm just a night person, because I also like the radiologist name "Nighthawk".

Nighthawk....you won't like them so much when they miss things like massive free air on a CT scan (so you are not consulted until morning) and read all normal scans as 'cannot rule out [insert reason for scan here]' (so you are consulted for 'rule out' purposes).

Nocturnist sounds so....vampire-like or something. As if he can't go outside during daylight hours. Signing the chart as 'nocturnalist' is just...well, ridiculous. What a tool! I hate it when other docs tell patients what 'the surgeon needs to do' before I've even been called for a consult; it takes longer to explain why I'm NOT going to do this and why I AM going to do something else instead, and then the patient/family get all worked up about being told different things....ugh. Huge pet peeve.

WS, maybe you need to come up with a fancy term for yourself. You could sign your charts as "mastician", "areolist" or "mammosurgeon".

Originally Posted by Smurfette

Nighthawk....you won't like them so much when they miss things like massive free air on a CT scan (so you are not consulted until morning) and read all normal scans as 'cannot rule out [insert reason for scan here]' (so you are consulted for 'rule out' purposes).

Most likely true, but I still like the name. :]

Originally Posted by Winged Scapula

And secondly, where do non-surgical consultants get off on recommending surgery vs other treatments? I mean, where does the nocturnalist get his surgical training to determine that removal of implant is the preferred method of treatment over perc drain placement? Where does he get off telling the nursing staff that the patient was going to the OR, before the patient was even seen by a surgeon?

Oh I hate it when the primary team does this! They consult you, but not before already telling the anxious patient and their family that "they're going to have surgery in the morning." Or they've already recommended one treatment modality over the other. Or they send the patient to your clinic and when the patient arrives, suitcase in hand, they announce "I thought I was having surgery today?".

I mean, I don't tell the patient "we're going to have the oncologists treat you with 5-FU" before I consult Heme/Onc!

Edit: best response I've ever heard:

We got consulted for a patient with a moderate-sized retroperitoneal bleed after a groin stick during a cardiac cath. Stable vitals, stable H&H, normal coags, no need for intervention, etc. The ER had already told the patient they were going to be rushed off to the OR in the middle of the night for "a life-threatening bleed." Needless to say we got into a heated discussion with the ER resident when we wanted the patient admitted to the floor for obs instead. He insisted "I would bring the patient to the OR." And my chief resident at the time then calmly replied, "oh? And what would you do when you got there?"

Awesome.

Originally Posted by Buzz Me

Oh I hate it when the primary team does this! They consult you, but not before already telling the anxious patient and their family that "they're going to have surgery in the morning." Or they've already recommended one treatment modality over the other. Or they send the patient to your clinic and when the patient arrives, suitcase in hand, they announce "I thought I was having surgery today?".

With respect to the Twitter feed of S*** My Dad Says:
"Are you a BE/BC surgeon? No? Then quit your bulls*** consulting and let me see this abdomen."

Don't start with the whole IM/medical student presentation of "This is a xx-year-old male with hypertension, diabetes, heart failure, etc..." Cut the to the frakking chase and tell me why the heck you are calling me at 2am.

One line presentation, mental masturbators. One line!

"We have an old guy with free air under the diaphram,"

or

"We have a woman with a 8cm symptomatic aortic aneurysm on CT scan,"

is all I need to get moving with a bit of urgency. And I won't be annoyed at you for interrupting my dream of me on a tropical island a load of nubile, scantily clad, open-minded women with a thing for me. Save your oratory orgasms until I ask for details when I see you in the ER.

Am I being a bit too cynical, or is it the fact I am getting into the "old man" range?

Originally Posted by Buzz Me

Oh I hate it when the primary team does this! They consult you, but not before already telling the anxious patient and their family that "they're going to have surgery in the morning." Or they've already recommended one treatment modality over the other. Or they send the patient to your clinic and when the patient arrives, suitcase in hand, they announce "I thought I was having surgery today?".

Yeah, that happens not infrequently in my office as well.

I mean, I don't tell the patient "we're going to have the oncologists treat you with 5-FU" before I consult Heme/Onc!

Although I have apparently convinced my patients that I should be making those judgements, as they will call and ask my opinion about the medical advice the Med Onc has given.

Edit: best response I've ever heard:

We got consulted for a patient with a moderate-sized retroperitoneal bleed after a groin stick during a cardiac cath. Stable vitals, stable H&H, normal coags, no need for intervention, etc. The ER had already told the patient they were going to be rushed off to the OR in the middle of the night for "a life-threatening bleed." Needless to say we got into a heated discussion with the ER resident when we wanted the patient admitted to the floor for obs instead. He insisted "I would bring the patient to the OR." And my chief resident at the time then calmly replied, "oh? And what would you do when you got there?"

Awesome.

Yeah, that's a classic...heard my Chiefs do it and have pulled it out on occasion myself.

Apropos of nothing, one would think that the PACU would be a good place to code. It really isn't.

I'm surprised I'm not sick given the number of flies I see landing on food here in Bali. Then again, I've been in worse places and come home GI safe.

I'm hoping WS didn't just jinx herself and will send us all a postcard.


It's too cold here already for Sept. I blinked and would've missed summer had it not been for two weeks of record breaking heat. Mother nature seems to be leaning towards bipolar disorder.

Bumpity. We need some action in this section.


I love the week after the ABSITE, because I feel like I can get back to doing **** that is actually useful.

Where are the MS4 threads freaking out about the rank list, I was just checking my calendar for that time of year.

Originally Posted by Thanatos

Where are the MS4 threads freaking out about the rank list, I was just checking my calendar for that time of year.

I think the level of paranoia has increased sustantially during the last few years, and SDNers are more gunshy about sharing experiences and ROLs, fearing that program directors will identify and then punish them. It's made SDN a lot less fun during ROL/match time.

On a side note, I just saw that my previous program director is now on facebook, and I thought that even though she's a very great doctor and mentor, and an overall great person, she'll have a hard time getting facebook friends for obvious reasons....nobody wants the boss (or potential future boss) checking in on them....

A lot of my attendings are on FB, and also my PD from medical school. Every time I see a new one show up on my friend suggestion list, I'm tempted to close my account.

One of my attendings told me way back in 2007 that he's on FB to check up on applicants to his lab and to med school. The amount of background scrutiny has probably gotten a hell of a lot worse since then.

Originally Posted by TheProwler

She is going into derm actually. The other TYs are doing stuff like rads and anesthesia.

Apologise for my ignorance, but what is a TY?

Originally Posted by rigid

Apologise for my ignorance, but what is a TY?

Transitional year.

Originally Posted by SLUser11

I think the level of paranoia has increased sustantially during the last few years, and SDNers are more gunshy about sharing experiences and ROLs, fearing that program directors will identify and then punish them. It's made SDN a lot less fun during ROL/match time.

On a side note, I just saw that my previous program director is now on facebook, and I thought that even though she's a very great doctor and mentor, and an overall great person, she'll have a hard time getting facebook friends for obvious reasons....nobody wants the boss (or potential future boss) checking in on them....

Yeah I remember the baseline paranoia that consumed a lot of my classmates. Its funny to be on the other side of it, when one of my attendings walks up to me and goes "hey buddy, my kids got me this iphone thing for christmas and I'm trying to figure out how to (fill in the blank)" This guy is not going to hax0r into SDN and trace your identity.

None of my attendings are on facebook that I've seen, we do however have a "social media" policy that dictates what we can/cannot post on facebook. One of my co-residents had a bunch of cool pictures of us at work having fun that had to get taken down. Whats most unfortunate is that I have a video of myself surfing on an (empty) patient stretcher down a long hallway at like 3am, and now I have no one to share it with.

Originally Posted by Thanatos

Where are the MS4 threads freaking out about the rank list, I was just checking my calendar for that time of year.

I'm sure someone will create a thread 2 minutes after rank lists are closed. You know, since we're so paranoid At least that's what happened last year.

Wouldn't want all the PDs to figure out who we are and drop us from their rank lists since we had the audacity to rank them #2.

So has anyone tried Yoga for back/neck pain?

I don't have chronic problems with it, but it will recur every now and again, especially after a busy week with *longish* (in the breast world) cases.

I've found that power yoga/Bikram/Ashtanga (as opposed to the traditional restorative/meditative) yoga fits my needs best. I can actually turn off my brain for 60-90 mins because all you can think about (instead of patients) is, "its so ****ing hot in here, ouch that hurts, huh...that guy is sweating tons/I can see his balls through his shorts, etc." With restorative yoga, I cannot relax enough to just "let go" and clear my mind, so I am always fidgeting, etc.

I've found my back and neck feel better, I'm less stressed and have regained some of my old flexibility. In addition, it might help stretch out/elongate my muscles because as user maxheadroom has seen, I often get comments from strangers on my arms/shoulders because of the rowing.

No yoga...but the occasional deep-tissue massage will work wonders on all those upper back knots. It's the long cases that involve loupes and a headlight that kill me (and by long, I mean 6+ hours).

Anyone use those small led headlights before? I use the big ones that strap on the head and they hurt my head after a while and pull on my hair.

Originally Posted by Buzz Me

No yoga...but the occasional deep-tissue massage will work wonders on all those upper back knots. It's the long cases that involve loupes and a headlight that kill me (and by long, I mean 6+ hours).

Yes, there's certainly a role for deep tissue massage (although I hate the pain I'm in while getting one), but I am starting to prefer yoga for helping me *prevent* those knots, have better posture, and providing things I can do at home.

Originally Posted by filter07

Anyone use those small led headlights before? I use the big ones that strap on the head and they hurt my head after a while and pull on my hair.

We're trialing them here. They're not bad...not quite as bright and the battery pack gets warm after a while...and they only last 4 hours, so for long cases you'll have to switch them out a couple times.

Originally Posted by Winged Scapula

Yes, there's certainly a role for deep tissue massage (although I hate the pain I'm in while getting one), but I am starting to prefer yoga for helping me *prevent* those knots, have better posture, and providing things I can do at home.

Very true. I try to stretch during long cases, and definitely after, but need to do so before as well.

Originally Posted by filter07

Anyone use those small led headlights before? I use the big ones that strap on the head and they hurt my head after a while and pull on my hair.

I think some of the neurosurgeons here use headlights that clip onto their loupes. My loupes have a little tab that you can clip a headlight onto, but I don't have the light.

Unintentionally hysterical moments with your always-proper-never-inappropriate-extremely-genteel-southern-gentleman-elder-statesman-type Attending:

<While doing a port>

Attending: Ok, wire's in. <Gestures for C-Arm to come in>. Do you have lead on?
<Absently reaches up to gesture towards your chest (which should have lead on but doesn't) and initiates a "patting" motion but then stops just short>
Attending: <Mumbles to self, appears slightly flustered> I almost lost my head there and accidentally felt you up.
Attending: <Louder, now speaking to you> Ok, get away from the table and protect your ovaries.

Again, absolutely nothing inappropriate was intended or occurred; he's generally prone to "kind grandfather" type interactions with female residents. I never would have expected him to use a phrase like "felt up." So glad I had my surgical mask to hide my laughter so I didn't make his discomfort worse that it already was.