An education in contrast

I've spent the last week in a small private hospital with a plastic surgery group attached to it. Being over there is like a night and day comparison with hell-hole of a University Medical Center where I spent the previous 6 weeks. Sure the Academic Mecca is great if you want to be the 15th person scrubbed in on a surgery on a patient who is one of 19 people IN THE WORLD to have their specific kind of cancer (true story!), but you could go 2 months without seeing an uncomplicated lap choley in an otherwise healthy individual.

Case in point (which I referred to in my last post): Woman in her 60's with an acute abdomen that hits you over the head with the stigmata of acute appendicitis...CT evidence to back it up. Can't do it laparscopically because she's had 5 previous abdominal surgeries and now has a ventral hernia the size of my head. Try to do it with a LLQ incision...oh wait, there's no way to get the appendix exposed because of the adhesions. Midline incision leads to 2 hours of cutting adhesions, the finding that the cecum and terminal ileum are gangrenous. So a bowel resection, reanastamosis, and ventral hernia repair later, what should have been a 30 minute case turned into 5 hours.

On the other hand, private practice is where I saw my first childish temper tantrum be thrown at the private hospital...hundreds of dollars of instruments were thrown across the room onto the floor to make a point, curses were aimed at the cowering scrub nurses and circulators, stories were told for days afterwards...all because 2 minutes of waiting eats into the bottom line. The cases are more simple, and it's straight forward treatment delivered to the average patient. I feel like that is what has been missing after 6 weeks at the academic Mecca, however now I'm missing the intellectual stimulation and the feeling of being part of something larger.

Oh, Plastic Surgery, you are so glorious.

No one is sick, no one is dying, no one is grumpy. I get to watch boobs change size, tummies get tucked, big sticky-out ears get pulled back saving years of therapy down the line, and bumpy, crooked noses made straight and feminine. Everyone is there under their own will, everyone is pleasant to work with, no one has scutted me out in a week...I haven't even had to write a note! Oh and I get to leave when cases are over...usually around 3 PM...and cases start at 7:30. Sleep is so awesome.

But it feels like something is missing. I have no sense of urgency in my days, no need to get everything done 10 minutes ago because Dr. So-and-so wants to round. I'm not part of a team delivering health care, there are no decisions to be made. Everything runs on autopilot. There is no physiological medical purpose to the majority of these surgeries (except breast reductions) that I have seen, absolutely no pathology to eliminate besides the overly self-critical psyche. Plastics seems, in essence, an exercise in feel-good, preventative psychiatry.

Oh well, one more week until the shelf to go. I started making my first forays back into the library since the boards and I don't miss it very much. I'll take the narsty wound infection smell of the surgical floor at 5AM over that damned carrel any day. I'll be pounding through NMS casefiles, Surgical Recall, Pre-Test Surgery and whatever else I can find. I'm not too sure how the shelf questions are going to be asked, but I'm sure that it won't be too bad. Hope it goes well, until then


Albinoblackbear said...

I'm not allowed in the blogosphere right now but...bah...if I wasn't here I'd be staring at the wall with drool coming out of the corner of my mouth so...

I thought the 'last minute' was supposed to focus the mind! Helllooooo last minute! Come focus my mind!!!

Nice that you've been enjoying cush plastics and getting your sleep groove on again.

Have you seen any dudes get calf implants yet? I suppose you're on the wrong side of the country for that...THAT kills me.

A friend of mine is a plastic surgeon and he still does ER call, so he loves it. Cush boob jobs during the day then middle of the night crazy facial lac repair.

Where oh where are you happy medium? How's the navel gazing coming?

OK I'll stop rambling now and get back to physics. Ugg. Or should I say U=mgh!?

Bostonian in NY said...

I tried the same interwebs ban during the run up to my boards...it failed in similar spectacular fashion. Once you get the fear back in you, you'll be able to focus for about 45 minutes.

No calf implants yet. Though I've often wondered how ripped my calves would look with implants...NOT. Try walking up a lot of stairs, or pick up backpacking for a summer or heaven forbid doing a frigging heel raise in the gym. But no! I'll get huge calves by filling them with silicone and paying a couple grand to an overeducated stranger.

Calf implants reek of "I am insecure about something in my life and need to compensate with gratuitously stupid body modification." Get a dog or a tribal tattoo or buy a child from a third world country...anything by overly expensive implants.

I've decided that there is no happy medium. My navel gazing is a non-productive downward spiral of self-loathing circular logic that is probably going to result in either the status quo being maintained indefinitely or radical life-altering changes for multiple people. In light of my upcomming shelf exam, navel gazing is currently on hold until I can procure a bottle of Bushmills Single Malt and some study-free time. Good luck

Albinoblackbear said...

"I am insecure about something in my life and need to compensate with gratuitously stupid body modification."

Absolutely, though I feel the same when I see a woman with a giant boob job...despite the fact that there is no way to grow a pendulous bosom in the same way one can grow meaty calves.

Nice tribal tat slam! Oh and nothing says originality like a barbed wire armband.

Ah yes, the status quo. Well, now you've met the herd so at least you know what you're getting into.

Good luck not ruminating on that whilst studying. I'm really going now. (I was actually studying in between..I swear).

Dragonfly said...

The doctor threw a tantrum? There was me thinking it was a patient. Good grief.

Albinoblackbear said...

Ahem...remember that time you had a blog??

It's like you have a life or something...