OK, so it has been a while......again.

So, I am done with pediatric internal medicine and have moved on to my elective.....Cardiothoracic surgery.

There are a few reasons that I asked for this rotation.

1) I know that I want to go into surgery and I hear that CT surgeons really utilize PA's more than any other surgeon. I wanted to see if CT surg was for me.

2) I heard that there was a possibility that this group might be looking to add another PA.

3) I heard that on this rotation, if I bust my ass, I will get to do a lot.

4) The more surgery experience I get the better.

5) Managing ICU patients scares the shit out of me, so I better get some experience while I am still a student and can fall back on that.

I had several people try to talk me out of this rotation. My preceptor has quite a reputation for being "difficult" and let me know on my first day that he has made several of our students cry. I knew this going in. I was encouraged by a student in the class before me to go on this rotation and was encouraged that with my personality I could handle it/them. I was also told that with hard work they would recognize that I want to learn and take me under their wings so to speak.

In the beginning of this rotation, I was bored. I was told in the first week, "you will get to scrub in next week". That surprised me as I have done sugery on 3 other rotations.....but I think that they are used to having students that this is their first surgery rotation, so I get it. Well, they actually let me scrub in on Wednesday of that first week......and anytime I want ever since.

In the beginning of this rotation I was thinking that I did not like CT surgery. Anything is boring if you only get to watch for 5 hours. SO, once I started to get to do things, I really started to like it! I got to put in my first chest tube solo today. I have been assisting the radial artery harvesting, and was told at the last one that I will be doing it next time.......

Well the other day that came true and I got to do a good portion of it myself!

I have been writing this over a series of a few days and a few developments have taken place. Seems like I am in high demand!! I am getting job offers left and right and people are trying to snag me. The question is......Seattle or Portland? Life or no life? No holidays or holidays? No call or call? The holidays and call would suck, but with them comes not only a ton of great experience to back me but a gigantic paycheck. The only question now is.....When do I start, and where?

It will definitely be nice to have the comfort of knowing that I will have a job waiting for me when I get out, but as of now, negotiations are stressful!!

Flying solo.....

Sometimes it is really nice when they let you take the reigns and fly solo. What a fun day! More to come, but 4am comes early....

After I was done, although the light hides my beautiful work!!

Tidying things up after a radial artery harvest for coronary artery bypass.

It's been a while.....

Hi everyone! So, I know that it has been a while since I have written anything, but family practice is just not that exciting. There are crazies and drug seekers, but I think that here, without EMTALA, we can kick them out and fire them as patients if we want. Simple as that.

The beauty, though of family practice is that I have time to have a life. Frankly, I don't know what to do with myself! It helps that former me (the other Lisa B. from Seattle that was my roomie in PA school) is here now, and that I will have her to hang out with. It is great but strange to be back in Seattle. Two of my best friends have moved away, and everyone else is having kids etc.

One thing that has been great is that I have a chance to get to the gym again. I started going a few weeks ago, but was still eating kind of crappy, and really not pushing myself to the limits that I knew that I could go so I made a decision. CrossFit. Don't know what it is? http://www.crossfit.com/

If, I am going to do this, I figure that I have to not get in my own way with my eating habits, so I am back to my old regimented ways.....but now, I'm going paleo. Basically it is eating anything that a caveman had acces to, like meat, berries, veggies, nuts. Basically all of your carb sources come from fruit and veggies. No sugar (or artificial sweeteners), no grains, no bread (sigh), no alcohol (although red wine and tequila are considered paleo alcohol), no caffeine (I will allow myself one coffe a day). I am going to do a modified paleo in that I am going to allow myself cream in my coffee, and cheese on certain things. Today is day one. I started crossfit almost a week ago, have gone 3 times, gotten my ass handed to me and loved every minute of it!!! Since starting the zone and going mostly paleo, I have lost 2 lbs in a week.

I don't expect to drop a ton of weight, but I do expect my body composition to change greatly. I already feel the difference in my mood and sleep. The only problem is that the first two days I woke up with a raging headache. Not so bad this morning though. I will keep you all updated on my progress on this. I look forward to getting my strength and my hot bod back!

11'ers, you will see a new, fitter me in 5 weeks!

I promise to post more interesting office antics soon. I will also post progress of my transformation! Todays difficulty.....resisting the free pizza and doughnuts. The doughnuts smell so good!

How about a nice warm glass of go f&@% yourself!

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Death number 2...

Last night was a little insane......but I like insane, so it was good for me.

The usual traumas coming in.....little old ladies falling down and hitting thier heads. One we think had a sneaker heart attack.

People getting shot with drug deals gone bad, but they were just "minding their own business" at 3 in the morning in a shady part of town.

Guy and his wife go to a strip club, someone says something to his wife, he punches the guy, turns out it is a bouncer, he then gets jumped by a bunch of bouncers.....and looks like it.

Then there is the "Level 1 trauma, direct to OR" page. That means it is a good one (actually a bad one). Ambulance rolls in, guy in on the gurney, pumping on this girl's chest. Stab wound to the right chest. I look at her and think, "That is what a dead person looks like." She is white, and her eyes are open. BUT, we still try to save her. It is insanity in there. It was one of those situations where they pour betadine on the chest and cut. Sawed her open to get to the heart. There is blood everywhere. She is still pulseless and we can't get any sort of presure into her. He's got her heart out of her chest and is manually compressing it. Epi straight to the heart. Then calcium, then bicarb, then Epi again, then we shock her heart. We have been at it for 10 minutes now (CPR was already done for 10 in the ambulance), but we decide to try for 5 more minutes, but literally she has lost all of her blood volume. Looking at where the blood was coming from, whatever stabbed her went into the right atruim of her heart. She didn't stand a chance really. It was crazy. Her "friend" that stabbed her went in at just the right angle that it went in her right chest, down at an angle between 2 ribs, and into her heart. I think it was tamponade that killed her before even bleeding out. Sad, the girl looked like she was in her mid 20's. This death was definitely real. She looked dead. It was strange to thing that she was dead......and tha someone that she knew did this to her. I'm not sure that that other person realizes the gravity of what she did. People amaze me.

Well off to more trauma tonight!

Warning....graphic images in this post.

Well the Civil war was a little more civil that I anticipated, but it was still a super busy night for us on the trauma team. A rundown of the night.

Guy in our unit in respiratory distress - drowning in his own secretions basically. Two hours trying to manage him. Eventually admitted him to the ICU.

Lady in our unit desatting to the 80's. She perks up with nebs, but is supposed to go to a nursing facility today. I have a sad feeling that she will be back to us with pneumonia and imminent death soon. She has some gnarly rib fractures and is in her 70's or 80's. That has over a 50% mortality rate. No joke.

Trauma - Fall 71yo, head bleed. Non-English speaking. REALLY hard to get a hx. Finally got an interpreter.

Trauma - Fall 71yo, head bleed. (yes again). She doesn't look 71. She is SUPER fidgety and twitchy. Hers was an alcohol related fall. She hit her head and knocked herself out. Here is where I was a little proud of my sleuthing skills. She says that she has been drinking for years, but that she only drinks 2-3 glasses of wine a night. So I ask, "Do you empty the bottle with those three glasses" to which she says, "Well there's a little left". SWEET, score for me! THEN, I later find out that her "bottle" is one of the liter and a half double wine bottles. Damn it! Now I have another question to add to the bank though! She required a buttload of sedation to stop moving in the CT scanner.

Trauma - fall 91yo, sweet as all get out. Possible cord involvement, but lower extremity weakness is resolving. Impressive cervical CT. Crazy looking at it that this lady has the use of all 4 limbs (old injury we are suspecting)

Trauma - 31yo - got drunk and crashed her car. Chunks of her hands taken away. Glass all in her wounds on xray. Her hands look like Freddy Kruger. She lost most of the skin and was down to ligaments and tendons. It was insane looking.

Called to OR for emergency surgery. They asked for the PA student to scrub in. I was like, "you're sure they asked for me?"

A girl about my age that has been on ECMO, had her spleen spontaneously rupture. They need another pair of hands in there to help. So I scrub in and it is insane. You are anti coagulated on ECMO, so she is bleeding like nobody's business. They are throwing deep ties on her splenic artery and other bleeders. They seem to get that under control, but there are other things like the liver that is spontaneously bleeding. They give me the bovie and ask, "do you know how to use this?" I say yes, and they say, "stop the bleeding." They are trying to work on her femoral artery to get a new line for ECMO in there. Meanwhile the bleeding is not stopping. The vessel gets a stitch, but she is bleeding from everywhere else. They get the other line, but her vessels are so clamped down that they can't really perfuse her. We did everything that we could but there just wasn't anything more that could be done to help her. So she died. It is sad. Sudden for her family, although she has been in critical condition. It doesn't even seem real.

Trauma 0530: Guy that fell at 11pm. Got drunk, fell down, was locked out of his house. Finally got in, looked at his head, realized that he needed to come to the hospital. Arrives to us at 0530 as a trauma. He is still wasted (1$ duck farts for any score in the game I guess) He comes to us with this. Impressive. I have his permission to take and use these pictures

Full moon = crazy? I think there's proof.

I usually don't blame things on the full moon, but the past few nights have been bizarre. A couple of nights ago, I saw my first dead person (that was not in cadaver lab). We got called to a code, but she was DNR. She looked peaceful (and dead). Then we get a trauma. Self-inflicted GSW to the head. Strange, the guy put a note in his pocket that said "Do not resuscitate. I am an organ donor" wow, he was planning ahead. BUT, I didn't even think about this, you can't take that at it's face value, because you don't really know that it was his handwriting. Turns out, that this guy was a bad boy and hurt someone else before he took himself out. He is on life support still, but it is a fatal wound. Transplant team on stand by. At least in his selfishness he was thoughtful enough to possibly help someone else with his organs. That is the only piece of light that comes out of that story.

That same night we had 5 traumas. 4 of whom were drunk. One guy stumbled into traffic and got hit. Tib-fib fracture that was almost open. You could see the bone trying to pop through the skin. THAT turned my stomach a little bit. This guy was wasted, and at first he kept screaming that the Portland police did this too him. Later he was saying that he hopes that the person that hit him is a doctor and drives a BMW. He then proclaimed that he would settle out of court for $10k. It reminded me of the scene in the movie Friday where the crack head guy acts like he falls in the mini-mart. This guy was a piece of work. He was saying that it was the 2nd time in a week that he had been hit by a car and that he doesn't know what is wrong with people and their driving (apparently, he just ran out into the middle of a busy street). His blood alcohol was 373 when he got to us. That is almost 5 times the legal limit.

Then we get the drunk lady that cries all the time. Got beat up by "a couple of whores" Former IV drug user, Hep C, chirrosis, etc. Crying because a nurse at the other hospital said something "mean to her". She is still crying. No matter what we do on the floor, she still cries. This lady has no coping skills (and no teeth). I don't know why, but I seem to be the only one that can talk her down. So I make an attempt to help the nurses by coming in to talk to her and calm her down a couple of times a shift. She has a small spine fracture, but we need to scope her because her rectal was positive for blood and her CT was ok. I think that she has probably got a leaky varices.

THEN, there is the serial killer looking kid. THis kid is creepy. He looks right through you. He got shot in the face while robbing two people at knife point. He has a pseudo aneurysm in his face that can kill him. He could have gotten a fibrinogen shot to make it go away or a really extensive facial surgery. He picks the surgery because that means he won't go straight to jail. Then he starts refusing all of his meds. He has a trach and a MRSA infection in his lungs, but refuses to cover his trach, so he coughs MRSA mucous everywhere. Pulled his foley, last night pulled his trach out, and is trying to pull his new PEG tube, which can also get really dangerous. There is way more to it, but I am in a time crunch and cant write it all. The point is he pulled his trach than told us to get a doctor to come sew it up. We told him that these don't get sewn up. He claims that he doesn't "need" and of this....like the feeding tube. But he can't swallow, and aspirates when he tries to swallow. AN psych left a great note saying, "the patient feels that he is stable" I am glad that psych is letting patients determine their own stability. I say that anyone that is decanulating themselves is a danger to themselves. Anyway, it will be interesting to see what has transpired with him over the day. We were at the point where we were going to have to call security last night because he was wandering the halls (planning an escape route I'm sure), coughing MRSA everywhere, which we just can't have. And literally, you will see like 1/4 cup of yellow mucous coming out of his trach. It's no joke.

Anyway, gotta run!