Saturday, October 3, 2009

First Call

I'm a night-owl. I like to stay up late. But I also like to sleep. The last time I fasted completely from sleep was eight years ago during a night of insomnia. Other than that I remember once when I was a kid I decided to stay up all night with a friend to see what it was like. I wasn't impressed.

But Friday night/Saturday morning became the third time in my life I went for 24 hours without sleep. It was my first real "on-call" experience in medicine, on my surgery rotation for my 3rd year of med school. The day started at 6AM Friday morning and ended at 10:30 AM Saturday morning, with 20 of those 28 hours spent working in the hospital. I spent the eventful evening running between the ER and the operating room as we saw a shreded leg from a motorcycle accident and point blank shotgun blast to an abdomen, among other things.

At around 4AM as I stood over an operating table, holding a retractor (a rather unimportant job), I was fading with my eyes attempting to force themselves closed. But I became aware of the importance of the circadian rhythm as 6AM rolled around and I began to feel as good and as wide awake as I do most mornings. This was a pleasant surprise. After rounding on our team's patients I headed back to Loma Linda for a much-needed nap.

You may have noticed fewer posts on this blog in the past week. It is likely to remain that way for the next five weeks as general surgery is a very busy rotation. I will put this teaser out there though... I'm thinking of writing a post entitled "Lapin Maija."


Anonymous said...

clever title idea! :-).

Be well, Matt!

Matt Perkins said...

thanks! ... hopefully the post will be clever too =)

TLF+ said...

LOL I don't think the Service Academies mention it, but I got the Army Achievement Medal (peacetime version) for staying up the better part of 72 hours (a few cat naps) keeping Company, Bn. and exercise safety nets operating.

The whole thing had its share of humor - a) I was in the CANG 40th Inf. as OPFOR to... the 82nd Airborne (there's a fair fight - but watching them jump into the desert was awesome). b) the reason I was up so long was that we had three guys trained and cleared to run the Bn. commo - one was "killed" and the other captured... so there weren't any other choices. Kinda like somebody having to hold the retractor, I reckon.

Anyway, thanks for the laugh and I give thanks for your continued progress. Blessings on the surgical rotation!

robroy said...

I pulled all nighters for all my tests in the first two years of medical school. We had the very traditional basic sciences x 2 years then clinical years x 2. I figured that I would never be taking that biochemistry test again, so I was going to give it my all.

I am pretty sure that I always got a a couple of 15 minute naps every day/night of my surgery rotation. My first rotation of the third year was Medicine. I had wanted to go into pulmonology/critical care. I made my one and only B in Medicine. Surgery was next. I loved it and did very well. Hence, my career choice.

I was totally deceived because all the surgeons save one were Mayo trained. No instrument throwers, hardly ever even an off colored remark. Only later during residency did I learn about surgeons misbehaving. That is sad and embarrassing how we have the often well deserved reputation of being hotheads and treating our "underlings" badly.

I really love the OR. It is like an inner sanctum of some strange religion. Ablutions before entering. Priestesses of holiness (or sterility rather). But once one gets over that nonsense, the OR is just fun - or that how I try to run it. I do want everyone to be serious on the inside, but relaxed and joyful on the outside, knowing that we are doing wonderful things and that all our absolutely essential parts of the team.

I am doing a cochlear implant this week - simply one of the coolest operations known to man. If you have a chance to see one, take advantage of it.

My longest day was when I was fourth year resident. Me and the attending operated for 24 hours straight. We started at 7:30 with regularly scheduled cases. By the time we finished with those, it was late in the afternoon. The trauma cases started coming in. My lower level residents kept seeing more patients in ER and funneling them into the OR. We finished at about 8:00 the next morning. Both the attending and I came out and collapsed. With work rules, one can't do that anymore in residency. Too bad.



Matt Perkins said...

Tim and Robroy, thanks for your interesting reflections. Now when I'm in the OR under the watchful eye of the scrub nurse I'm going to have a hard time not thinking "priestess of holiness." The surgeons I've met at Loma Linda and Riverside have all been great to work with. They ask tough questions and make you squirm but you can tell they want you to learn and have high expectations - nothing wrong with that. I've been amazed by the compassion and excellent patient interaction I've seen from the surgeon I'm currently working with. I do have a friend though who has been assigned to do his general surgery rotation with an "instrument thrower" at another hospital.

The Underground Pewster said...

When you have to be a "limb holder" during your Orthopedic Surgery rotation, you will look back upon those nights spent on General Surgery as "retractor holder" with fondness.

Matt Perkins said...

lol... well, I guess I'll be finding out about that soon... have my ortho rotation in about a month.