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thesinglesurgeon · 7 years

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Reflections on Surgery

I went into surgery scared. I heard rumors of crazy schedules, apathetic residents, confusing pimp sessions in the OR when you just don’t know what to say, and people cursing and yelling more than what’s considered to be normal. Well, all of things happened. I was at the hospital from 430am-630pm EVERY DAY. On weekends, it was only 5am-noon. I never worked so hard in my life, but the work was different than I expected. I had to work hard to be heard by residents and actually contribute to the team. I had to really come up with good ways to be involved in patient care. My goal everyday was to do one thing that was actually helpful for a patient, not just helpful for my education. When I scrubbed out of my last surgery, an emergent abdominal bleed due to a mets carcinoid tumor coming from the ED, I actually felt sad. I didnt want to go. I had been so busy, but I could sense I really loved surgery. But as I walked out on my last day feeling genuinely depressed it was over, I was certain I had loved it. Surgery is probably the most difficult rotations because of the exhaustion compounded onto a fast schedule. I barely had time to catch up with my own thoughts during the rotation, and it was only over this last weekend I realized what I thought about it and how to do well (I got my evaluations this weekend and I was told by an attending I was the “best medical student he’s ever worked with. I thought it was a prank, but apparently not!).

How to Succeed on Surgery Rotations:

Realize right now that you are not the focus. These people are tired, have to run the list, round, operate, run the list again, etc and don’t want to waste time. You need to get into the flow, or you’re not going to contribute. Be ready with all the information you need about a patient, but only say the basics. If they ask for yesterdays labs or the IVF he’s on today, you can spit it out. Otherwise, only talk about the basics (vitals, ins/outs, labs, what happened overnight, relevant physical exam of wounds/drains/closures.).

Talk to the nurses every morning and every afternoon. As a med student, you have time. When residents are charting, get up and find your nurses. I would ask them to tell me about patient X and take notes while they talked. 90% of the time, the interaction was pleasant. When people didnt tell me about the patient, I’d just ask more specific questions. Why does this help you? You learn the story from the nurses, something that gets lost on the chart. You find out if there’s a wacky family member, if the patient is cheerful or sad, what small obstacles might “not matter” to the team, but that you can keep an eye on. I would make sure my patient got his throat spray for his NG tube everyday and readjust his abdominal binder frequently. It made him feel better, the family felt reassured, the pack of doctors coming in to round looked informed, and it gave me something to do that (sort of) helps.

When someone talks about your patient, get close by and add information. Get in the conversation. Yes, you will feel weird and awkward joining the VIP circle of attendings and residents, but fake it til you make it. Pipe up when they say “labs arent back yet” and they are. When they say “I think he had a bowel movement last night” you can say “he had another one an hour ago, too.” Say it fast, don’t interupt someone else mid sentence, and importantly: act like you know what youre doing (I swear, this is essential). They will quickly realize you understand whats happening and know when to contribute AND you actually follow your patients.

Have a plan. Always. Even if it sucks. When you finish your 45 second patient presentation, wrap it up with a plan. On surgery, it should be focused on getting out of bed (OOB), advancing the diet, getting rid of Foley’s and NG tubes, replacing electrolytes (” ’lytes,” as they say), and ordering any additional images. If someone needed respiratory therapy last night, order a chest xray. If someone seems nontender and is hungry, advance the diet. Keep in mind: you can’t win here. On the same service, we had attendings who basically did the opposite with their post-op patients and you can’t really predict what they want. But have a plan anyway, and say it. If it sucks (which it might), write down their plan and make sure it happens. Don’t defend yourself unless you’re sure they are making a mistake (which as med student, you really can’t be sure about that!). Just nod courteously and move on. Later in the day, you can ask a resident about why they chose a certain aspect of the plan, but don’t bother them during the morning rush with this.

In the OR:

Know basic anatomy. Like BASIC: the arteries and veins in the region, muscles, and maybe a major nerve supply. Even though I tried to review anatomy the night before a case, I would ALWAYS panic under those lights and freeze up.

When you suddenly freeze up and don’t know what to say mid pimping, talk through your thoughts. Now you look less dumb and you help yourself out. Once I could not identify this giant vessel in the lower abdomen, I was stuck. I started talking, “well it’s not a midline structure, so its not the aorta. It’s not pulsatile, so it’s not an artery anyway. it’s too thick to be a nerve. I think it’s the veins that merge into the IVC..it must be the iliac vein!” They thought I was so smart to walk them through my thoughts, but really I was doing it for me.

Ask to close. Everytime. 90% of the time, they say yes. Just do it. Be ready to be hotly criticized the entire time, but regardless, they helped me out. Don’t panic, and just move your damn hands and do it. Unless you abruptly ask them, it’s like they forget you’re a med student that wants to learn. So speak up.

Once I knew my team, I would come in at the end of a case (if I had been in another one that ended early) and ask specifically if I could close. They thought that was “good initiative.”

Know how to instrument tie. This is the easiest thing ever, and you need to learn this.

Stack up stools before the case starts, and hold the suction like it’s an extension of your arm. If you make yourself a part of the case, even in this small way, they’ll let your hand hold other things. By the end of the clerkship, they let me use a Ligasure to cut a met tumor off the liver. It was awesome.

If you know the detailed patient history, you can ask questions about the procedure relative to the patient during those OR “quiet times.” Once we waited on a fudiciary for about 7 minutes, and it could have been awkward silence, but I asked about the chemo regimen for the patients tumor and mentioned comments found in her chart. It ended up being a great learning experience, I appeared interested and knowledgeable, and there wasn’t an awkward 7 minutes of use just standing there.

Go to handoff. This might be obvious to some of you, but in our school, this isn’t explicitly required of med students. Some teams dismiss med students when cases are over around 3-4, others kept us around forever. Whatever team you’re on, insist on going to handoff. This is a normal request of med students, so you shouldn’t get much resistance. Have the list printed off, and WRITE DOWN EVERYTHING they say. Pretend you are the intern and track the plan for each patient. The next day, you will be invaluable. When attendings quickly ask about patient social work needs during rounds and the intern stepped away for a second, you can chime in. You’ll also know what to look for in the charts (has the PT/OT stopped by yet?). This was my best advice from a resident and it worked really well. Go to AM and PM handoffs, write down everything, check it off when it happens. You are officially being helpful if you do this.

Be ready to fax and call. When they casually mention “we probably need that person’s records...” go get them. Get the patient consent form from the nurse station, fill out all the information you can, have the patient sign it. In my experience, I had to call back the other hospitals or PCP offices repeatedly until I got records to be sent over, but I usually had what we needed in 30 minutes.

I hope you find this list useful! It’s exceptionally difficult to integrate into surgery teams as a “useful” med student, but it can be done! And don’t forget to set aside time to 1) take of yourself and 2) study for the shelf exam. Good luck =)

#m3 #medblr #surgery #clerkship

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enzoseven · 4 years

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oldie

LyricsYo, shout out to everybody that worked on the album You feel me, son? Yo, shouts out to Ty Dollas Shouts out to Hodgy Daddies, shouts out to Left Brizzle Shouts out to Domyon, shouts out to Frankie Ocean Shouts out to Syd the Dude, shouts out to L-Boy AwkBig eared bandit is tossing all his manners In a bag and wrapping them in seran wrap bandages Tossing 'em in baskets with the rest of those sandwiches So when he says "Catch up, nigga" it looks like an accident Um, flowing like my pad is the maxiest My bitch white and black like she's been mimicking a panda It's the dark skinned nigga, kissing bitches in Canada Then kicking all out like Mr. Lawrence did Pamela Put her in the chamber all against her Wilt Chamberlain I never had a Reason, nigga I was just Ableton Not a fucking Logic contradicting dick head Flyer than an ostrich moshing in a tar pit Semen scented cheetah printed tee In that 'Preme five panel, I'll repeat it for the season Previous items in the present With the normal ass past like I cheated on my team It's me (Tried to get that nigga, but, Golf Wang)To have some type of knowledge that is one perception But knowing you own your opponent is a defeating bonus I'm Zeus to a Kronos, cartilage cartridge is boneless Smiles of cowards in lead showers Dead spouses in red blouses Children who fled houses on Mustang horses and went jousting I'm on my Robin Hood shit, robbin' in the hood Whips, drugs, jewels, and your pet, I'm stealing your rings Coke diamonds and your Vet, soldiers lace the fuckin' boot And salute like the troop when you shoot you gon' poop It's kill Hodgy, nigga, stay the fuck off my stoop And out my Kool aid, JuiceHodgy got the juice, I got the gin Jasper got the Henny, my nigga we get it in Wolf Gang party at the hotel I call a ho, you call a ho, and all the hoes tell You know Left Brain need a freak I need a bitch to go down like a Nitty beat Yup, uh, and her ass fat Don't be surprised if I ask where the hash at Nigga I'm tryin' to smoke, bitch get higher Domo where that Flocka Flame? Talkin' 'bout a lighter Still bang salute me or just shoot me Cause if you don't salute me then my team will do the shooting Yeah my nigga Ace will pull the black jack The king Mike G is in the cut with the black mac Livin' like the Mafia, bitch, don't get to slacking up And if these haters actin' up, throw 'em in the aqueduct Free my nigga Earl, yo, I don't really ask for much But two bad bitches in front of me cunnilingusWhat the fuck is caution? Often I leave you flossin' and cause exes next to coffins Lost in translation, the dreams you chase Got you diving for the plates like you stealin' home base That's great, I'm home alone dreamin' of two on ones With Rihanna and Christina Milian, bring it on And Travis is in the closet organizing and hangin' the tramp Three lettermans that Ace has been making him No strays while we catchin' matinees, huh? I'm gettin' blazed thinking 'bout those days I had the top off the GT3 like toupees One finger in the air, all's fair when crime pays My grand scheme of things is to be attached To the game like bitches to their wedding rings And you don't even need to look cause we gleam obscene In the light, ride slow to my yellow diamond shining Like the Batman logo over Gotham, rock LA to Harlem If you say "get 'em Mike G" then I got 'em One man squadron, nigga I'm a problem From Briggs I got bars and plans to Pimp these Polish bitches into pop stars Humanity kills, we all suffer from insanity still And if I said it then it is or it's gonna be real OF 'til I OD and I probably will, uhIt's still Mr. Smoke-a-Lotta-Pot, get your baby mommy popped With my other snobby bop, do I love her? Prolly not Know your shit is not as hot as anything I fuckin' drop Bitch I'm in the zone, stand alone, like Macaulay Cock I've been runnin' blocks since a snotty tot Big wheel was a big deal with the water Glock Now I'm all grown, sing songs just to give 'em watts Fire what I talk, but still cooler than the otter pop Op Dom neck shit in your wish list Mad sick shit, mad dick for your bitches On some slick shit, your mistress on my hit list And I'm lifted 'til I'm stiff out of this bitch Odd in your motherfuckin' area Blood clots give me five feet 'fore I bury ya Suicide flow, let the big wave carry ya Tyler got the mask like he held Jim Carey up And fuck your team, ho nigga wassup Wolf Gang so you know we not givin' no fucks You know me dog, I'm a chill in the cut so I can Cut it short, break it down, couple pounds, roll it upGet me a Persian rug where the center looks like GalagaRent a super car for a day Drive around with your friends, smoke a gram of that haze Bro, easy on the ounce, that's a lot for a day But just enough for a week, my nigga what can I say I'm hi and I'm bye, wait I mean I'm straight I'mma give you this wine, the runner just brought the grapes My brother give it some time, Morris, and Day Course you know the vibe's as fly as the rhymes On the song, cut and you could sample the feel Headphone bleed, make this shit sound real Used to work the grill, fatburger and fries Then I made a mil and them psychics was liars Now, how many fuckin' crystal balls can I buy and own Humble old me had to flex for the fogs Down in Muscle Beach pumpin' iron and bone Bumpin' oldies off my cellular phone Yeah, bumpin' oldies off my cellular phoneGoddammit, this rapping is stupid and it's hard Gotta do it over and over and over again but here I goHey it's Jasper, not even a rapper Only on this beat to make my racks grow faster Got a TV show, so I guess I'm an actor Pot head, half baked, lookin' like Chappelle Rollin' up a blunt with that fire from hell Still ignorant, still hit a bitch Wolf Gang, nigga, so I still don't give a shit Catch me in the back with Miley on my lap Bong rips as I feel on that little bitch catHah, nigga came through with a 9 bar real quick Just for the bitches, little bit of money in my pocket Fuck it, Wolf GangYeah, fuck that, look, the contrast is a pair of lips Swallowin' sarapin, settin' fires to sheriffs whips (Whoosp, whoosp) fuckin' All-American terrorist Crushin' rapper larynx to feed 'em a fuckin' carrot stick And me? I just spent a year Ferrisin' And lost a little sanity to show you what hysterics is Spit to the lips meet the bottom of a barrel So that sterile piss flow remind these niggas where embarrassed is Narrow, tight line, might impair him since I made it back to Fahrenheit, grimey get dinero type Feral, fuckin' ill apparel, wearin' pack of parasites Threw his own youth off the roof after paradise La di da di, back in here to fuck the party up Raidin' fridges, tippin' over vases with a tommy gun Never dollars, poppa make it rain hockey pucks And 60 day chips from fuckin' awesome anonymous Call him bloated 'til he show 'em that the flow deluxe Off the wall loafers, Four Loko, and a cobra clutch Vocals bold and rough, evoke a ho to pose as drum And let me hit and beat it with a stick until the hole was numb The culprit of the potent punch Scoldin' hot as dunkin' scrotum in a Folgers cup, or Nevada Drivin' drunk inside a stolen truck, shittin' like his colon bust Belly full of chicken and a fifth of old petroleum Supernova, I'm rollin' over the novices I'm roamin' through the forest and spittin' cold as the porridge is Stay gold 'til the case closed and the story end Post mortem porkin' this rap shit and record it To escort it to the morgue again, lord of lips Bored of this, forklift the tippy top, best under 40 list Stormin' the gate, ensurin' the bass, scorchin' ladies Motherfuckers sore in torso and face Get at me with savages, have a pack of Apache Indian pack of niggas who don't give a fuck if we nasty as flatulence As a matter of fact, your swagger is tacky So see me you can't like Crunchy Black catchin' a taxi Back like lateral passin' With that motherfuckin' gladiator manner of rappin' As an addict I let percocets and xannies relax me Fall back if your paddies is Maxi, pleaseOF, shit that's all I got From my bigger brother Frankie to my little brother Tac From that father figure Clancy to that skatey nigga Naks Shredding down 'Fax, Wolf Gang run the fuckin' block Storefront, knee tat Book cover is the same lettering on lettermans and cotton socks And grip tape, and my shoes Um, I was 15 when I first drew that donut 5 years later, for our label yea we own it I started an empire, I ain't even old enough To drink a fuckin' beer, I'm tipsy off this soda pop This is for the niggas in the suburbs And the white kids with nigga friends who say the n-word And the ones that got called weird, fag, bitch, nerd Cause you was into jazz, kitty cats, and Steven Spielberg They say we ain't actin' right Always try to turn our fuckin' color into black and white But they'll never change 'em, never understand 'em Radical's my anthem, turn my fuckin' amps up So instead of critiquing and bitching, being mad as fuck Just admit, not only are we talented, we're rad as fuck Bitches

I don't own this lyrics I got it from odd future

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cryptswahili · 5 years

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3 People Who Hate Bitcoin With a Passion

There’s something about Bitcoin that stirs up strong emotions in people. Libertarians love it. Anarchists adore it. Cypherpunks crave it. But not all of the emotions Bitcoin engenders are positive. Bankers fear it, politicians distrust it, environmentalists resent it, and a few people, why, they veritably hate it.

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

When people develop an aversion to something, their immediate instinct is normally to steer clear of it. Be it baths or Bitcoin, if you loathe it, you’re prone to avoid it at all costs. For some masochists, however, steering clear isn’t an option. Like a wobbly tooth they can’t resist prodding, they keep returning to Bitcoin time and again, fascinated and repulsed in equal measure.

These subjects are prone to defend their Bitcoin obsession on the grounds that they’re simply trying to protect innocent investors from succumbing to its wiles. “Rat poison squared” as Warren Buffet memorably dismissed it. Their inability to leave Bitcoin alone, however, betrays a deeper fear: that the cryptocurrency may achieve global domination, rendering their life’s work redundant. In this framework, Bitcoin’s haters are less motivated by altruism for the innocent than by an existential dread that, should it prevail, they risk being proven wrong and ridiculed. Like moths lured to an open flame, the following subjects just can’t seem to escape Bitcoin’s orbit.

David Gerard

David Gerard’s hatred for Bitcoin is biblical. If the writer was terminally ill and Satoshi Nakamoto handed him the cure, Gerard would likely refuse to take it on principle. He fills his days screeching at all things crypto, but reserves particular disdain for Bitcoin, the demon that spawned them all. Best known for his blog “Attack of the 50 Foot Blockchain,” Gerard’s work can also be found on sites like Foreign Policy, where he crafts such impartisan articles as “Forget Bitcoin, Try Your Mattress – Cryptocurrency is about as safe as keeping your money in a sock under someone else’s bed.” He also penned a guest post for The Block titled “The problem with Bitcoin.” The problem with Bitcoin, it transpires, is everything. Gerard finishes his tirade in Krugman-esque terms, opining:

There’ll be something called “Bitcoin”, descended from the present software and blockchain, for decades. It just takes two interested people, after all. How much it will interact with the rest of the world is an open question. Most new technologies don’t really go anywhere, after all.

Nouriel Roubini

“Dr. Doom” is the poster boy for Bitcoin hating, and his proclamations don’t need repeating for the umpteenth time. Like a broken clock, Roubini is occasionally correct – as is David Gerard – in taking down fraudulent ICOs and things that don’t need to be on the blockchain. Both merchants of doom have called wolf too many times, however, giving bitcoiners cause to dismiss their every utterance out of hand.

As this publication observed in taking Nouriel Roubini to task over his paean to central bank digital currencies, “Whatever happens to central bank digital currencies, they will never displace decentralized cryptocurrencies, just as Roubini will never displace the gnawing pain that tells him he should have bought bitcoin in 2013.”

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Nouriel Roubini isn’t the only economist who struggles to understand the economics of Bitcoin. The man who famously wrote: “By 2005, it will become clear that the internet’s impact on the economy has been no greater than the fax machine’s” is similarly skeptical about Bitcoin. In 2013, he penned a NYT op-ed titled “Bitcoin Is Evil” and has been sporadically sniping at it ever since. “BitCoin” as he calls it, is backed by nothing, has no intrinsic value and “Its price rise has been driven purely by speculation – by what Robert Shiller calls a natural Ponzi scheme.” Proving he’s not a complete technophobe, however, Krugman has a hot take to share: he believes Bitcoin’s underlying blockchain is interesting.

Constructive criticism of Bitcoin is healthy. In fact, some of Bitcoin’s biggest critics are also its biggest proponents because they recognize that only through picking apart the cryptocurrency and eyeing it through a questioning lens can it be improved. Wherever Bitcoin goes, and whatever sort of financial system it spawns, it will never be good enough for the Roubinis and Gerards of the world who will go to their deathbeds still spitting bile at the cryptocurrency they loved to hate.

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

The post 3 People Who Hate Bitcoin With a Passion appeared first on Bitcoin News.

[Telegram Channel | Original Article ]

#cryptocurrency

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teiraymondmccoy78 · 5 years

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3 People Who Hate Bitcoin With a Passion

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

David Gerard

Nouriel Roubini Nouriel Roubini

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

Kai Sedgwick

Kai’s been playing with words for a living since 2009 and bought his first bitcoin at $19. It’s long gone. He’s previously written white papers for blockchain startups and is especially interested in P2P exchanges and DNMs.

Original Source http://bit.ly/2GqNreQ

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bobbynolanios88 · 5 years

Text

3 People Who Hate Bitcoin With a Passion

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

David Gerard

Nouriel Roubini Nouriel Roubini

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

Kai Sedgwick

Original Source http://bit.ly/2GqNreQ

#IFTTT #Cryptocurrency and Bitcoin

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adrianjenkins952wblr · 5 years

Text

3 People Who Hate Bitcoin With a Passion

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

David Gerard

Nouriel Roubini Nouriel Roubini

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

Kai Sedgwick

Original Source http://bit.ly/2GqNreQ

#IFTTT #Cryptocurrency and Bitcoin

0 notes

courtneyvbrooks87 · 5 years

Text

3 People Who Hate Bitcoin With a Passion

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

David Gerard

Nouriel Roubini Nouriel Roubini

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

Kai Sedgwick

Original Source http://bit.ly/2GqNreQ

#IFTTT #Cryptocurrency and Bitcoin

0 notes

mccartneynathxzw83 · 5 years

Text

3 People Who Hate Bitcoin With a Passion

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

David Gerard

Nouriel Roubini Nouriel Roubini

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

Kai Sedgwick

Original Source http://bit.ly/2GqNreQ

0 notes

vanessawestwcrtr5 · 5 years

Text

3 People Who Hate Bitcoin With a Passion

Also read: 30 People Who Were Really Wrong About Bitcoin

The People Who Love to Hate Bitcoin

David Gerard

Nouriel Roubini Nouriel Roubini

In good company with Gold. @Convertbond: While everyone was focused on Gold and Silver, #BITCOIN dropped another 40%, traded below $58

— Nouriel Roubini (@Nouriel) April 16, 2013

Paul Krugman

Which other public figures detest Bitcoin? Let us know in the comments section below.

Images courtesy of Shutterstock.

Need to calculate your bitcoin holdings? Check our tools section.

Kai Sedgwick

Original Source http://bit.ly/2GqNreQ

0 notes