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guidewire: 我的外科医生生涯第一周
作者:USMedEdu
发表时间:2010-07-27
更新时间:2010-07-27
浏览:1899次
评论:1篇
地址:140.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

发信人: guidewire (guidewire), 信区: MedicalCareer
标 题: I survived my first week
发信站: BBS 未名空间站 (Sat Jul 24 07:51:44 2010, 美东)

never been an attending before. this is a whole new experience to me. sorry
I have to type in English directly, I am not using Microsoft Word, but I
guess Dr. Newbie can be my spell checker.

Monday: Arrived at office at 8:30, was told by my senior partner that the
plan is to shadow him in the office, though it would be a light day, showed
up on my shirt and tie. politely pointed out by him that I can use a lab
coat, but "it is totally up to you". being introduced to all the new
employees and partners, this is a big group, there is no way I can remember
all those names and faces,

starting to follow my senior partner to see office patients, being
introduced as his "associate", I shake patient's hand, and said, nice to
meet you, my name is Dr. Guidewire, one of the surgery ..... guys. the word
"fellow" almost slip out of my mouth, cause I am so used to it. finally I
am not a fellow anymore, I need to remember that. we saw one of his patients
who needs some revision, so he booked that case for me on Tuesday, I will
have my very first case as attending tomorrow!

in between patients, the senior partner lecturing me about how to fill out
billing card, how they handle billing, etc. this is all new to me, in
residence/fellowship, nobody taught you about this.

thought my day will end early by only doing office hours, not whole lot of
office patients. suddenly got called by the NP in our group, there were 2
patients in the ER, one with bleeding groin and unstable, the other with
mesenteric ischemia. all my partners were busy. so I have to see those 2
patients. finally I found out where ER was, and made my way there. the
diagnosis is quick, first patient had SMA embolus, needed surgery stat,
luckly, one of the senior partners scrub out and toke the patient, so I can
concentrate on the unstable bleeding patient, got her stablized and decided
she does not need surgery and sent her to ICU.

finally I was wrapping up my day at 5 pm and ready to go home, got called
from one of senior guys, " hi, I have a case going on now, don't know if you
are interested", he really wanted my opinion about that case, so I have to
scrub in. turned out to be an interesting one, patient has May-Tunner
syndrome, which is a pretty rare, or non recognized disease, luckily I saw
fair amount in my training, and proved to be useful in the case, the end
result is beautiful, the grumpy husband was very happy when we talked to him
after the case.

finally I got home, at 11:00. this is harder than fellowship, will I be able
to survive the rest of week?
--


Tuesday:

my case was scheduled at 7:30, I was told be there at 7:15. when I was there
, no body was there, no OR nurse, no anasthesia, no surgical resident, the
patient did not get in the OR until 8. luckily, they did not need me to prep
the patient. it is a little hard case, at one point I almost think I could
not do it, luckily, (I use that word again, you need a lot of luck to do
surgery), I got it. 2 senior partners poke their head in several times to
make sure I am not killing my patient, I have 4th year resident scrubbed in
with me, he did not doing much, I was saying in my mind, sorry, buddy, this
is my first case, I can not afford to have bad result, I may not know how to
fix it if you screw up. patient was successfully off the table, I guess I
passed the first test.

went to round on the floor with the NP and resident, saw several new
consults and booked 2 cases for myself on Thursday, I am getting my feet wet
now.

saw one patient needed permacath placement, she was on dialysis for 8 years,
nobody tried AVF or graft on her, so I also booked her venogram to look at
her veins. she also need pace maker by a cardiologist. when I rounded later
that day to see that patient, I saw a note on the chart from the
cardiologist, asking the nurse to tell me not to do the venogram, cause he
thought I was doing the venogram to see if the subclavin if open or not for
him, and I was trying to do extra procedure on the patient. I was so pissed,
first, I am busy enough for my own staff, who give a shit what you are
going to do, whether the vein is open or not is your problem, not mine.
second, if you have doubt, why just pick up the phone and call me, instead,
he just asked the nurse to tell me not to operate on my patient? WTF!

I ended up home around 8, better than Monday, feel little nervous about
tomorrow, I am going to help out with 2 big cases tomorrow.
--


Wednesday

operated with my partner all day, turned out to be great, we usually
operate on patients weigh at least 2 to 300 pounds. and had to operate in a
deep hole, the artery used to calcified as a lead pipe, not able to clamp.
last aorta I did in my fellowship was a patient like that, we lost 5 liters
of blood in the case, that is his whole blood volume. Luckily, he end up
doing well though. this time the first patient was only 100 pound small lady
, the exposure was so beautiful, a monkey can do the case, blood loss, 400.

went to round on my 3 patients, 2 pre op, everything seemed to be tucked in,
went home at 7.

I was thinking about my cases for tomorrow, feeling nervous, they are not big ones, but I never operated just by myself, there will be nobody check in for me tomorrow unless I screw up. I went over everything in my mind, labs, films, equipment, just to be cautious, I called OR 10 pm and asked them to get a ultrasound machine to my room, I know they have one, just don't want to waste OR time for them to find one for me at that time.

Thursday

my cases scheduled at 7:30, I know they are not going to start on time, so I
took my time in the morning. when I arrived, it was 7:50, I almost feel
guilty, never been to work that late in my life, thank God, bye bye 5 am
morning round.

As I was expected, the patient is still in the holding area, but this time
the anesthesia, the resident, the OR nurse all there waiting for me, instead
of I waiting for them. no body was upset or surprised that I was late. it
seems that is the way it suppose to be.

we went into the OR room quickly, guess what, there is no ultrasound machine
there!, but the nurse was saying I will get it right away, so we prep, when
I ready to start, she got my machine, and this is actually anesthesia one,
and no one in the room knows how to use it, even the anesthesiologist in
the room. so I went ahead did the first part of case without ultrasound, but
I really need it the second part. we did the first part smoothly, after
half hour, I still don't have my machine, there is another surgeon follow my
room and I am waiting here for people to find me a piece of equipment I
ordered last night. finally I had enough and hold the F word and called the
charge nurse in the room, magically, within 5 minutes, I got what I want.
guess the key is going uphill.

the turn over time is little longer than I expected, but the case went on
very well, this time, they sent a intern to help me, probably the 4th year
was pissed for not letting him to operate Tuesday, I was a resident before,
I feel him, that sucks. but on the other hand, as a fresh attending, there
are many eyes on my back, I was watched with each movement, if there is a
bad result, does not matter whether the resident screws it or not, I am the
one to blame. I have to survive first, then be a nice guy later.

finished OR around 2, got chance to go to the office and chatted with the
junior partner, he give me some advise, and showed me the CPT code, I was
pleasantly surprised how much I made for those 2 cases. he also asked me to
scrub in with him for a EVAR tomorrow, I feel I am useful.

went home at 6.
Friday

went to have a meeting with cardiologist, all the surgeons in our group meet
with a large group of interventional cardiologist, I attended many
interdisciplinary meeting before, all of them were about patient's care from
different perspective, whether friendly or hostile. but this one is all
about business and politics, I can't say too much here, that is something I
heard of but never experienced, that is a shock for me. when we done, one of
my senior partner told me, welcome to the real world.

then did the EVAR with the junior partner, everything went on smoothly. glad
to found that the anesthesiologist is also a CMG. we will have a couple
drinks this weekend together.

thought this would be a sweet early day, and end up called to help the
junior partner for his other case, he helped the 4th year to do the proximal
anastomosis, and I did the distal one, so everybody can get out early.

went home at 10 pm.

I was so exhaust, and just drop on the floor when I entered the door, but I
survived my first week.

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共有1条评论
1   [DrNewbie 于 2010-11-20 02:08:22 提到] [FROM: 98.]


发信人: JNeuron (JJ), 信区: MedicalCareer
标 题: 老CMG, Step1 244/99, 感谢宝坛信息
发信站: BBS 未名空间站 (Thu Jul 22 12:30:12 2010, 美东)

去年5月开始有考板意向. 当时真的是一无所知, 不知从何下手. LG听说有个医学论坛,
于是开始来宝坛潜水,获得很多宝贵信息.7月3日考试,不到3周得到结果.

感谢 神一路保守. 由于各种原因,我准备地较仓促. Kaplan notes (2001版) 1遍, FA
4遍, UW 2遍. 没作NBME或其它题库. 能得到这个成绩, 非常感谢各位过来人的无私分
享.


因为第一次发帖, 很费劲. My writing skill is poor. 大家将就着看吧.

感谢大家的回帖. 大家想知道详细经验, 不是我谦虚, 我真的不知道说些什么. 我其实
对USMLE 了解不多. Kaplan notes 是很早以前朋友考完送给我的. 因为来宝坛, 才知
道了FA 和 UW.

最近改题, 从48/section减为46/section. 我对改题以前的题型have no idea. 就说说
我考的题吧. 比预料的简单. 或者说比UW的题简单. FA和 UW基本cover ~90%. 所以说
将FA 和 UW尽量掌握熟练, 到真实考试应该没有问题. 题干很长的不多, 短的只有两行
. 所以如果UW作习惯了, 真实考试就没问题了.

当然, 我的运气不错, 考了好几道neurology 方面的题, which is my area. 我想这也
帮助了一些.

还有我认为很重要的: 心理因素. 如果压力过大, 考前睡眠不足, 临场状态不好, 将会
影响正常发挥. 我要感谢 神的是一直有喜乐平安, 考前在hotel睡的很香, 所以考试当
天精力充沛.

还有朋友问是full-time study or part-time? 我有个2岁男孩, 我是边带孩子边学习,
考前2月送孩子去Daycare. 也是考前2月开始作UW. LG曾经劝我延期, 但我不想拖了,
早考早放松.

唠叨一堆, 不知对大家问题是否有帮助.

愿 神祝福大家.
--

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