Life of a Medical Student

Five Things I Learned in the Operating Room that Revolutionized my Sewing

Posted on Jan 18, 2014 in Life of a Medical Student, Sewing

As a medical student, I’ve spent a lot of time in the operating room learning how to sew people back together, and took away a bunch of cool techniques to use in my sewing (fabric, not people) at home.

Now I’m no surgeon, but after the emergency department, the operating room is without a doubt my second favorite place in the hospital. I like it so much so that I did an acting internship on the trauma surgery service and I’m still spending some weekends volunteering with the service (much to the horror of emergency medicine residents, who seem to universally dread the 80 hour weeks and endless scalp-suturing). I have a profound respect for the attention to detail, fine work, and value placed on technique that these surgeons develop. Here are some of the things I learned from them (still done with substantially less finesse than they do it with). These techniques may not be new, and maybe they have sewing names that I don’t know, but they were new to me so I thought I’d share.

1. Closing holes (invisibly) with a running subcuticular suture

subcuticularThe subcuticular suture is a technique used in skin closure, done with absorbable sutures, which creates a cosmetically pleasing and virtually invisible seam. The basic idea is that the sew parallel to the skin, immediately below the surface. I used to use an overcast stitch to close gaps in pillows and things when you turn them right side out, but it’s virtually impossible to do it without being left with external evidence. By mimicking the subcuticular technique, my seams are virtually invisible now.

The way I do it is to take small bites right at the fold line where the seam need to be closed, in line with the direction of the seam, making sure not to pierce the outside of the seam. If you line up each new bite with the exit point of the previous stitch, when you pull the whole thing tight, it lines up perfectly and invisible. Tie a knot at the end, and as a surgeon would say, “bury the knot,” by simply passing the needle down through the seam and out again at a point a fair distance from the knot. Cut the string and the end disappears into your work.

Subq stitching

2. Stuffing small things with tweezers

wound packingYou often have to pack wounds with gauze post-operatively (or after draining an abscess in the emergency department), and we use a lot of this packing strip material to do it. Often, you’re putting it into a hole that is just a centimeter or so wide, but sometimes quite deep. To get it all the way in, we usually use a combination of forceps and cotton-tipped applicators.

It never occurred to me to use tweezers to stuff little things (like the tiny pillows I’m making for my miniature dorm), but I’ve started using them now because it allows me to get a lot of stuffing into a tiny hole, which means shorter distances that I need to oversew. (I don’t need to use a cotton tipped applicator to get it in deeper, because there are no squishy internal organs in my pillows that I can damage with my tweezers).

pillow stuffing

 3. How to hold scissors (I’m serious)

I never thought that my whole approach to holding scissors would be changed by my time in the OR, but it was! And honestly, this is one of the biggest revelations I had while I was there. Scissors in the OR are, surprisingly, often dull and crappy. This means that you inevitably suffer an embarrassing moment where you try to snip a thread, the scissors awkwardly jam the suture thread between the blades, and you look like a fool who didn’t learn to use scissors in the 1st grade.

But one scrub tech (the poor soul who is responsible of making sure none of us mess up the sterile field and that the surgeon has all of the instruments he needs before he knows he needs them), gave me a simple tip: Push against the top finger loop with your thumb and pull on the bottom one with your fingers. It makes the blades align with more force and lets you cut through thick string (like suture), even with a really dull blade.

scissors_reduced

4. Hemostats are the pliers, clamps, and extra hand of delicate work

This tip is all over the internet already, so I don’t feel a need to elaborate too much, but everyone should have a hemostat in their tool kit for sewing, or any other type of DIY really. In the OR, they go by all sorts of names – the Kelly Clamp, Mosquito, Kocher, Halsted, all sorts of others. But they all serve the same basic function – they hold really tightly onto thin things and lock into place. I have three types – one curved, one straight with a serrated jaw, and one straight with a smooth jaw. You can buy them for virtually no money at all on amazon. I’d also recommend buying a complete dissection kit (like this one). The scissors pictured above also came from my dissection kit, and they’re great for precision cutting.

hemostats_reduced

5. Using a loop and extra thread to tie a knot when the thread is too short

This was a technique I saw a surgeon use (after biting a resident’s head off for letting me cut a suture too short), and I saw it several times thereafter. In surgery, if you can’t tie a knot, you basically have to take the whole length of suture out and do it again, so being able to tie the knot even when someone messes up, is a good thing. This isn’t exactly the same as was done in the OR, but it’s the same basic idea: making a loop to put a longer string through, so that you can use that length to tie a knot on a really short string.

Knot Tying

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Frankenfruit (a byproduct of teaching Julia to suture)

Posted on Mar 6, 2013 in Life of a Medical Student, Projects, Sewing

sofort3256I’m on my surgery rotation right now, which means getting up at 4am and working 16 hour days, roughly 12 hours of which I seem to be standing in a sterile operating room hardly daring to move much for fear of contaminating myself (there is no scratching your head in the OR – I haven’t done it yet, but medical students are notorious for such behavior). It should sound awful, really, but somehow I’m having the time of my life.

And the fact of the matter is, no one should have ever let me near a suture kit, because I’m sort of enamored with the whole process. Not to mention all of the surgical instruments used in laparascopic surgeries, which I think could revolutionize the way I sew (I haven’t quite figured out how, yet). And when I got home from work the other day, I took it out on some helpless fruit.

I’m just a beginner, but I think the results are kind of fun! Click the images in the left column for vertigo-inducing gifs of the process :-)

P.S. I ate all the fruit except the grapefruit – turns out I forgot I don’t actually like grapefruit.

P.P.S. Before any surgeons berate me, I should clarify that although I learned these during my surgery rotation, these are not suture techniques that are used in the operating room, they’re more like the kind that you would use in the emergency room to close lacerations.

 

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Liquid Diets and Sippy Cups

Posted on Nov 17, 2012 in Life of a Medical Student

Every once in a while, I get to do something that reminds me why I’m training to be a doctor. Yesterday, I had a day like that. I was recruited by one of the doctors working with a 13-year-old boy who has a new diagnosis of Crohn’s Disease to visit him and instill some optimism about his condition. And 20 minutes of chatting and a gift of a plastic cup later, I think I can say I’ve made his hospital stay a little bit better.

Why me? It’s not something I’ve been terribly open about before, but I’ve recently been struggling with a Crohn’s flare of my own. It’s a painful and embarrassing disease and I’ve spent a long time playing the denial game.

So that’s not Starbucks in that cup. It’s Ensure. Yeah, that stuff that you feed to old people in  nursing homes. And what I’ve been living on for the past three weeks. The ensure diet is one of the treatment options that some doctors suggest to induce remission without using side-effect-plagued corticosteroids. My doctor suggested it when I wasn’t tolerating any solid foods and it’s worked wonders. The cups I drink it in hide the proteinaceous smell and make it look like I just have an addiction to iced lattes.

When I went to go and see this patient yesterday, I found that he was also subsisting on the ensure diet and it was not going well for him. He asked me how did I get it down? He was not impressed by the stuff and we spent a long time discussing where each flavor ranks in the spectrum of taste. I have strong feelings:

So today I went out and bought him a cup like mine (but not pink), filled it with ice and ensure, and brought it to him. When I got there, I found he’d had a feeding tube put in his nose last night because he was having so much trouble drinking the ensure. He looked at me skeptically and asked if he should hold his nose. I told him no, that’s what the lid was for! He hardly believed me when I told him it was just ensure with ice. As I was leaving, he had agreed to drink and was getting the feeding tube removed from his nose.

I remember from my experiences as a patient how much the small things matter and try my hardest to incorporate that into my own practices. One of those times was when I was a senior in college and I had to have a piece of my small intestine removed. The most painful thing after abdominal surgery? Coughing. I was coughing up all sorts of stuff after being intubated and was miserable for two days. Until a nurse came in, saw me coughing, stopped dead, and said “I’m going to give you a present.” She came back with a round, hard, blue pillow. A cough pillow, apparently. And sure, they give a lot of people those pillows, but the fact that no one had thought to give me one before made her special. Her name was Cathryn. She’s the only nurse whose name I remember.

I spend hours every day trying to figure out how to solve the medical problems of my patients, making decisions about medications and treatments and testings. But I think that when all is said and done, it’s the small gestures that make our patients feel like we see them as people rather than medical problems. I hope I never forget that.

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Sad Notes in Medicine

Posted on Oct 2, 2012 in Life of a Medical Student, Life, the Universe, and Everything

When you enter a career in medicine, you’re signing yourself up for a career where you will participate not only in the gratifying role of making someone better, but also in the painful and saddening role of watching someone fail to get better. It’s something (I hope) we all accept in going into it, but that doesn’t make it any less sad.

I was fortunate to have some exposure to death and dying before getting on the emotional roller coaster that is medical school. I met my first dead patient at the age of 15 while I was working as an apprentice on a local ambulance service. In the throes of a dramatic thunderstorm, we found ourselves struggling to extract the 67 year old man from a barn stall shared by his thunder-spooked horse and his now hysterical wife. But before we even started the process, even me in all my naivety could tell by the color of his skin that there was nothing we could do. We transported the man to the tiny local ER, where he was pronounced within a few minutes.

I’ve seen a lot of patients die by now and unfortunately I can’t say I remember them all, but some of them still resonate with me. And I had an experience recently that I’m certain will stay with me for the rest of my life.

On my first day on my neurology rotation I met a patient admitted for a headache who had some odd but nonspecific findings on his MRI. Other than the headache, he was cheerful and active, antsy to get out of the hospital and back to work. He was a physician, and he spent time teaching us about the diagnostic tests we were running on him. All of our tests came back negative. It turns out, that happens more than you’d think on the neurology ward service.

So eventually, the headache seemed to be somewhat better, although not completely resolved, and he was discharged to follow up as an outpatient. He did not improve and, in fact, seemed slightly worse when he came for his appointment, so he was readmitted. Because I’d met him before and I love a good medical mystery, I took him on as my patient. For the next two weeks, we ran more tests and checked for everything we could think of. We were bouncing ideas off most of the medical specialties you can find in a hospital.  I spent hours pulling articles about rare disease presentations and learning about obscure syndromes. We were all coming to the same gut feeling, though, a really bad gut feeling. And we were right, it was ultimately found to be an incredibly rare presentation of an aggressive cancer and the prognosis is very poor.

The wonderful thing about being a medical student is that while the doctors you are working with have to see 15 patients, you’re only following 2 or 3. And so it meant that I got to spent a lot of time with him and his family. In his lucid moments, we talked about genetics, his medical school experience, his son who had spent time in New Hampshire close to where I grew up. And through the experience I witnessed a family go from expecting to go home with their loved one in a few days to realizing that over the course of three short weeks, seemingly without warning, they’d lost him forever.

He was a wonderful man. I’m grateful for the opportunity to be one of the last students of many that he taught and I feel privileged to have been allowed into his family’s life as they went through the heartbreaking ordeal.

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Countdown to Wednesday

Posted on Jun 21, 2012 in Life of a Medical Student, Life, the Universe, and Everything

I know, it’s been a while since I’ve posted. And fifty-two weeks of sewing is way behind…

Studying for the dreaded “Boards” is a really not-fun period of time in the lives of medical students. But on Wednesday, it will be over and I’ll be back, more human, and sewing/crafting/doing stuff again :-)

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Talking to Strangers? Best Hobby Ever.

Posted on Mar 1, 2012 in Life of a Medical Student, Life, the Universe, and Everything

I got into a car with a stranger this morning. Yeah, I really did that. And it’s moments like that which make my life so great. So the story: I got to campus today to find the UPMC garage that I often park in when I’m running late full. “No Event Parking – LEASES ONLY” sign out front. Really, at 8 in the morning? So I grumbled to myself and drove on to park at UPMC Montefiore. This has happened before, usually in the afternoons, but I’m accustomed by now. After my 8am class, I had to walk past the first garage to get to the garage I was actually parked in. One of the really friendly security officers was managing the chaotic traffic trying to get into the garage (this is typical of when things like this happen – it involves a lot of people trying to pull in, discovering they were really serious about not letting people in, having to make eight point turns to get back out, all sorts of fun frustration and traffic back-up). She was talking to a woman in a car waiting to turn around, so I stopped and ask what the event was. Swimming competition.

The woman’s daughter was swimming in it (but by this point, her frustration was to the point that as far as she was concerned, the swimmers could all just drown. Her words, not mine). She was desperate for parking, and the security officer directed her to Montefiore. She was worried she wouldn’t be able to find it, but the security officer and I assured her it was really easy. Then I jokingly said “I’m walking there to retrieve my car – you could follow me.” And she suggested I get in the car. So I did. To drive a quarter mile down the street. And then, she let me out at my car, I pulled out, and she took the super awesome spot I got at 8am before the rush.

Some day this behavior might get me killed. But that’s ok. Interactions like this are worth it. We had a great five minutes and while she probably would have found it on her own, I was able to relieve some of the aggravation, put a smile in her day, and give her a great parking spot. And I had fun in the process. It’s the little things. And this leads me to – why I love talking to strangers.

Strangers have no expectations of you. People you’ve never seen before, might never see again, interact with you every day. But those strangers are people, too, we all have things going on in our lives, and we’re all having a day (whether it be a good one or a bad one). And there’s some intrinsic satisfaction in being able to elicit a smile from a stranger. It’s all about exchanging energy. If you give someone a positive vibe, they often return it. Whether or not it gives them satisfaction as well is impossible to tell, but that doesn’t really matter.

I have a lot of interactions with strangers. There’s a security guard in the medical school building. He’s a little man, not too old and not too young, and he has a shy air to him. I said good morning to him once as I was walking by. He looked so happy to receive it and returned my smile, so I did it again the next day. Now I do it every time I see him. Sometimes two or three times a day. And I don’t know about him, but it makes me feel better every time. I’ve sat in the chairs in that lobby waiting to meet with someone before – I’ve only ever seen one other person acknowledge his existence just to say hi.

There’s a parking attendant at a garage I used to park in. He has to validate your ticket every time, which means you have to interact through a little window once a day, five days a week. That’s a lot of 30 second interactions. Assuming I’ve parked there at least 250 times in the past 5 years (maybe more), that’s at least two hours I’ve spent interacting with the man. He knows how my schoolwork is going, he tells me about how his dad is in the hospital, how he’s biking to work, the community college calculus class he took. He loves calculus, he thinks it’s fun, and he works through a book of problems while he’s sitting in his little booth killing time. I think that’s inspiring – he’s working a job that doesn’t require a lot of eduction, but he’s seeking education because he enjoys it. He doesn’t take calculus because he thinks it will get him a better job. He took it simply because he wanted to learn it. And I never would have learned this if I hadn’t taken the time to find out how his day was going.

Being a doctor is all about interacting with strangers. Especially in the ER or in the EMS work I used to do, you sort of hope that you’ll never see any of these people again. People don’t come into the ER because they’re having a good day and want to say hi. They come because something really awful is happening to them. And they expect you to fix their physical problem – they don’t necessarily expect you to brighten their day. But, sometimes, it’s trying to brighten their day that makes all the difference. And I like to make that a goal. I’d like to make my patients feel physically better, but I also want to get them to smile at least once during our interaction. It doesn’t work for everyone, and you have to learn when to put the smile away because frankly sometimes excessive cheerfulness really pisses sick people off. But for the successes I’ve had, it’s always always worth the effort.

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