I've Been Up All Night, I Might Sleep All Day...

Let the fun begin.

Tomorrow evening, I begin a two week block of overnight ER shifts. That means from 8 pm until (theoretically) 8 am I will be in the hospital watching over in-patients and seeing emergencies. The rumor is that this is a better rotation than daytime emergency (which I've already survived once) but 15 hour days are not uncommon and no days off. The strangest part, I think, will be adjusting to the 12 hour flip of my daily clock. I haven't had to man an overnight shift since clinics in vet school and I'm a little worried it will take me a long time to make the adjustment. With that in mind, I'm going to try to begin the switch today. The goal is to sleep for many hours this afternoon and try to stay up as long as I can tonight. Hopefully, that will allow me to sleep most of tomorrow as well and be "up and at'em" by 8 pm tomorrow.

For the past 2 weeks, I have been on the surgery service's rotation. I spent the first week with the neurology department and, once again, I am flabbergasted by how frequently owners submit to advanced imaging such as MRI and CT. On average, we performed 2-3 MRI studies per day! I think, during my five years in general practice, I convinced--maybe--3 clients to be seen by a neurologist for that procedure. But, I must say, MRI studies are friggin' cool. Being able to see within the brain and spinal cord and not just be guessing about what might, maybe, likely, probably could be there almost feels like cheating. Of course, it helps when you have an exceedingly brilliant neurologist and a well-trained resident pointing out the things that are wrong.

This past week, I was with the soft tissue surgeon. It ended up, through luck of the draw, to be just me and him...All the residents were out of town and the surgery intern was assigned to the orthopedic service. This is both good and bad. Good, because I was scrubbed in on everything, bad because we had 9 or 10 patients in the hospital for several days and I was the only one examining, writing up paperwork, and calling the owners on all of them.

From a strictly surgical standpoint, I got to see and participate in the full spectrum of outcomes. The first day on service, we were to correct a patent ductus arteriosis (PDA) on a very adorable, 16-week old, Springer Spaniel puppy. A PDA is a communication between the aorta and the main pulmonary artery that is supposed to close within the first few days of life and must be ligated if it doesn't. The reason behind this is simple: the PDA creates a circuit for blood flow which negatively affects systemic blood pressure and greatly increases the stress and workload of the heart. If uncorrected, most patients will die from heart failure within12-18 months. The good news is that the prognosis is excellent. Most of these surgeries go off without a hitch, despite dealing with LARGE vessels very near the heart through which the entire blood-volume of the patient flows, and the surgery is immediately curative.

On Monday, however, the surgery did not go off without a hitch. We were nearly finished when the PDA tore resulting in massive--I don't have a strong enough adjective, really--hemorrhage. It was one of the most gut-wrenching and stressful experiences of my veterinary career. We worked for nearly 45 minutes trying to staunch the flow of blood and repair the tear while transfusing blood as fast as was possible. Despite an amazing effort by the surgeon and the technical staff, though, we watched as the patient's heart rate became slower and slower, then the heart shivered and just stopped. I thought I had become pretty jaded over the past few years, but this one bothered me and has stuck with me.

Luckily, the rest of the week's surgeries went well--even the second PDA surgery. I am in awe of the ability of the surgeon to have a short memory and knock that surgery out of the park. It was a good thing I had a mask on otherwise everyone could have made fun of the mouth-agape-in-shock-and-horror look I had while he was dissecting through the fat overlying the monstrous vessels. Other fun, new things I did that I've never done: biopsied 3 livers this week and none of them bled afterwards, operated a "Ligasure" (a wicked-cool cautery device that seals vessels as wide as 8 mm) resulting in (intentional) splenectomy of 2 patients, ligated portal vessels the size of my pinkie finger, operated the camera for a laparoscopic and and arthroscopic procedure, and assisted on a tibial tuberosity advancement surgery to correct a torn ACL. All of which was very cool. Oh, and I got to neuter a dog, you know, for old times sake.

So, now off I go to try to fool my body into believing night is day and day is night. I've often wondered what it would be like to be a vampire...