transitioning

I'm getting ready to move to DC for good. Things I have to do include finalizing my living situation, graduating, moving, getting all my paperwork together, going to weddings, saying goodbye to New York and the people I love who have to stay here.

I never knew that it would take all of April and May to really feel like I am grown up enough to be an adult, to buy real estate, to have to do my own taxes, and most of all (and scariest) to be a doctor!!!! I think most of my classmates feel this way. I am scared that I don't know enough, that I am not smart enough, that I will accidentally kill patients (!!), and I'm even scared that I picked the wrong specialty!! I think it also might be because I miss the OR--haven't been there since October, really.

I already had one of those weird moments last week. I went to a bar with a friend, and some random dude started talking to me, and when he asked me why I was moving to DC, I thought about it for a while, and said, "Well, I'm going to be a doctor." It was the first time. I think he wanted to run away after that. Next time I go to a bar, I'm going to say, "I work in healthcare" and see what happens. It will be very interesting...most guys would be scared of a little girl telling them she was an orthopedic surgery resident in the Army. Maybe I should have gone into peds.

WRAMC for good..

WRAMC is over...

I'm done! no more ortho sub is.

I said goodbye to everyone yesterday. My patient I talked about in my last entry asked me, "So you're leaving Ma'am? Like, for good??" I just told him "I better see you walk into clinic next year when I come back, ok?" He ended up doing so much better. He moved up to the floor from the SICU. We slowly d/c'd his wound vacs. He turned less green. He started talking. He started asking me what was going on with his arms and legs. He confessed his dissatisfaction with his "stump" that was left of his leg--no one had told him that he was going to get a high speed prosthetic. I probably operated on him at least 5 times, and each time was progress (skin grafts...closing...). I was so happy to be there for him to get better, and to tell him and his parents that he was getting better, that the infectious disease people had said he was getting better...

This place is amazing. They do awesome work here. The patients get better and leave the hospital, broken in many ways, but fixed as far as what you've done for them to make their lives as full as possible. I'm glad I had this experience. It makes me feel happy that I chose to go into medicine, and now, into orthopedics.

I don't know how i'm going to feel in 6 years, but I'm thinking that being a trauma surgeon could be cool... don't tell Mom and Dad, i don't think they'd like that idea.,,

WRAMC gets 80% of OIF casualties

I drove out of WRAMC today on Georgia Avenue and saw people lining the streets with American flags and signs saying "Support our Troops" and "Come Home" and "Welcome home." It's Friday night. Here, on Tuesday, Friday, and Sunday, the Air Force brings us the war casualties flown in from Langstuhl. Granted, the patients aren't fresh off the field--they have to be stabilized in some sort of way before they're safe to fly the 6 hours or so--but they are often incomplete with temporary wound dressings, like unfinished amputations, wounds sewn together loosely, makeshift external fixators made out of syringes, joints shattered and held loosely in splints...some of them come intubated...

There's one patient here who makes me want to cry every time i see him. He's like 20 years old and missing all his limbs except for his right hand. Apparently nothing was shielding him when the IED went off. He's totally all there in his head. All his limbs can't be closed yet because they keep getting infected. And they keep having to cut more and more of his limbs off because he isn't healing. The worst part, though, is seeing his parents at his bedside. He looks just like his dad. His mother looks on all the time like she's crying. It's so different when you have to tell parents what is going on, to tell them that today we took him to the OR and a cup of pus came out of one of his legs... that he has scary bacteria and now mold growing in his wounds that won't heal. And every day he gets thinner and thinner and loses more and more blood because he keeps having to go to the OR.

Does God want me to be here? I feel needed.

WRAMC, post call

I should be sleeping, but I wanted to comment on my first week here. It was the worst logistical nightmare EVER.

Otherwise, when I was actually doing stuff, I had a good time. Last night was my first call night. I don't think I really admitted any patients on call during my Columbia sub internship (the rotations you do that kick your butt fourth year). Call at WRAMC on an airvac night, outside of routine ER stuff, means admitting patients airlifted from Langstuhl, i.e., Operation Iraqi Freedom casualties. I got to read about my patient before he arrived. We got a 10 minute heads up, and he magically appeared in the casting room on the 5th floor. It was the smoothest admission I have EVER seen. The whole process took less than 30 minutes from the time he hit the door. EVERYBODY was there to help--anesthesia, the Xray techs, nurses, tranportation, etc. And for the first time I had ever seen, EVERYBODY there cared about the patient (I mean, how could you not care about him??). Anyway, I love my new patient. It's sort of like having a little brother to take care of. An IED had blown off his foot and while he was trying to escape his vehicle he shattered one of his fingers. He was so optimistic about the whole thing, and all he wanted to do was get well, heal, and be with his expecting wife. Luckily for him, he was a "simple" case, and things were pretty straightforward and it was awesome to tell him that things were gonna be ok. The next morning we took him to the OR to check him out and clean him up a bit. Besides the fact that I love the OR, I was again so impressed that all the people working there were all trying so hard to make him get well soon.

In general the patients here are pretty amazing. They are all so grateful and so happy to be alive. Often they've been in situations where the guy next to them didn't make it out. Sometimes I get all teary. This morning there was a guy who told us, I can't believe I woke up. Another thing about these patients is that they are all young, and have so much of life ahead of them. They heal well. You're really trying to fix them up so they can live as full of a life as they can in the future. That's really refreshing.