I saw my last patient of MS3 today! It was a 68-year-old woman who fell from a ladder while pruning a tree outside. She ended up being totally fine. The attending gave me tomorrow off to study for my three exams on Thursday --- family med, ambulatory internal med, and radiology. (Okay, technically the radiology exam is only 8 questions. Humor me. ) With 6 weeks of radiology research, a radiology elective, and a nuclear med elective, I won't be interacting with any patients (Step 2 CS doesn't count) until October, when I start a cardiac surgery ICU sub-i. I'm gong to be so rusty.

Okay, back to the books!

Today was "surgery day" in the ER, in terms of the patients who presented. First up was a 31-year-old male with textbook appendicitis signs and symptoms --- periumbilical pain that migrated down to the RLQ, nausea, vomiting, decreased appetite, elevated WBC, positive psoas/obturator signs, positive Rovsing's sign, rebound tenderness, and slight guarding. The surgery resident who consulted said that fewer than 10% of acute appendicitis cases present so classically. In fact, we didn't even bother getting an abdominal ultrasound or CT and the patient went straight to the OR for a lap appy.

Next: a 45-year-old male who accidentally sliced off the tip of his left index finger with a chainsaw. After debriding the wound and cleaning out bone fragments, the attending used a bone cutting instrument (not sure of the name ... something that starts with "r") to even off the end of the distal phalanx. Then he yanked out the fingernail and I got to help suture the finger.