This morning, we went right down the line and took out three tricky teeth on a very nice fellow who didn’t speak English. Mykala picked me up for lunch (we’ve been lunching together a lot lately) and I shared a miniature revelation.
“I think I know why most surgeons have big egos.”
“Why’s that?”
“There’s some sort of thrill when you stitch tissue back together. Something in the limbic system or whatever yells up from the depths ‘You put it back together!’ And things build from there. I can only imagine what happens when you’re a surgeon who actually saves lives: ‘I am the reason that person is walking around, can hug their grandchild, lives to exist another day.’”
Back at school for the afternoon, there was no time for such philosophizing. At the end of the afternoon, 15 minutes before we were scheduled to be done, I ended up extracting a tricky upper molar on a lady in a lot of pain. Or, well, attempting to extract. I had good mobility on the tooth, was making good progress, but I was out of time. The attending stepped in.
Crrrrrack.
Crown’s gone. I didn’t even see the releasing incision that came after that.
Fffffzzzzz zzzzzzzz!
The Hall drill sounds exactly like a pneumatic drill that your car mechanic uses because… it’s a pneumatic drill like your car mechanic’s. Anyhow, there goes buccal bone.
Pop.
Out come the roots.
“That was fast!” said the patient. “Well, that’s what you get when the experts step in,” I said. I went home appropriately humbled.
There’s a sharp division between school and home. The minute I got home, all of this swirling in my head, it just went away. It was like getting a big hug warm after being out in the cold. Mykala had made delicious fresh Mexican (seriously, fresh guacamole, fresh tortillas). Now, I’m sitting here on our couch, finally cleaning out my inbox, talking with Mykala about her future as a double Master’s holder in Human Development and Licensed Professional Counselor slash Well Coach slash general boon to humanity. We’re watching The Holiday. It’s going to snow tomorrow.
Seriously, how awesome are Jude Law’s glasses in that movie?
I object to this bill in its current form because I
believe it fails to use existing tools
and does a worse job than those existing tools at
solving this problem.
Such reasoning makes for an excellent argument against many pieces of legislation claiming to fix “broken” systems.
177 days 16 hours 35 minutes until graduation. It’s actually getting close, now. This week, I’ll wrap up my oral surgery rotation. Then, 7 weeks of outreach over the next few months. They’re running out of hoops to make me jump through.
Someday, just one and a half seasons from now, I’ll post some pictures of a very happy version of me graduating.
Today, we ate donuts at a new place named The Donut Cooperative. I wish I had a picture of the fresh powdered cinnamon vegan donuts we devoured. Whenever these new restaurants open, Mykala and I joke that our visiting them condemns them to a horrible future of insolvency and closure. Thus far, I think we’re responsible for the closure of two bakeries and an Italian ice shop (shoppe).
I’m not usually thinking about that joke when we go in, but I almost inevitably start thinking about the costs for these shops (shoppes): did they spend too much on decorating, is their menu too large, are their hours appropriate, how may months of operating expenses can they cover with minimal income? It’s got to be tough for a new shop (shoppe) when people are preoccupied losing their jobs rather than finding new places to eat.
We had three trick-or-treaters this year. Down from four last year. Next year, I suppose things’ll be different. We might live in a different house. I’ll be working instead of going to school. I’ll have patients of my own, instead of patients of the school’s.
I don’t know, exactly, how it will be different. But I know it will be different. Exciting and scary.
My hands trembled as I opened the letter today. PASS. With an 84, exactly the score Mykala had guessed I would get. (Boards are scored 49-99, 75+ is pass, and I haven’t talked to anyone who got over a 90). All the studying, drilling, worrying are behind us (I’ve given Mykala 42 of my 84 points).
We ate True Thai to celebrate, just like when I passed part I. No more giant written board exams remain. Now, just the patient-based boards in the spring.
So happy I don’t have to study again. Or pay that $360 to retake.
We’re suspended for a moment on this spinning blue pearl,
here together and alive right now, conscious, though no
one knows why. It is a question of caring. When one of us
considers the experiences of another, all the failings
and the achievements in someone else’s life, we are
seeing from this common place, knowing that it’s all
taking place in doubt and the absolute solitude and
terror of being human, and knowing that it’s all
temporary.
“Tell me about your patient.”
“I, uh, well. She’s here to get #30 out. Uhh. She has hypertension and is taking medication for it.”
“Like?”
“Hydrochlorothiazide.”
“Which is?”
“Err… a loop diuretic.”
“Nope.”
“A potassium sparing diuretic.”
I was wrong the second time, too. HCTZ can be paired with a potassium-sparing diuretic, but it’s only a calcium-sparing diuretic. It’s really really not a loop-diuretic. Anyhow, that dialog is from today, up in oral surgery: our current surgery doc loves to pop quiz us… hard… in front of the patient. If you get it right, he may just keep asking things until you get it wrong. I simply am not quick enough on the draw — so, I can’t remember what I DO know, and I can’t even put forth a good guess when I do NOT know. I get flustered when these things happen:
I don’t have enough time to think (3-4 seconds would be nice).
I see a patient for the first time.
I anticipate doing something I’ve never done before.
I’m intimidated by a dominant personality in a position of absolute authority.
Oral surgery puts all these together, and I turn into a wreck. For every question like this:
“Patient is on Celecoxib.”
“Which inhibits COX-1 or 2?”
“COX-2.”
Or this:
“You didn’t ask your patient if they smoke, but I would guess they do.”
“I… I’ll add that to the history.”
“Which automatically makes them ASA what?”
“ASAII.”
I get things like this:
“And what’s the name of the position when you raise the patient’s feet above their head to help them recover from vasovagal syncope or orthostatic hypotension?”
“I… well, I just… I mean, I was studying it in the… it has this name which”
“The Trendelenburg position.”
Or this:
“Good. You remembered that Coumadin is a Vitamin-K dependent coagulation inhibitor. Which factors does act on?”
“Umm. IX and…”
“Nope.”
Interestingly enough, I would have SWORN I said IX, which on further investigation appears to be correct. But that doesn’t matter. This surgeon really seems enthusiastic about helping us; I appreciate this. I really do. Also, his expectations are high. Very high. Thing is, I absolutely can NOT get a read on whether he thinks we’re all total screw-ups (what are they teaching the kids these days), or if he thinks I’m a screw-up and need remedial education.
I can’t tell if I bother him or if I’m giving myself too much credit, and I’m simply like a fly buzzing around the head of a hiker, only deserving of a reflexive swat to clear the field of view for more interesting things ahead.
I really suspect it’s the latter.
I’m way too easily crushed by doctors like this — I’m not looking to be coddled, but I can’t help but seek out affirmation. I know it’s not a good way to learn, but I can’t help it. Somehow, some way, I just have to forget that I might bother this surgeon, and that he’s going to make me look foolish in front of patients (justified or not, in search of education or a reminder of seniority). After figuring out how to ignore these distractors, I need to learn.
After all, you have to look down at rapidly rising pool of blood in an empty tooth socket, the surface of the deep red liquid pulsing with a heartbeat due to the size of the vessel that was injured, and think clearly enough to figure out how you are going to achieve hemostasis, close, and get on with it all. I’m sure all of my colleagues aren’t even phased by this, and simply go on with their lives when they get home.
As for me, I’m a little bit shaken up.
I still wonder where I stand with the attending surgeon. I know it doesn’t matter, the surgeon absolutely couldn’t care less about me, and that this over-thinking just gets in the way, but it all makes me worry.
