Day 7

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I woke up a little later then expected today; 7am which is far to late. I was going to run this morning but I felt so faitgued it would be more of a wobble. I was working in the OR with Sean in the AM. We didn’t have a surigcal case right away so took in a 33 year old woman who came in in a wheel chair complaining of all over weakness, worse on the left side that started about a week ago.  This was the first time she ever had such a condition and its presentation was a sudden onset. She couldn’t move her left arm at all, and had decreased strength in all 4 extremities. On her neuro exam, her cranial nerves were intact, and she had no vision troubles but she had a hyperspastic patellar reflex on the left with penduluing, absent achilles reflex bilaterally, bilateral babinski signs, and disdiadokinesia. She developed fecal/urinary incontinence today and had trouble taking deep breathes. At first we were thinking that this could be a stroke presentation but since she had upper and lower motor neuron signs, no trouble with speech, and given her age group this might be a fast progressing ALS. We sent her to the ER for a more thorough workup and will follow up with her tomorrow. Neuro cases are fascinating and always difficult to pinpoint, and this one was a heartbreaker. She is a beautiful young Filipino woman, and what she needs a workup that will costs thousands if not hundred of thousands of dollars; something our clinic that runs off of fundraising money does not have.

The second part of the morning I spent in the OR assisting Sean in a sebaceous cyst removal. I injected the Lidocaine with epinephrine to numb the young women before he made his incision and cut out the cyst. I was first assistant to the surgery, and it took a while to cut around and deep into the tissue before we were able to completely remove it. I learned how to suture today and practiced doing subcutaneous, interrupted sutures to close the incision. I love surgery and all the excitement of an OR. Even the standing I don’t mind, because the adrenaline makes it go by so much faster.  The procedure went extremely well, and the girl walked out with a smile on her face in the end.

The afternoon session I worked in pharmacy. I realized right away how pharmacy is just not my thing. Filling prescriptions and handing them out, I get bored really fast. Just give me a scalpel and let me go back to the OR!  The Filipino’s I worked with in the pharmacy refer to me as Barbie. Not sure if it was the pink scrub pants and blonde hair that gave them that idea. I snuck back into the OR for a while where a 6 year old girl had to get a foreign body removal from her hand. Dr. Schuster dug around a while and was unable to find any pieces of remaining wood from her accident, so Rob sewed her back up. She waited a while for the Ketamine to wear off that we gave her to knock her out for the procedure. It definitely hurt a lot given it was an incision to her hand, and as a small child it is less tramatizing to just have them unconscious. I went in and out of pharmacy, sneaking in to see interesting patient cases that others were working on. We all didn’t get out until after 6pm because the place was packed. I am exhausted, and tomorrow we were told the entire area is going to be without power. We’ll still have clinic, but no OR. No fans or even the limited air conditioning that we do have will most likely make this a very “interesting” day.