My anesthesiology rotation ended today. I'm very sad, as I enjoyed this rotation tremendously. I now have a much better understanding of cardiopulmonary physiology, autonomic pharmacology, muscle relaxants, and airway management. I can now perform basic airway management, including tracheal intubation, and I'm decent at starting i.v.'s. Next up...my "radiholiday."
I received this email today. My understanding is that it is likely I'll be part of Team 4, set to be deployed between October 23 and November 11.
Dear MRC medical student volunteer,
We need the assistance of 3rd and 4th year medical students willing
and able to deploy to the Lafayette Louisiana area as part of an
ongoing University of Minnesota Medical Reserve Corps and Mayo Clinic
collaborative relief mission.
We are sending 4 teams of physicians, nurses and mental health
professionals to Lafayette over a 60 day period. Team 1 has just
returned and Team 2 is currently deployed in the area.
Team 3 will depart on October 9 and return October 25.
Team 4 will depart on October 23 and return November 11.
We are recruiting 4 medical students for Team 3 and an unspecified
number for Team 4. You must be able to participate for the entire
duration of team deployment. If you are interested and able to
volunteer for either team please contact me immediately via email.
I'll look forward to discussing the details with you.
Thank you very much,
Today I basically had a single case - a 3-vessel Coronary Artery Bypass Graft (CABG). The monitoring in this case was pretty intense. First, we had the basic monitors that everybody under general anesthesia has:
pulse oxymeter - heart rate and oxygen saturation
ECG - for showing a continuous electrocardiogram, monitoring for cardiac ischemia, etc (oh, he came in with ST-depression, evidence of ischemia)
non-invasic blood pressure cuff - for blood pressure (duh)
Ventilatory monitors - to show us air flow, pressures End-titdal CO2, FiO2, inspired oxygen concentration, inspired anesthetic gas concentrations
Temperature probe - for looking at "shell temperature"
And since this case was a bit involved, we also had:
Arterial line - continuous blood pressure monitoring (when every 3-minutes is just not sufficient)
Central venous line with a pulmonary artery catheter - pulmonary pressures, core temperature, measurement of cardiac output and cardiac index, and right ventricular end-diastolic pressure
Transesophageal Echocardiography (TEE) with doppler - this uses an echocardiograph machine similar to what is used in regular echo, but the probe is placed in the esophagus rather than on the front of the chest. Amazing pictures, nice view of the heart valves, and we were able to see and estimate (using color dopler) the direction of blood flow and detect some blood regurgitation from a bad valve. This site shows some of what we could see.
And then there were the monitors on the bypass machine, which I mostly ignored and let the perfusionist worry about.
It was also pretty freaky to see the cardioplegia - I could look into the hole in his chest and see a non-beating heart, the ECG was flat (i.e.-"flatlining"), and his pulmonary artery pressure was zero (i.e.-no flow through the lungs). Yikes! And yes, he was brought back to life near the end.
A group of U of M MRC volunteers has already been deployed to the Gulf Coast in support of the medical missions around Katrina. From what I understand, these are all licensed providers (MDs, RNs, DDSs, etc). Reports back from this group indicate that there is some need for medical student support. There is a second deployment leaving this Sunday which will include some medical students. Since this would entail me missing my last week of my anesthesiology rotation, I'm not able to go. There is third deployment that will likely be gone between October 9 and October 25th that would interfere with both my radiology and ophthalmology rotation. But there's a fourth deployment from October 23 to Novermber 8 that would only interfere with my ophthalmology rotation. I am now anticipating being part of that fourth deployment.
It's interesting hanging around a busy OR area. Staff know that I'm not an attending physician nor resident so they sometimes fail to censor themselves. Overhead today from a nurse coming out of an OR:
"I hate surgeons." She turns towards me, realizes I'm there, and says "Let me rephrase that....I hate surgeons."
Medical School is tough - they even grade you on sex. I passed my sex class at the end of year 1 (old news), and now I've honored my sex rotation in year 3. I hope that clears up any confusion or ambiguity.
On Monday I started my anesthesiology rotation at the newly renamed University of Minnesota Medical Center - Fairview. According to the director of medical student education, we should be able to handle ASA I cases (patient is otherwise free of disease; the simplest cases) by the end of our 3 weeks. We'll see.
We mostly just show up at 6:30 into our assigned OR room and spend the day with a CRNA, since the CA1s (first year clinical anesthesiology residents) are relatively young and not the best teachers right now. On day #1 I managed my first (human) intubation with a little assistance. That was sweet. Yesterday my room was an MRI suite, and do be in there requires special safety training which isn't worth going through, so I found another room. Got to do another intubation, this time on a 6-year old, which went well and with no assistance. Also got to mask a kid for his entire procedure (PICC line placement - they ran a large i.v. from a vein in his arm to just outside his heart for long-term antibiotic therapy). So we anesthetized the kid but then I had to hold a mask over him and watch his (spontaneous) breathing and help him breath if needed. It went well, but my hand ended up really tired after masking for 45 minutes. The good part was that I got to sit down for 30 of those minutes. Otherwise, I was standing for the other 8.25 hours straight - no bathroom break, no lunch break, no coffee break.
My 3-week rotation with the Program in Human Sexuality has come and gone. It consisted of sitting in on individual therapy sessions, group therapy sessions, a some supervision meetings for the post-docs (PhDs or PsyDs getting trained in sex). The major groups I worked with were sex offenders and people with compusive sexual behavior. I didn't see much women's health or transgender medicine, which are the other two major areas. Getting into therapy sessions was difficult, leaving lots of down time. But I learned a few important things, and am glad to have had the experience.
Next up....Anesthesiology, AKA The Big A.