This morning was rather stressful because apparently all the instructions for today were given at afternoon rounds yesterday, which I missed because I was in surgery. All the cases for today had been divvied up, leaving me with no options.
The nurse put my name down for a lame labrador. It seemed fairly interesting, so I didn't mind too much. About five minutes later, another student approaches me and tells me he'd actually claimed that case last night, but didn't put his name into the system. I find out later that this student was supposed to find me after rounds yesterday and talk about the remaining cases, find out which one I wanted and sort out what was going to happen this morning. He didn't do that. He picked a case and went home.
At first, I put up a defense. "I haven't had a chance to do an orthopaedic exam yet," I explained, basically thinking you should have put your damn name on it, it's mine now. He agreed he would just come in on the consult and we would share the case. I go off and read all the patient notes, and eventually learn that he's started studying up on a completely different case and I may have successfully stolen this case for myself. I was a bit relieved, because it's unfair that my day would have been entirely screwed up and it was all his fault for not finding me yesterday afternoon while I was in theatre.
Then, as I'm reading the patient notes, a popup says one of my classmates is looking at that file on another computer. He's not on surgery this week, so I go ask him what's up, and he says it's a medicine case. We scratch our heads over this until we figure out the consult is scheduled under both medicine and surgery. I investigate, and long story short, it's a medicine case. No more case for me.
Just as I was about to get stressed out again, a new, urgent case pops up. A puppy fractured its femur. A case! Turns out it was not really the best case to have on a friday.
I did the consult when they arrived, and was pleased to find that I'm slightly less bumbly than I was in the first one. I was also pleased to find that the clients were willing to pay for the expensive fancy surgery. Thus the patient came under my care and dominated my entire day. Mostly that meant setting up a cage for him and then doing tons of paperwork.
In the afternoon, we went into surgery. It was interesting, but the hip area is challenging and the surgeon had a difficult time pinning the fracture back together and making sure he got all the pieces in the correct position. I became very glad that I was with the chillax surgeon, because eats-students-for-breakfast tends to get frustrated quickly and start throwing instruments around the room (not even joking). This guy was basically like "Aw, damn it," in a completely relaxed manner as he casually mentions he can't see anything and has no idea if his pins are in the correct place. After three hours of digging around in the hip joint trying to reduce the fracture and hold it together, he sews up a bazillion muscles, closes the wound, and we're off to radiology. However, if the pins aren't in the correct place, we have to come back in, take everything out, and do the alternate procedure where we just remove the femoral head rather than trying to hold it together with pins.
Guess what we found on xrays?
The sad thing is that the femoral neck, our goal during surgery, was very nicely aligned. He had fixed that part of the fracture perfectly. It just turns out that there was another fragment that must have come from somewhere else. Therefore, we had to go back in, re-scrub, undo all the skin staples and all the sutured muscles, and dive back down to the joint. At this point it's 6pm and we're looking at probably 2-4 more hours.
Before committing to the femoral head osteotomy, he tried to find that extra fragment, but couldn't. As far as he could tell, the joint surface was undamaged, though it was possible the fragment was too deep for us to reach. He called in the other surgeon, because once you take out the femoral head there's no going back--there's no chance of future improvements if the patient doesn't do well, like you can't do a total hip replacement when the puppy gets older. So we wait around for the other surgeon to arrive, and then they peer at it and poke at it for a good twenty minutes, discussing the pros and cons and what they think about what they see. The entire time, I'm thinking leave it, leave it, leave it. As much as I would like to see an FHO performed, I really didn't want to be there until 10pm on a friday. Finally, after much deliberation, they decided the best standard of care would be to leave the repair in place, and come back for a second operation if an FHO becomes necessary in the future. Phew!
I still had to write a surgery report, sort out some extra post-op meds, and do all the puppy's paperwork for the weekend, but at least I got home while it was still light out.
No comments:
Post a Comment