Sixth email, sent April 14, 2013:
"In last weeks email I believe I mentioned that I was going horse-back riding again with Laurie. We went for another ride across the creek and up the hill to the old logging roads. This time however, Laurie took me up the steeper terrain. And she wasn't kidding; there were a few moments I was quite nervous that my horse wouldn't make it up (or down) the hill successfully on all four legs (for anyone who has seen "The Man from Snowy River," there were moments I felt like the main character on his trusty steed, though I didn't have as much trust in my steed). We also got lost a couple of times. On several occasions we came across fallen trees on the trail, this required harrowing 3-4 foot detours. Harrowing, because the terrain was damp-ish leaves on top of loose dirt and slate rock with brambly bushes and tree branches. At one such juncture, there was a thick tree top occluding the trail, i.e no trunk to contend with. My horse, having had quite enough of detours, decided he was just going to plow through the downed tree. During that moment I found a new use for riding helmets: wrecking ball. I ducked my chin to my chest and let him bowl us through the tree branches. We made it through without a scratch (though Laurie did warn me to look for ticks after that.) On our way back down, my left leg got caught on a tree trunk as we went through a narrow gap. I am still rocking a sizable bruise from that. What an adventure! I had fun, but I'm not sure I want to go up grade that steep again.
I have completed my first week in the trenches, as they say. I must admit, I am physically and mentally exhausted, and overwhelmed by the onslaught of information. Before I started, I knew I would be bombarded by information and my expectations have definitely been met. I wake up around 5:15 change, eat breakfast and walk to the hospital to be in the locker room by 6:25. That's so I can change into my scrubs and be in the office by 6:30. It's then time to round on patients (check-up on hospitalized patients) before 7 o'clock conferences, meetings or OR cases. The rest of the day is a mixed bag: time is spent in the OR, outpatient clinic or other parts of the hospital. We act as consultants for the rest of the hospital (7-7, M-F), so even on a day without previously scheduled surgical cases, someone may need to go to the OR or have a bedside procedure.
Some basic terminology to help you through the next part of this email (and subsequent emails...): Chest Tube = a drain tube placed into the chest cavity to drain air or fluid; Pneumothorax = air around the lungs; Pleural Effusion = serosanguinous (clear, pinkish/red colored) fluid around the lungs; Hemothorax = blood around the lungs; Empyema = pus (i.e. infection) around the lungs; Thoracotomy = opening made through the chest wall, with spreading of the ribs, to get a clear view of inner structures; Lobectomy = removing one of the five lobes of the lung (3 are on the right, 2 on the left); Pneumonectomy = removal of an entire lung, either right or left side; Pulmonary Embolism (PE) = blood clot within a vessel of the lung; Deep Vein Thrombosis (DVT) = blood clot in one of the deep veins of the thigh.
I got to see some interesting cases this week, including two patients who needed a pneumonectomy performed through thoracotomy. Pneumonectomies are relatively uncommon procedures. For these two gentlemen however, their cancer tumors were located such that a lobectomy would be inadequate to remove the entire tumor. Fortunately for these two gentlemen, their tumors were on the left side. Right-sided pneumonectomy patients have much worse outcomes, than patients with left-sided pneumonectomy. This is a well documented phenomenon and nobody is entirely sure why that is. I think a thoracotomy pneumonectomy is the most extreme procedure I will see. It is uses sparingly because of the difficult road to recovery. Not only is lung function greatly diminished, but every breath hurts due to the fact that the ribs are spread apart and an inch long chunk is taken out of one rib. Pain control is of the utmost importance. Patients who are in too much pain to breath deeply, cough or walk about are at high risk for pneumonia, DVT and PE. From there it can be a rapid downward spiral of multiple severe complications and death. The advent of technology has allowed for video assisted thoracic surgery (VATS), aka endoscopic surgery. By using small incisions and not spreading open the ribs, this helps decrease pain and healing time after surgery. As such, I think I will see more VATS lobectomies than its much riskier predecessor.
I have the sense that placing chest tubes will be a large part of my job. Just this week I saw patients draining every fluid I can think of, including a malignant pleural effusion (cancer cells present in the fluid). I've already assisted in several placements; the ones I did myself were in the OR during thoracotomy cases (there are several reasons to do a thoracotomy, they're not just for pneumonectomy) when you can stick one hand inside the chest cavity in order to feel the ribs from the inside. This makes for extra assurance that you're not going to puncture something important. It's definitely surreal to have your hand in such an important space (I was really creeped out the first time I felt a beating heart hitting the back of my hand).
That's a taste of what my job will entail. I did get to work-up two new patients during a clinic day. It was refreshing to have a task that I actually felt comfortable and mostly competent doing. I hope to have more of those this week.
Warren and I were invited to a pig roast yesterday by his new branch manager. It was about 20 minutes away, in the woods. There was a shelter, bathrooms and "crick" running behind the woods. We had a good time with great tasting pork, sides, beer and bonfire. There was a range of ages in attendance. I now have a new facebook friend, potential local hair stylist and a gal who really (emphasis on really, I suspect she was pretty drunk at that point) wants to get together to drink wine (her circle of friends sticks with light beer and shots). Warren and I agree that there is an accent here in PA, it's a mix of New Jersey and Canadian with a hint of Southern (or maybe it's just "hick"). All in all we had a great time.
That's it for now. I've heard from several of you about liking my emails. Thanks for the feed back! If any of you would prefer to be taken off the list, please let me know. Also, I'm thinking about getting a blog so I can update more frequently with smaller amounts to read in one sitting. Please let me know if that appeals to you. I'll let you know the verdict next week :-)
Have a great week!
Kristen"
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