Tube and Lube

I just started my glorious new rotation of anesthesia/ultrasound.  My day consists of early awakenings and oh so early returns to the home base.  I still get up around 5:45am, which is not too dissimilar from my MICU mornings.  After some breakfast, reading email, and some highlights on the NYtimes, I drive to work around 6:30.  I'm only now getting into a routine in the anesthesiology department.  No one truly oversees you, which is good in the sense that you can make your day as long or short as you like.  However, there is most definitely the sense that you are a distraction to the regular flow of the OR.  I was recently told by a CRNA to go stand in the corner, which seemed entirely inappropriate given the nature of my rotation...to learn and act as part of the anesthesia team.  Clearly, this would be difficult to do with zero vantage point.  I dismissed it as a case of the Mondays (and perhaps a juvenile need to enforce authority over someone when you can get the chance) and got on with my day.  In the afternoons, I join the ultrasound team, which consists of our ultrasound director, ICU fellow, and another EM resident.  We scan away at any patient that is a potential appy, choley, AAA, pneumothorax, or any other interesting finding.  Ultrasound seems like an ingenious way to make procedures safer and give additional diagnostic information in little time.  In addition, to your potentially life-saving FAST exam for free fluid, there is the additional utility of a no radiation bedside tool.  It is another tool to make yourself independent of consultants that may delay the workup.  Of course at this stage I still feel like I couldn't grab the ultrasound on my own and make a definitive case for DVT or gallstones, but hopefully in a couple of weeks the skills will be sufficient.  For now, it is a laid back, enjoyable opportunity to learn without the responsibility of patient care as a distracter.

It has been odd not caring for my own patients during this rotation.  I feel liberated and yet surprisingly less purposeful.  It is almost as if by rendering away my patient care abilities, I've suddenly become more relaxed, but feel less good about my day.  However, it has helped me reconnect with family and my sense of humor.  I will not forget the drama of my last day in the MICU ending with the entirely appropriate comment by my fellow intern who I was orienting to her new rotation "What's wrong?  You look so upset."  It's hard not to be upset after witnessing a traumatic cric in a patient who was actually DNR/DNI and then getting the kickback by all the MICU nurses for allowing the patient to be admitted to our service despite a new (old) CMO decision made by the family.  What can I say!  I actually confronted the attending of this particular case today at conference immediately following a very a pro pos discussion on ethics and code decision making.  I got what seemed like a partial apology for my involvement in that case, but no admission on guilt in singlehandedly getting a patient to rebuke their code status when their situation was more than hopeless.  I suppose I need to learn to forgive and forget because there is no question I will be in the same situation some day soon.