The perception I have of myself is that I am a relatively level headed guy, very mild tempered, forgiving, hard working, affable, and loyal person. This perception has been verified by what many people have told me about myself (I do understand people do tend to hold back the bad things, not wanting to hurt feelings. Also, one of these people was my mother). One of my major flaws is my inability to forgive and respect someone I consider a "bully". In my value system, other than someone directly disrespecting me or my family, or blatantly lying to me, this is probably high on my list of things that will get my blood boiling. I lose respect for those that pick on the weaker or less powerful (physical, mental, or political) to get their way or things they want.
I understand my role in my group. I am a grunt. I personally have no aspirations of being famous or politically powerful. I do my work to the best of my abilities. I look at try to do what is in the best interest of the patient. All I ask is that all others do the same.
Story #2: Crying wolf. Calling an emergent consult on something that is not emergent.Ortho: This is Dr. bone
Dr. Iconsultforeverything: Yeah, this is Dr. Iconsultforeverything. I have a girl down here in the ER with an ACL tear. We would like an Orthopaedic consult.
Ortho: Uh, just put it in a knee immobilizer and send it to clinic.
Dr. Iconsultforeverything: We would like a you to come see the patient now.
Ortho: But, there is nothing to do. I am going to put them in a knee immobilized and have them follow up in clinic.
Dr. Iconsultforeverything: LISTEN, I AM THE ATTENDING AN I WANT YOU TO COME SEE THE PATIENT.
Ortho: Ok ....
(End result is the patient was sent home with a knee immobilizer, crutches, and an appointment for 1 week.)
Story #3: Attending trying to get resident into trouble.Ortho: Hey, this is ortho returning a page.
Dr. Ijustcompletedmyintenship: yeah this is the senior medical resident, Dr. Ijustcompletedmyintenship, and we would like to consult ortho for a possible compartment syndrome.
Ortho: I'll be right there.
(Stryker monitor in hand. Ortho resident runs up to the floor and walks into the Patients room)
Ortho: Hello, I am Dr. Bone, are you Mr. Igetadmittedalot.
(Patient looks up from his full lunch and takes his spoon out of his mouth)
Mr. Igetadmittedalot: Yes, I am Mr. Igetadmittedalot. (He takes another bite of mash potatoes)
Ortho: Does your leg hurt?
Mr. Igetadmittedalot: No.
Ortho: Has it ever hurt?
Mr. Igetadmittedalot: No. But, it is swollen.
Ortho: thank you.
(Resident walks out of the room and finds the senior medical resident)
Ortho: Hey, Dr. Ijustcompletedmyintenship. Why did you think this was compartment syndrome?
Dr. Ijustcompletedmyintenship: Well, his leg was swollen.
Ortho: Was there no other reason for this, like his renal disease, Diabetes, peripheral vascular disease, etc.. Oh, and if you thought it was a surgical emergency, why would you feed him?
(End result, the medical team receives an impromptu lecture on compartment syndrome)
Story #4 (Break in Chain of Command)Ortho Attending: (ring ring, answering phone) Hello.
Dr. Iconsultforeverything: This is Dr. Iconsultforeverything. I called your resident about a patient with back pain. The radiology report shows a possible coccyx lesion.
Ortho Attending: Well, get a CT scan.
Dr. Iconsultforeverything: Well, he has back pain after being hit in the back with a chair. The radiologist read a possible fracture or lesion in the coccyx. (Then going around in circles about something, ortho attending tunes him out for a bit)
Ortho Attending: What do you want us to do?
Dr. Iconsultforeverything: I just think someone from orthopaedics should see him.
Ortho Attending: Why? What are you concerned about?
Dr. Iconsultforeverything: Well there is a possible lesion or fracture of the coccyx and the patient has back pain.
Ortho Attending: Well what does the exam show?
Dr. Iconsultforeverything: He has back pain.
Ortho Attending: But, does he have @$$hole pain. What does the rectal show?
Dr. Iconsultforeverything: (silence) ... Well, I just think someone should see him.
Ortho Attending: Ok, Dr. Iconsultforeverything, I will send my resident down to do your examination.
(End result, patient was actually examined. He had back pain. Neuro exam negative including negative rectal exam)
These are some basic stories that are not to say how good orthopaedics is or how much I am above other services. They are just stories. In residency and in practice, we all have them. I would like to open the comment box for more stories. Orthopaedic patient bashing stories welcome.I really don't have a story I can share. I believe in a chain of command. This probably has to do with my military background. I have been involved with many situations where the chain has been broken. It causes problems that are not needed and situations that are blown out of proportion. It is usually done by people that think they are "above" the chain, or forcing their perceived power.
You may write me down in history
With your bitter, twisted lies,
You may trod me in the very dirt
But still, like dust, I'll rise.
Step, step, breathe.... Pace yourself. Control your breathing. Check .... arms tooChicago marathon is coming up soon. I am in my taper. Most of this next 1 1/2 weeks runs will be to keep my legs fresh, remembering my planned pace, preventing injury, and preparing for race day mentally. The marathon is a mental exercise for me. I think I will do OK this year. I have been hampered with injuries this training period. So, my training was not up to what I would have liked. This year I hope to finish without injury. I hope not to make the same mistakes I made in St. Louis. I learn what my body can tolerate with each marathon and training period. Sometimes I push to hard and fast; and other times not hard enough. The more races I do, the better I get at preparing physically and mentally. It is very similar to surgery.tight. Need to concentrate on keeping loose. I need to preserve energy. Check .... stride is comfortable, pace is good. My legs feel loose. Need to keep from leading too much with my dominate right leg. Step, step, breath, step step, full breath. Check ... slight elevation. Check foot position, arms position, pace. Settle your knees down, they are coming too high. You will fatigue your hip flexors. Check ... down hill. Control your fall down the hill. Stay away from decelerating heel strikes. Remember St. Louis at the 24 mile ... lactic acid build up .... aaarrrgghhh. Step, step, breathe .... check .... Arm position, foot position, stride length, heart rate, pace.
Yesterday, we did a basic case. As I do, I have a mental plan of how I would approach the procedure. From the set up, to the size of implants, I have in my minds eye the way I would approach this case. I know where the rate limiting steps are. I know what is acceptable and what the room for error is. How do I know these things? It comes from experience. I have enough experience to know what works for me. I know what my skill sets are and how to work with my skill deficits. But, this is a perfect case for a chief to spread his/her wings. So, I step back and let the chief make decisions. This is how they find out their own limits.
I watch my chief make decisions on a basic case. Occasionally I make little suggestions, usually when I am asked. The case goes relatively smoothly. The results are FFT. The x-rays look OFT. So, now let’s look at the case as a whole and be critical. What was done well? What could have been done better? Yada yada yada. I think this assessment of surgical cases is extremely important in the growth of a surgeon. It is how we improve our skills and limit our mistakes. My critique of this procedure was “time”. He was leaking time during this case making it longer than it needed to be. We talked a little about how to be more time efficient. I recommended that he work out ways of limiting the down time. You should always be moving forward. Hands should be moving with a purpose. This is a vital training tool that sometimes gets lost in the dust of intramedullary rods, locked plates, and pedicle screws. Sometimes we get caught up in the end result and not ho
w we got there. Heaven forbid we talk about outcomes.Step, step, breathe .....As I complete this training period. I will look back at the faults of my training. I will make adjustments. I will readjust my goals. I will look at what I did well and what I didn't do so well. I will look at my marathon attack plan and see how well I was able to keep to it. I will make adjustments to both my training plans and marathon plans. Then back to the grind.
To all that have continued to check my blog, thank you for continuing to visit. Things should be slowing down (I hope), so I should be able to more consistently post. As a resident, I remember thinking that my attendings had it easy. We would do the grunt work and they would just come down to the OR or Clinic after they were done drinking coffee in their office. Sometimes, I wish that was the case. The past 3 weeks have been particularly brutal. It is the main reason for the dearth of posts. Over the past few weeks, we have been unseasonably busy. We are still getting a lot of trauma and the elective load has been steady. What wears you down is not one day, it is the accumulation over time. I am recharging and getting be back on my game.
