Warm Blankets

Cross-posted on Dose of Reality

Inside every operating room, or at least very nearby, is an appliance that looks like a refrigerator. It does not, however, keep things cold. Instead, it is devoted entirely to keeping things warm; specifically, it keeps blankets warm so that when patients first come back to the OR, or when they are just waking up, they can be wrapped in a warm blanket (or two, or three) so that they are comfortable in the subarctic temperatures that sometimes occur. Today, I got the opportunity to experience the warm blankets for myself. I was watching a laparoscopic operation (read: a procedure performed with instruments on the ends of sticks inserted into an abdomen blown up like a balloon, so that there is no need to really open up a giant incision). One advantage to these is that, during most of the procedure, there is not much for the medical student to do since it is all inside the abdomen and it is all shown on huge TV screens around the OR. There is then no need for the student to scrub, wear a sterile gown and several pairs of gloves, and focus vigorously on contaminating neither her/himself nor the operating field. Instead, the student can stand or sit and watch the TV. In the cold. The cold that is usually mitigated by said gown and gloves, as well as by the lights and the pressure of working not to contaminate anything. I was cold, and while I was lamenting not having grabbed a scrub jacket from the locker room, I saw that one of the nurses had a blanket wrapped around her shoulders. I snuck into the hallway, grabbed a warm blanket, and wrapped it around myself. It was amazing.

It turns out I am not the only one who loves warm blankets. In addition to at least one notable person in my life who extols the virtues of heated mattress pads and heated throws, look who else loves warm blankets. He snuck into the basket while I was turned away to fold a sheet:

As the weather turns toward the chillier, but it’s not quite okay to turn on the furnace, consider joining me in front of the blanket warmer, or if you aren’t quite ready to invest in one at home yet, in front of the dryer. It’s warm.

Puppy Love

I think I won points with my urology resident today because I have a cute dog. She also has dogs (who are both adorable), and we bonded over their love of being covered when they sleep. Also our love of them… She informed me of a product called a “cave bed” that is a normal dog bed, but with a plush cover that creates a cave in which your pet can snuggle. You see them here or here (complete with a review). Maybe someday, Walter…

Urology!

Cross-posted on Dose of Reality

Somehow it’s already been two weeks of my urology rotation, and I haven’t shared with you all how awesome it is. I have been busy with other things (like ERAS – the online residency application – which I will tell you more about later), so here are a few highlights:

• My first week included “the Nesbit,” which, as far as I could gather, is a symposium organized each year to feature interesting research from urologists at UMMS and other important people in the field. This hear it was specifically about Health Services Research, which was a fantastic coincidence. Everyone was very gung-ho public health (with the possible exception of one speaker, but he was there primary to remind us of how much we need to continue to work on communicating our work with colleagues who do not have lots of statistical background), and it was fascinating. Topics ranged from specific descriptions of interesting studies and funding mechanisms to frontiers in urology (both methodologically and geographically).
• I’ve gotten to spend some time with the Neuromuscular and Pelvic Reconstruction (NPR) service, who are the urologists that spend the most time with female patients. They do joint cases sometimes with the urogynecologists (with whom I thoroughly enjoyed a rotation last November), and provide a slightly different perspective on things going wrong in the pelvis. I’ve seen some crazy reconstructions, some procedures for incontinence and some interventions for painful bladders.
• I’ve also gotten to see other things that I’ll likely never do again, like the construction of a new bladder from a piece of stomach combined with a piece of small intestine, for a child who was effectively born without one. So cool!

I would highly recommend a urology rotation for anyone. Here are just a few of the the specific (and I’m sure widely applicable) skills I have learned or refined so far: foley catheter placement, suturing and knot-tying, cystoscopy, penis jokes, and smiling and nodding at gynecologist jokes.

By popular demand

Walter's tongue many weeks post-op - I think this is our new normal.

Same sleepy puppy...

Catch-Up

Somehow, in the midst of rotating with the midwives, a family wedding, and two board exams, the blog was a bit neglected last month. Oh, and the month before because of the ICU… Sorry! Here is a quick catch-up post to share some fun things that I did but didn’t blog about.

1. Hell’s Kitchen. I went to Minneapolis to see my lovely cousin get married, and in doing so got to see my mom and sister, among others. On the Saturday morning before the wedding, we decided to try Hell’s Kitchen, advertised as the most amazing place since sliced bread. We’d gotten mixed reviews from some, but wanted to check it out. It did not live up to the hype. I got the huevos rancheros, which were by far the best of anyone’s breakfasts, and they were fine. Not amazing, but fine.

2. Creamy Turnip Soup. This was an adaptation of Mark Bittman’s Creamy Carrot Soup, and used up many of the turnips that my CSA so vigorously produced. It was delicious, and delightfully simple. Sautee a chopped onion and as many turnips as you wish (or carrots, in which case you may wish to add a potato) until they are just tender. Add about 5-6 cups of water or stock and cook until the vegetables are soft. Use an immersion blender to make it smooth, and season with salt and pepper.

3. A lovely picture of peas. Nothing more to say, just wanted to share this pretty picture from my CSA back in June. Join a CSA here!

Tub Birth!

Cross-posted on Dose of Reality

For the past month I’ve been rotating with the midwives, as I outlined here. One of the things I was most looking forward to this month was getting to attend a tub birth. Delivering in the tubs, which are fairly spacious and definitely still located inside the hospital room, seems to make most of the physicians delivering babies nervous. As a result, I’d never seen one, and was very curious. It didn’t seem that this wish would be made reality until the last day of my rotation. Due to some quirks of the healthcare system that I won’t enumerate due to HIPPA requirements, this particular mother decided to labor in the tub. The whole process went very quickly and easily, and she and I caught the baby together. So exciting!

This whole rotation has made me think a lot about how I’d like to do antepartum, intrapartum, and post-partum care in my own future practice. While lots of things, like having 30 minute rather than 10 minute prenatal visits to allow for questions and teaching, have helped me to understand why so many women so strongly prefer the midwifery model to the physician model of care during pregnancy, few things seem to emphasize this as starkly as the tub birth. In the world of low risk, low intervention pregnancies and births, there’s no reason not to get in the tub and deliver there if that’s what the woman wants. It’s warm, is really helpful for pain during labor, and is a great way to get skin-to-skin with your baby right after birth. In the world of high risk, high intervention pregnancies and births, it seems that behind even the most benign of deliveries lies a strong concern about something possibly going wrong, and the need to do everything possible to prevent that.

This preoccupation with potential problems is what physicians are trained to do. We see the possibility of a critical airway with every cough, spinal cord compression with every twinge of back muscles, and hidden malignancy with every fever. While we are continually told in school to think “horses, not zebras” when we hear hoof beats, the rare and the bizarre are emphasized in lectures, exams, and the questions we’re asked on rounds. How then, is the well-intentioned medical student to take a step back and recognize a truly uncomplicated and normal process as it takes place, rather than waiting and finally conceding after the fact that nothing went wrong? After working with the midwives for a month, I confess that I haven’t shaken the niggling doubts I have each time someone mentions a mother pushing for seven hours before her baby is born. I think that most of the midwives have some doubts too. But they’ve helped to remind me that most women know how they want to birth their babies, and that most of the time, they’re right.