Monday, June 30, 2008

1/2 Over

Quill from Statia Public Pool Exams are almost over. I did pretty well at them...never as good as my type A, anal retentive self would like, but that's just me. I was hoping to scale up and really get on top of the curve going into the last half, but I'm ok. If I maintain the same momentum, I'll be fine.  Today marks the 1/2 way point in the first term and there is some relief with that. The slide to #3 exams is coming. Built upon that knowledge is the impending fear of cumulative final exams...the enemy of aging memory. It starts again fast an furious tomorrow AM. I'm sure that we are behind in anatomy, but know that he'll make it up in the first hour talking about 500 words per minute and skipping over whole sections for our own digestion later. I love this part of anatomy...the chest. My early experiences in PA school in cardiothoracic surgery set the pace.

Flashback: I had the pleasure (or pain) of being a student under the guidance of Dr. John Kirklin, Sr at the University of Alabama-Birmingham before he died. To say that I was in awe of this man, surgeon, researcher, and teacher is an understatement.  What I learned was invaluable and my absolute love for the open chest was solidified there. I say pain because the hours were brutal; In house call every 3rd night, and regular hours from 4 AM until midnight...often.  But he was a consummate teacher and it was well worth the price. He was constantly asking pertinent clinical and basic science questions of students, residents and fellows (we had a huge team), challenging us to deeper understanding of anatomy, physiology, and surgical care. I only wish I remembered half of what I learned there 25 years ago. Then there was the hands on...

The operating rooms at UAB CV surgery were typically crowded with lots of folks learning...students, residents, fellows, visitors...all watching the well honed team of Dr. Kirklin and crew do their heart surgery thing. This one morning I was told to scrub, which wasn't unusual, but I'd never done it with him. 4 of us, including Dr. K, were at the Dr. John Kirklin Srscrub sink and I was too afraid to ask what my role was (that awe thing). We got into the room, gowned, gloved and the surgery began. I was told where to stand to "watch" and I did gladly...I LOVE surgery. Then it happened. About 30 minutes into the case, with the chest filleted open, he looked up and caught my eye and said, "come here"...I came hither, taking one step forward to the left, lateral position at the patient.

He held out his hand and asked for mine. He then positioned my hand around the beating heart of this 60 something patient and said hold that, and don't move. Holy coronary! I did as I was told and "held the heart" as Dr. K and team sewed in the vessel bypasses as planned. The heart beat was slowed but beating still. I was holding the heart in a position to allow him to see what he was doing (even though I couldn't) as ice cold cardioplegia solution dripped on fingers and rendered them numb. I didn't dare move. I didn't move. But I did it, and the surgery was successful and so was my education.

Needless to say, opening that cadaver last week at the costal sternal junctions with a small saw was not as satisfying and smelled much different, but my excitement for the chest instantly resurfaced. I love this imagestuff! Exploring the recesses of the mediastinum (cavities in the chest) the lungs, and all the associated structures that exit and enter the chest is exhilarating to me. Because I know that in that knowledge comes the ability to practice better medicine, auscultate more specifically, read chest x-ray and MRI's better. At least that is my hope. If not, it's been a heck of an "oh wow" flashback experience, none the less. The advantages of having been there. Nice.