Rotation Block 5: General Surgery

During late November through Mid December, I had my general surgery rotation at Banner Del Webb Hospital with Dr. Marco Canulla and Dr. Kathleen Koerner. The best thing about this rotation—it was right by my house!!! The past few months I had been traveling to Scottsdale and Wickenburg every day! The hospital was less than 10 minutes from my house!

This was a pretty sweet rotation. I realized that I really liked surgery and enjoyed the OR more than I expected. What I did not like as much is the sometimes crazy hours they worked and the ridiculous turn-around time from one case to the next. There were a few days were we got there at 5:30 or 6 am and were there until 10 or 11pm! It was nuts! I am very happy that I decided to do a preceptor/department based surgery rotation as opposed to a ward based rotation. Ward based rotations (at teaching facilities with residencies) are important for students looking into surgery residencies. It is great exposure, you typically see some pretty cool cases, and any ward based rotation is good to get more comfortable with the residency environment. The downside, though, is that it is with residents who are training and therefore get to do most of the work, leaving the student to watch or do very minimal participation in the case. On my rotation, I was able to scrub in to most of the cases, and many times was the 1st assist on the case! I had a ton of opportunities to run the laparoscope, make incisions, use the electrocauterizer, use laparoscopic tools, and do closures! And as I am a hands-on learner, this was very helpful to me!

Another student, Stephenie Sterrenberg, was on the rotation with me, and we usually both scrubbed in on the surgeries or took turns. We also rounded on all the surgical patients each morning and wrote notes, so we still got a lot of hospital experience. And the learning was good too. Dr. Canulla is a laid back, hip-hop lovin’, get-er-done kinda guy who would perform 25 minute lap cholecystectomies. He seemed absolutely fearless! There wasn’t a case he would turn down, and he did general and vascular surgery. So in addition to the GI surgeries, I was able to assist on a lot of AV fistula grafts and revisions, which got extremely bloody sometimes! He took a genuine interest in our learning, quizzing us on things like fluid maintenance in addition to surgical knowledge. He was always looking for ways to improve the rotation as well from our perspectives. He was a great model of a preceptor. Dr. Koerner was an AZCOM grad and was fresh out of her surgical residency. It was awesome to get her perspective on things, and she was really patient and easy going in the OR. She remembers what it was like to be a student, so she made sure that we had a lot of opportunities for hands-on involvement. I was also able glean some osteopathic surgical philosophies from her. Nothing crazy or anything, but just thoughtful methods that perhaps took an extra few minutes, but showed that they improved healing time and patient comfort, as well as enhanced post-surgical performance. This mostly involved different types of irrigation, different methods of closures and so forth. True, being fresh out of residency translated to some longer cases, but she always seemed happy that we were there! It was a really strong rotation, but I was very grateful that we had a 2 week winter break afterwards! And then there was the shelf exam. That did not go as well for me. True, I passed, but it just took me longer to get through the questions. And as we only have 2 hours 10 minutes for 100 questions that are all clinical vignettes. Needless to say, I had to bubble the last 15 questions in with “C.” So thankfully I still passed!

Rotation Block 4: Psychiatry

In Block 4, I had my psychiatry rotation, which was with Dr. Karp, DO, at Rosewood Ranch in Wickenburg, AZ. Rosewood Ranch is an inpatient based center for eating disorders. They see patients from across the nation for anorexia nervosa, bulimia nervosa, binge eating disorder, and mixed disorders. They also have both male and female patients. The structure of the program was very interesting to me. The rehab features both a very custom nutrition program along with group and individual cognitive based therapies. The idea is that when someone is so nutritionally imbalanced, they are cognitively affected as well. There is also three levels to the rehab. The first is the inpatient facility, after which they can transition to a residential setting, where they converted a motel to apartments for the residents. There, they have more freedoms and choices, but still have the program structure and support they need. A typical treatment period is variable from patient to patient, but was usually 30 days inpatient, with an additional 30 days in the residential. Many also choose to do an outpatient program, where the patients work or go to school, then have evening classes and programs as they continue to transition back into life. Another neat aspect they have is called Family Week, where the patient’s family comes to Wickenburg and has day classes with the patients. With eating disorders, it doesn’t just affect the patient, but the entire family. They learn in detail the psychological and medical aspects of eating disorders, and have a lot of family based healing therapy. Many times, the eating disorder will tear the family to shreds.

I learned so much on this rotation! This was recommended to me by an upper classman as a great way to immerse yourself in patient interaction and delving deep into the patients’ psyche. The first few days I mainly sat in on the group therapy sessions so I could gain a good grasp of the concept of the program. Then I sat in on new patient interviews and the daily and weekly interviews with Dr. Carp. The next week I spent going back and forth between the inpatient and residential facilities. The third week I spent at family week, where I was able to witness both the damage that an eating disorder can cause, as well as the healing that can take place with therapy, commitment, and work. The final week I spent conducting the new patient evaluations, along with daily and weekly interviews. I even was able to dictate my initial evals! It was a really great experience for me, and I grew a lot as both a person and future physician.

The whole time I tried to put myself in another’s shoes. Whether it be the patient, thinking about how easy a mental disorder can take control of my life, and the tailspin of detriment that can result, or the perspective of a brother, father, or significant other, who is watching this happen to my loved one. There were many times at Family Week that I cried as I witnessed the hurt and anguish that has come from this underestimated disease.

On the positive side, I bonded with many of the patients, trying to connect with them and showing them that I really cared. It was really rewarding to me to see the progression of some of these patients, and it is awesome that I am still in contact with many of them today.

While this may not have been the most academically challenging rotation, and true, I didn’t see a ton of pathology like I may have in an acute psych ward. But I gained so much more than that. I got so deep into the minds of those around me, and this was emotionally challenging for me. I feel that it prepared me to be able to handle other mental disorders as well, as I worked in acute, and chronic settings, and also worked with the family aspect. This helped me to see how I can apply this to the Army physician setting in working with PTSD or other acute stress disorders. One thing is for certain—I will always be grateful for the lessons I learned from Dr. Karp, but even more importantly, the wonderful, courageous patients at Rosewood Ranch!

Oh, this rotation was actually my first NBME Shelf exam, which are nationally standardized tests for all the core medical rotations. You basically get 2 hours and 10 minutes to answer 100 clinical vignette based questions. It really is not enough time to get through everything, especially as I am a slower test taker. I felt the Psych exam was fairly straightforward, but it asked a lot of questions about the type of therapy that would be best in different cases that I wasn’t prepared for, especially since it is so subjective and different psychiatrists use different methods. I also did get to the last 8 or so questions, so I had to bubble in “C” for the last handful. Luckily, I still did okay despite that fact!

Absent

I have been way too negligent of my blog over the past few months. I am trying to get them up now. Things have been insanely busy and I haven't had the necessary time to dedicate to updating the blog. I will post my medical school rotation reviews first, then I'll go back and write about my family happenings, including Thanksgiving, Christmas, New Years, and Valentine's Day. So hang in there, if anyone still checks in!