A new Hulden

Rusty Hulden ...

was introduced at Thanksgiving. This is Indiana's new cousin. John's brother Chris and Rita rescued Rusty recently. He and Indiana got along very well. Rusty is 10 and likes his quite new home. He and Indiana took naps just a couple of feet from each other after meeting only an hour earlier. That sounded weird, but you know what I am saying. In the puppy world, that is good. They shared a small space just fine. Rusty minds very well and has just a little separation anxiety, which is expected. Rusty's good behavior reminded us of how spoiled our little beggar is. This was most evident when Indiana rested her nose on the Thanksgiving table during dinner. Bad Parents!!

Stuck

So, a little embarrassing, but it did happen so I have to fess up. I stuck myself for the first time. I did think it would take me longer than 5 weeks for this to happen. Thank the Lord it was a clean needle. So I only contaminated instead of incident report, testing for the patient, me etc... all at the insurers expense. So none of that. It was a clean needle. It was with the same surgeon that intimidates me and I let it get to me. I put a hypo on the local syringe that she didn't' prefer and in her insistence, changed it quickly. There is a plastic tab that you cut off with special scissors. I was in a hurry and had seen others pull it off with their fingers. So I did that. Before I knew it I felt a strong vibration in my thumb. I looked down and noticed the needle sticking into the my thumb and had bent sideways and broken off when it hit the bone. It was an 18 gauge needle, which is not a small one. I had just a moment of shock, then damage control. We learn to not react until we have thought through everything, because that is usually when the contamination multiplies. If I were to contaminate my back table, I would have to scrap it all and start all over. This would be the worst thing you can do in my job. I backed away from the table, told the assistant surgeon that she would have to self serve instruments off of my mayo stand for a moment. I called over the circulator who I had to quickly convince this was a clean stick. So she helped me change my blood filled gloves in a sterile manor and get back to my job. I don't think the surgeon knew what happened which is great, she just knew I was MIA for a couple of minutes which I am sure didn't contribute to her confidence in me. But I continued like nothing happened doing my best to assist her.

So I learned a lot. No matter how stressful it is, I will take the time to be slow and methodical to insure safety for myself and everybody else in the room. After the surgery, I looked at my thumb that was already a nice shade of purple and still numb in a small spot.

I have shared a few of these stories inspired by intimidation, but I have had several surgeons tell me I am leaps and bounds from where most are after 5 weeks. I don't have to worry about any inflated ego, situations like the one described above put me right back in my place.

Really Oregonian?

Jack in the 1920's

20 - 0 at half vs. USC

Sent from my iPhone

Mr. Colon

So, this is Mr. Sigmoid Colon everybody. I saw one that was distended greater than the one that is in the picture. This happens when there is an obstruction, adhesion etc... I have assisted in several of these bowel cases. Usually start with an exploratory laparotomy. These cases can be really long. I like assisting in them, because they usually consist of three instrument pans that I am familiar with... and the bowel is a great way to keep your hands warm in the cold room. :)

This week I have continued to assist in about 4 surgeries a night. So far this week I have done all surgeries solo except for one. That means just the surgeon(s) and I scrubbed in for the procedure. I am solely responsible for setting up the sterile field, draping the patient, handing everything to the surgeons they require during the procedure, being a second or third set of hands during the surgery, helping to close, applying dressings, casts etc... Still haven't figured out the part where I have two retractors in one hand, a clamp that is occluding a vessel in the other hand and then the surgeon says, hand me a stick tie STAT... umm?

There are those off surgeries and days where it seems that nothing goes right. I heard that just happens. My theory is that they are sparked by a very agitated and tired surgeon (usually female surgeons btw!) Makes everybody tense and lowers the success in the room. But, these are few and far between and I still like the challenge, although I find myself tentative when working with those surgeons and the thought to avoid them crosses my mind, but I cannot give into that. Got to step up to the challenge.

The comfort of being a new student is fading and expectations are increasing. I'm up for it though. I willingly signed up for this I keep reminding myself :)

Hong Kong at Night

Sent from my iPhone

Hong Kong at Night

Sent from my iPhone

And still more...

Sent from my iPhone

More from Hong Kong

Sent from my iPhone

Hong Kong

Sent from my iPhoneUnbelievable!

View from my hotel in Hong Kong

Sent from my iPhoneLots of smog. Amazing view though.

Taiwan

Sent from my iPhone

Taiwan

Sent from my iPhone

Monday in Taiwan

Sent from my iPhoneLunch time. That is my boss, Matt in the background with Jadan the sales director for the supplier we visited. I ate some of the body of the fish. The head was just for looks.

Monday in Taiwan

Sent from my iPhoneIn a suburb of Taipei

Monday in Taiwan

Sent from my iPhoneThis was actually pretty good.

Monday in Taiwan

Sent from my iPhoneThankfully I didn't have to eat these. Although, the culinary adventures continued. Nothing raw, but I ate tripe and pig anus. Today for breakfast, Special K. I'm so happy!

Monday morning in Taipei

Sent from my iPhoneDiet Coke for the most part is not sold in Japan. It's all about Coke Zero there. Well here it looks like we are getting closer to Diet Coke. I'll try it later.

View of Taipei 101 from my hotel window

Sent from my iPhone

Leaving for Taiwan

Sent from my iPhoneAt the airport...still no Diet Coke.

Sunday in Tokyo

Sent from my iPhone

Sunday in Tokyo

Sent from my iPhoneOlder area of Tokyo

Sunday in Tokyo

Sent from my iPhoneThis will be the tallest building in the world when completed.

Sunday in Tokyo

Sent from my iPhone

Saturday In Tokyo

Sent from my iPhoneMore Harajuku images

Saturday In Tokyo

Sent from my iPhoneHarujuku area

Saturday In Tokyo

Sent from my iPhoneA wedding procession at a shrine in a beautiful park.

Saturday In Tokyo

Sent from my iPhoneThank the good Lord. After eating raw sea urchin eggs, raw oysters, raw fish of all kinds, and raw horse meat (very good by the way), I had breakfast at the Golden Arches.

Saturday In Tokyo

Sent from my iPhoneLooking down the street toward my bosses apartment.

Dinner Friday Night in Tokyo

Sent from my iPhoneYup I ate that. Pretty good too. Some kind of smoked fish. No, it's not my cigarette.

Dinner Friday Night in Tokyo

Sent from my iPhoneLotus Roots

Puppers!

She is back. With John being out of town and me working so far away, she had to go to the babysitters for a couple of days, but... She is back.

1 Month down

Time is flying by. I have been at the hospital now for 4 weeks. The last couple of days have been all Ortho cases for me, which is fun, but a challenge. So in total joint cases, you wear bunny suites - just like the picture. I thought I was deaf before, but with these suites on I can't hear a thing. Plus I have an individual air system, so all I can hear is the pump. At least with the clear shield and no face mask I can read lips.

I also wish I was more of a tools kind of person. It would make it a lot easier. A drill is a drill, just these are $50,000 drills. Ortho is more light and not as serious as some of the other specialties. I would like to be able to finally be familiar with something and then be able to do it well. That will be a while and not while I am a student. I do feel very comfortable with open appendectomies and laporscopic cholesysectomies. I can do those by myself, but I have already checked those off my certification list, so onto more unfamiliarity I am afraid. Did a vascular case today and it was difficult going from major tools like hammers drills and saws to micro instrumentation you hold like a tiny pencil and tiny needles you can barely see. I am in school tomorrow taking practice exams and turning in all of my lovely paperwork for the last two weeks, which I better get back to as it is 1am.

Miss my hubby lots, but he is having a wonderful adventure in Japan. He is just leaving the Japan office and going to dinner right now. This being on two different sides of the world from each other is weird. I am also so proud of him for eating the real Sushi. He had Uni for breakfast at 6am. Now that is hard core.

On the subway in Tokyo

Sent from my iPhone

Breakfast of champions!

Sent from my iPhoneYes, I ate that yellow crap oozing out. Thank goodness for chewing gum to get the taste out of my mouth.

Sent from my iPhoneHomemade bacon in Tokyo

Asia trip

Sent from my iPhoneJust touched down in Japan. After an 11 hour plane ride, now an hour train ride.

Over 40

So I have now scrubbed over 40 surgeries. I have experienced Ortho, Vascular, Neuro, Genitourinary, OBGYN and General specialties. The last couple of days I have experienced some long stressful surgeries where the surgeon was stressed and I could do few things to please them. This is good experience. I have to keep calm, keep my emotions in check and just do my job the best I can. My job is to remain calm when the tension gets thick. Everybody in the room has the patients best interest as their #1 priority and that is all that matters.

Yesterday was also my first total knee which was a great experience. I knew it would be rough with all the power tools and hammers etc... but it was a lot rougher than I thought. I was retracting the tibia with the entire weight of my body. It only took 1 hour to replace a person's knee. I am amazed that the person will walk within 12 hours of that. But they did. Oh, and the patient was awake and talking during surgery with just a spinal. After we took down the drapes I made eye contact with the patient and smiled through my bunny suite mask covered in all kinds of splatter. That may be a little disturbing to the patient today???

John Now Posting

Look Out.
John is now posting to the Blog. He is going to be traveling on business to Asia next week for 9 days. Tokyo, Hong Kong, and Taiwan. He is going to use the blog to keep in touch with all of us. The posts will say posted by Casie, but you ll be able to tell. For example I wouldn't post a cheesy pic of myself at Depot Bay.

Thank you for helping me pray for him to have a safe and successful trip.
Casie

Casie at Depoe Bay

Sent from my iPhone

Gracious Gift

So my mom surprised me by sending me a new laptop. I really needed one since leaving my job left me without one, but I never imagined she would send me such an amazing gift. I have used it in my clinicals everyday and I am so thankful. I don't know how to thank her enough. I have the best mom in the world. !!

Fall

One of the reasons I still live in Oregon.

Brain!

Scrubbed my first crainotomy. Subdural Hematoma. Saw my first brain. Looked like ... brain. To see it pulsating was pretty cool. Worth staying 2 hours late for. Going to be tired tomorrow, I mean today. It was demanding and fast pace, but I loved every minute of it.

Oh and the day before I solo scrubbed a case that was a inguinal hernia in which the patient vomited feces all over the O.R. because of the obstruction. Of all the things I have seen, that was the grossest. ;)

Goodnite!