A year at U of R

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Sunday, January 28, 2007

Snow Nurse

After the ice storm, is started to snow. It has been snowing gently, a few inches every day, for the last week. Enough snow accumulated to build a snow man ... or rather a snow nurse.

Ice Storm

Winter didn't begin until the middle of January. It started with an ice storm. This wasn't much of a storm ... it was more like a freezing drizzle than solidified on contact with the ground. It was very beautiful, seeing all of the trees encased in glass. Here are some photos of the ice.

Gastric bypass reversal

Regarding my latest posting on gastric bypasses, I'll add that I've also seen clients with gastric bypass reversals. Gastric bypass isn't an easy procedure, and there are lifelong consequences in terms of diet, digestion and nutrition. Some clients, although they may lose weight, can't tolerate the side effects of the surgery. They end up having the procedure reversed.

Watching surgery

Watching surgeries is always fun. I feel guilty that I'm so fascinated with someone else's insides. I'm always interested seeing the layers of skin and viscera, and trying to identify different internal structures. Unlike the colored and labeled models we learned on, when I see the real thing, I can hardly tell a bladder from a bowel. Good thing I'm not the surgeon!

For one of the surgeries I observed, the anesthesiologist chose to use MAC anesthesia, or Monitored Anesthesia Care. The client was given the same drugs as are used for general anesthesia, to induce amnesia, sedation, and for pain relief. However they were given in tiny increments as needed during the procedure. By doing this, the patient was just over the boundary of sleep, but maintained respiration on their own. However the boundary between sleep and awake was rather slippery.

The client snored through most of the procedure, but every few minutes, the patient would rouse and open their eyes a little. Several times, the client woke up wincing, and clearly said, "Ouch, it hurts!" "Sorry, sorry," the surgeons said quickly, and the anesthesiologist gave another tiny bolus of fentanyl or propofol. In a few minutes, the client would resume snoring.

It was a little disturbing to me that while I could see the client's insides, and the client was awake and complaining that they could feel it too. I asked the anesthesiologist if it was normal for the patient to wake up. "The patient won't remember any of it," he assured me. "And they're not really in pain. They might just feel some pressure. If the client was really in pain, you'd know it. They would be yelling and jumping off the table."

I still had my doubts. We were taught that if someone winces and says they're in pain, you believe them. I asked him about each of the drugs, and when the client's memory would return. I think that the anesthesiologist was thrilled to have someone take an interest in his art. He explained each drug, and then confided, "If I was going to have anesthesia, I'd never have general. Epidural anesthesia has fewer risks, and you stay in control. I'd want to know what was going on!"

After the surgery, it took less than two minutes for the patient to wake up. The patient was still on the OR table, as the doctors quickly cleaned up and removed drapes. The client looked around, and said, "Is Judy there? I like her!" I walked into view, and smiled. What an honor! I had been with the client through the whole process, from the waiting room through the OR. I had spent a solid hour getting to know the patient and their family in the pre-op area, chatting about their jobs and the weather. The client trusted me.

"Did I say anything while I was asleep? I bet I snored," said the patient. For the first time ever as a student nurse, I lied.

Saturday, January 20, 2007

Gastric bypass

Gastric bypass and stomach stapling weren’t what first came to mind when I imagined my surgical rotation this spring. I’d imagined the rotation as a drama-filled TV miniseries filled with gunshot wounds, heart transplants, and trauma. However as I’ve learned from all of my previous rotations, the only thing that will surprise me is if I’m NOT surprised by what I learn. If gastric bypasses are one of the mainstays of the unit, I’ll make the most of it.

On my first clinical day of this rotation, I flipped through patients’ charts, familiarizing myself with the forms. I felt sadly voyeuristic as I searched curiously for how much the many gastric bypass patients weighed before surgery. I was amazed by the Body Mass Indexes of over 50 (normal is 18-25). I would have to weigh almost 300 lbs to have a BMI like that.

I tried to imagine myself at 5 feet tall, and 300 pounds. I can hardly carry a backpack that weighs 40 pounds. How would I even move if I was carrying an extra 200? I wouldn’t be jogging or biking century rides. Would I make it up the stairs to my apartment? My life would be radically different.

Part of me felt very self-righteous about NOT weighing 300 pounds. I go to the gym. I run every weekend. I don’t buy ice cream or eat Oreos. I’ve earned my weight! So why can’t these people just give up Oreos too? Think of the health care dollars it would save!

However obesity may be one of the only diseases where people point the finger at the patient. No one would blame cardiomyopathy on the heart transplant patient. But society blames obesity on the victim.

I dropped the charts back in the rack, and followed the nurse I was shadowing into the patient’s room. The patient smiled cheerfully at us from her bed, and asked us how our day was going. She was delighted to learn that I was a nursing student. Her husband sitting nearby peppered me with interested questions. The two of them held hands, and bantered with the nurse. The couple radiated warmth and good humor. They were much more concerned about making the nurses’ job easier than in their own needs and care.

I left the room smiling, imagining the patient in a few years. Maybe the couple will be running down a beach or biking down a trail together, and doing the things I take for granted. Maybe they’ll be sunbathing in Hawaii! I imagined how much their lives will improve.

A gastric bypass seemed much less like a mark of someone’s failure, and more like an opportunity for them to regain a lost life. Maybe a gastric bypass is more like a heart transplant than I had imagined.