On skin and general anesthesia

Thanks for all the kind words and well wishes for Myriam. She is doing much better - her pain is well controlled and she is off for a week of rehabilitation therapy at a fancy facility and then home! All is well.

A comment on my rotations - Last week I completed a two week rotation on dermatology. It is commonly referred to as "Derma-holiday" due to the short hours and supposed easy-ness of the rotation. Unfortunately, that was not my experience. Pain is watching some resident do skin exams over and over and over for 10 hours. I experienced the phenomenon of negative learning in which I turned my brain off, became a zombie and forgot things that I used to know. Fortunately for me, that experience is over, I passed the test for that rotation, and I never have to do it again. Yippee. Also, some of you members of the masses are a little nuts in the way you compulsively check your skin and come to the dermatologist demanding that every little mole and skin tag and pimple be evaluated and removed. Not that it's not good to keep tabs on your moles - just do it in moderation. And wear sunscreen.

Now I am on anesthesia. I have had to do loads of scary things that make me instantaneously break out in cold sweats. One for instance is starting IVs - the last time I attempted to start an IV was the very first week of my M3 year on a classmate - she cried. It was traumatic. Today, I tried to start an IV on a patient (thankfully under general anesthesia) five times. The last two were successful. My resident let me take home many an IV catheter and all IV starting supplies and my beloved husband has volunteered to be my human pin cushion when he returns home. That's love people. I also intubated someone the other day. Here is what I did - you take the laryngoscope (the L-shaped device) in your left hand and insert the blade into the mouth and pull the tongue and everything anteriorly as so:


Then you are able to visualize the larynx - see the vocal cords:


The intubation tube is then placed down between the vocal cords and into the lungs.




It actually takes quite a bit of muscle to visualize someone's cords. Especially if they have chubby cheeks, a short neck and a big tongue.