2006年 07月 15日 ( 2 )
インターン。その後のその後
現在我々の科をローテーションしているインターン。
以前も書きましたが、かなり問題になっています。
医学部卒業してすぐに心臓外科の病棟当直は、まあ大変ですが、もう学生ではないので甘やかす事もできません。このあたりは日本でも良くある話でしょう。

チーフフェローのA君は、多方面からインターンに対する不満を受けて、大変です。そういう問題をうまく解決するのもチーフフェローの仕事。
彼からメールが教授以下スタッフに回ってきました。彼の苦労がしのばれます。
一部抜粋します。

I have heard numerous complaints both from nurses, as well as from the other residents on our service, as well as from patients about the conduct - both personal and professional, about the two interns currently on our service. I have personally invested a significant amount of time and energy on both of them in an effort to understand what problems may be hindering them, and what we as a group can do to assist them. Although I was willing to ascribe inconsistencies and difficulty in taking direction earlier in the year to this being their first clinical rotation, I am getting increasingly frustrated and disappointed by their attitudes and their lackadaisical approach to their work. This has to stop now, and whatever you are capable of doing to get them to understand what the work ethic of a general surgical resident should be, would be greatly appreciated.

It is my expectation that the interns will assume fully the responsibility of taking care of cardiac surgical patients as though they were doctors taking care of their own patients, not as a "shift-worker." I am disturbed to hear several complaints (particularly this early in the academic year), not only by the nurses as well as by the fellow who was on last night that XXXX has failed to answer pages and has failed to attend to patients in need (one in particular who required transfer to the CCU). I was personally disappointed in his extraordinarily abrasive attitude when I brought to his attention several missing details in a heart transplant that he pre-op'd for the OR this morning. This relationship is clearly a 2 way street, and while I will go out of my way to protect general surgery residents coming through our service, I expect that they will act as responsible adults and doctors when asked to execute their duties. I think, as we discussed, that a healthy relationship between our services is critical not only for the residents from an educational standpoint, but for the specialty of cardiac surgery in general.
[PR]
by ctsurgeon | 2006-07-15 13:43
off pump CABG
今週は忙しくて疲れてしまいました。
毎日2例の手術。それもBeating heart CABG + mitral repair + Dor手術(医龍の最終回でしていた手術とほとんど一緒)や、David手術(大動脈弁温存基部置換手術)、コテコテの再手術など、ヘビーな症例ばかり。
どれも執刀できるから文句は言えないのだけど。

今日はバイパス手術が2例。
オフポンプバイパス手術で心臓の裏の血管(回旋枝)を縫い始めたとき。
それまで安定していた血圧が下がり始め、心臓も張ってきて、明らかに怪しい状態。
麻酔科の先生が「心臓のポジションを戻して休ませてあげたら」と言うものの、前立ちのアテンディングは「5分で終わるから辛抱して」と。
そういう時に限って視野は悪いし、だんだん心臓が弱ってくるのがわかるので、非常に焦った。そうすると、拡大鏡を通して見る視野がどんどん狭くなって行く。これには困った。
こういう時こそ、深呼吸して慎重に。。と自分に言い聞かせるのだけど、助手をしているアテンディングは焦って興奮してるし、平常心を保つのはなかなか大変でした。
案の定、吻合が終わった直後に心室細動(いわゆる心停止)、すぐ電気ショックでもどりました。間に合って良かった。。
焦って縫った割には吻合は上出来だったのが救い。
でもまだまだ修行が足らないことを実感しました。
[PR]
by ctsurgeon | 2006-07-15 13:06