Flexible Fiberoptic Bronchoscope

This past Monday we had a difficult airway lab where we practiced anesthetic scenarios with patients who have difficult airways. This means that for some reason it is hard to get the breathing tube in - maybe the patient has a really tiny mouth or a fat tongue or a tumor (or a knife!) in their throat. In this situation we can use a fiberoptic bronchoscope which has a camera on the end that allows us to see into the mouth/throat/trachea and then, once we are sure we are in the right place, we can slide the endotracheal (breathing) tube over the scope into the trachea. Unfortunately, this is easier said than done! The camera lens can get blocked by spit or blood and it requires a good bit of hand-eye coordination to maneuver it where you want it to go. The best way for us to get good at using it is to practice in non-emergency scenarios (like, before you realize that you just put someone to sleep and now you can't pass the tube into their trachea). In that first picture you can see me putting the scope in - I am passing it through the mannequin's nose (because sometimes putting it through a patient's mouth is not an option - what if their jaw is wired shut?) and if you look closely you can see the endotracheal tube loaded onto the scope. In the picture below you can see the screen where the view from the camera on the end of the bronchoscope is projected (don't worry, the picture is MUCH clearer in real life). I have gotten the scope where I want it and I am sliding the tube in over it.

Fall Party at the lake

We decided to have a little "welcome to fall" party at the lake. We provided the ammo, guns and champagne. Everyone else provided the food. Great day!

Shock Trauma Center

On October 1st I started my third clinical rotation! (recap: one, two) This month I am down in Baltimore at the Shock Trauma Center (STC) which is part of the University of Maryland Medical System.  This is a specialty rotation which I signed up for - we had to request this rotation because it is so far away, if I hadn't been selected I just wouldn't have gotten a trauma rotation.  To get there I take an Amtrak train from NYC to Baltimore and then I take a bus to the University of Maryland where I am staying in a dorm room that is within walking distance from the hospital.  The trip takes about 4 hours door-to-door which would be fine except for the fact that we are still expected to show up for class every Monday morning in NY - boo!  There are three other students at this clinical site with me, but none of them are from Columbia:

We work 12 hour shifts from 6:45-6:45.  This first two weeks I was on night shift and the next two weeks I will be on day shift (my body hates me right now).  STC is a free-standing hospital but we are connected to the University of Maryland Medical Center (UMMC) so, to differentiate STC staff from UMMC staff (and to discourage stealing of scrubs), the STC gives us pink scrubs to wear:

So far I've seen gun shot wounds, stabbings, car crashes, falls, sports injuries and patients who are already inpatients somewhere but then they have a medical emergency and need surgery immediately (like 2am on Saturday).  All in all it has made me very anxious about all of the ways that I can get hurt!  I don't have any cool work photos but I do have this photo of Eric and I at school last Monday learning how to do cricothyrotomies on pig tracheas:

A cricothyrotomy is a way we would secure an airway in an emergency when, for whatever reason, we are unable to intubate our patient.  Here is a picture of where you would do it on a real person:

This is what they are doing on TV shows when someone shoves a ballpoint pen in a choking person's neck - lets keep our fingers crossed that I never need to do one :)

27th Birthday

It officially happened last Monday!  I spent the weekend before visiting Chuck.  I took a bus up after clinical on Friday.  We spent Saturday tasting our way through a couple vineyards on the Connecticut Wine Trail - it was a fun way to spend the afternoon enjoying fall in CT but it was hard not to compare it to our vineyard trips out in CA (we were enjoying ourselves enough that I forgot to take a pic though)!  Sunday night Chuck drove me back to the city and we had a tasty dinner at a French restaurant in the East Village called Antibes.  On Monday I had class and I walked in to find that some of the other students had done a bit of decorating:

We get out of class around 2pm this semester so we headed out to a wine bar and then spent the afternoon geocaching in Central Park (previously explained in this post; I am now 100% addicted and I am enjoying addicting as many others along the way as possible).  Here is a pic of us after our last find (Eric found it!):

L to R: Adeel, Paige, Emily, Eric

This past Friday was my last day of clinicals at Cornell.  After I got out I met up with Kim who was one of my roommates out in LA., she was in town for a wedding this weekend.  After a few drinks with Kim I went over to Katherine and Sheldon's apartment for dinner.  In honor of my birthday they made spaghetti (the literally made it, they got a pasta maker as a wedding present) and a cake!

You will note that Katherine and Sheldon are wearing scrub pants that I brought them and you will also note that the birthday candle pickings were slim at Duane Reade and thus I have a 3 on the top of my cake - it still tasted amazing ;)