Monday, June 18, 2012
4 versus 6 years
There are basically two main pathways to becoming an oral and maxillofacial surgeon: a 4-year program and a 6-year program. The difference is that the 6-year program is a dual degree program. This means that 2 years of the residency are spent in 2 years of medical school in order to earn the MD. Usually the years in med school are years #3 and 4 or years #2 and 3. These years in MD school are completed in the first half of the 6 years. The 6-year program residents also take the USMLE national medical boards to become fully licensed Medical Doctor. Both 4-year and 6-year programs earn a certificate in oral and maxillofacial surgery. The medical degree is peripheral to our training. And when I say that, I mean the MD is not needed to become a very competent OMS. The MD is a good education but adds very little to the specific training of OMS. It does, however, add a nice safety net for two big reasons: 1) if you can't practice OMS in the future due to injury, you can do something in medicine that only requires a sharp mind: radiology, medicine, etc. and 2) turf wars: if for some reason you find yourself battling for privileges to do certain procedures that some people may think a DDS/DMD OMS cannot perform, you can show that you have an MD and this might open a few doors for you. (might) The truth is most MDs will always see you as dentist even if you have an MD. Which in my book is perfect because I want to be an OMS, a specialty in dentistry. The MD allows me to play the card as it serves me best.
The medical education in med school has allowed me to see what MDs go through in order to become a physician or surgeon. It is a good education which can be very rigorous at times. The USMLE is no joke (I will discuss this topic later). But as much as I learn in med school, I still believe it is not necessary to become an oral surgeon. During the rough rigorous times, I ask myself, "Is this really what I wanted? For example, do I need to learn about OB/GYN in detail? Do I need to sit in class for a whole year learning basic sciences again in order to become an OMS?" Answer-No I don't need to. But it adds to my education and may play a role in my future privileges at a large-city hospital.
It would have been nice to not take a break from dentistry and OMS for those 2 years and kept the momentum going in the field of dentistry going from dental school to OMS. Now I am interrupting this momentum and moving into medicine. I feel I am not as sharp as I would like to be on the things pertaining to dentistry/OMS as I might have been if I attended a 4-year program which has smaller breaks and all training is applicable to OMS.
Deciding to do a 4-year or a 6-year was a big decision. They call it the million-dollar decision because it is possible to make $1,000,000 with two more years of practice instead of the MD education. I took the decision seriously and I chose the 6-year route. Sometimes I question it in times of struggle in med school, but when it really comes down to it, I believe I made the right choice for me. I may go back and forth a little and question it, but I truly think this is normal, natural and healthy. I believe I am not the first 6-year OMS to question my decision. But even when I question it and pause to really contemplate it, I still come back to the same decision that the OMS/MD route was best for me.
For those interested in OMS and deciding between 4 and 6, I recommend evaluating yourself and seeing if you really desire the MD. If you love education and want the MD, then go for it. But if you are not fully desiring it or you are doing it for the wrong reason, then it might be more hassle than it is worth to you and you will end up hating the time spent there. I truly love education and learning even though it can be painful at times. I am excited to apply my knowledge and show what I know and what I can do as I get further along in my program.
Even though the MD is not needed to become an OMS, I appreciate the education and I would choose it again.
The medical education in med school has allowed me to see what MDs go through in order to become a physician or surgeon. It is a good education which can be very rigorous at times. The USMLE is no joke (I will discuss this topic later). But as much as I learn in med school, I still believe it is not necessary to become an oral surgeon. During the rough rigorous times, I ask myself, "Is this really what I wanted? For example, do I need to learn about OB/GYN in detail? Do I need to sit in class for a whole year learning basic sciences again in order to become an OMS?" Answer-No I don't need to. But it adds to my education and may play a role in my future privileges at a large-city hospital.
It would have been nice to not take a break from dentistry and OMS for those 2 years and kept the momentum going in the field of dentistry going from dental school to OMS. Now I am interrupting this momentum and moving into medicine. I feel I am not as sharp as I would like to be on the things pertaining to dentistry/OMS as I might have been if I attended a 4-year program which has smaller breaks and all training is applicable to OMS.
Deciding to do a 4-year or a 6-year was a big decision. They call it the million-dollar decision because it is possible to make $1,000,000 with two more years of practice instead of the MD education. I took the decision seriously and I chose the 6-year route. Sometimes I question it in times of struggle in med school, but when it really comes down to it, I believe I made the right choice for me. I may go back and forth a little and question it, but I truly think this is normal, natural and healthy. I believe I am not the first 6-year OMS to question my decision. But even when I question it and pause to really contemplate it, I still come back to the same decision that the OMS/MD route was best for me.
For those interested in OMS and deciding between 4 and 6, I recommend evaluating yourself and seeing if you really desire the MD. If you love education and want the MD, then go for it. But if you are not fully desiring it or you are doing it for the wrong reason, then it might be more hassle than it is worth to you and you will end up hating the time spent there. I truly love education and learning even though it can be painful at times. I am excited to apply my knowledge and show what I know and what I can do as I get further along in my program.
Even though the MD is not needed to become an OMS, I appreciate the education and I would choose it again.
Sunday, September 4, 2011
Medicine and Dentistry
A lot of people ask what the difference is between a medical student and a dental student. Here is what I can gather: there is little to no difference. The difference is in the field of study. There are a lot of traits they have in common.
Here are some Similarities found in the students of medicine and dentistry:
Brilliance and ability are equal in both classes.
Both classes have big time gunners.
The gunners are very competitive.
Once the students get into medical or dental school, there is a myriad of resources to help them succeed.
If school classes are not required, most students will not go to class and then study on their own.
Students like to make fun of the other class. This is usually harmless and usually comes from people who have never worked with the other field i.e. students and residents. In practice, there is a very cordial, respectful, working relationship.
Here are some Differences in the fields of medicine and dentistry:
Medicine likes to ponder the process of diseases, make a list of differential diagnoses, then treat the patient, usually with medicine which can take some time.
Dentistry likes to diagnose and correct the disease, usually quickly with surgery.
Dentists know enough medicine to know the dental implications.
Physicians know enough dentistry to know the medical implications.
My experience in medical school is quite different from dental school and from the experience of the other med students. The major cause of this is the fact that I do not have to compete against my classmates in order to out rank them and get into my residency. I am glad I do not have to do that. It is very nice to be able to learn for the sake of learning. It is awesome. In fact, I study a whole lot less. The funny thing is that my grades have not changed that much. But that little difference on every test over the course of the year is the how a student gets ahead of the class and into the resident of their choice. I am glad I am already into my residency of choice. I have already taken the classes back in dental school so it is a review for me. And on top of that I have had lots of patient interaction. That is why medical school during OMS residency is a "vacation".
Oral & maxillofacial surgeons have a foot in both fields. I love that an OMS can do the dentoalveolar surgeries like tooth extractions, implants and wisdom teeth along with surgeries like facial cosmetics, trauma, head and neck cancer, and cleft left and palate and more. Many doctors may get upset that we can do so much, but I don't need to apologize for the scope of OMS being broad and full of good surgeries.
Here are some Similarities found in the students of medicine and dentistry:
Brilliance and ability are equal in both classes.
Both classes have big time gunners.
The gunners are very competitive.
Once the students get into medical or dental school, there is a myriad of resources to help them succeed.
If school classes are not required, most students will not go to class and then study on their own.
Students like to make fun of the other class. This is usually harmless and usually comes from people who have never worked with the other field i.e. students and residents. In practice, there is a very cordial, respectful, working relationship.
Here are some Differences in the fields of medicine and dentistry:
Medicine likes to ponder the process of diseases, make a list of differential diagnoses, then treat the patient, usually with medicine which can take some time.
Dentistry likes to diagnose and correct the disease, usually quickly with surgery.
Dentists know enough medicine to know the dental implications.
Physicians know enough dentistry to know the medical implications.
My experience in medical school is quite different from dental school and from the experience of the other med students. The major cause of this is the fact that I do not have to compete against my classmates in order to out rank them and get into my residency. I am glad I do not have to do that. It is very nice to be able to learn for the sake of learning. It is awesome. In fact, I study a whole lot less. The funny thing is that my grades have not changed that much. But that little difference on every test over the course of the year is the how a student gets ahead of the class and into the resident of their choice. I am glad I am already into my residency of choice. I have already taken the classes back in dental school so it is a review for me. And on top of that I have had lots of patient interaction. That is why medical school during OMS residency is a "vacation".
Oral & maxillofacial surgeons have a foot in both fields. I love that an OMS can do the dentoalveolar surgeries like tooth extractions, implants and wisdom teeth along with surgeries like facial cosmetics, trauma, head and neck cancer, and cleft left and palate and more. Many doctors may get upset that we can do so much, but I don't need to apologize for the scope of OMS being broad and full of good surgeries.
Sunday, August 21, 2011
Medical Pimping
Pimping can be an awesome learning experience or a horribly humiliating experience. There is a fine line between the two.
Pimping is when an upper level resident, attending, or other faculty member asks you questions about a topic, any topic. These questions start out simple and basic and rapidly accelerate into the deep details of a very specific topic. It can be about anything. It can start anywhere and end anywhere. The purpose is two fold. The first part is to teach the student or show where the student should focus his/her studies because of lack of knowledge. Second, is to be Put In My Place.
Another, more gentle, name for it is the Socratic Method.
Example: When you admit a patient to the hospital, they have other medical issues and they become your responsibility. So you need to know them even though not directly related to OMS. So you present your patient to the attending, then they start firing away. What is the most common type of mandibular fracture outside of the United States? What are surgical approaches you would use to gain access? What are possible complications of different approaches? What is Frey Syndrome and how can you treat it? What is the DOC for pinworms?
Pimping is usually done at conference, case discussions and morning rounds on patients with all of the attendings and residents present. This can be very stressful because you are singled out one at a time and you are on your own. If done correctly, pimping can be constructive and reinforce what you know and even teach you. This type of pimping is usually more gentle, constructive, and purposeful. On the other end of the spectrum is the more traditional, surgical style of pimping. It can be malicious. If so, it is usually meant to humiliate and publically embarrass the student. Some attending surgeons seem to do it for sport to show that they know a lot and some do it just to belittle another student. I like to believe that the majority of attendings do it to teach. Even if it comes across in a harsh manner. The bad part about these pimp sessions is that eventually the attending will get to the edge of your knowledge and you will not know the answer. This happens every time. So you are exposed every time. This can mess with someone's mind when they have been labeled the "bright and intelligent one" their entire life.
So through these pimping sessions I have been humbled to dirt. I have had to learn to be ok with not knowing the right answer. I have also learned to NOT say "I don't know" if I am not 100% sure of the answer. I should give my best educated answer. This will help me not look like a fool. I want to impress others, but there is a huge difference between 1st year OMS residents and the Seniors/Chief residents and then there is another big jump to attending surgeons. The learning curve is incredibly steep in every year of residency, part of it is due to the pimp sessions. So it is a love/hate relationship with these sessions.
My goal is to gain a large base of knowledge while in my 1st year and build upon it. I need to do more reading from the OMS textbooks and truly grasp it. I need to attend the conferences and journal clubs. I need to review head and neck anatomy. I need to learn medicine. I need to practice OMS procedures. There is a lot to do.
As far as pimping goes, my long term goal is to be an attending surgeon and use pimping successfully as a teaching tool in a humanistic way.
Pimping is when an upper level resident, attending, or other faculty member asks you questions about a topic, any topic. These questions start out simple and basic and rapidly accelerate into the deep details of a very specific topic. It can be about anything. It can start anywhere and end anywhere. The purpose is two fold. The first part is to teach the student or show where the student should focus his/her studies because of lack of knowledge. Second, is to be Put In My Place.
Another, more gentle, name for it is the Socratic Method.
Example: When you admit a patient to the hospital, they have other medical issues and they become your responsibility. So you need to know them even though not directly related to OMS. So you present your patient to the attending, then they start firing away. What is the most common type of mandibular fracture outside of the United States? What are surgical approaches you would use to gain access? What are possible complications of different approaches? What is Frey Syndrome and how can you treat it? What is the DOC for pinworms?
Pimping is usually done at conference, case discussions and morning rounds on patients with all of the attendings and residents present. This can be very stressful because you are singled out one at a time and you are on your own. If done correctly, pimping can be constructive and reinforce what you know and even teach you. This type of pimping is usually more gentle, constructive, and purposeful. On the other end of the spectrum is the more traditional, surgical style of pimping. It can be malicious. If so, it is usually meant to humiliate and publically embarrass the student. Some attending surgeons seem to do it for sport to show that they know a lot and some do it just to belittle another student. I like to believe that the majority of attendings do it to teach. Even if it comes across in a harsh manner. The bad part about these pimp sessions is that eventually the attending will get to the edge of your knowledge and you will not know the answer. This happens every time. So you are exposed every time. This can mess with someone's mind when they have been labeled the "bright and intelligent one" their entire life.
So through these pimping sessions I have been humbled to dirt. I have had to learn to be ok with not knowing the right answer. I have also learned to NOT say "I don't know" if I am not 100% sure of the answer. I should give my best educated answer. This will help me not look like a fool. I want to impress others, but there is a huge difference between 1st year OMS residents and the Seniors/Chief residents and then there is another big jump to attending surgeons. The learning curve is incredibly steep in every year of residency, part of it is due to the pimp sessions. So it is a love/hate relationship with these sessions.
My goal is to gain a large base of knowledge while in my 1st year and build upon it. I need to do more reading from the OMS textbooks and truly grasp it. I need to attend the conferences and journal clubs. I need to review head and neck anatomy. I need to learn medicine. I need to practice OMS procedures. There is a lot to do.
As far as pimping goes, my long term goal is to be an attending surgeon and use pimping successfully as a teaching tool in a humanistic way.
Friday, August 12, 2011
1st Finals Week: Finding Balance
I finished the first module of 2nd year of MD school. It was the general concepts of pathology and pharmacology. We also had a practical physical exam and a practical for taking a medical history with standardized patients. Standardized patients are volunteers who spend an afternoon in a gown in a small exam room. Then the students rotate one at a time and perform a memorized portion of the head to toe physical exam or take a medical history of the actor patient.
The Physical Exam Practical is to help students ease into the hospital rotations next year. The med students learned the exams in 1st year. So the OMS residents had to catch up in this area. They gave us a 2 hour rundown of what the others learned over the course of a year. The instructor told us that all we have to do is go through the motions of the physical exam. We did not have to record any findings. The only recording we had to do was the medical history portion of the exam. The other med students advised us that all they do is pretend like they know what they are doing and they get good scores. A sort of "fake it till you make it" philosophy. The instructor also gave us the same advice, followed with the statement that we would be learning each of the physical examinations more in depth this year before we head to the hospital rotations. So we memorized the script and motions of each of the portions of the physical exams. The head and neck exam was straight forward having done many of those in dental school. But the script states we must say, "I am inspecting the skin of your head and neck" and "I am inspecting your outer ear" as we go through the motions. It was a little awkward but the patients know that it is part of the script. It was fun. One advantage we did have during this exam was that the OMS residents have had years of patient interaction so talking with the patient, helping them feel comfortable, taking the medical history, asking them personal and potentially awkward questions was quite easy. We did not, however, have experience palpating the lymph nodes and pulses in the groin on male or female patients. Or how to palpate the and listen for sounds of the heart on a bare chested female. We had to learn how to gown and drape patients so they did not feel awkward, especially the females. My only hope was that the upper body examination was a male during the test. Most volunteers were males and retired. Males help the timed exam go faster since there is no need to gown and it is less awkward. Well, nope, no such luck, I walked into the room to find a cute, athletically fit, 21 year old Latina. Big difference from the usual retired male.
The practicals were pass/fail and everybody passed. No biggie.
The first written exams were pretty stressful. I did not know what to expect because I wasn't here last year like the rest of the med class. The first couple of weeks of the module, I came home at noon every day, but the last week and a half I studied pretty hard where I stayed at school until midnight. The week prior to the exam there was no school so all the students could study for the exam. It was a whole week off! Ridiculous amount of time to study. So the weekend before the Monday exam, I decided to go on vacation with my family. We went and visited some old friends. It was a nice break. So the last 3 days before the exam, I did not study. But I felt prepared enough to pass. That is the beauty of already being in my residency. I don't have to compete against others who are trying to get into dermatology or whatever else there is. There are some pretty smart kids in the class and some pretty competitive ones as well. I am done with those days. I am already here. I don't need an A in every class. So I didn't study as much. But the interesting thing was that I only scored a few points lower than I normally would have if I would have studied intensely like I did back in dental school. It takes a lot of energy and effort to gain a few points but that little bit is what makes all the difference. Crazy.
So I have come to the conclusion that all I need to do is study consistently every day after class until about 5pm. I can have all evenings and the entire weekend: Saturdays and Sundays to be with my family. I can study hard during the week and even more so during the week off prior to every final and do well on my exams. That is how I need to balance my days. I can spend time with my family and not study for too long and be successful at school and at home. I think balancing life is one of the biggest lessons I can learn during residency and it is getting more and more important to do while life is getting more and more complex. I think I am starting to learn how to do it.
Saturday, July 16, 2011
Confusion All Around Me
So one more week has passed! This is the start of medical school. My first year of residency is actually spent like this: I start off on OMS service (meaning I work in the clinic, surgical suites, operating room, and take my turn with being on call) I do this until the medical school starts. Then I am in medical school only and do not work in the OMS service until winter break. During winter break, I am back to the OMS clinic or wherever the chiefs want me. Usually the upper residents want a vacation during this time so that means the lower levels work over the holidays taking call at the hospital. At the end of the school year, I will take the USMLE step 1. That is part 1 of 3 of the medical boards. So that is how the first year of my residency is run at this program.
As an OMS resident, the medical school accepts my dental school education to cover the basic sciences that were done in the 1st year of medical school so they only require the 2nd and 3rd year of medical school to be completed and then they will count the rest of the OMS service of residency as 4th year of medical school and my intern year for medical licensing. Right now, I am just starting the medical school portion. So I am in year 2 of medical school (1st year of OMS residency)
I am in my dental residency which includes 2 years of medical school to get the MD training as well as my certificate in the specialty of OMS. Does this make sense? Because this does not make sense to most people I encounter at the medical school: medical students, staff, faculty, and admin. I try to explain it in as few words as possible but it is just difficult.
I get comments like, "So you are in dental school AND medical school?"
----No, I graduated from dental school, now I am a resident in oral and maxillofacial surgery.
"Wait, you are starting your residency and treating patients before finishing medical school? That is impossible. You are not allowed to do that."
----I know it sounds confusing; I am in a dental residency and going to medical school as part of the residency.
"No that is not allowed, you must be mistaken. Come back when you know your case better."
----It's ok, the medical school dean and I have spoken and the associate deans as well know about my situation now. Every year you have OMS residents do this. The dean sent me to you to take care of my registration, enrollment, financial aid, and schedule. They said you can call them with questions."
*Phone call made.
"My boss says to help you with what you want."
"So you are taking medical school classes so you can prescribe drugs...?"
----No, I can already do that. I already had the pharmacology and pathology.
"What is it that you do?"
----Right now, I am a medical student, when the school is off for breaks I do oral and maxillofacial surgery at the clinics and hospital.
"Oh so you do like chipped teeth, root canals and fillings."
----No we don't do that stuff. That is for general dentists and endodontists"
"...???..."
----Someone who specializes in root canals will do that. At the hospital, we treat traumatic patients with fractures of the orbital bones, midface and mandible. For soft tissue, we do any lacerations of the head and neck including ears, scalp, tongue, nose, lips, eyes, cheeks, chin... anything on the face, head and neck. We also do infections that have progressed into the fascial spaces that come from the teeth. But in our clinic we mostly do the scheduled stuff like wisdom teeth, dental implants, tooth extractions, orthognathics, cosmetic surgery and a lot of consults and follow-ups.
"Do you take call?"
----Yes.
"But not like a real doctor..."
----Hahaha...Yes like a real doctor.
So this is the conclusion that I have come to embrace: OMS is somewhere in between Dentistry and Medicine. I believe it has a foot in both realms and we can pick and choose when to play either card. When fully trained, an OMS can do cosmetic surgery like face lifts, skin peels, and augmentations of the lips, nose, chin, eyelids and cheeks. But an OMS can do more of the traditional dental treatments of extractions of teeth including wisdom teeth, benign pathology of the head and neck, and dental implants. The list of procedures that an OMS can do is long and is partly in medicine and partly in dentistry. Instead of narrowing down what I can do like most specialties, OMS opens me up to a bigger, wider spectrum of surgeries. It is wonderful.
While in residency I have 3 cards to play: med student, doctor, and resident. This allows me benefits from all three areas. For example, parking: I get resident parking at the hospital which is covered and way closer than the student parking which is uncovered. I am a doctor when I walk into a private hospital and doctors eat for free! Private hospitals have great food and I can eat as much as I want. Medical students get great discounts on books, organizations, and they even get a free membership to an awesome gym which is open all of the time at any hour and has everything a gym could offer.
So in the end, hardly anyone knows what I do. This allows me to do as I please.
As an OMS resident, the medical school accepts my dental school education to cover the basic sciences that were done in the 1st year of medical school so they only require the 2nd and 3rd year of medical school to be completed and then they will count the rest of the OMS service of residency as 4th year of medical school and my intern year for medical licensing. Right now, I am just starting the medical school portion. So I am in year 2 of medical school (1st year of OMS residency)
I am in my dental residency which includes 2 years of medical school to get the MD training as well as my certificate in the specialty of OMS. Does this make sense? Because this does not make sense to most people I encounter at the medical school: medical students, staff, faculty, and admin. I try to explain it in as few words as possible but it is just difficult.
I get comments like, "So you are in dental school AND medical school?"
----No, I graduated from dental school, now I am a resident in oral and maxillofacial surgery.
"Wait, you are starting your residency and treating patients before finishing medical school? That is impossible. You are not allowed to do that."
----I know it sounds confusing; I am in a dental residency and going to medical school as part of the residency.
"No that is not allowed, you must be mistaken. Come back when you know your case better."
----It's ok, the medical school dean and I have spoken and the associate deans as well know about my situation now. Every year you have OMS residents do this. The dean sent me to you to take care of my registration, enrollment, financial aid, and schedule. They said you can call them with questions."
*Phone call made.
"My boss says to help you with what you want."
"So you are taking medical school classes so you can prescribe drugs...?"
----No, I can already do that. I already had the pharmacology and pathology.
"What is it that you do?"
----Right now, I am a medical student, when the school is off for breaks I do oral and maxillofacial surgery at the clinics and hospital.
"Oh so you do like chipped teeth, root canals and fillings."
----No we don't do that stuff. That is for general dentists and endodontists"
"...???..."
----Someone who specializes in root canals will do that. At the hospital, we treat traumatic patients with fractures of the orbital bones, midface and mandible. For soft tissue, we do any lacerations of the head and neck including ears, scalp, tongue, nose, lips, eyes, cheeks, chin... anything on the face, head and neck. We also do infections that have progressed into the fascial spaces that come from the teeth. But in our clinic we mostly do the scheduled stuff like wisdom teeth, dental implants, tooth extractions, orthognathics, cosmetic surgery and a lot of consults and follow-ups.
"Do you take call?"
----Yes.
"But not like a real doctor..."
----Hahaha...Yes like a real doctor.
So this is the conclusion that I have come to embrace: OMS is somewhere in between Dentistry and Medicine. I believe it has a foot in both realms and we can pick and choose when to play either card. When fully trained, an OMS can do cosmetic surgery like face lifts, skin peels, and augmentations of the lips, nose, chin, eyelids and cheeks. But an OMS can do more of the traditional dental treatments of extractions of teeth including wisdom teeth, benign pathology of the head and neck, and dental implants. The list of procedures that an OMS can do is long and is partly in medicine and partly in dentistry. Instead of narrowing down what I can do like most specialties, OMS opens me up to a bigger, wider spectrum of surgeries. It is wonderful.
While in residency I have 3 cards to play: med student, doctor, and resident. This allows me benefits from all three areas. For example, parking: I get resident parking at the hospital which is covered and way closer than the student parking which is uncovered. I am a doctor when I walk into a private hospital and doctors eat for free! Private hospitals have great food and I can eat as much as I want. Medical students get great discounts on books, organizations, and they even get a free membership to an awesome gym which is open all of the time at any hour and has everything a gym could offer.
So in the end, hardly anyone knows what I do. This allows me to do as I please.
Sunday, July 10, 2011
1st Week
A common sentiment around residencies in teaching hospitals is that you do not want to be injured in July because that is when all of the new docs are on call. Well, the day after the 4th of July I was on call for the first time. This was a bit stressful because people do not come into the hospital on the night of a big holiday, they finish partying and then come in the day after. So I was expecting a big day and honestly I had to say that I was nervous.
In preparation for my first on-call service on the Tuesday the 5th, I came in on Monday the 4th to shadow a more experienced resident. That morning, I rounded on patients that were on our service. I cleaned some facial wounds on a patient who had an accident and the face sustained some deep abrasions. The patient also had some deep lacerations. The lacs was sewn and now the patient was in the hospital trying to recover. To minimize the scarring the scabs would be scrubbed off with hydrogen peroxide and saline solution. This causes a lot of pain and so the patient would be given a dose or two of morphine just prior to starting the cleaning. This patient had to do this 2 times a day.
Another pt came in that day after falling and sustaining a laceration to the head. Her forehead was lacerated exposing the bone. The bones surrounding the eye were broken. The patient suffered an orbital floor blowout. This is when the muscle and other soft tissue surrounding the eye breaks through the bone and falls into the maxillary sinus instead of being in the eye socket. So ophthalmology was consulted on this case, as well, in order to assess her vision more closely. After I showered the gaping wound with saline solution and got rid of the rocks, dirt, pine needles and other debris I sutured together the deeper layers of the scalp and then closed it up. It was very fun to suture.
This was on the 4th of July. The 5th of July I was on call but luckily it was not facial trauma call. It was tooth call only. So no more facial lacs to sew up, just fascial space infections from rotten teeth. When teeth are broken down and get infected but do not get fixed with either a root canal treatment or extraction the infection can spread from the tooth and break through the bone and get into the head and neck spaces. This can be life threatening. Once the infection spreads to the face and neck, the treatment is to remove the source of infection (the tooth), incise and drain the pus, and then give the patient some strong antibiotics to help fight off the bacterial infection. Usually the patient has a huge swelling on one side of the face. Then you look inside their mouth to see if you can narrow down the source of the infection and I usually see multiple teeth that could potentially be the source. For examples see http://www.dental--health.com/
In preparation for my first on-call service on the Tuesday the 5th, I came in on Monday the 4th to shadow a more experienced resident. That morning, I rounded on patients that were on our service. I cleaned some facial wounds on a patient who had an accident and the face sustained some deep abrasions. The patient also had some deep lacerations. The lacs was sewn and now the patient was in the hospital trying to recover. To minimize the scarring the scabs would be scrubbed off with hydrogen peroxide and saline solution. This causes a lot of pain and so the patient would be given a dose or two of morphine just prior to starting the cleaning. This patient had to do this 2 times a day.
Another pt came in that day after falling and sustaining a laceration to the head. Her forehead was lacerated exposing the bone. The bones surrounding the eye were broken. The patient suffered an orbital floor blowout. This is when the muscle and other soft tissue surrounding the eye breaks through the bone and falls into the maxillary sinus instead of being in the eye socket. So ophthalmology was consulted on this case, as well, in order to assess her vision more closely. After I showered the gaping wound with saline solution and got rid of the rocks, dirt, pine needles and other debris I sutured together the deeper layers of the scalp and then closed it up. It was very fun to suture.
This was on the 4th of July. The 5th of July I was on call but luckily it was not facial trauma call. It was tooth call only. So no more facial lacs to sew up, just fascial space infections from rotten teeth. When teeth are broken down and get infected but do not get fixed with either a root canal treatment or extraction the infection can spread from the tooth and break through the bone and get into the head and neck spaces. This can be life threatening. Once the infection spreads to the face and neck, the treatment is to remove the source of infection (the tooth), incise and drain the pus, and then give the patient some strong antibiotics to help fight off the bacterial infection. Usually the patient has a huge swelling on one side of the face. Then you look inside their mouth to see if you can narrow down the source of the infection and I usually see multiple teeth that could potentially be the source. For examples see http://www.dental--health.com/
I do not know if this is the usual for all people in this area but for the patients that come into the emergency room this is pretty typical. So brush your teeth and see your dentist.
So far I feel I am a little lost in the hospital as I follow my upper residents. The patient I am watching over has a gun shot wound to the face. The bullet entered the cheek broke the mandible and now is lodged in the back of her head. The OMS team is in charge of correcting the mandible fractures. The patient is also pregnant and OB/GYN is over the fetus, neurosurgery is over the brain damages and the trauma team is the admitting service. That is how the hospital works: one service admits and is in charge of the patient while they consult other specialists to work on specific areas of the patients' charts.
Well, it is exhausting waking up around 4 or 5am and then getting home between 10 and 12pm. I am glad that I made it through the first week of OMS residency and I did no harm. I was even able to help a few people.
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