Funny moments in clinical clerkships

Since I posted the falling asleep at surgery, I figured I should follow-up with some of my other less exciting but just as hilarious faux-pas'. Where to start? How about insertion of foley catheters? A simple technique to be sure (especially in a male, but a bit more challenging in a female). I had watched at least 3 foley insertions into females when my opportunity arose. I grabbed the foley kit, placed it on the bed of the patient confidently, and then noticed that there were some instructions printed on the kit itself. Pausing for a bit, I started reading the instructions and that's when the patient asked, "Have you done this before?" in a worried tone. I answered truthfully, "Well, I've seen many done." "Oh - I'd prefer someone who's done this before, if you don't mind." The next time, I simply grabbed that kit, plopped it down, and ripped it open like it was my umpteenth time doing foley insertions. Alas, I failed to place it into the urethra correctly the first....second...and third time. However, I felt much better when the nurse failed, then the intern failed, then the floor "Foley specialist nurse" failed and we were on the brink of calling urology when finally the proclaimed Foley specialist was able to get urine out.
Lesson learned: Do not read the instructions on packaging in front of patients.

Another time, I was accompanying an elderly lady who had just "bounced back" into the hospital for possible small bowel obstruction due to her advanced ovarian cancer. The attending had just previously finished speaking with her daughters that the condition was such that surgical intervention was probably more harm than benefit so it was essentially palliative care only at this point. I was to escort the lady to get a CT scan to confirm the diagnosis and evaluate for other possible metastases. There were several other CT cases ahead of us so we have to wait in the holding area. Trying to pass the time, I attempted some light hearted conversation. I noticed they had placed some magazines in the waiting room, and I thought it was incredibly silly. Almost all the patients here in the holding area are lying in bed. So I mentioned this as a point of humor: "Look, they even tried to decorate this room like a regular waiting room. Are you interested in 'Country Cooking'?" Right after I asked, I realized how callous a question it was. The lady had been vomiting for the past few days and couldn't keep anything down due to the presumed obstruction and was probably still starving/feeling hungry. The woman smiled softly,however, and said, "No, thanks." Trying to salvage myself a bit, I eyed the magazine and asked, "How about 'Living'?" to which at first the lady said, "N-..well, yes, I am interested in that." I was horrified at what I had just asked. The magazine was "Living with Martha Stewart" but the "Living" part was the largest part of the title - the only part that I was able to read clearly from across the room. Not knowing what else to say, and fearful my mouth would only sink me into deeper depths of embarrassment, I shut up.

Those were the funny moments. How about the more recent humiliating moments? Like the time my attending asked me about Ranson's criteria. I had no idea, and was told to read up on it. That night (it my was 3rd day in surgery rotation), I visited my lab first where I fixed a few things before returning home. I then started reading the textbook and that promptly put me asleep. So, in the morning I had not yet read about Ranson's criteria for acute pancreatitis. I found out, however, that my scheduled surgery with the attending won't happen until 1:00pm meaning I should be able to find 5 minutes in lunch to quickly commit to memory Ranson's criteria. Saved - or so I thought, until the attending strode in at 7:00am. Opps - I forgot he was going to do morning rounds with us. The moment I saw him, I knew I was doomed. "Dr. Bien - what are Ranson's criteria?"
"Umm, uh uh...I don't know."
"You don't know?", incredulously, the attending asked.
"I didn't get a chance to go over that, yet"
"Let's see what your schedule last night was. You were finished around 7:00pm, and then you went home-"
"Actually, I went to lab and didn't leave until 10pm"
"Ok, then you ate for one hour until 11-"
"Well, I finished eating at 10:30 and then cracked open a textbook, then fell asleep," I said in a vain effort to save myself.
The attending didn't buy it for one moment. They had just paged someone, so he then said - "Let's round. Harold - since you didn't learn Ranson's criteria, stay by the phone and answer it when the doctor calls back and read about Ranson's criteria"
There I was, shamefully sitting in what in essence was the corner of a classroom wearing what might as well would've been a dunce cap, trying to read up on Ranson's criteria. Not the best way to impress the attending (who was also my preceptor, and thus who would have a profound influence on my grade). But on the upside - I finally did learn about Ranson's criteria!

I fell asleep during surgery..and survived!

I knew it was bound to happen sooner or later. I often find myself dozing off at inappropriate times without much control on my part. For example, during lecture with our chair of surgery while I'm on the surgery rotation - I fell asleep right in front of him. With an attendance of just 4 students, it's probably impossible to miss noticing the one student who's head keeps jerking forward and backward. But I digress - I had feared, prior to entering 3rd year clinical clerkships, that I would fall asleep especially during surgery with the long hours and early mornings.
Well, it finally happened today. I was at a simple partial mastectomy (aka lumpectomy) with sentinel node biopsy. For some unknown reason, I got incredibly sleepy halfway into the procedure. Trying to keep awake, I grabbed the vacuum and attempted to "suction the smoke" from the electrocautery. Instead, I started to drift off. I usually caught myself drifting off in time to wake back up and prevent anything bad from happening, but this time - I fell completely asleep at least once where my eyes closed and I actually started to fall in towards the patient. Luckily, I woke up and arrested my descent and the attending did not notice (or at least didn't say anything). So, I calmly placed the vacuum aspirator back onto the operating table and then tried valiantly to stay awake. I fell asleep once more, nearly completely, and thank god the surgery was over. Lessons learned:
1) Falling alseep in surgery is not the end of the world
2) Make sure you eat something before embarking on a long day of surgeries