The Med Student Chronicles: Daylight savings time is not my friend

As a urologist, kidney's are part of my field. In fact, as I write this post I am sitting in the library waiting for a transplant to get started (the transplant surgeons do the artery and vein, and this particular patient has complex urological anatomy so we do the ureter).

It takes me back to my surgery rotation of 3rd year of med school. I knew pretty early that surgery was something I wanted to go in to and I was pretty excited. I started off the rotation on the surgical oncology service, and it was pretty busy. Each morning you came in around 4:30AM, and we ended up being there till about 7/8 most nights. Exhausting.

By the time Friday rolled around you were ready for the weekend. Unfortunately our school wanted us to get a feel for what a surgery residency was like, so they mandated weekend call. I had the luck of being the first one to take a weekend call, so that weekend I started Saturday at 5:30am,and was on till about Sunday at noon or so. I was honestly dreading it, but it is what it is and was hopeful I'd see some interesting trauma's or cases.

The day went by pretty smoothly, a few small trauma's but nothing to exciting. Around 8pm we headed down to the residents lounge and started watching some basketball. Around 9, the transplant resident who was on call rolls in and lets the team know they have a kidney coming in, and then looks at me and asks if I want to scrub in. Normally the residents let the medical students go sleep a bit around 10/11 unless any traumas came in, but this was a once in a lifetime chance! I was SO excited, and said of course I would like to scrub and help. I'd seen some pretty cool cases on the surgical oncology service, but a kidney transplant trumps all that. To take an organ and transplant it into someone else...crazy.

Anyways it takes about two hours for the kidney and the patient to make it into the OR, and by the time we finally make incision its about 11:30 on saturday night, already 18 hours into my shift with another 12 to go. Didn't matter, I was pumped, ready to go. Gonna watch a kidney transplant!

Everything starts off great. Nice big incision. As a brief aside, the reason as a medical student you always think about the incision is because really that's the only thing you get to do. In the days of laparoscopy with only a few small incisions, there aren't many opportunities for med students to practice closing. Thus we always look forward to big incisions. But anyways back to the case.

The attending and resident dissect down through the subcutaneous tissue, down to the bladder.  This is what it looked like at that point:

I had a pretty good view of what was going on, and had a hand on a retractor. Life is good.

Suddenly it all changed. See a kidney transplant essentially boils down to three major steps. Hook up the artery, hook up the vein, and hook up the ureter. The tricky part about kidney transplants is that sometimes you are working deep in the pelvis, and its tough to see and get an angle that deep in a patient's body. To compensate, the surgeon's turn their body and angle themselves to look down.

This is what it looked like

Literally all I could see was the residents back. He had a hairy back, with tufts of hair poking out above his scrub top.

I repositioned, and if I stood on the tip of my toes and totally angled my body and leaned over the table I could catch a glimpse of what was happening!

Ohhhh but it hurt my back so much. That lasted about five minutes, and I repositioned and once again could only see my residents back.

I start to nod off. The thing with being scrubbed is you have to keep your hands above your waist at all times, and there it nothing to lean on. It's really awkward, and by this time its 1:30 in the morning and I've been up for 20 hours. I needed to distract myself to stay awake.

I started counting my resident's back hairs. It seemed like an impossible task, but I was determined to get a number. That worked for about 15 minutes, but then the counting made me sleepy. 

Its 1:45 in the morning. When will this night end???

I start to think I could have been in bed right now. There is literally nowhere else in the world I'd rather be. If this was torture I would have broken a long time ago. 

Look back at the clock. Its 1:55. Time seems to have stopped. This needs to end. I hear someone mention bleeding, but at this point I'm in a delirious in between state with no concept of words.

I can't stop staring at the clock. 

1:59

I watch the seconds hand turn the corner, past the thirty. I can't believe its almost two in the morning, and I could have been in a nice bed. I wish I could see something, anything. The second hand turns, turns, and bam it's 2:00 

The clock stops. The minutes hand starts rolling backwards. 

What is happening? I rack my brain looking for an answer. I'm sure in my sleep addled mindset I'm hallucinating. Throughout all this, the minutes hand keeps rolling backwards, and then all of a sudden stops.

The clock shows 1:00.

It just doesn't make sense. It was just 2! How could it be 1? And then it hits me.

Its daylight savings time. That beautiful time of year, where the whole nation rejoices in a free hour of sleep. Well let me tell you my friends, nothing is free. That night daylight savings time equaled an extra hour of call, an extra hour of torture. 

And to top it off, at the end of the case when it was time to close? The attending says "Its been a long night, why don't you just use staples instead of suturing and be done with it"