The Quiet

Disclaimer: The purpose of this site, PAges from Kasaundra, is simply for me (Kasaundra) to process my thoughts during my clinical year and to include you, my readers and supporters during this process. Everything posted on this site is my opinion and in no way reflects the entities of Kimaw Medical Center or Hoopa Valley Tribe. This statement applies to this post, all previous and all future blog posts.


In preparation for my move to Salyer, CA to work on the Hoopa Indian Reservation I asked several students about their experiences here. I am living with Dan and Sonja, who have kept all five students before me, and they are an incredible couple. I am living in their garage apartment, which is well equipped with just about everything I could ask for. I have no cell service unless I drive approximately 10 miles into town and I am learning to live with only a landline again.

One of my classmates had told me she would turn on the TV low here to create some white noise because it is so quiet. I have lived by myself for several years and didnt think this would be an issue. Well, I was wrong. For the first four nights I woke up at 4:30 am, an hour before my alarm in a panic, thinking I had missed my alarm. There are no sounds of a neighborhood waking up, though I live near several other homes. There are no traffic noises, car alarms, dogs barking, or garbage trucks. The birds chirp but not until much later in the morning.

After I left San Francisco and I was settled into my new home in Vallejo, I was sitting in my room and realized how much I had missed the chirping hum of the crickets every night. The sounds of the city are much different than the sounds of the country. I am finding I enjoy the quiet, especially after a long day in the clinic. The quiet here is peaceful.

This is where I live. It is about a six hour drive from Vallejo, four hours of highway driving to Redding then two hours of two lane winding mountain roads. From my apartment, the grocery store is an hour drive either east or west on a two lane winding road. My drive to work takes 35 minutes on a two lane, winding road. It is a bit different than my commute at my last rotation, but I also find this refreshing. There are two radio stations available when I am lucky, so instead I have been listening to audio books.

I experienced the "first rain" of the season last friday. And it did rain... it poured for about 24 hours straight. I was getting a bit stir crazy on saturday morning, every time I would go outside to assess the amount of rain falling it would pick up again to a hard, steady rain. Since the first rain it has been raining on and off all week. Between the rain showers, when the sun comes out I try to find my way down to the river, which is only about a 15 minute walk from my apartment. It is so peaceful to sit and appreciate the way the sun hits all the mountains surrounding me, to listen to the  turbulent flow of the water over rocks, and to drink in the beauty of my surroundings. The river has become one of my favorite spots.

The river today during the break between the morning showers and afternoon clouds. 

Surgery

As I am nearing the end of my surgical rotation I am reflecting on the last five and a half weeks. Surgery has been stressful! In the beginning I was incredibly nervous to be in the OR, to make a wrong move, to cut the suture too short or too long. With time I have come to realize if I am doing something wrong Dr. Lanflisi will correct me. In the middle of the rotation I felt I was studying the wrong material, unable to answer any questions and was having some self esteem issues. Now, after a conversation with my preceptor and clinical coordinator and a few more weeks of practice I feel more confident in surgery. Answering questions during a surgical procedure is still challenging for me, especially when the question is completely unrelated to the surgery, I often times clam up and have difficulty articulating anything. This is partly because there are usually 4-5 other people in the OR that are quiet, not interrupting the conversation Dr. Lanflisi and I are having, this increases the pressure a bit! I think my preceptor has realized this and after I struggle for a bit he will walk me through the thinking which allows me to come up with the answer.

I have enjoyed surgery, but I dont think it is where my home will be as a provider. I have enjoyed being a part of procedures and look forward to seeing how this will be incorporated into my next few rotations.

During this rotation I have seen mostly abdominal surgeries. I haven't seen any breast cases (odd because they make up 30% of Dr. Lanflisi's practice). Last week I assisted in a lung resection for a patient that had lung cancer. The lung is a truly astounding organ. For the procedure the anesthesiologist must intubate the patient in a manner that allows him to control each lung separately, this is done with a double lumen tube.

 The photo above shows the trachea and bronchus with the intubation tube in place. See how there are two balloons, the first one (at the top of the photo) keeps external air out of the patients lungs, this allows the ventilation machine to ventilate the lungs. The second balloon in the patients left bronchus (on the right side of the photo) allows the anesthesiologist to control the lungs separately. The photo below shows photos of the inside of the trachea and bronchus, the camera is inserted to confirm the intubation was done correctly. With this intubation the anesthesiologist can "drop" one lung during the surgery to allow the surgeon to operate on that lung without it being ventilated. 

The best part of the surgery was watching the remaining lobe of the left lung re-inflate at the end of the surgery. Watching all the little alveoli pop open as the air fills the lung, bathing in the oxygen they had been deprived of.