Don't you hate pants?

Midway through clerkship and I've survived! I've finished my anesthesia rotation (which I loved - yay for IVs and intubations!) as well as my vascular surgery rotation which I absolutely adored ever so much.

I was so nervous right before I started vascular. 1) It was my first ever surgical rotation 2) It had the reputation of being very intense and very busy 3) Did I mention that hot cardio resident was the senior resident on the team? Hence, I thought it'd be horrible. That I'd hate it. I mean what do I know about aortas and blood vessels? Um, they carry blood. Blood is good.

Luckily, it turned out to be an incredible experience. I mean I had my hand on a patient's beating aorta - not something one experiences everyday. Surreal and amazing at the same time. There certainly was never a dully moment on this rotation. And it sure was full of some very "interesting" experiences.

One day, I was sent to help out at Vascular Clinic. Normally this is a relatively easy and relaxed time. You go in, introduce yourself to patient. Ask them about their problem (usually it's a AAA or peripheral vascular disease) and then do a focused physical exam. So you palpate their abdomen for masses, and feel for pulses from femoral down. Patients are usually told to remove their pants for this and to put on a gown so we can look at their legs and feet more closely. Easy-peasy. Routine. OR so I thought.

I had seen many a patient by this time and that I had the 'act' down pat. I spoke too soon. I should have guessed that something was not quite right when the clinic nurse warned me the next patient was looking rather 'unkempt.' But again, I'm supposed to be all professional and stuff right? No judgments here.

Stuff
[knocks on door]
Hello sir, I'm St...
[stops short when she sees patient has gown on backwards and is not wearing ANYTHING waist down. I.e. The man is naked as a jaybird]
No Pants Man
Is this gown on backwards?
Stuff
Yes, yes it is. Now how about I put this blanket on you.
[Proceeds to cover man up while hurrying to finish the interview as fast as humanly possible]

So let's just say our patient population in vascular was never predictable.

Another day I was following around hot senior for the day (in clerkship thus far, I have latched myself onto whoever tells me to follow them and then don't let go. You learn pretty quickly that if you don't, your resident/team will forget about you and go their separate ways, leaving you lost. Oh so very lost. I was lucky in that my vascular seniors would usually tell me to follow one of them).

We get called down to the ER to see a consult for an "ischemic toe." As we're going down the lift, he pre-warns me that the patient has some "psychiatric issues." He mentions something about OCD and possibly schizotypal personality disorder. Apparently the patient had been in the night before but left AMA. Okay, we had our psych lectures last year. I could deal with this. I'm a patient-centred medical student. Boy was I wrong:

Crazy toe man
[sitting in bed looking rather wild-eyed and agitated]
Hot senior
Sir that toe is going to have to come off
Stuff to self
Crap. This guy looks scary
Crazy toe man
Oh I know. It's dead. That's why I cut off the dead part yesterday myself. Doesn't it look better now?
Stuff to self
[slowly moves closer to senior. Senior looks like he could defend us if necessary This is somewhat reassuring to me]
What?! He did what??!
Hot senior
Yeah, well that's just the top part. The whole toe is going to need to come off. Plus we're going to need to admit you to hospital. You have an infection in your leg.
Crazy toe man
I can't stay in hospital. I need to take my heart pills.
Hot senior
Sir this is a hospital. We have all the pills you need.
Crazy toe man
Yes but I need MY pills. Plus I don't have an infection. Look it's so pink. It's got to be healthy.
Stuff to self
[inching even closer to senior]
Yeah pink because you have a rip-roaring cellulitis. Man look at that massive pitting edema.
Hot senior
[pokes leg to demonstrate pitting edema]
Actually your legs are very swollen and that pink is actually your infection. We're going to need to give you antibiotics. And then take off your toe.
Crazy toe man
[Getting more agitated]
It's NOT infected. I can still feel it and move it. See. SEE!
[Moves foot with dramatic flair]
Stuff to self
[Is now right next to senior. Really wanting to grab his arm at this point and hold on for dear life]
Oh man. This is not going well. Can we get out of here now?
Hot senior
Yes it IS infected.
Crazy toe man
[getting VERY agitated]
NO it's not! I DON'T have an infection. And you're not putting me to sleep to take off my toe.
Stuff to self
[Has now completely glued her entire body to senior's side, cowering behind him ready to hide behind him should anything come flying at her]
This is not good. Please stop antagonizing him.
Hot senior
Okay fine then we'll just take it off here. You can stay awake. Then you can come stay with us for a few day. We'll get you your meds.
Crazy toe man
[Apparently appeased by this proposal]
Okay
Stuff to self
What? What just happened here?

And so hot senior amputates crazy toe man's toe in the ER using only local anesthetic! Apparently, the patients in the next beds were none too please with the sound of saw on bone. Go figure.

Ah Vascular. I miss you.