The other day, my staff and I were doing a laryngotracheal reconstruction on a three month old, and we were discussing the veritable merits of precordial stethoscopes and halothane. It actually became quite heated, and I began to realize that I appeared quite opinionated (not unusual for me). I was also reminded of something that I have been plagued with for the past couple of months–senioritis. Now, I have done an internal medicine residency prior to this so most of my staff are empathetic. In fact, I believe they might consider an intervention if I was still enthusiastic about being a resident. I anticipated the disease so I took a few steps to try to minimize my symptoms–outside rotations.

My residency at the University of Wisconsin has actually allowed me several months to do something out of the ordinary. We don’t have a nurse anesthetist school, but we do have many highly qualified CRNAs. This allows our program to maximize resident learning experience. We are also witnessing a rapid rise in medical student interest in Anesthesiology. Elective rotations in the CA3 year are becoming increasingly accepted as part of resident training as a result.

I have already touched on my visit to the Iowa Pain Clinic. My piece on Dr. Rosenquist clearly detailed the benefits of that experience. In addition, I have two months of echocardiography, and I am currently spending a month on the Trauma/Burn Service. This probably doesn’t sound appealing to some of you, but I think this will be quite useful for my future in critical care.

The echo rotation is divided between operating room studies and cardiac outpatients and referrals. Residents become very saavy using this instrument as a tool. I have already completed one month, and I got daily exericise doing operating room transesophageal echos (OR TEEs). I spent the rest of the time going through the CME course from the American Society of Echocardiography as well as sitting in on cardiologists reading transthoracic echos. I am sure some of you are reading this thinking, "What the #*&! are you doing that for?!?" It was during those hours in the back of that dark room where I saw PA hypertension so severe that there was early systolic collapse and compression of the LV from the size of the RV. I have also seen an RV hole with biphasic flow contained by pericardium that was thought to be secondary to endocardial biopsy post transplant. There is an unbelievable array of calculations and derivations which can be elicited with the TEE. There is a lot more time to concentrate on these in cardiology as opposed to OR TEEs which usually consist of a cursory survey and then getting to the point.

I am in the middle of my trauma rotation so I don’t have any momentous moments to report as of yet. However, there have been a few airway issues–one of which required a cricothyrotomy. I am waiting for the moment when I can use the retrograde intubation kit with the next facial trauma that requires mechanical ventilation. I am certified in ATLS, but this is the first opportunity that I have had to actually put it to practical use. I have come to understand when something requires direct peritoneal lavage instead of simply an abdominal CT scan. And I am finally beginning to understand those stupid foam restraints to intubation around the neck, and why everyone seems to be sporting them out of the ER, complaining only of the pain from this thing poking them in the chin with complete alertness. I comprehend when something should go emergently to the OR for spinal cord injury, and some of the indicators of morbidity and mortality in this patient population. I am awaiting the ER thoracotomy, direct cardiac massage, and my first chest tube–Madison is not really a mecca of traumatic incidents.

If trauma and echo don’t excite you to learn something new, how about the following:

Maybe you have done some of these rotations as a medical student or CA0. However, having been away from these areas for a while, I see things in a different perspective and with more knowledge. I can take away things from these experiences that I might not have been able to perceive as easily in the past. Depending on my expected responsibilities, I have more time to read and perform other activities–like write narcissitic pieces for a web site. Or you could try these at a different hospital just to see what another institution may do and what a new city is like.

Outside rotations have certainly given me a multitude of valuable experiences, allowed my department a break from my embittered attitude, and made me more tolerant in the OR. Quite honestly, I am starting to miss my monotony of checked off vitals in the relentless pursuit of train track anesthetic records. Only another two weeks until my return.

Check out what the ABA says about this at www.abanes.org under the training policies section. Obviously, finding out what your own program thinks about this is imperative as well.