I started my new orthopedic rotation a week and a half ago. On this rotation we spend 2 days a week at one office in the city, 2 days in the OR in the city, and half a day in the office in the country and half the day in the OR at a country hospital. I have found that I really enjoy the mornings that we spend at the country office. While the office itself is very nice, I think it is the patients at this location that I am drawn to. I blame it on my upbringing. These people are similar to those that I have grown up around.

Before I go any further let me first say that just because you are from "the country" that doesn't mean that you are stupid. A lot of the patients up there may be less educated but they still want to understand their injury or disability just as well as someone with a graduate degree. These people tend to put more trust in you than those in highly populated areas do. Whenever I am in a room with these patients I have instant compassion and a strong desire to help them. I genuinely want to help them, it's almost a feeling of needing to help them. Helping them comes in many forms for me. It may be casting a broken arm, taking sutures out, or answering their many questions. It makes them feel important. Growing up in the sticks I can appreciate how valuable a specialists' opinion can be. I also know what it's like to see a doctor who clearly would rather be at his usual location with his usual clientele. It is very important to me that my patients never feel as if I would rather be treating another type of person.

I'm not really sure what all this means in the grand scheme of things. I do not think I would be content in a very small town right out of school. However, I cannot deny the compassion I carry for the rural underserved patients. Perhaps someday I will find myself back in the country. It's kind of ironic that I have spent my entire post high school life avoiding the country and now I find that that is what I am most drawn to.

Yesterday was an OR day, and as you all know I really like ortho OR days! I was with the shoulder surgeon and his PA. We had three different kinds of shoulder replacements on the menu for the day. I had never seen any shoulder surgery at all so it was once again a baptism by fire. It turned out that shoulder surgery is one of my all time favorite kinds of ortho surgery. The shoulder anatomy can be difficult to really understand because everything is so packed in and tight. These surgeries really helped me to understand the anatomy and how it all works together. You can't put a tourniquet on for this so its a really bloody surgery and bloody surgeries are my favorite kind. The first replacement we did was called a reverse shoulder replacement. This is a pretty cool operation. They basically put a prosthetic "ball" on the glenoid (the socket part of the shoulder) and then put a "socket" where the humeral head is(the ball part of the shoulder). Hence the term reverse. It's a good procedure for the older person who doesn't need a lot of function but wants pain relief. You can only lift like 10 lbs with it and can only raise your arm to about shoulder height but it gets rid of pain from an arthritic shoulder.

The second operation we did was a hemi shoulder replacement. In this procedure they leave the socket side of the shoulder alone but replace the humeral head with a prosthetic ball. This one gives more function than a reverse but isn't as good at relieving pain symptoms. The guy we did this on was an angus beef farmer so he needed his shoulder!

The third and final operation of the day was a total shoulder replacement. In this one they remove the ball and socket components and replace them with prosthetic parts in the normal anatomic position. Normally this takes about 2 hours to do. It took 3 1/2 yesterday! Our patient was a thick muscular middle aged male with massive deltoid muscles. We were working down in a 5 inch hole. In order to get down in the hole you must retract all of the surrounding tissues and bones. This is absolutely exhausting. It was more tiring and physically demanding than any other joint replacement surgery I have done but I loved every minute of it! I even woke up with sore legs and pecs this morning. I wish I had more time with that doctor.

My time at this rotation site was overall a good experience. I wasn't quite sure how it would go rotating with so many doctors but I ended up liking it. All the doctors were welcoming and liked to teach. It's too bad that the practice is in NEPA or I would be interested in working there. I start my next ortho rotation on Monday and am looking forward to new people, new experiences, and new challenges.