Wednesday, July 30, 2008

I Get High With a Little Help...

Ok, so the picture above is from one of my last patients at Children's. I think I talked about the 12 year old who stuck some things up his, um, weenis. Today the picture loaded, and I am using it as an example of some strange things that people do to get high. Now, there is a certain pain/pleasure described by patients who stick things in their urethras. There's actually a name for this which I couldn't find because I am too tired right now, but the link is to
an interesting article on the subject. Strange Found Bladder Objects

I am bringing this up because I am currently on my first official rotation of my second year: EMS/Toxicology. I spend my mornings in the Poison Control Center of Western New York which is based out of Children's Hospital. We go over cases that came in the day before, and follow-up on cases that are currently active. Most of the cases involve overdoses and ingestions (such as kids swallowing bleach).

Every day I have to make a small presentation about this or that drug that we've been consulted on. I have talked about acid/bases and what happens when you come into contact with them. Tonight I finished research on my project for tomorrow which is on overdoses of muscle relaxants. What those crazy kids won't take to get high.

During the rest of the day, I am on 24 hour call for the Poison Control Center and for Erie County EMS. I get called if there is a question directed to the PCC from a hospital regarding treatment of a patient in their E.D., and I could potentially be called for any incident in the county requiring a physician to be on-scene. During the school year, we get called for mostly school bus accidents where there are a large number of patients that don't necessarily have to go to the hospital, but who all need medical clearance before being released. Every once in a while we get called for something more interesting: Swat Team Shooting

i also get to do ride-a-longs with local EMS including Mercy Flight, BFD Rescue 1, Rural Metro Ambulance, and possibly some other agencies. There are a couple of other "fun" projects, but I will elaborate on those toward the end of the month.

For now, I have to go to bed and get ready for my PCC rounds this morning. Oh, and if you see this vehicle around Erie County:

That'll be me behind the wheel!!

I promise to share interesting stories as they come.... until then, stay safe!

Oh, and on the veggie front. It's been almost 3 weeks. Today I tried the Super Veggie at Subway, and it was tasty. I was sooo tempted by some fish, but I promised to make it a meat-free month, so I kept my pledge. A week to go, but to be honest, it's actually getting easier to make the veggie choices, and I am learning to be very creative when going out to eat.

Friday, July 25, 2008

Marathon Weekend

Ok, so I've been very busy over the last several days with this and that and being a vampire. Once I got used to the night schedule, I had three days in a row where I had to do daytime things, and tonight I go back to nights. Two days of a nights with a turn-around shift where I get off at 4 in the morning and go back to work at 1 p.m. But, it's my last weekend at Children's until January.

Some of the things that have happened:

We had the intern's welcome picnic at a park in Eden, very beautiful, and I was trying to share pics, but they're not uploading for some reason. Then I worked that night.

I had a very strange case of a young boy with a swollen, um, weenis. My attending was concerned he might have constipation causing a blockage of his ureters leading to infection, and we found... well, couldn't load that photo either, it showed a number of wires in his bladder. He finally admitted he had stuck them up there. He went to surgery that night.

Monday, another shift in the E.D. We actually cleaned the board, and I was lucky to get sent home somewhat early.

Tuesday I tried to clean and catch up on all the things I hadn't been awake during the day for.

Wednesday, my EM class went to U of B for some procedure training on cadavers. I got to help with the teaching, and we had a lot of fun catching up since we hadn't seen each other in a while. I kept myself awake most of the night to try to stay in vampire mode.

Yesterday I went to one of the local firehouses to run through procedures with their EMT's. One of my future jobs in EM will be medical director for the local EMS agencies, so this gave me some practice.

OK, have to be running, get dressed and off to work. We'll see what the evening brings.

On the veggie front: I resisted temptation at the picnic where they were grilling the best-smelling BBQ. Ribs that were falling off the bone. MMMM... I had the salt potatoes, salad, and mac and cheese. Ok, ok, I had a matchbook-sized piece of ribs, but I didn't enjoy it, well, yes I did. Other than that it's been soy in my coffee drinks and cheese sandwiches. Veggie burgers are the mainstay of my existence at the hospital, although they did have a veggie soup the other night. We went to a local Tex-Mex deli that was supposed to have fish tacos... I had the bean and cheese burrito. Can veggies eat fish? What do you think?

Sunday, July 20, 2008

Sharing at a Time of Pain

In my last entry, I talked about a sad case that came into the ED. A small 5 year old running in the backyard with his new bow and arrow that he received for his birthday. In a freak accident, he tripped and fell right onto the back of the arrow.

Initially it was thought that he had suffered some eye damage, but then he began to have seizures which signified a brain injury, and he was transferred to Children's Hospital. Our E.D. was mobilized from the moment we heard about the patient coming in on Mercy Flight. Neurosurgery and ophthalmology were both called in even before the child arrived. He spent less than 5 minutes in the E.D. before being rushed up to the CT scanner, from there straight to the Pediatric ICU.

The injury was devastating. There was a laceration to one of the blood vessels in the brain, and he was bleeding which was leading to the seizures. A sister hospital is the regional stroke center, and he was sent there to further assess the damage in their brain imaging suites. Unfortunately, it was too extensive.

When I came on duty last night, I ran into one of the ICU fellows that I know and casually asked about the child. His face said it all. From one of my colleagues, I heard the rest of the story. One of the ICU nurses came downstairs and was telling us that the family decided to make the child an organ donor. Throughout the evening, multiple phone calls were being made to awaiting hospitals. At one end death, on the other end hope for a life.

I keep the green donor ribbon on my sidebar as a reminder of the importance of organ donation. The lives that this little boy touched will be immeasurable, and he will remain in our memories for a very long time.

Saturday, July 19, 2008

Lots of Boom, Not Much Bang

Ok, so on Wednesday morning, the SMART team was asked to provide medical backup for a Bomb Squad training session. For some reason the photos I had aren't uploading, but there really wasn't much to see other than a pic of the Erie County Sheriff's Bomb Squad van and a small explosive going off. I had to leave to go to work, but my understanding is they set off several more explosions during the afternoon. We were asked to be there in case someone was injured setting up the charges.

Wednesday afternoon I worked and saw only about 6 patients as the board was so "constipated" - nothing moving out so nothing moving in, that we couldn't get patients back to rooms. I would see one patient and then wait forever before the next one could even be brought back. I did see two corneal abrasions, one in a 15 year old who just got a new airgun for his birthday and promptly shot himself in the eye with a pellet. He was lucky and just had a scratch in his eye.

Thursday I spent the entire day in Base Station training. We have to provide "Medical Control" for the EMS units that work in the city. They have written protocols that they follow whenever they go to a run, but sometimes they face situations which are outside of their scope of practice, so they call an MD to get medical direction on how to treat these patients. The majority of our day was learning about the EMS system and the protocols. We then spent the last part of the afternoon running through actual cases and learning how to give medical direction.

Last night I started a 4 day stretch of nights. Again, I came into a "constipated" board and didn't see a patient for the first half hour that I was working. Things did not improve throughout the night. We've been seeing a lot of diarrhea and dehydration lately as it is the Enterovirus season, and a lot of kids are getting it. We make sure they don't have any fevers or other infections, hang a bag of saline and then send them off. We also continue to see a lot of traumas, mostly falls from swings, slide poles, front porches, etc.

We had one unfortunate case tonight of a 5 year old running with a bow and arrow who tripped and had the back end of the arrow go through his eye and straight back. We know he's got a head bleed, he was having seizures, and things do not look well at this time. I will find out later today or tomorrow from my colleague in the ICU how he's doing.

Ok, off to bed for now. It's vampire time for me. The vegetarian thing is going well. Lots of fruits, salads and cheese. The hardest thing is I live in Buffalo where the most common take out order is pizza and wings. Pepperoni pizza. I found a slice that had one piece of pepperoni which my colleague ate for me, and I munched on the often-forgotten celery sticks that accompany the chicken wings. I also can now sympathize with my true vegetarian colleagues who claim they can never find something to eat. Seriously, what's up with a hospital cafeteria that thinks a vegetarian entree is cauliflower with cheese? Oh, and rice milk is sooo much better than soy, or even almond.

Tuesday, July 15, 2008

Summer Crushes

Today was a bad day for kids to be playing at the playground. We had two patients with broken bones as a result of playing on the "merry-go-round." You know, that big silver wheel with the bars that you spin around and around until you get your friends deliriously dizzy, and then they try to stand and fall over? When I was a YMCA camp counselor, we used to see how many we kids we could spin off. Total carnage today: a broken forearm and a broken leg.

Today was a bad day to be under the age of 18 and pregnant. We had about 4 patients come in with threatened miscarriages. Interestingly, two of them had taken the "morning after" pill after "the accident" and had still turned out to be pregnant. All of them will have to come back in a couple of days to confirm that they miscarried and to make sure they don't need any further procedures.

Today was a bad day to be the surgery resident. I think I counted about a dozen patients with abscesses that came in today. That has always been one of my favorite procedures, opening up an abscess and draining it; then packing it and having the patient come in and have the dressings changed every couple of days. I liked to watch the wound gradually heal, and the patient improve greatly. Now, I have to call a surgery consult for those patients, mostly because we are usually too busy to allow an ED resident to get away for a procedure like that. So I miss that satisfaction.

Today was a bad day to fall on your head. Patient One was sitting on a car with some other kids when the owner decided to back out of the driveway and then stop quickly. She fell on her head. Got away with a minor concussion. Patient Two took a backward header off the front porch. Depressed skull fracture that got taken IMMEDIATELY to the OR by neurosurgery to evacuate a growing hematoma (blood clot.) Patient Three has ADHD. A week or so ago, he had an accident off an ATV and also had a depressed skull fracture with a brain bleed. He was taken to the OR by neurosurgery, spent a couple of days at the hospital, and then got discharged home. Today he decided to try jumping off the porch, or something like that, and landed right on his surgical site giving himself a whole different kind of head bleed that, too, required IMMEDIATE transport to the OR.

Well, those are the major highlights of the day. I have something fun planned for the morning that I will write about tomorrow. Then I go back to the E.D. for the 1 - 11 p.m. shift.

On the veggie front: cereal with soy milk, coffee with a touch of milk, lunch was a grilled cheese sandwich with veggie chips and some fruit, dinner was a veggie brand feta cheese and spinach Hot Pocket of sorts and some of the great grapes and cherries I bought yesterday. It's funny, you would think there would be a lot of healthy things in a hospital cafeteria... not so much. I do have to admit, I was seriously tempted by the BBQ chicken wings they were serving, but I reached down below for the grilled cheese... 27 more days to go.

Monday, July 14, 2008

One Can Always Dream

This is what I came into this morning. I think it lasted for about 15 minutes.

And then, one of the early patients was this:

Look around the middle of the top third of the film, and you will see a bright long object... that, folks, is a dental drill. This 5 year old was in the dentist's chair when the drill bit "fell off," and he swallowed it. Luckily, this should pass within the next couple of days. I gave them all the warnings in case it did not pass easily.

By the time I left, this is what it looked like:

And, this was the waiting room:

As you can see, a veritable smorgasbord of ailments. Again, we were so busy and had so many providers that around 5 p.m. we had a "constipated board;" no one was moving in or moving out.

I am about midway through the rotation so I thought I would take the time to get a few rants off my chest:

onto the soapbox:

- people are not an endangered species, please stop having children. I sometimes think birth control should be federally mandated. When you come in and tell me about your 5 children at home, and how you can't afford a bottle of $2.50 Tylenol for your child's fever for which you want me to write you a prescription so that Medicare (read, us taxpayers) can pay for it, please don't also tell me about your smoking/drinking/marijuana habit, because I can't see justifying $7 a day for a pack of cigarettes, or whatever you pay for the carton, when your child is sick.

- oh, and please don't tell me you don't "smoke inside because of the kids" because we know you do. If I can smell the smoke on the baby stroller, someone's been smoking around it, or it spends a lot of time out on the front/back/basement or wherever you say it is you go to smoke.

- missing your period for 2 months after unprotected sex, and already having had 2 children should make you think that you might be pregnant; which means that if you're considering having another child you might want to stop drinking/smoking/and doing drugs. There are a lot of important developmental changes happening to your baby during this time. And, don't use the excuse that you're only 19, and it was "your birthday." Start taking some responsibility. I can only wonder what's going on with your other 2 children if you're freely admitting to me that you "like to party" and drink and smoke marijuana daily.

- I think I have said this before, but please don't bring your entourage with you into the E.D. I don't need to meet your sister, sister's baby, your neighbor, neighbor's baby, your baby's daddy, his mama, etc. Oh, and bringing your 11 year old nephew with you for a "female exam" and talking about your sexual partners isn't appropriate, and I will be asking him to step out of the room, so don't be mad when I do.

- All I cansay is that we've been seeing way too much of CPS (Child ProtectiveServices) lately. We had a horrendous case of abuse where the childwas taken away from an abusive mother, put into an abusive foster home,transferred to a second abusive home, and adopted into her currentsituation where she was being brought in for possible abuse. She's11. I can't even begin to imagine her life or what will become ofher. Sigh.

Off the soapbox...

As for my vegetarian pledge: Like I said, I can't go completely vegan. I had a little cream in my coffee drink this morning. Cereal with soy milk. Lunch was a veggie burger with cheese and mayo (not vegan as it's made out of eggs) and veggie chips. I then went to the local upscale Wegman's supermarket to make a salad. I added a number of their "vegetarian" sides to my spinach and greens. Lot of garbanzos and beans; barley and peppers. There was even a tofu curry mix that was very tasty. I bought a number of "veggie" frozen entrees, some rice and soy milks and a bunch of fresh fruit for snacks.

I am still recovering from the weekend of gluttony so I felt hungry, but I know the stomach will shrink down and adjust to the smaller portions. Here's where it becomes the mind over matter, but I know it gets easier every day. At least, that what I will remind myself.

Sunday, July 13, 2008

41 Hours of Gluttony

So, I just got back from 2 days in So. Cal. visiting my mother and eating entirely too much... It's just that there are no decent, authentic, Mexican food restaurants in Buffalo, and I was dying for some home-made food, and some food from my favorite Mexican restaurant, AND my favorite steak house, etc. Afterwhich I vowed to myself that I was going to take the 30 day vegetarian challenge. However, this mostly came as a consequence of visiting my favorite Mexican food chain restaurant, Green Burrito, and having the "mini" super nachos. Carnitas, mmmmmm.

Ok, so anyway. Having thought about the amount of animal protein I consumed, not to mention all the other badness, I began to think about how I really should start taking better care of myself. I had read Oprah's 21 Day Cleanse and had been tempted to try it out. Although, I know I couldn't do the caffeine part. I live on caffeine. So, I'll make some minor adjustments.

I also don't think I could go completely vegan. I can do soy instead of milk, so that's not a problem. I don't know how I would do without cheese. I may have to try some of the soy products and see. I am planning on following the PETA recs Vegetarian Starter Kit and be a more earth conscious eater.

So, we'll see how I do over the next month. I also challenged a friend to get in shape for a 5K in November. I should be able to run it by then. At least, I hope so.

Tomorrow back to the pedis. We'll see what the morning brings!

Tuesday, July 8, 2008

Lawd o Mercy!

Today was a non-workday, and I spent the better part of the morning at Mercy Flight Operations. Basically, the training involved learning helicopter safety and a lot of flight physiology. Plus we had a little lunch. I missed this part last year, and so I joined this year's interns for the lectures. Which I find funny since this is relevant for me because we do our rotation with Mercy Flight in our second year.

Irregardless, we had a good time learning about their operations, and I was able to daydream a lot about getting up in the sky and flying with them. Like I said, my rotation starts at the end of the month.

So, not much to write about tonight, and I am in the middle of preparing a lecture on suturing for the new interns which I will present tomorrow.

Cheers until then!

Monday, July 7, 2008

You Can't Chose Your Parents

I always said that I could never be a pediatrician or a veterinarian because whatever happens to children and animals usually is the fault of someone else. I felt I would always be angry at someone when treating my patients, especially the injured ones. Today was a good example of when bad parents happen to children.

Patients seen in the E.D. today:

A 5 year old with a cellulitis, skin infection ("he was at his father's and I don't know what happened to him"). I wanted to give him a dose of antibiotics and then send him home with a prescription. Mom said she was tired of waiting and needed to go "check on her bicycle" which she states she didn't lock. A nurse asked me how they had gotten to the E.D. if the mom had ridden a bike. I said some questions I don't want to know the answers to. Anyway, I asked mom to wait a few minutes, and we would have the antibiotic. Well, she disappeared with her son and didn't return. Our social worker got involved, called the contact number that was for a "neighbor" that lived 1/2 mile away who said they would try to get a hold of mother. She eventually did show up... 3 hours later. We got the child the dose of antibiotics and got them their prescription. I hope she fills it.

When I walk into a room and the mother starts the conversation by saying, "I just got her back from foster care, and she's been sick ever since" I kind of start to wonder what's going on. I don't like to judge people, but this mother was the poster girl for a "Don't Do Meth" campaign and the father looked like, per the RN, something out of "Deliverance." The mom couldn't answer my questions about fevers, vomiting, wetting diapers on her 2 year old. All she could tell me was, "she hasn't really been eating or drinking and the doctor told me to bring her here." I had a nurse ask if the girl had a genetic disease because she "had a look about her." I asked the nurse to go in and look at the parents. We ended up admitting her for hypoxia (low oxygen saturation), dehydration, and hypoglycemia (54, in kids should be around 100). I think social work might be getting another phone call.

Ok, so you're married to a doctor, and you have 4 children under the age of 5. You decide to pack the kids into the car around noon and head off to your local Target and Lowe's to pick up a thing or two. It's summertime. It's midnight as I write this and my thermometer on the way home tonight read 80 degrees with high humidity, so I am sure in the bright sunlight of midday it was much warmer. You get out of the car and leave your kids for "just 10 minutes" with the car doors closed, the windows closed, the car turned off, in the middle of a parking lot. Soon people come by and notice the children in the car, yelling and crying for help. They stand and wait to see if someone shows up while they call the police. The police arrive and wait a few minutes to see if someone shows up before they break the windows and open up the car. Total elapsed time, about 30 minutes. EMS arrives and notes the infant (9 months old) is drenched in sweat and no wet diaper. All the kids get put into the cool back of the ambulance. Dad gets called, but he can't come because he's in surgery. Mom finally shows up and get promptly shown the back of the police car. Auntie, who's also a doctor, gets called and meets the children en route to Children's. All four are seen and evaluated in our ED. CPS (Child protective services) gets called. The four are discharged to the care of their father once he got out of surgery. Will have to hear later what happened to mom.

A woman walks into a bank carrying a year old child. She walks up to another woman and asks if she would please hold the child for a moment while she takes care of something. The second woman agrees. The first woman walks out of the bank and never returns. EMS and police are called and the child is brought to WCHOB for evaluation. Social work and CPS, already there, are brought in to discuss placement of the child who is otherwise healthy. About 5 hours later the mother shows up in the E.D. looking for her child. Buffalo PD is promptly called to escort the woman to a different waiting area. Will have to ask the resident involved what ended up happening with the mom.

I had to call CPS for a case of suspected abuse. A 9 year old "smacked around" by his father causing a bloody nose. I counted and took pictures of all the bruises and lesions he said were inflicted by the father and his new stepmother. He has 3 older brothers and 2 younger step-siblings who are still living in the home. He called his mother for help from an older sibling's cell phone, and she brought him to the emergency department. Seems she is "getting help" and doesn't have custody of the children, their father does. She gets to see her children bi-monthly. She asked if there was any help CPS could give in the custody dispute. I said I didn't think so but I was sure they could connect her with the appropriate resources.

We had another child who fell out of a window and came out the other side looking like they had been thrown into a cement mixer. Head injuries, broken arm, broken ribs. She was being admitted to the PICU.

I worked on a 2 year old riding a motorized ATV who fell off the back and also had a head injury to add to an earlier one suffered when he banged his head on a wooden door. He was going to be admitted as well.

I had a 4 month old that flipped over in their car seat when the transit bus they were on stopped hard. He had bruising all over his face. A head CT did not show any injury to his head. What was interesting is that while I tried to examine the child and talk to the mother, she was more interested in berating the "baby daddy" because he, "wasn't there when his son needed him, he had no interest that his son was injured, why wasn't he a good dad and arranging transportation for them, don't blame me for what happened it was the bus driver's fault, etc."


On a good note, I got to show my final patient her 16 week old baby. She was concerned that she hadn't felt the baby move, and I got to print her a lovely picture of her baby, nice heartbeat, moving all their limbs, a new life ready to enter the world. Hopefully, to a good mother. Hopefully.

Hitting Hard While Heading Home

This will be a quickie as I should have written last night, and now I am in a rush to get ready for my last shift of this set. Yesterday the flood gates opened and everyone who couldn't wait one more day for their pediatrician's office to open came in. We were full in all 20 rooms and had about 20 people in the waiting room. And, trauma stops for no one.

Everyone was "on their way home" from camping, picnicking, somewhere else, etc. and ended up in the E.D.

The cases I saw:
2 year old with sudden case of vomiting - got IV fluids, drank juice, sent home

15 month old with fever - got tylenol, IV fluids, drank juice, sent home

11 year old with rash - this was a medical mystery ala House style, don't know what she ate, drank, wore, or swam in but she was broken out all over and her face was so swollen she could barely see out of her eyes - she got benadryl, steroids and some pain relief, sent home

38 year old car crash victim - since the hospital has an adult service, we don't see the over age 21 set, except in the case of trauma where they need immediate evaluation, so I was a "consultant" on her case, which basically means I told the adult medicine physician what to order, what to look out for, etc. - she was admitted along with her 8 year old daughter who was also in the vehicle for observation (they were coming home from camping and swerved to avoid a car that cut in front of them going the opposite direction, rolled their vehicle over several times, luckily, they had their seat belts on)

11 year old car crash victim - riding with mom and sister, sitting in back seat, had neck and knee pain, all of the films were negative and she was sent home

15 month old with fever - motrin, drank juice, sent home

4 year old car crash victim - sister to the 11 year old, she wasn't a trauma, so I saw her later on, she will have some bruising on her face but nothing else hurt

2 year old fell out of 2nd story window - supposedly fell off couch near window and fell down to street below, he didn't seem to have any injuries on CT scan but his fall was significant (> 20 feet) so he was kept for observation

6 year old with vomiting - IV medication, drank juice, sent home

and finally 1 year old with fever - given motrin, drank juice, sent home

If you're wondering about the juice, we need to make sure the pedis aren't going to get dehydrated until they can follow up with their primary doctors, so we make sure they can keep fluids down. Everyone gets a P.O. (per oral) challenge prior to leaving the E.D.

Ok, running off to get dressed for what will be another busy shift, I am sure, probably with less traumas since most people are home following the holiday weekend. Will post tonight as tomorrow should be a fun day learning about helicopters!

Oh, the kiddo with the wound under the arm had to go back to the OR because he became so swollen from all of the blood products he needed, they couldn't close his skin after surgery so he was left open and was closed yesterday

The other pedi with the fall down the embankment was doing ok last I heard.

Saturday, July 5, 2008

On the Warm Side of the Color Spectrum

As predicted, we were busier in the E.D. today. At one point we had about 12 patients in the waiting area, and all 20 rooms full. We managed to clean out the waiting area, but then as I was leaving, it started filling up again. And that didn't include the traumas. Traumas take priority, and they go straight to the code room regardless. So you might be busy seeing patients and then have to drop everything to see the trauma.

I think at one point I might have mentioned the triage system which assigns a priority to patients based on how sick they are. In general, the color codes are:
Red - see immediately
Orange - see within 10 minutes
Yellow - see within 15 - 30 minutes
Green - see within 30 - 60 minutes
Blue - see within an hour or two

If you know anything about colors and the color spectrum, you know that blues and greens are cool colors and oranges and reds are warm colors. As an intern, you generally see blues and greens. As you get more comfortable, you venture into the yellow and might actually get to see an orange.

Now, as an unofficial second year, my colors are generally yellows, some oranges, and occasional reds. I do get the occasional green or blue depending on how busy we are, but today especially my attendings physically started handing me orange charts to evaluate, and I was directed into the trauma code room, actually paged once to the code room, where the color is always red.

Also, it makes working more interesting. I don't see as many of the garden variety patients that come into the E.D. I see the sicker kids with more extensive and chronic illnesses. Amoungst my patients tonight I saw a sickle cell patient with chest pain (orange), a cystic fibrosis patient with an exacerbation (orange), vomiting in a 5 day old (yellow), and three traumas (all reds).

The traumas were:
- a 2 year old that fell 15 feet down an embankment and ended up on a concrete landing, to CT and admitted
- a 10 year old who fell off of his bike, onto the street, where a car ran over him, he got discharged with a skin burn on his leg from where the tire scraped his skin
- a year old baby that was sitting on her sister's lap when she fell over backward off of a porch swing, a CT scan showed a head bleed, and as I was leaving they were going to the CT scanner with neurosurgery, she will for sure be admitted to the Pediatric ICU as she was intubated (had a breathing tube in) and seemed to be having seizure-like activity, I'll find out how she did tomorrow

As for the patient with the axillary artery laceration, they ended up being transfused 6 units of blood. Given that the average adult has about 5 - 6 units of blood circulating, they had to replace the patient's entire blood volume and then some. He's still in critical condition in the Peds ICU.

That's it for tonight. Back to the warmth tomorrow.

Friday, July 4, 2008

Hurray for the Red, White and Blue

So, I had to work in the E.D. this Fourth of July. Missed the local fireworks' show again. It seems as if I haven't seen a 4th of July show since I graduated from medical school. Like I said in an earlier post, the medical year starts on July 1, and it seems like I've always been on-call or working on this day.

Not that I can really call today work. In fact, I only saw 3 patients in the eight hours I was at the hospital. Why only 8 hours? Well, I got sent home early because there were so many providers (an attending, a fellow, 4 residents, and a physician's assistant) and about as many patients. Why only 3 patients? See above.

I actually thought it was going to be a crazy shift when I first arrived and was promptly directed to get dressed and head into the trauma room. We had a nine year old who fell through a glass door. He managed to cut through his axillary artery, a major blood vessel which feeds the arm located just underneath your armpit. His parents initially took him to another hospital which really only lead to a delay in treatment since they had no idea how to manage such a case.

Upon arrival to our E.D. he had bled so much and received so much fluid that his blood was like Kool-Aid when we were drawing labs. The surgery attending controlled the bleeding with his fingers, and the patient was rushed upstairs to the O.R. We later heard that he had been transferred to the Pediatric ICU with a pneumothorax (collapsed lung) thought to have occurred during the initial trauma. I'll probably find out how he did when I go back tomorrow.

That case took up about the first hour and a half of my time. When I came out of the trauma room, I didn't pick up another patient for another half an hour. I finished all the labs and work-up on the patient, and then sent them home. That's when I was able to pick up my next patient, almost 2 hours later.

So, how do you spend your time when you are sitting around waiting for patients? Why, of course, by talking about past patients and personal experiences.

One of the threads of discussion centered around the trauma case. The child had beensweeping a patio area when he stumbled and fell through the glass. We were amazed at how doing something as simple as chores could turn out to be so dangerous and then recounted many tales of events where we should have been dead but nothing happened.

mine was silver

I always think back to high school and the time I stuffed 9 members of my track team into a 4 door Mazda GLC. I was driving, two girls sat in the front bucket seat, 3 girls sat in the back seat with 2 other girls sitting across their laps, and another 2 girls jumped into the trunk. We drove from our high school to our brother school for a track meet - on the freeway, about 5 miles away. That was a tragedy waiting to happen, that surprisingly didn't.

The nurses jumped in with some of their best personal and patient stories. We ate, we laughed, we watched the clock. Finally, I was given the tap on the shoulder. Go home. As a medical student, I was told to never argue when your resident told you to leave. Just say, "Yes, thank you," grab your things and walk out the door. Which is exactly what I did.

Another day of pedi fun tomorrow as we see what damage was done by the holiday. And the fact that most pediatric offices will have been closed over the long weekend, and some things that have waited this long just can't wait a minute longer...

Thursday, July 3, 2008

Treat Em & Street Em

So, the fun with the pedis today consisted of walking in a room, wondering why the patient hadn't been previously seen by their pediatrician within the last 2 weeks, wondering why they were coming into the ED at 5 in the morning with a complaint that had lasted 2 weeks, diagnosing their condition, and then signing their discharge papers as I sent them home with their script, knee brace, stretching exercises, etc.

The second bit of fun consisted of trying to decipher which personality my Dr. Jekyll/Hyde attending was going to display today. At times he switched between personalities between patients, and I had to anticipate which one I would be presenting to next. Often, I found myself going to the other attending because the thought of another round of cold indifference vs. joviality was too much to bear.

My one patient that did get admitted was a 7 day old infant with a fever. I performed my second successful lumbar puncture. Albeit, I got it on the second stick, and it wasn't a "champagne tap." That is a tap with no blood at all. Rumor has it, if you have such a tap, the attending buys you a bottle of champagne. But, it's like the Holy Grail. Everyone quests for perfection, but whether the reward is there or not remains to be seen. At least the satisfaction of doing the best for your patient is still there.

That was about it for today. Nothing exciting during my shift. I work all weekend, and I know with the holiday there are bound to be some interesting cases. Stay safe during this holiday weekend. I'd like to have a relaxing one as well... sigh, I can dare to dream...

Wednesday, July 2, 2008

Starting a New Year, Figuratively

When I first found out I was moving to Buffalo, the first question I asked was, "Do they have squirrels there?" At the time, I was living in a nice suburban neighborhood near a lake just north of St. Paul, Minnesota. I'd built up sort of a squirrel army. I had 4 bird feeders set up, and the squirrels challenged my creative energies keeping them off of them.

Finally, I gave up and had a special corn feeder and corn spinner for the squirrels. During the winter, I put out a 5 pound "wildlife feeder block" and I had deer and squirrels coming to the yard to eat. My cats at the time had plenty to look at, and on my days off I could almost imagine I was living somewhere in the country. Somewhere far from the things of man to quote a line from "Joe vs. the Volcano."

I was sad leaving the financial freedom I had enjoyed as a house physician under contract. I chose when I wanted to work, and my now husband enjoyed being a kept man for those 8 months. I knew I was making the right decision, though, by taking an emergency medicine residency spot. In three short years we would once again be able to return to the lifestyle to which we'd begun to grow accustomed... and then some.

So, I moved into a much smaller townhouse with my two cats, my fiance went to live in Atlanta where he would be able to find work, and the year began. I adjusted to a new working environment, a new way of doing things, a little loss of independence since I was now an intern again, and a whole new patient base.

I went from the drama of ECMC, to the sheer wave of humanity at BGH, to the pleasant ultrasound rotation, and from there to the CCU. The new calendar year started at the small town ED where things could be just as busy as the big city ED but with fewer resources. Also, that was the month I learned how much fun a Buffalo winter could be.

February brought anesthesiology and, after almost 10 years, finally marrying the love of my life. I went from delivering babies like crazy to actually enjoying my pediatric rotation. After a great honeymoon in Riviera Maya, I came back to the drudgery of the MICU followed by ending the scholastic year in sheer hell on the geriatric service.

Now I am back on the pediatric service. Officially, this is my last month of my intern year. Unofficially, I am already considered a second year resident. In addition to my ED shifts this month, I will be attending all the required lectures and training sessions to prepare me for this next year.

Today we had our first: learning to drive the Ford Expeditions that are our SMART (specialized medical assistance response team) vehicles.

Needless to say, it was a lot of fun, and my colleagues and I enjoyed the time spent away from our clinical duties. I had a night shift on Monday which consisted mostly of patching up kids that had run out in front of cars. Most were not serious, and one I had to admit to the pediatric ICU due to a laceration of her liver. Tomorrow I start a 5 day stretch of shifts including evening call on the 4th of July. Let's hope there aren't many burn patients.

Until then, I changed the name of my blog. It's time. I found some squirrels in my own back yard. Not quite the squirrel army I had in Minnesota, but we'll get there.... in another 2 years.