Sunday, August 31, 2008

End of Summer Call

So, here it is the last weekend of summer, and I am on-call. Normally, there would be a medical student on as well, but they finished their rotation on Friday. So I am alone. Luckily, there are only 11 patients in the ICU. I plan to write "on the fly" during the call, so let's start off with the major players. Check back periodically, for, hopefully, updates.

11:20 - 11 patients in the ICU: 3 MVC's (motor vehicle collisions), 4 post-ops, a fall down stairs now with a broken neck, the young patient who had the car fall on them, a stabbing, and the ATV rider with the head bleed. I plan to transfer 2 out of the ICU by the afternoon. The stabbing victim has lost the bottom part of their ear and is going to have a wicked scar down their left cheek along with some loss of sensation in that part of their face. One of the MVC's is lucky that they were wearing their seat belt and the airbag went off when they had their head-on collision. Things could have been much worse. Again, pot can kill. That's about it for now. We'll see what the rest of the day, and the great weather, will bring.

1940 - The day has gone well so far. Except I had one death in the post-op group. They had a lot of illnesses, and as I have said before, seniors just don't have the reserve to overcome a major insult. I was also able to send the stabbing victim up to the general ward. I've had one admission. They fell down some stairs two days ago. The family found them at the bottom of the stairs unconscious but because of the patient's known alcohol use, the family thought they just needed to "sleep it off." Yesterday, the patient was fine. Today, not so much. They were confused and agitated. Turns out they have bleeding into their brain. There's a plan for neurosurgery to operate on them tonight. So, I am minus two, plus one. Rumors and speculation are that we might be getting another one, but I haven't heard anything yet. The evening is just beginning, and there's plenty of havoc still to be wrought. Will keep you posted...

9/1 0140 - Well, a lot can happen in 6 hours; like the2 more admissions I just got. One fell off of a ladder while working on the ceiling. High ceiling because they fell about 12 feet. Numerous broken ribs, and I had to have them intubated (breathing tube put in) because we couldn't control the pain AND have them be able to take good breaths. The second fell out of a tree stand. Not quite hunting season yet, so we're unsure what they were doing up there, but regardless, they fell about 18 feet. One broken vertebrae, and they're acting "strangely" so they come to the Trauma ICU. Oh, and to add some fun to the rest of my night, reports are that there was a riot at Attica prison, and there were a number of stabbings; all coming to ECMC. One sounds serious enough to probably be going straight to the OR. The rest we haven't heard about yet. They haven't arrived yet, but I am trying to get a jump on my morning work... speaking of which, have to be going. The patient with the brain bleed just got back from surgery, and they need a central line. Will probably fill in the rest of the night later this morning when I am finally home... home... sigh.

12:27 - Finally, home. Almost 30 hours' later from when I left. The final body count: one death, one transfer to the floor. Minus two. Four admits leads to plus two balance on number of patients. My admits last night: got drunk and fell down stairs - massive head bleed requiring surgery to drain the blood, got drunk and tried to hang some ceiling tiles then fell off scapholding - broken clavicle and multiple rib fractures so not able to breathe well and had to have breathing tube placed, got drunk and high on home grown marijuana then got depressed so climbed up 18 foot hunting stand and subsequently fell but not found for 6 hours - broken top of vertebrae actually pretty lucky no other injuries, and finally got drunk and high then drove off embankment down 20 foot ravine rolling car over several times - broken ribs leading to laceration of a part of lung and spleen causing massive internal bleeding... too bad you were still too drunk when I admitted you this morning to realize the error of your ways. As for the prison rioters, well none were admitted to the ICU, and the worst of the lot had a cut ear, cuts on the face and a long cut on the forearm. They'll all live to fight another day.

As for me, I am going to sleep now so I can get back to patching up the next round of revelers in the morning...

Wednesday, August 27, 2008

The Back Story

Well, I started my new rotation in the Trauma ICU at ECMC on Monday. It was actually kind of exciting to be back in the ICU, and I was on-call last night. Yes, 26 long hours of fun. Did I mention it's been a while since I've stayed up more than 24 hours straight?

One of the things I love about ECMC, as I have mentioned before, is that patients have the most interesting stories. Now, some of my colleagues will argue that BGH and Children's have their share of stories, and I agree that once in a while a good one will come up, but I still feel that the best stories come out of ECMC. And, getting to know my patients, plus the 5 new admits I had to the ICU, can be an interesting venture.

Two patients came in with blood alcohol levels that put them in the "inebriated" category having fallen. Mind you, both presented to the ED in the morning after their respective falls. They both admitted that they drank "a couple of beers a day." I guess they just didn't specify at what time of the day. Both ended up with back injuries requiring multiple scans and films. One had a broken wrist and the other had spinal shock. Both will end up doing well.

In the "payback's a b*t*h" category, don't mess with a mama's little girl. You might just end up getting a beat down with a lead pipe leading to a broken face, some major bruises and cuts, and the humiliation of having to spend the night under arrest in the ICU. Oh, and again, please stop doing cocaine, I'm having a hard time controlling your pain (because your synapses are all fried) and your blood pressure (because I have some limits on the kinds of medications I can use.)

And, again, you might want to reconsider your life's choices when you're in the ICU because you got kicked in the chest by a mad female. The bleeding led to an infection which led to a worse infection in your lungs which then led to the surgery where they had to cut into your chest to clean things out. Now, your heroin habit caused me problems like your fellow patient's cocaine habit with your pain control. Granted, you have four tubes sticking out of your chest so I feel just a little bit more sorry for you because I know those are uncomfortable. But still... rethinking those life choices might not be such a bad idea.

Of course, the worst are therandom events where someone was just having fun and it led to tragedy. Like riding an ATV and now having a spinal fracture leading to the strong possibility of never walking again. Hard when you're just 16. Or 17 doing something simple like working on your car. Now you'll be lucky to not be brain dead. Luckily both have very supportive families which will help as they'll have very long roads ahead.

One of the more interesting things is being pimped again (meaning being asked questions by the attending that tests your level of knowledge and puts you on the spot.) In the E.D., not so bad. In the ICU, back to pimping "surgery style." But still, very good to be back to the familiar. Can't wait to see what the rest of the month brings...

Sunday, August 24, 2008

A Moment of Reflection

I didn't write a whole lot this month, but then not a whole lot really happened. I went on my first helicopter flight. I learned an awful lot about overdoses and toxicology. I took classes in HAZMAT, terrorism & creating a incident command post.

I think it's a bit fitting that the closing ceremonies are tonight. I was able to dedicate the majority of this last month to watching the games. Now, for some, this might be thought of as a waste of time. But, I think I can always find something inspirational. Right now, Dara Torres who is... eek!!... my age won a silver and missed gold by 0.01 seconds. Wow.

I set some new goals (a five mile Turkey Trot I plan to run with some of my colleagues), and I continued some previously set goals (I am still eating vegetarian, 6 weeks!). We'll see how I continue to do.

Tomorrow I start in the Trauma ICU at ECMC. I am sure there will be a lot of tales to be found there. So, for tonight, we'll go to bed wondering what the new dawn will bring.

Saturday, August 16, 2008

A Good Day to Die... Er, Fly...

Almost 16 years ago I had the most amazing day. I was doing three weeks of training in Manhattan, and I had one day off; a Sunday. I rented a car, drove 3 hours out of the city to the end of Long Island, Mantauk where I rented a sailboat and had 2 glorious hours on the water. The whole drive out had been rainy and overcast. When I arrived to Mantauk, the cloud cover broke, and I had those two hours of sunshine and fine wind.

Afterward, I drove to a local place, Mama Jojo's, where I had a whole lobster dinner with an iced cold Corona, and the best cheesy bread rolls I think I've ever had. As I ate my dinner at an outside table overlooking the harbor, a light breeze blew, and there was a nice sunset. But then, the clouds came back, the rain started, and I made the 3 hour trek back to Manhattan. It was the best day.

The next day, back at training, my instructor asked about my day off. After I had expounded on the glories of the day, he said to my surprise, "So it was a good day to die?"

I looked at him in disbelief. How could anyone want to die after having experienced such a wonderful time. Then he explained:

There was an American Indian chief who awoke one morning, stepped out of his teepee, and proclaimed that it was "a good day to die." His fellow tribesmen looked at him confused. The chief continued, "Look all around you. The prairie grass is high and green. The skies above are the brightest blue. The buffalo are grazing nearby, and a clear stream runs close by. It is a perfect day."

"Who would want to die on a gray sullen day? Today is a good day to die."

I was thinking about this as I arrived at Mercy Flight on what was a glorious morning. The thunderstorms that had been plaguing the area had dissipated into a bright blue sky with big fluffy white clouds. A fine breeze blew from the west. What could be more perfect?

Our first flight took us north to a community event where local schoolchildren were learning about community safety. Here's a pic as we approached:

You can see the school buses and one of the local firetrucks which I got permission to climb up on and ride up on the cherry picker to its full height of 102 feet.

Here's a pic of Mercy 7 which I took from the top. This was the helicopter we were flying today:

And here she is close up. It's a much bigger helicopter than the one I rode last week.

We spent about an hour at the community event and then flew back. During our shift, we were put on alert twice but did not fly out. Finally, around 5 p.m. we were called to pick up a transfer from near the New York/Pennsylvania border. It was a 25 minute flight, so the longest I had ever been on a helicopter.

My thoughts continued as we flew over the green hills and valleys to the south of Buffalo. Cows sat in the fields. Rivers flowed through canyons. The air was clear, and everything seemed right with the world. Of course, not everyone was having my day.

Our patient was a young man enjoying his beautiful day by riding his ATV with a group of friends along the local trails through the woods and a quarry. He fell off and was knocked unconscious. On his physical exam, I guessed he had a broken nose and most likely a skull fracture. He had scrapes and bruised all over his abdomen. Relatively speaking, he was doing ok, and we flew him the 20 minutes back to ECMC where the trauma team took over. It was their 3rd trauma from this ATV event, so they were very busy.

I guess I'll find out in the next couple of days how the patient did.

From there we flew back to base, and my shift for today ended. The first pic is the sunset I saw on my way home. What a glorious day. And, although for me it was a "good day to die" that would not be allowed for the patients under my care on this most beautiful day. I can thank God for that and everything today.

"Vivir con miedo es como vivir a medidas" - a life lived in fear is a life half-lived.

Friday, August 15, 2008

Ooo... Pretty Lights!

Just a couple of thoughts on my ride-a-longs with the local ambulance service:

If you see flashing lights behind you, move to the right.

If you hear a siren, put down the cell phone, look around you, and move to the right.

If a large moving vehicle with flashing lights and a siren suddenly appears in your rear window, turn down the radio, put down the cell phone, and move to the right.

Lights and sirens coming toward you on a street means... um... move to the right.

If you are driving and come to an intersection where everyone else is stopped, don't take it to mean that they are waiting for you... it's probably because everyone else saw the big moving vehicle with the lights and sirens coming down the street.

Emergency vehicles are like deer, if you see one there might be others, so take a few seconds to make sure a second one isn't following the first.

If you call 911, a lot of people are suddenly going to show up. If they're at your house, that means that can't be at someone else's, so don't call unless you've got a legitimate reason.

One final thought: yield to emergency vehicles, they might just be heading to save someone you love.

Tomorrow, another shift with Mercy Flight. Better weather on the horizon, so we'll see what the day brings.

Sunday, August 10, 2008

First Flight

Quickly, today I flew for the first time with Mercy Flight. During my 12 hour shift, we had one run: a trauma that had to be flown from a city to the north down to ECMC. I will find out from my colleagues how the patient did. I just thought I would share some photos from the event.

All in all, a very exciting day. Tomorrow back to tox and another week of being on-call for tox and EMS. Until then!

Friday, August 8, 2008

The Spirit of the Olympics

I honestly think I must have had something to do with the olympics in a former life. Nothing will bring a tear to my eye as easily as watching the opening ceremonies and seeing the olympic cauldron be lit.

Growing up watching Nadia take the gold, I dreamed of finding my sport and competing in the olympics. At my age, my only hopes now are sailing and equestrian. Still, one of my more reachable goals is to attend an olympic opening ceremony. One day... maybe in two years in Vancouver?

As the next 17 days progress, I know I will be watching the competitions; still getting misty as the U.S. flags are raised and our national anthem plays. Do you plan on watching?

Thursday, August 7, 2008

Continuity of Care

Ok, so I really haven't written because there hasn't been a lot going on. I am in the middle of my EMS/Toxicology rotation, and I have been going daily to the Poison Control Center of WNY for lectures and to follow up on the cases we have been asked to consult on, and then my afternoons are spent in a variety of different activities. Mostly, I am enjoying driving the SMART 1 vehicle around town, and I am starting to take calls with the fire department and ambulance service.

Last week Friday, I spent the evening with the crew from Rescue 1. There were two calls, both of which were canceled en route. However, there's still something to be said for pulling out of the fire house, lights and sirens, riding the big red truck. I enjoyed the time spent with the fireman, and I wish them continued safety.

I went out with one of the attendings and a fellow resident as medical back-up for Erie County Sheriff's SWAT team. They did a raid on a house, and we were there in case of injury. It was very interesting and exciting in a "Cops" style, up close and watching the action sort of way. No injuries, thank God, and I wish on them continued safety.

I spent a good part of the weekend preparing for a lecture on ventilators that I gave yesterday at our EM grand rounds (oh, yes, grand round Wednesdays are back!) It seems to have been well-received. So kudos for me.

Today I did a ride along with one of the paramedics from the local ambulance company. It was interesting because in the middle of one of our calls, I received a page from Poison Control about a case. As I rode in the back of the bouncing ambulance, I took information about this case. I was on my third phone call by the time we reached the VA to deliver our patient.

After I called back the consulting hospital, ECMC, with our recommendations, the paramedic, Tony, asked if I wanted to go to ECMC and see if the patient had been transferred. I said yes, and we arrived just as the patient was starting to be evaluated. It was nice because I was able to follow the case. We call that "continuity of care;" when the same provider follows a patient through their medical course of treatment. Of course, one of my colleagues took the case over, and I will follow up, along with Poison Control, in the morning, but it was interesting to see one of the patients I get called about in the E.D.

Tony and I spent a good deal of the shift going from call to call, and there's a lot of forms that need to be filled out for each run,so Tony spent most of his time typing on his portable computer. The cases were pretty run of the mill, but it's always good to see what the EMS guys are dealing with "pre-hospital."

Tomorrow it's back to PCC in the morning, but Saturday is my first Mercy Flight shift. I hope the weather clears, and we get to fly! And, yes, I plan to have my camera at the ready.

As for the veggie thing. I am at the end of my last week. How hard has it been? Just a little. I spend so much time out of my home, that I usually eat out. I am realizing just how difficult it is to eat vegetarian and healthy in this town. Choices are very limited. I did find a very tasty eggplant parmesan at a restaurant called Towne near downtown Buffalo. I judge Italian pastas on the sauce, and this one was just the right blend of tomatoes and spices. Yum.

Just a few more days of the pledge, however I am considering more my choices in foods.... I just made the pledge to eat only free range egg products and limit my intake of eggs in general. I think we'd all make a difference if we just considered where our foods are coming from. And, with the gas crunch, more restaurants and local markets are supporting local growers which don't have to be shipped as far. That's something we can all benefit from. (ok, ok, off the soapbox)