Tuesday, September 23, 2008

No Tooth Fairy For Me...

So I spent my morning looking in eyes and my afternoon watching teeth be pulled. It was then that I realized that teeth are really gross. I'm going to start brushing like 10 times a day to avoid some of the grossness I witnessed today.

Now, you might wonder what an ED doc is doing in the dental clinic... well, I am learning to give those shots in the back of the mouth that make one side of your mouth, lip and tongue numb so the dentist can work. This way, when patients come into the E.D. complaining of a toothache, I can give them a shot to make them feel better until they can be seen by a dentist.

After giving one said shot, I stayed around to watch the dental students learn to pull and work on teeth. I guess I never realized in the adult mouth that the roots are very long. Ew... certainly not the joy of wiggling that little loose tooth in your mouth when you're 6 or 7... getting that little salty taste... and then "pop" off it comes. Put it under the pillow and the tooth fairy comes. Mine brought silver dollars which I still have somewhere... at least a couple of them.

I was lucky and never needed braces... my mom at 70 still has all her teeth, nice and straight... always bragged her father/my grandfather could pop beer caps off with his teeth... speaking of which, I am off to brush my teeth again before going to bed... brush and floss... better add in the mouthwash for good measure...

Monday, September 22, 2008

Taking the Easy ROAD...

Ok, so I didn't get a chance to write as much while on my Trauma ICU rotation. I really meant several times to sit and write about that day's events. My feelings. My comments on the stupidity of my fellow man. Seriously. Trauma Drama 24/7.

But, I found myself coming home most days, especially after 27 hours on call, exhausted and not wanting to do much more than play with my cats, play on the computer, enter a world of escapism. My cats wondered about my strange hours; getting up at 4:30 to be out the door by 5:30 so I could start rounding at 6:00. Then coming home close to noon after having been gone since the day before and sleeping all day, waking up to eat something, pour some food in their bowls and then going back to sleep. Shampoo, rinse, repeat.

So, some of the stories from this last month on the TICU service: I probably knew more about the surgeries than most of my colleagues, and had actually performed more of the surgeries than the second year surgery residents I worked with. I got to put in central lines, I put a breathing tube in one patient, and I put in an arterial line to measure blood pressure in someone's foot.

There was an article in the local Buffalo newspaper about the inordinate amount of ATV accident victims being sent to the E.D. We had at least 3 - 4 of them, including a husband and wife who got drunk and crashed their ATV. The wife is doing better. The husband, not so much.

We had a number of shootings including a 13 year old shot by a guy rumored to be in a love triangle with her and another 16 year old girl that he'd already shot and killed. A 16 year old shot in a drive-by straight through the head. The CT showed a trail of debris from the front to the back where the bullet lay lodged. Don't know how that patient will do. We had the suicidal patient that decided to shoot themselves through the stomach. They had a large belly and shot from one side to the other. I am still trying to figure out the trajectory on that one.

We had the motorcyclists hit by cars. The drivers of cars hitting other cars, or trees, or flying off the road and flipping over.
People hit by other people's cars. A patient hit by their own car which they thought was in park. A patient was hit by a city bus. And, the patient changing the oil who got crushed by their own car.

We had a number of patients that fell off of, got kicked by, or run/rolled over by their horses.

We had the fell off ladder, fell off scapholding, fell out of tree stands.

Alchohol and drugs had a lot to do with a number of injuries, including the patient who got drunk, fell down the stairs, broke their neck, and is now a quadraplegic.

We had the surgical emergencies: bleeding duodenal ulcer, perforated gastric ulcer, dissecting thoracic aneurysm, ruptured brain aneurysm, etc.

I had the end of life talk with two patients' families. I pronounced one patient and wrote the withdrawal of care orders on the second. I developed a rapport with the family of a patient assaulted with a beer bottle to the back of the head who developed a head bleed and had basically lost the right side of his brain as a consequence. As I showed them the CT scan, I learned that the patient was a very talented artist. Art and spatial relations comes from the right side of the brain. I asked the brother if the patient would want to continue on with the part of the brain gone that was their major talent. He told me the patient would want to live. But, he was torn. He considered it more of a religious decision. But, he wondered if they were making the right decision.

I ended my final shift admitting a little lady who had t-boned another car at 50mph and had a liver laceration and the patient with the bleeding duodenal ulcer. As I came home to sleep, I turned the pager on vibrate and placed it on the bottom of my bag. When I awoke some 10 hours later, about 6 trauma patients had come into the E.D. The next morning there were another 4.

I got to do something fun, despite having a cold, on my last day of the rotation:

As part of our residency, we provide medical support at Buffalo Bills' games. So, I spent the game treating the overindulgers, the fighters, the nauseated, the injured, and whomever else wandered into the north side medical clinic at the stadium. I did get to watch a couple of plays, and we all huddled around the TV as the final kick resulted in a win for the home team!

This month I am doing the relaxed, Mixed Bag rotation of Ophthalmology, Oral MaxilloFacial Surgery and Radiology. In med school, we talked about taking the "easy ROAD" R = radiology, O = ophthalmology, A = anesthesia, and D = dermatology. These were considered the high money specialties with a minimum of patient time and or short clinic hours with no weekends and minimal calls. So, I am essentially doing 2 out of the 4 with my weekends off to enjoy... oh yeah, and a week's vacation during the final week.

So, we'll see what excitement I can drum up over the next THREE weeks...

Wednesday, September 3, 2008

Stopped by a Chip in the Road

Well, today I had an allergic reaction to some ginger on, of all things, a potato chip. I always watch what I eat in terms of baked goods that tend to include it, and I have learned to also ask about Allspice which caused a similar reaction. But, a potato chip? Didn't even think about it when the bag was offered to me, I took one, tasted good, than about a minute later I could feel the pressure in my chest.

Luckily, I was in the TICU at that time. I grabbed my bag, sucked on the inhaler I always carry and got a Benadryl from one of the RN's. Things seemed ok for a few minutes but then my voice started changing so I went down to the E.D. where I was given a dose of IV steroids and IV Benadryl. Within a few minutes I was feeling much better, and they kept me for observation for another 1/2 hour. I came home and slept off the Benadryl.

Of course, when I awoke, I noted 5 trauma code pages that went off... wonder how many of those are going to be in the ICU when I get back tomorrow morning... I am guessing that the "gun shot wound to the chest" will most likely be there. So will I. Bright and early. Now having learned to add "Spicy Chips" to my list of "foods to check before I eat."