My First National Conference!

Back to Chi-town! A few months ago I was elected as our residency programs rep to the national group Emergency Medicine Resident's Association. Which means I get to go to the national conference being held in Chicago this week!

I can't wait. I've heard a lot about these national conferences, and I signed up for some exciting lecture presentations several weeks ago. I plan to take my camera, so I should have a lot of shots to share.

I spent my intern year of surgery in Chicago, and I loved the town. What I have mostly been talking about to my friends is the food... yum. I probably gained about 20 lbs during the year I was in Chicago.

One place I have to mention is Garrett's Popcorn on Michigan Ave with a smaller store near Macy's (formerly Marshall Fields) on State. Mhmm... they pop the corn fresh in this huge tumbler then add the butteriest caramel or cheese topping. You can buy the mixed bag or splurge and get a bucket. They also have to die for caramel nut mixes including almonds, macadamia nuts or standard peanuts. So good.

Ok, with that I have to keep packing... will write more when I can... Cheers!

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...

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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...

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."

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...

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...

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.