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.

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.

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.

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!

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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?

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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)

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.

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?

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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.

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.

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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.

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.

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!

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!

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