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...
SUNY Buffalo - South CampusSo, for the last two days I have been in an ATLS (Advance Trauma Life Support) class. Basically, the class teaches the principles of caring for the trauma patient. We had a series of lectures, intermixed with small group learning sessions, a cadaver lab, and then an oral exam and a written exam. It's been a wonderful respite from the geriatric service. For the last two days I have been reviewing a lot of the lessons learned during my surgical residency. As we went through case scenarios, or during particular lectures, my mind would drift back to the patients I had seen or operations I had performed. Several times I had to bring myself back to the current lecture before I lost track of where we were.
One of the funnest parts was the cadaver lab. Suddenly, for just a moment amoungst the familiar smells and sounds, I was back in medical school, excited about pulling back the plastic over the cadaver and beginning to explore and appreciate the gift that someone had given - the ultimate gift of themselves. What was interesting, and just a little eerie, was that one of the participants, an EMT who was auditing the course, actually knew the patient. He said that during his time as an EMT, he had picked up the patient and transported them to the hospital multiple times. We performed various procedures on our body donor. I remember in medical school, on the first day of anatomy lab, my group standing around the shrouded body; staring down, uncomfortable, not liking the smell, trying not to think about the fact that soon we would be meeting our first and most important patient.
Not just that. We all knew that soon one of us was going to have to pick up a scalpel and begin the dissection that would continue throughout the next 4 months of our lives. I have to admit that I was the one that picked up the scalpel and made the first incision; offering a small apology in silence to the body donor. Later, as a third year medical student on my surgery rotation, I remember being allowed to hold the scalpel and make the small incision to remove a small fatty tumor. I remember thinking that the skin was so much more pliable, so much more... alive. Then, during my last rotation of my fourth year (an emergency medicine month if you can imagine) I was allowed to place a chest tube in a patient who had a pneumothorax (collapsed lung.) The surgeon walked me through the procedure. A cut into the skin overlying the 5th rib on the side. Then a deeper cut into the muscle. I then put a Kelly clamp into the muscle layers and started spreading them. Slowly. The surgeon would come over from time to time and check my progress by sticking a finger into the wound. "Keep going. A little faster, I want to go home soon and get some dinner some time tonight," he teased. When I got just above the pleural layer overlying the lung cavity, he told me to spread and push. He was standing at the back of the room joking with the E.D. attending when I broke through the pleura, and there was a sudden, surprising, rush of air. He heard it and said, "What did you just do!!?!?!?" Then he laughed at the startled, and just a little frightened look on my face and said, "Very good. Keep going." I grabbed the chest tube, placed it into the chest cavity, and then he showed me how to sew it in place and place a dressing over it.
I was thankful for that experience as during the first month of my intern year on the cardiothoracic surgery service I placed 13 chest tubes. I've placed many more during the last 5 years. Now, here I was again. A body donor, a scalpel, talking one of the new interns through the steps, showing them some of the tricks I had picked up along the way. At one point I grabbed the scalpel myself and placed a chest tube in less than 30 seconds. Of course, on a real patient there would have been a lot of other things happening, prepping the patient, wearing sterile gowns, giving anesthesia, etc. But, still, there was a certain satisfaction in how far I had come, and how the thought of making that incision no longer frightened me. I miss surgery sometimes, but I know I have made the right choice for this point in my life. And I am happy to have to have spent the last two days, albeit slightly melancholy, reliving a very important time in my life. Tomorrow back to the Geriatric service. Seven more shifts, and it is over. Get me back to the E.D. Back to the trauma and the drama. Back to my new life.
