hard night

I am currently in week 8 of rotations. This means 2 months of walking, no-- make that frantically running ('cept when i was on neuro), the halls of a hospital, pretending I knew exactly what was going on, while having my third ulcer and shitting my pants ("that, my friend, is why I wear brown shoes" -Dr. Johnson). In truth, I think I've got the "I'm on top of everything look" while in front of the residents and attendings. By myself, when I'm running from floor to floor, the sheer terror takes over my face and people usually ask me whats wrong. =)

2 months of being in the hospital means that death has come across my path as well. And although I may joke about some things, this is not going to be a happy post for me.
Being on trauma surgery means you will be exposed to patients dying, which hit my med student partner and I hard on the first day, but nothing compared to what I experienced earlier this week.

Sunday night was my second day/night on call. Things were busy as usual (read "first call") and then we got a trauma red (1 * 1* 10* 20--meaning trauma red* 1 person* arriving in 10 minutes* trauma bay #). The normal trauma bay was packed so this trauma had to go to another room that usually isn't used for traumas. All we knew was it is a 19 yo who attempted hanging.

When the trauma arrived, it was the usual organized chaos. People were running around the small room, calling out for things they needed, yelling physical exam findings. Except I knew, with that dreaded-pit-in-my-stomach feeling, that this was going to be bad. She was cold to the touch. CPR had been going on for who knows how long. We, the med students, were actually told by the residents to go away, to do something else. My partner and I would visit and see them pushing more atropine, more epinephrine. They eventually got a pulse and a BP that was "acceptable" but she was on a ventilator and cerebral hypoxia was clear.

We found out that she was from Ohio, a freshman at the U here in town. That she didn't get into the sorority she wanted and felt suicidal. Her roommate found her.

I lost any sort of "composure" I could fake. I ran away, out of the ED, searching for a hiding spot so I could cry. Everyone keeps telling me that its OK to show how upset I was, how upset I am. That there is nothing wrong with it. But its impossible to think I could ever be of help while I break down like this. Its hard to remember what the hell I am doing here while faced with something like this. I am told that the sadness of these circumstances never goes away, you just learn how to deal with them differently or something.

That night she was transferred to the pediatric intensive care unit.

She coded several hours later.

First call

so its been a while since i've posted ( a whole week!) and a ton has happened--its crazy how one week feels like a month on this rotation--not necessarily a bad thing just bizarre.
I was on call last tuesday night and it was INTENSE.

I, of course, am a black cloud. A couple of residents told me (kiddingly i hope) that they do not want to do call with me. Ever. Again.

Our first trauma call was at 8pm and we were non stop except for a hour from 4:30 to 5:30....then we needed to preround. We had a pick ax to the head x4, a motor cycle vs tree, motor cycle vs car head on, person vs train (3 limb amputee in the field), gunshot wound to the chest, and i think one more...all on a tuesday night.....

I was handling myself pretty well until the person vs train. He was trying to commit suicide and so when he came in he was screaming and yelling all kinds of stuff---in part because of the severe pain he was probably experiencing and in part because he realized he was still alive and was really upset about it. They quickly intubated him and I stood with my mouth on the floor, in shock as well. He was bleeding from every missing limb profusely, people were rushing all around, getting as many lines as they could into his body, pumping him as fast as they could with blood and saline. I eventually woke up from my freaked out daze, grabbed a roll of gaze, and applied pressure to his right stump avoiding the sharp shards of his tibula and fibula poking out. They got him as stable as possible and wheeled him to the OR to complete the amputations. I had several nightmares about him the following night.

my next call is tomorrow (sunday!) which should be interesting. I wonder what the max number of traumas in a 24 hour period is.....

Slash

my 19 year old pt was walking his grandma to church last friday night when a couple of guys from out of no where jumped out of the bushes and stabbed him 5 or 6 times. He had never seen them before and has absolutely no idea what provoked them. Luckily his grandma was unscathed.

His stab wounds, however, were significant. One went thru his diaphragm, one into his heart, and several piercing his bowel. He has had multiple surgeries, including a bilateral skin graft from his upper thighs to his abdomen, and a tracheostomy. But the pain is not so bad---he is super tough---just wait til he gets out of the hospital, he'll find those guys, who ever they are.

I go to check in on my super strong, bad ass 19 yr old knife fight patient, and he is happily (although he is tearing up from the pain on his legs) lying in bed glued to the tv, premiering sponge bob square pants. The little yellow square is running around on the big screen, and that's when it hit me. My 19 yr old "slash" is a little kid trapped in a big scary adult world. He was somehow forced into this "bad ass" lifestyle, when all he would rather be doing is watching cartoons, selling lemmonade at the street corner, riding his bike through the community.

There is no doubt there will be some sort of "revenge" on his behalf. And his predator will be lying in the bed next to him watching barney or pokemon.

first day

40 pts on the floor in total, 13 hours at UMC, 5 traumas, 4 pts on the floor for the med stud., 3 ABG attempts, 2 cups of coffee, 1 trip to the bathroom, 1 paper to present, 0 obtained ABGs, 0 food.
It was a crazy first day on trauma. Besides being exhausted, I loved it.

gratitude

After the first time I scrubbed into a surgery, I noticed the residents made sure to say "Thank you!!" to the attending as they were scrubbing out, so I did the same. I was confused to why we were thanking the person who had just verbally attacked everyone in the room. And then I realized that we were saying thank you because they had left it at verbal attacks and had not actually thrown anything. . . .

Say what?!?!

For years my fam volunteered on Turkey day to feed the homeless at church on the south side of town. So last year, I used the fact that hundreds of underserved people would be at the same place and I organized a medical screening for them on Thanksgiving. About 8 other students and a doc volunteered about 4 hours in the morning to do HTN screening, listen to heart & lungs, diabetes screening and a few depression screenings. If something abnormal came up, we handed out a flyer to get people to go to one of the free clinics in town. Overall, it was a good success.

This year I was ready to pick it up----I wanted to offer the rapid HIV tests & TB tests, so a doctor in my college recommended the health dept. I called them today. And I am livid at how it all went down.....

"Hello! My name is Samantha and I am a 3rd year medical student at the U of A. Last year I started up a homeless screening clinic and I wanted to expand it to include the rapid oral HIV screening tests. It would be about 3 hours in the morning of Thanksgiving day. I was told you would be the person to call to help."

----Well, we couldn't do it on Thanksgiving day. Could you do it the day after?

"Unfortunately, no. Thats when the potential patients would be there, and not all med students get the Friday after Thanksgiving off. Is Thursday a bad day?"

----- No. Its just that we can't pay people time and half for a holiday since we're county.

"Well this would be more of a volunteer thing. Last year, the doctor and the medical students volunteered their time."

-----Thanksgiving is a family day. And we wouldn't get paid time & a half.

......
The conversation continued like that. I asked for another organization in town that may help, but I was to make sure to tell them that the health dept said they didn't have to work on Thanksgiving.

So basically, they are interested about getting paid and not about screening one of the highest populations of HIV. What the heck is that about?!?

PS little do they know that when i get fired up about this kind of thing, i get even more determined. There WILL be rapid HIV screening on thanksgiving day!

myths uncovered

I have completed my three weeks with the Pediatric Surgeons and I start Trauma Surgery on Thursday...after 3 days of orientation to surgery (yeah, that would have been good before I started pediatric surgery....). I am definitely excited to try out this trauma stuff---especially since i'm interested in emergency medicine.
Surgery is an interesting field. Besides shadowing a surgeon before I started med school, the only exposure i've had was Turk thru Scrubs and of course Greys Anatomy. Most people think that surgery is just like Grey's anatomy, or they think its so far off. I'm here to tell you thats a little bit of both.
Myth #1. Everyone sleeps with each other. Although there are some crazy sex scandalous stuff that goes on in the on-call rooms; no, the residents I worked with were definitely NOT sleeping with the attendings, nor were they sleeping with each other. The fact is, they were so excited to actually sleep, and they are all so wound up tight during the day, that i'm pretty sure no night-time activity goes on for any of them.
Myth #2. All that surgeons do is cut. Well that is close to true for the attendings, but not at all for the residents. The residents would finish up a surgery, run out of the room, go see a patient who was vomiting post-op day 2, give some meds, discharge another patient, stop by x ray to see an image on a different patient, and be back in time to start the next surgical case. I was amazed how efficient they were (btw nothing like my neuro rotation). The attendings would finish a case, see the parents of the kiddo and then read part of the paper, or polish their devlish trident.
Myth #3. Surgeons do not have good bedside manner. This is sad, but true. I saw docs make awful jokes---my skin would crawl, I'd feel so awkward. I saw them talk down to teenagers and the parents of the teenagers. Yes, they could preform amazing tasks with their knowledge of anatomy, and skill, but no, they are not like our favorite SBS teacher in any way, shape or form.
Myth #4. All doctors are good looking and have time to do their hair, makeup, and workout---just like the docs on Greys or Scrubs. Yeah right. My resident told me one day that it had been 3 days since she washed her hair. One person mentioned working out, once. The truth is---they all work really hard and they love it. They couldn't think of any other way to live their life.

thats all i have for now. i know it sounds like a lot of bashing, but as i said before i'm actually interested in surgery, so I'm just trying to really think this out before i sign myself up for this kind of lifestyle. =)

change of heart

Being on peds surg I've seen some amazing things. Inguinal herinas that were so small I could hardly believe that was the reason we were operating (it was on an infant), Mastectomies for teenage boys with gynecomastica, doing crazy operations on 34 week premies. But the surgery I saw the other day took the cake. These surgeons performed a nissen---its when the doc takes the fundus (top) part of the stomach and wraps it around the esophagus and sews it together. This is done for patients with GERD (gastro-esophageal reflux disease); when it is medically unmanagable. They did it on an 8 month old. And guess what...they did it laparoscopically. Five tiny incisions and that was all. It was amazing.
The anatomy was incredible. I could see the tiny heart beating against the diaphragm. All the vessels along the stomach were pulsating. I was so excited about this surgery it got me thinking. I may actually go into surgery some day. (say what??) Yeah, they kicked my ass. And I did hate my life at first. But who knows......

Breakfast with Mr. Webber

I am currently on my pediatric surgery rotation. To say it has been difficult is not doing it justice. But every evening I look forward to escaping the horrors of pediatric surgeons as I sleep, only to have dream after dream about scalpels, writing SOAP notes, and being yelled at as I push my patients out of their bed so I can sleep in my dream. Even dreaming is exhausting.

You can imagine my surprise when I wake up at O-dark-thirty every morning to have a collection of songs from musicals stuck in my head. In the first few days, I woke up singing different phrases from Phantom of the Opera. I was so out of it, I didn't even know I was singing the famous Andrew Lloyd Webber musical until I was on my way to the hospital. The next few days it was CATS. Followed by Les Miserables. And just when I thought I had a thing for Mr. Webber, this morning it was Rent.

What is the connection to pediatric surgery and musicals? Could it be my roommates are playing different muscials in my room as I sleep? Or have I crossed into the Twlight Zone? These are the important questions I have.

parents

you know things are bad with this generation when a surgeon is about to do a 4 hour open abdominal surgery on your premie 3 month kid and you think perfect! now i can finish all my errands.....

how old am i

This is my favorite quote from scrubs.....


"All right, calm down. Now listen - you've been to four years of college, and four years of medical school. So I can safely assume that you are at least eight..."- Dr kelso from Scrubs......and there is my life......

Christmas came early

my first real ER patient was Santa. I was there for a neuro consult but I had the feeling he just needed to know what to fill my stocking with. He had a full beard and a jolly laugh...he was early this year----i mean he should be up in the north pole planning my gifts..but i guess the cold weather does get old.....he had tattooes all over his body and was missing all teeth 'cept the two bottom ones---but what can you expect when you eat all the kids cookies?? His diabetes---insulin is hard to come by in the north pole---had given him a neuropathy---he had decreased sensation in his feet and a radial nerve palsy..... His famous trade mark: Occupation in AZ: apparently due to the lack of reindeer he worked on horses, which means several falls to the head---they are not used to pulling the sleigh....