January 13th, 2004

White Coat

So I'm a bad updater...

Yesterday, O Best Beloved, was an exciting day - so exciting that I had to go home and tell everyone about it, then I studied, then I went to bed, and I didn't even update so all of you could hear about the Very Neat Thing that happened yesterday.
Joerg let me go in to the revision of the amputation instead of him, because he got to go in on an aorta bifemoral arterial bypass today, as I was in lectures until 0815 again. Stupid lectures. But I went, and we were getting ready to have anaesthesia talk to the patient, when all of a sudden everyone's pager went off at once. When everyone's pager goes off at once, it's a Code77 - a trauma alert. So we yelled to the Charge Nurse that we were on hold for the surgery and ran to the ER. 19 year old male, gunshot wound to the jaw, ETA 5 minutes. Got there and put on gowns, and they wheeled him in. He had a little tiny wound in front of his ear, and blood everywhere, but he was talking to us, and moving his fingers, and generally in good shape for having been shot in the jaw, so we guessed maybe it was a graze, but we did all the films and Dr.E and I went back down to do our diabetic surgery.
Surgery was fun - for once. Dr. S, who's our radical-muslim-priest, after hearing about the antics of BW's residency class, was operating, and as we were trimming bone back to get good soft tissue coverage, he explained it all to me, let me ask questions, talked a lot. Then suddenly he hands me the rongeurs (these clippy things that we use to bite off bits of bone) and said "Do you want to do this?" Sure thing. So I nibbled away at the bone and it was really surprisingly hard work.
Everything went well - we used a new skin graft that's made of small intestine submucosa from pigs to cover the wound - and we're very hopeful. It's supposed to have great healing times.

And then we got out of surgery, and Dr.E's pager went off. It was BW. "You guys have got to see this." See what? Turns out they found the bullet when they did a CT scan. In his brain. Right in the middle, between the cerebrum and the cerebellum. Wow. It's pretty darn cool-looking on CT, especially when you see the guy, who's just fine except for the fact that the right side of his face is stuck. 7th nerve paralysis, they call it, and it's developed over the last day, so it might not even be injury-related. Lucky man.

And that, O Best Beloved, was the excitement of yesterday. It was followed by "Oh, Nykki? Can you go remove the staples from the suicidal patient's wrist?" In the last week, he's tried to kill himself three times, twice what we'd call serious attempts. I was removing the staples from his first attempt. This is significant because it meant I got to do something. And I did. And they looked good. And he said it didn't hurt.

Which brings me to today. Today so far has been lovely; I've removed sutures from two clinic patients with eyebrow lacerations, attended a Code77 involving a man whose brother stabbed him after he hit the brother in the face with a baseball bat, and am now waiting for a page to go change the trach tube on our patient who's finally woken up from his cerebral contusion. The kid who got stabbed (FW people, that was the "traumatic arrest" on my pager the other morning - he was found down at the scene with no blood pressure due to having bled it all over the floor of the apartment when someone stabbed him in the leg and transected two major vessels) is awake today, and extubated, and responding to people. He may recover, maybe fully, despite having almost died.
We rounded with staff. Staff explained to J, who was shot through the stomach the other day, that he can't eat yet. We were scooping mac and cheese out of his abdomen not two days ago, complained EH. What, he think we want to do it again?
I'm finally getting into the swing of Trauma, and clinic, and I don't think JB hates me any more. That feels good. It's all starting to be all right. Routine to a degree, routine enough that I have some locus of control. And everyone seems to like me, support personnel included.
Scott and the other 3rd year come back on Monday. Monday, already! Then there'll be just a week and a half left. I have to study tonight, and every night, so that I can just review later.

Rumour has it we might be changing that trach tube now...I'm going to go see.

Curves tonight, must go!

Update - later. Left wallet at hospital, with Curves Card. No Curves for me. Will go tomorrow, when Angel is going to choir. Also no trach change, doing it tomorrow.
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Nescafe rabbit

One for the road....

The other day, several months ago, in the hospital:
Cue me, sitting at a random charting/nurses workstation desk in the back room of the Infant ward, writing notes. The telephone rings.
Me: Infant workroom, this is Nykki.
Caller: Hi, this is Dr. XYZ, and I was paged about three hours ago. I've been in surgery and just got out. Anyone around there who paged me?
Me: Um, I'm not sure, Doctor. Just a moment.
I go up front and ask the nurses if anyone paged Dr. XYZ. They all, unsurprisingly, say no. I look around a bit before returning to the phone.
Me: No, sir, they seem to have left.
Caller: Hm, figures. All right, well, if you see anyone who paged me, tell them to page me again. I'm going home.
Me: Yes, sir, I'll do that.
We hang up.

Hospitals are big places. Academic institutions are even bigger. All of the 30 kids on the Infant unit are being managed by a minimum of 2 different teams, usually more like 5. All of those teams have at least four residents, plus attendings, plus medical students. We all have things to do, even the medical students.
Three hours after you got the page? Why even bother? Surely, after four years of college, four years of medical school, and at least seven years of surgical residency you'd know better.
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