Agraphia Medical Tragicomedy

Scheduling Changes

And suddenly the surgical department realized - we need someone to cover the Surgical/Trauma Intensive Care Unit for the night.

Though some unfortunate planning on my chief's part I ended up being the one who lost this particular Russian Roulette. I find myself amidst beeping monitors, medication drips, and unfamiliar patients.

Let me back up a moment. Intern year is all about uncomfortable firsts - your first prescription for narcotics, your first lab orders, your first blood transfusion, your first CT scan, your first crashing patient. All of these things are difficult in their own way. That being said, usually the degree of autonomy is matched to skill level.

Unfortunately, a mistake was made in the schedule and nobody was scheduled to run the trauma ICU tonight. Now, I'm on trauma this month, but there is a HUGE distinction between covering the regular floor and the ICU. The floor I can deal with. The ICU I simply do not have the experience to run.

Unfortunately I don't have much choice, as I find myself here with pager on hip. Currently I have a gentleman on the razor's edge of dying from his intracranial hemorrhage, another who chose to up and stop breathing about an hour ago, and one woman who is trying her best to grab the famous pink elephant.

I've got people I can call if I need to, and so far I've been pretty liberal with the phone-a-friend. But even though nothing has happened for the past hour, I've been lying wide awake.

If someone dies tonight... is it my fault?

30 minutes

Many of my stories happen at 4:30 in the morning.  Why?  Because that's when I'm forced to make the choice: my sleep, or my patient?

This was a particularly nice 16 year old who lost control of his car on black ice, careening into a tree at high speed and breaking most of his ribs.  The crash caused his windshield to instantly shatter, giving him a few scattered cuts across his face  and one huge slice through his lip.

Ribs will heal on their own, but the lacerations to his face need sewing.  Now, I'm no plastic surgeon, but I am an ER doc and I sew up a lot of wounds. Importantly, the vermillion border - the demarcation between the lip and the face - is one of the most cosmetically important areas of the face. Even a millimeter of disunion is instantaneously recognizable by the human eye.

And so, 24 hours into my trauma call I was faced with a choice.  Let one of my less experienced colleagues fix his lip in a few hours, or take the time to do it now, myself?  My body was screaming from a difficult call night; 15 or so trauma codes in the last 12 hours, sleep deprived for a month, contorting my back to examine patients in c-spine collars all night long.  I felt the overwhelming, primal need to crawl into a corner and sleep.

I suppose, in the end, it was a false choice.  I went into this profession for a reason - to help people.  Knowing full well that these 30 minutes of my time would directly impact every interaction he has with people for the rest of his life... well, that's time well spent.  The repair went wonderfully.  He'll have a barely noticeable whitish scar through his lip.

What I've gotten used to in medicine is this:  most patients will never realize how important my small time in their life really was.  A missed diagnosis here, a well-repaired laceration there, a timely intervention when needed.  I think it's a large part of why I went into emergency medicine - I want to be there for the important stuff.

When he gets out of the hospital, I'll tell him.  "Your lip looks great, man.  I'm glad you're doing better."  He'll probably never know why I was more concerned about his lip than his ribs.

Too Busy For Laundry

A question:  Can dirty clothes stay on the ground so long that they become clean again?

Traum-o-rama

Tomorrow I start trauma surgery.  Gunshot wounds, stabbings, and falls from ladders, oh my!

Stories to come, and lots of them... one thing I've never been quite clear on is why all gunshot wounds happen when a patient is "standing on the corner, minding my own business" when "some dude" (or occasionally, "a couple dudes") just happen to walk up and start firing.

Here's a warning to everyone in this city for the next month.  Avoid all street corners. Mind someone else's business, never your own.  Perhaps most importantly, when Some Dude strolls on by, RUN!  You'll know him when you see him.