Saturday, August 19, 2017

Estoy con capacidad de sentido común.

He said that he had been hit by a car. Flown up and over the car and on the way down his foot had hit a mailbox. Only trouble with that story... didn't fit with his injuries.
You can ask him again, and usually the story changes a bit each time, but despite the inconsistencies, he sticks to his story.  The mailbox is at fault.
So I document.. Subjective: Patient reports....
Objective: Foot smashed
I pulled the Ortho resident aside. One look at the foot and it was obvious it would never be the same again. Say I was in the jungle, and the same foot came to me. I would not have the tools nor the know-how to put it back together again. She assured me I wouldn't have to amputate, that with a good cleaning and monitoring, patient could potentially keep his foot. Granted, who knows how he would walk on it. And in the end, for a variety of reasons (infection, necrosis of the bone, etc) may have to end up amputating anyways.  #thinkingahead

Another, on a motorcycle, hit from behind, went flying forward. He came into our trauma bay screaming about his carotid. Every two seconds, would ask us if his carotid was okay. His carotid was okay. Ankle not so much. But no worries about the carotid. Had us all a little, thinking he was weird, but then just turns out this wasn't his first motorcycle accident. Last time he had almost died from a severed subclavian artery. Carotid. Subclavian. Close enough... i guess ;)

We've had a string of cute kids come by on our trauma assembly line, in addition to our nightly appendicitis.
For the past two nights I've seen little 1yr old kiddies having taken a tumble down a flight of stairs. The most recent, dad had kept him calm on the ambulance ride to the hospital by feeding him potato chips. Note to all parents: don't feed your kids while on your way to the hospital in an ambulance. Or better yet, don't let your 1yr olds play at the top of a flight of wooden stairs.
We had a kid crack his jaw by over-rotating a back flip on the trampoline and landing on the frame. He was actually asleep when we saw him. Waking him up I realized too late that I was standing right by his head, potential for unnecessary startling. But, instead of being scared by waking up in a strange place with a strange person looking down at you, he paused a second and then smiled and waved up at us. We enjoyed his wit and one-liners interjected between our commands to 'move this' or 'move that'.
We had another kid with a broken leg. But he wasn't seeing us because of his broken leg. No, that was old news. He was seeing us, because despite his full leg cast he was out riding ATVs and falling off them. This poor kid was so brave, which I didn't see initially. He was happy and making jokes when we first assessed him. But later, after returning from CT imaging, Mom had stepped away to charge her phone, and not seeing anyone had scared him. I had returned to follow up at that point and caught the tail end of his tears.
Then the other day, I got to meet the next Broadway star. At least, that's his next goal. He's spent his summer practicing 6hrs a day. He was very excited at the idea of spending the rest of his summer on the couch watching Netflix though. I have no doubt we'll see him on Broadway some day! Super smart kid, and super interested about his appendix. I told him, that when he retires from dancing he should go to medical school.

Much Love.

Saturday, August 12, 2017

Estoy confundida.

It's raining!! So exciting! I love the rain! It's simply fabulous! Best thing since sliced bread! Like nooooooo joke! Dead serious! It's amazing!

Don't let the plethora of exclamation points fool you. We really do like the rain. 'We', being the unnamed faceless workers along the trauma factory line. For some reason, rain brings a sudden miraculous increase in the intelligence of the human race. They don't go out on an ATV without protective gear and attempt to play with cars. They don't climb trees, work on roofs or jump off bridges. They pay attention when they drive, or they just don't even go out at all.  They drink, but at home, on their couches, while watching Netflix.

Despite, this typical observed increase in the human capacity for reason, five traumas rolled into our trauma bays throughout the night. More than usual for a rainy night, but I can't complain as they were for the most part stable and two actually even went home.

Wishing you a lovely rainy weekend!
Much Love.

Thursday, August 10, 2017

Estoy contemplando cual es peor.

August came, and with it I have transitioned to night float. Somehow, it seems much more difficult to balance work and life outside of work when one is awake all night.  I mean... it has taken me three days to even finish this post. Perhaps, it is just me, and the fact that I am not a fan of working the night shift. Whine aside, I am thankful the month seems to be moving quickly.

In America, the general population very commonly has multiple medical problems. As a whole, we don't take very good care of ourselves. One way to avoid this problem, is to never go to the doctor.  We see it once in awhile. 55+ year old individual who comes to the hospital reporting no past medical history, but at the same time hasn't been to see a doctor in over 30 years. Guess what... they're not as healthy as they believe themselves to be. Far from it usually. And in accordance with their stubbornness, the reason for finally bringing them to the hospital has typically already been festering and ignored for weeks.

We had an individual come to us the other night after finally being forced to present to the hospital by his sister. Complaint was three weeks of abdominal pain. Upon further investigation, as I'm sure you've guessed, the story was so much bigger.

We found an 8cm abdominal aortic aneurysm threatening to burst with each bounding pulsation. We also found a 10cm mass overtaking his lung. He confessed he'd quit smoking on his way to the hospital. Too little. Too late.

Options were presented to him.
1) Just a guesstimate, life expectancy of maximum 6months from what was almost certainly lung cancer.
2) Possible sudden death at any unpredictable time from a ruptured abdominal aortic aneurysm.
3) Repair of the AAA, preventing possible sudden death, but taking on the risk of surgery which includes bleeding, infection, respiratory failure requiring intubation unknown ability to extubate, paralysis of lower extremities, kidney failure, and of course death... just to name a few.  And should he even recover, then still with a 6month life expectancy.
4) Do nothing, and let nature take its course.

He couldn't give us an answer that night. We didn't blame him.

What would you do?

Much love.

Thursday, July 27, 2017

Estoy corriendo.

Given that I covered call last Sunday and going straight into call this Saturday, under ACGME rules I am allotted a 24 hr period off. Happened to be today. Upon waking this AM, I grabbed my phone to 1) check the time and then 2) check the weather. Wasn't supposed to rain until 2pm. Good, I thought. Plenty of time to work inside a while and get out for a run before it rains. When I finally stepped out of my building, unwinding my trusty old mp3 player, I immediately felt the small pings of raindrops. Sure enough, I'd had one deadline for the day, and I'd missed it. I'm trying to be better about getting out when I have the opportunity so I took the run anyways. Glad I did, as the rain stayed light and kept me cool. I pretty much studied the rest of the day. Made food and a co-resident came and studied with me when she got off work. We try to learn by taking the disease process, or symptom or sequelea all the way down to the pathophysiology. By understanding the why, making the result much more clear. We keep hitting road blocks though. All the cellular pathways and mechanisms we crammed into our brains back in med school seem to be half-erased leaving just lines, boxes and inert shapes which lend to recognition, but without reason. Might as well just have brains filled with legos; could actually build something with that. We eventually get around our road blocks and keep plodding on. I'd had other goals for the day as well, but just like my rain deadline, I've gone too late. Will have to save them for the next time.

Much Love.

Saturday, July 22, 2017

Estoy respirando.

While I carry the consult pager this month, I also have my primary patients to take care of on the Thoracic Surgery service. One such patient kind of reminds us all of a flower child. I'm almost tempted to say that he can actually pull off his mullet, the one and only capable, but then... let's not get carried away.  He's always cracking jokes, so he gets along well with everyone. Even in pain he's making jokes. Due to all the past surgery on his belly, he had come to us (Thoracic surgery) as a last option. What would typically be done through the belly, we instead opened the side of the chest and got access that way. His lungs are just taking their time remembering how to be lungs again, instead of shriveled sponges. We've put chest tubes in. Taken them out. And then put them back in again. His pain doesn't help either. I dosed his narcotics so high, it would have been enough to completely halt my respiratory drive, but turns out...wasn't even enough for him. It's the first time I've ever seen someone's arterial blood gas actually improve by increasing narcotics.

And then on the consult side of things, we got another breast cancer gone far too long and literally eating away at the poor lady's chest. It's horrifying. Professional on the outside, screaming on the inside I continued with the interview. How did you go to work everyday? "I just put gauze on it, I thought it would go away." On exam I ask her if she's having pain. While squeezing her eyes tight and holding her breath, she tries to be brave,"no, that's not bad."
Honey, that's not bravery... that's denial.

Much Love.

Thursday, July 13, 2017

Estoy enseñando.

As consult resident for the surgical service, I get called on average 3-10 consults daily. But of course, there's always the exception. Today was one of those exceptions, not only did I not get any consults, but the 0298 didn't even go off after 12:00. I ignored it, and kept busy, so as to not jinx the situation. For the second you acknowledge the state of calm, the pager will go off with minimum three consults in a row. Literally, the second. From my perspective, it's always a welcome break from the typical hurried hecticness. Unfortunately, I currently have three students assigned to my team. One sub-intern, and two 3rd years just starting their clinical year (brand new babies!). And with days like today they don't get to see all the amazingness that surgery can be.  We spent time going over past consults. An esophagus, completely structured shut after being burned with oven cleaner. Do we take it out and pull up the stomach? Can we even use the stomach? Should we interpose colon in its place, and does that mean the voice box has to go too?  A breast cancer beyond control, infected and eating away at the patient's chest. More discussion on patient denial there, than actual treatment of breast cancer itself.  That's one good thing about medicine, there's no end to topics for study, and we've kept busy despite no consults today. The students haven't complained yet.

Much Love.

Sunday, July 9, 2017

Estoy recuperando.

Back to the crazy 24 hr calls in the ED on summer weekends. By morning, you're probably walking around with you head tilted to one side. Simply because, you're just too exhausted to get it all the way up straight. No sooner than you finally make it home the next day and you've crashed on the nearest flat place that can hold your body habitus.  Which then in turn, leads to a considerable amount of confusion when something wakes you mid-afternoon and you have no idea where you are nor what just happened!!

The human body never ceases to amaze me. The other day I saw someone walking down the hall, scratching her head and talking on her phone. You could tell she was part of a family, and as they were all solemn-faced standing outside of the MICU (and it had been the third time that day I'd seen them), one could only conclude they were there to say good-bye to a loved one. And I as struck with amazement. They were saying good-bye to someone, yet no thought to themselves. Someone they loved had stopped breathing, heart stopped beating and eyes stopped seeing. Yet she was talking on her phone, with no thought to her next breath. Beholding her family, with no thought to when she would see them last. And heart hurting, with what belief about eternity?

Our Creator in His divinity has made it pretty easy for us. Our bodies pretty much take care of themselves. Breaks down and builds up; heals itself where needed and when allowed. Then just like our relationship with the Creator itself, we can go mess it up pretty bad sometimes.  Seemingly, to the point of irrevocability sometimes.  But the awesomeness of God's creation can not be limited to science, and without our understanding it survives and healing is provided. The body could never hope to be the same again, nor should it be. It now holds a beautiful story instead. Healing and hope. Same for a relationship with our Creator, once broken and repaired against all odds, carries a story of glory unlike any other.

Much Love.