Monday, January 29, 2018

Estoy recogiendo casos.


New changes for the residency program happening this year...  Also happens to be the understatement of the year. Perhaps the biggest change involves our presence rotating at St. Vincent’s Hospital in Bridgeport, CT. After decades of operating and caring for those of the Bridgeport area our contract with the hospital will be ending as of June 30th. It’s been the hot topic gossip this month as I have rotated here. I go to see a consult in the ED, and the ED doc is more interested in getting the scoop on the story than my plan for the patient. Needless to say, it is going to be a rough transition for everyone.  I’m thankful I’m back for two more months before it ends, as I can use that time to grab up all the cases I can before we have to leave and no longer have the option.

In other news, we had a patient the other day, who would fall into the category of “pleasantly demented.” An unofficial official category, much more enjoyable than the otherwise demented individual. This one had an interesting twist, as you could seemingly have a normal conversation with her and then suddenly find yourself in a zone of déjà vu, not sure if she was crazy, you were crazy or both of ya were crazy. Anyways, her issue was managed conservatively with successful results and resolution without surgical intervention. On the morning of the day of her discharge the conversation went something like this…

Resident: Good morning ma'am. How are you feeling this morning?

patient: Are you part of the surgery team?

Resident: Yes

Patient: Thank you! You did such a good job!!

Resident: You’re welcome! A good job with what?

Patient: With the surgery!! I don’t even see a scar!!

*facepalm*

Much Love.

Sunday, January 28, 2018

Estoy sobreviviendo.

I was on call last Thursday, and as the night wore on and the ED persisted in calling, my nose started dripping, my ears started popping, and my head feeling heavy.  Morning came and I was one very tired and very grumpy surgery resident. Instead of making it through traffic, I, for once, just sat and rode the traffic home that Friday morning. Knowing I was fighting a head cold I started by taking a nap snuggled under my blankets. Nap went well, so I attempted to study, which didn’t go so well and ended in a second nap. A meager second medicated attempt at studying and I soon gave up and went to bed hoping to sleep away my cold enough to concentrate on my ABSITE the next morning.
I wasn’t the only one with struggles the next morning. Another came in the throes of full-blown flu, and another came with post-call exhaustion written on his face. As I paused my test to take a break, I noticed he too had paused his test, but to lay his head down on the desk and sleep.  Who is every really ready to take their in-service examination?  There’s probably someone out there with an amazing memory and stellar immune system who isn’t post call and could perhaps be ready. The rest of us… Lord have mercy.

In the end, it doesn’t really matter how we did, but that we keep moving forward. Use it as a gauge of our progress and strive for more. Never stop learning.

And in the meantime, it is also nice to have a short reprieve from the pressure of a looming exam. I got home from the test Saturday and got to take care of some daily activities which had been pushed way down on the priority list. Things like taking out the trash and recyclables. Doing the dishes and paying the bills. Just nice to celebrate being normal for an afternoon, which ended all too soon, as my head cold demanded even more sleep.  

Much Love.



Monday, January 15, 2018

Estoy confundida.

I find myself often confused. There’s so much to know in this world that I am at a loss for words when I recognize the concepts, ideas and facts I have yet to grasp. I understand that God created me with a very specific purpose. Yet my frustration mounts around this time every year when we approach the in-service examination, and it is painfully obvious how much I still have yet to learn. And even worse, just how much I have forgotten. It keeps me humble. My study book has more colored ink and coffee stain then actual printed ink, often making it difficult to find a clean spot to make my notes. I’ve officially decided on retiring the book after this year’s test. New book, new edition, new clean pages!!

I just got completely off topic. I was talking about being confused. Human behavior often confuses me as well. There was a point when I had entertained Psychiatry as a potential field. Human behavior can be predicted and explained, it follows a text book pattern. It’s really quite fascinating to study, and hence why I had entertained the idea. But then, take a read at my last post... I no longer think that would be fun.

I was confused by a page I received the other day. It didn’t help that the medicine doctor on the other end of the line couldn’t exactly tell me why he had paged. But he told me about his patient. She had undergone a bone marrow biopsy two days prior, and had been bleeding from the needle puncture site since then. Bleed enough that she was about to receive her fourth transfusion. Easy enough story, but why call surgery? We have knifes, if we cut what’s already bleeding, it will only cause it to bleed more. The medicine doctor wondered if we had any tricks to stop the bleeding. To which I responded, hold pressure. And, he laughed. Must have thought I had said a good joke or something. I reiterated the need to hold pressure expressing my 100% sincerity. He evaded the topic by saying they had put a pressure dressing. ....fast forwarding the rest of the exchange, I do end up seeing this lady. Taking down what was supposed to be a “pressure dressing”, I find the culprit, a tiny needle hole over her hip bone with a continual red leak escaping from underneath. I wad up a piece of cellulose polymer and with my finger push it hard against the insulting hemorrhage. And then I don’t move. Four minutes into holding pressure, I asked the patient if anyone had done that for her? “Done what?” She responded. “This!” I exclaimed, “Hold this pressure!”  No, she said. No one had held pressure.

I am confused. The lady’s blood was diseased. It’s why it did not want to clot. But instead of treating the disease, or even treating the patient. Nothing had been done for two days. She had been allowed to bleed for two days, with nothing more than a haphazard dressing. The nurse told me that at one point, they had found the patient laying in a 2 inch pool of her blood. I’m confused, why nothing was done for two days. I’m confused, why they would transfuse blood, but not platelets (which is what she actually really needed). I’m confused, why they thought a small dressing on a hip could suffice as a pressure dressing, and I’m confused why the idea of holding pressure was so funny to whom I initially spoke to on the phone.

I’ve used the situation as a teaching opportunity for the med students. Emphasizing the importance of holding pressure, and not being afraid to touch your patient.

One of our Vascular Surgeon’s at Westchester has his list of P’s for bleeding.
Pressure, Prolene, Packing, Protamine, Platelets, Patience and Prayer

If I could take liberties with Dr. Mateo’s list, I would make it as follows... Pressure, Prolene, Pressure, Packing, Pressure, Protamine, Pressure, Platelets, Pressure, Patience, Pressure, and Prayer.

Much Love.

Wednesday, January 3, 2018

Estoy diciendo que hay esperanza.

 Every medical student, at some point during medical school, comes to a realization that by looking at everything backwards they are learning a million and one ways to kill someone. If you know how something can kill, then you can figure out how to reverse it, prevent it and/or just plain stop it.

But that's over-rated, you don't need to go to medical school. Any Joe Schmoe can grab the nearest kitchen knife and go digging for his carotid.

He said that was his goal, the carotid, although he pronounced it with the accent on the wrong syllable. I guess he had tried multiple times and then fallen asleep. I don't know what changed during that sleep, but when he woke up, still alive, he let his brother bring him to the hospital.

Suspicion was low for severe damage, but due to the close proximity of numerous vital structures a CT angiography of the neck was obtained. As I set up to repair the wound he asked me how close he was. He asked with such intensity, and I couldn't interpret his motive for wanting to know.  When I tried to brush off the question, he asked again with even greater intensity.

Was he looking for how to do a better job next time? Or was he realizing with relief that he now had a second chance.

No matter what his motive for the question, I have two messages for him.
1) You are blessed.
2) There is hope.



Much Love.

"You are closer than this breath that I take"