Acute Care Surgery. The service for which I am currently acting chief resident. What exactly does that mean. Surgery for acute pathology, perhaps. So what is "acute" in the world of medicine. A dictionary will be happy to provide you with a vague definition such as; (of a disease or its symptoms) of short duration but typically severe. But you only feel wiser in reading that definition, when in reality you still probably couldn't explain something that is acute.
I'll share with you my cut off. Think of two weeks. I'm sure I picked that up somewhere back medical school. But needless to say, if duration is shorter than two weeks, you'd be safe in considering something to be acute. Longer than two weeks, and now you are looking at chronic pathology.
So Acute Care Surgery. Surgery for pathology of duration less than two weeks. Easy examples: appendicitis, cholecysitis, perforated ulcers, perforated diverticulitis, necrotizing soft tissue infections, volvulus, obstruction, incarcerated hernia.... basically if you are in the ED and need a general surgeon, chances are you'll be seen by an acute care surgeon.
So now looking at my service, I go through my patients appreciating their "length of stay". 34 days. 54 days. 20 days. 39 days. 15 days. 60 days. 124 days. 25 days. 85 days. 161 days. 26 days. 23 days. Just to list a few. The irony of my service's name is not lost on me. There is nothing "acute" about my collection of chronic patients.
One of my chronic patients, does an amazing job of remaining positive despite difficulty. He should write a book, give a TED talk, or something. We all could use some of his optimism. Every morning we approach his room and he's already woken, sat himself up and is looking at the door in anticipation. We came by 15 minutes late the other day, and he called us out on it. "You're late!", he said. I had no idea he was counting on our early morning rounds so much. Then the other day on my afternoon rounds he changed the conversation on me. He asked me about his pathology, and relating it to the pathology he had originally presented with. And I saw realization spreading in his eyes as clear as day. He had finally, for the first time, realized what his situation was since before he came to the hospital. Chronic.... stinks. It traps its human with pain and convalescence. Holds them hostage, preventing from living their life as desired. One could easily understand how they can slip into the role of victim to their chronicity. But even after mulling over our conversation and his realization, my patient was up and looking towards the door when we walked in the next day.
Much Love and prayers.
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