Murmurssss

heard my first "washing machine" type murmur today. a pt with endocarditis. it was LOUD and you could palpate a thrill on his chest. crazy.

faint? "bitch please"

welp..spent the morning in the OR watching the diabetics get amputations. I was a lil uneasy about going because i think its a little un-natural to watch someone cut off body parts for purposes other than killing someone...but i got over this really fast once i got back into the OR.

"Hi Dr. C, my name is D, I am a medical student and will be observing today if thats OK with you."

"That's fine. As long as you promise not to pass out. And if you are going to, make sure it is not on my operating field."

"yes sir. I promise"


The morning began with a couple simple toe amputations. It takes like 5 minutes, seriously. Just get the scalpel, cut, cut cut and pluck that thing right off.

Next I saw them take off the big toe of a women and the metatarsal behind it. first time they used the saw...if i was going to pass out, this would be it. but no. of course not! At one point i was standing next to the resident watching her suture closed the site that once was the big toe and blood just dripping. i wish i had been able to take a picture.

Next up, below the knee amputation revision...meaning, he already had a BKA but the stump got infected, wasnt healing [ie wasnt controlling his diabetes so nothing was healing] so they had to cut more of his leg off. Mental image...using a scalpel to cut to the bone, then using a small saw for the fibula and then a 'string saw' for the tibia. then watching them use a very sharp big ass knife [think kitchen knife for your turkey on thanksgiving] to cut the posterior muscles. then watching them dissect arteries, nerves and tendons. pretty sweet.

last up, a symes amputation. Basically dis-articulating the ankle and heel bone and taking off the foot from there. tons of cool anatomy there too...

i left the OR and went straight to eat lunch. i was starving :)

amputation? no big deal

"have you been taking your diabetes medication?"

"no"

"how long have you not been taking your diabetes medication?"

"5 months"

"why have you not been taking your diabetes medication for over 5 months?"

"um...i've been really stressed"

"ok sir. we are just waiting for your MRI results and then will let you know if we need to amputate some more of your toes....but it looks like you might have bone infections in both feet."

"ok. can i go back to sleep now?"

love them patients

i musta been pretty tired this morning when rounding...didn't notice my patient had the words 'bitch please' tattooed on his forehead until i saw him again this afternoon... it was in cursive. pure class.

A recent grad

"If residency is as awesome as medical school then I don't know what people complain about. Maybe this is just the rose-colored glasses of hindsight but hot damn, all the great friends I've made along the way really made it all worth while!" -brent, a recent grad

healthcare rant

fact: on average, every 2 minutes a doctor spends with a patient, they spend 25 minutes documenting

this morning, i walked into my patients 'room' [curtain...] and asked him how he was doing. then i said "do you know what is going on, has anyone talked to you about the plan."

nope, i have no idea what is happening. i tried to explain as best as i could...but then i had to go to finish documenting his progress note before rounds started.

later in the day, instead of explaining what is going on and how we are helping, i spent about 2 hours writing transfer paperwork for my patient. by the time i was done, i was so tired i spent maybe 10 minutes with him and then left for the day.

our medical system is ridiculous.

instead of using time wisely, talking to the patient, counseling them, explaining what they can do to help themselves...we end up having a ton of paperwork and documentation to do in order to legally protect ourselves from lawyers. thus, we never educate the patient well enough and they return again and again for things that can be prevented.

our medical system is ridiculous.

the first time i nearly killed someone

The title may be a little more dramatic than the actual events...but really, i could have done something very bad. good thing there are many safety guards in place to protect my patients from me :)

this morning during rounds i had 5 patients to see and came in extra early to be on top of everything. i was doing great, looked like a rockstar, had all my notes and updates organized. wrote the orders the doctor and I discussed he glanced em over and we moved on. we saw a couple more patients and then went to the doc's office to get a lecture from him. not 2 minutes in, we got a phonecall. he puts it on speakerphone [like usual] and its a nurse...asking about our order. "I just wanted to clarify the order you left for patient X, you want 60 units of long acting insulin 3 times a day? He was only on 58 twice a day before."

crap

we verbally clarified the order to 60 units twice a day. the doc wasnt mad, thank god. he just went into a speech about mistakes, how it is easy to make them, and to triple check all the orders we write. [to note, that extra 60 units would have made him hypoglycemic putting him into a coma and probable death]. We were told that from the time we write the order, 7 people see it, read it, and double check it before it is actually given...several nurses, nursing clerk, pharmacist, etc.

food for thought: "The average, major teaching hospital experiences an increase in risk-adjusted mortality of roughly 4 percent in the July-August period."

 this is when new intern's [just graduated 4th year medical students] begin their residency...practicing medicine on 'their own' for the first time. granted, like this example, there are lots of things in place to keep us from killing patients...despite our best efforts. but, accidents still happen.

stay away from the hospital in July and August....