Last shift

It was crazy busy and there were tons of traumas but our pods were packed so i stayed behind and helped run them while the resident was busy intubating and putting in chest tubes [my time will come!].

At around 3am I did my first LP [lumbar puncture].

 In lamens terms, I stuck a 6cm needle into the lower back of a women to rule out a sub-arachnoid hemorrhage as a cause of her headache. The spinal cord is not that low so there is no risk of paralization, but its still a tricky procedure. Unfortunately, i didnt get any CSF...only blood. [CSF is the spinal fluid...it should be completely clear...hence the name 'champagne tap' when you get clean CSF with no traumatic tap/blood].
It was my first try so I didnt beat myself up when after several attempts, we got a new needle and the resident tried. Made me feel a hell of a lot better when the resident tried several times and then had to call the attending because we weren't getting the fluid we needed.
next time will be easier, i hope...


Things quited down around 5am and I sat down with the resident and attending and good some great feedback from them. Couldn't be happier about how I ended my rotation at this incredible residency program! *fingers crossed for an interview there this fall!*

Patients

Saw a man with HIV and a CD4 count of 8, he was not going to live much longer :/


[trauma patient comes in, young lady screaming her head off to stop trying to kill her]
"whats your name honey" -charge nurse
"JESUS CHRIST!!!"
[charge nurse turns around. She calmly tells the nurse writing the chart] "Jesus, last name christ"

Lastly, the power of narcotic addiction:
-lady came in at 2am with 'cuts' on her fingers asking for pain meds. we gave her 2 norco and sent her home...she was obviously drug seeking.
-lady proceeded to lay in the parking lot in front of the hospital and got brought in by EMS
-lady demanded Dilaudid. we said no. she angrily left yelling and screaming.
[2 hours later--at aprox 4am]
-trauma alert, auto vs pedestrian. a lady had thrown herself in front of a car on the freeway on-ramp.
-lady comes in on the backboard. we notice...its the same lady.
-lady really wanted Dilaudid. lady also has multiple fractures including in her T spine.
-lady is now paralyzed.

Just some pictures

Helipad

Dislocated thumb, 4 year old

bicornate uterus on CT scan, looks like a heart

double layer lac repair at 3am

VP shunt on Xray

smashed distal 3rd and 4th digits

smashed digits after partial amputation in the ED

"I stepped off a curb wrong" -very very drunk man

the X rays after reduction of his ankle

Taking on more

Yesterday was the most challenging shift yet. It was relatively slow in the morning and then the afternoon picked up. At around 5 we had several new patients that just arrived and them we got several trauma activations. The residents went to go take care of the traumas and i was left alone to manage the pods. I wanted to show that I could be trusted with this responsibility and was doing pretty well. I also had to keep things together because sign out was at 7 and didnt want to make the residents look bad by not tying up loose ends in the charts and stuff.

I made one mistake by not asking for help sooner and got scolded a bit by one of the residents but when the shift ended she said i did a really good job and was proud.  I think I did pretty well under the circumstances and really, I can only get better from here right? I didnt get overwhelmed and I was still able to keep a smile on my face so I am proud of myself as well. As our shift ended a big black man walked into the ER with his wife, his lip and face was swollen and getting bigger by the minute. His allergic reaction was getting worse and we wanted to secure an airway before it was too late. It was a pretty dramatic event with at least 10 people standing around helping. The residents intubated him and after I went home and slept.

Who knew?

First time in my years as a med student that i really thought i was going to pass out...but dont worry, i didnt.

Let me preface, I was at a wedding the night before drank [Saturday night]...sobered up...drove home...got 4 hours of sleep before my 13 hour shift. oops.

Up at 5:30am... by 8am Sunday, still no food, water or coffee in my GI tract...
A guy came drunk as shit and had partially self amputed his entire foot. [he said he stepped off a curb wrong but to do that much damage he had to have drunkly jumped off a building..but he was probably too drunk to remember]. His tibia was sticking straight out and his foot was twisted to the left. Incredibly, he was neurovascularly intact so he didnt need to go straight to the OR. It was gruesome looking at it but it didnt bother me too much. that is, until the ortho resident had me help him reduce it before he splinted it....

I stood next to the bed holding his leg in my hand, knee under my arm. the resident stood at the foot of the bed and we each pulled in opposite directions. With a lot of force, he was able to put the ankle back where it was supposed to be. When he did this, i felt the cracking/ crunching sound of bone and was straining as it took a lot of muscle strength for me to hold his leg. immediately after, i began to notice little details like sweat dripping down my legs and getting a little dizzy. I turned away and kept breathing and smiling, talking to the patient and trying to act like i was fine so no one thought i was a wuss. I began to feel better but as I was looking away, I could not get the 'drip drip drip' sounds of blood dropping into a bucket below the foot.

"just keep breathing" i thought.

the feeling eventually went away. i have never fainted but i imagine this is what it feels like before you do...


Ironic situation of the day:
17 year old girl who hurt her ankle [got flown in by a helicopter off the hiking trail!]. Turns out there is no fracture, not even swelling. Its a mild sprain. She is crying her eyes out, loud as hell, grabbing onto "daddy"
vs
Man with partially amputated foot quiet for hours while waiting for ortho surgery [not a peep out of him, just some versed and he was fine]

They were right across each other in the trauma bay

New facts everyday

A wise fact I learned from an attending in the ED....

"Don't be a pussy" has no connection to being female. Please note the following word and definition.

Pusillanimous: lacking courage and resolution : marked by contemptible timidity. faint heartened. showing lack of courage.

Bet you didnt know that! I sure didint...

3 weeks in

The more I do this, the more I fall in love. I really don't understand why a medical student would want to do anything else? Every shift is so full of spontaneity, diverse cases, newly acquired procedural knowledge, and of course, lots of blood. I am enjoying everything about this rotation, the residents and faculty are wonderful and never to busy to teach, the staff and nurses are hilarious and also are always willing to help. The patient population is so wide and they are the sickest people I have ever seen. This week we had a male with AIDS that had a CD4 count of 8. That same shift I saw a man high on heroin and amphetamines that had his penis tattooed, stapled a huge scalp laceration, helped relocated several bone fractures, diagnosed a stroke.... i could go on forever.

I walk away from each 12 hour shift in a whirlwind. Not remember everything that happened because so much went on, exhausted yet awake on adrenaline. I get in my car. Take a deep breath. and smile like a lil kid in a candy store. Such a great feeling.