10.30.2010
Lighter
On a lighter note: a patient's friend asked me if I was Miss Arizona when I walked into the room the other day. Thought it was pretty funny. Vets always say the darndest things.
10.29.2010
Nail Biter
Patient of the day: 19 month old who was lethargic. She had a lot of other medical problems and had had an endoscopy yesterday. Since then she had been lethargic and vomiting brown. In the ED, she looked pretty bad...very lethargic, kind of hypotonic, pale. She got a LOT worse pretty quickly. PICU came down and we had probably 7-8 people around the bed for this one little girl. Her glucose finally got checked (somehow this order from when she first got into the ED had been overlooked) and it was 1. ONE! Glucose should be around 100, and below 40 is SCARY low. Hers was ONE. I have never seen anything that low, and I have no idea how she wasn't having seizures or how she wasn't dead yet. She was so dehydrated that they couldn't get an IV in, so they had to put an interosseous line in (basically punching a hole in her leg bone to run fluids directly into her bone marrow). She got some glucose which put her blood sugar at 187 and started looking better. She kept oscillating back and forth from looking a bit better to being really lethargic again. We never intubated her and she made it out of the ED to the PICU, but it was a REALLY scary situation. I hope she will end up doing ok. Lesson learned: always check a glucose on anyone with altered mental status...low glucose really can happen even when you're not expecting it!
10.21.2010
The Other Shoe
I should have been waiting for the other shoe to drop after a "fun" trauma. And boy did it drop today.
First patient: 14yo boy in a car accident. Intubated at the scene. Arrives in a c-collar (neck brace) thrashing around because he needs more meds to sedate him/paralyze him/take away his pain. It takes at least 15 minutes to get an IV in him to give him any meds. I felt for this kid the entire way. He ended up having a pretty significant bleed in his head and a number of other things but will hopefully do ok. Naturally it didn't stop there...
Second patient: 20yo man ejected from his car. Intubated at the scene. Helicoptered in. Went into cardiac arrest literally while walking in the door of the ED from the helicopter. His pulse came back for a while, then went away again. About 45 minutes of pushing meds, doing CPR, putting in 2 chest tubes, 2 femoral lines, and finally cracking open his chest and beating his heart for him, he was pronounced dead. If that wasn't bad enough, it was at that point turned into what I'll call a "teaching opportunity" for all the residents, students, and anyone else who wanted to to put their hands in his chest, learn the anatomy, etc. I politely declined to participate, but in reality I am immensely offended that this took place. He did not consent for his body to be donated to science, we were not doing anything to try to save him at that point, and while I understand some people would argue that if he died he might as well be "useful" to teach and learn on I do not agree. I heard stories about this at the beginning of 3rd year (ex. practicing intubating on a patient who had just died, etc.), and always thought "oh that would never happen and I would just say no anyways". Well, it happened today, and I did say no (which I'm proud of), but I'm afraid that it might come back to bite me ("she passed up a great learning opportunity", "she doesn't care about becoming a great doctor", etc.). Even if it does, I'm sticking to my ground and respecting this incredibly unfortunate young kid who died today. I hope everyone will be reasonable and respect my decision.
Didn't really want to tell this story, but it's the first time I've had a patient go from "alive" (with a pulse) to dead right in front of me. It was especially hard with it being a young guy. He was married (wedding band). Just heartbreaking. Definitely shed just one tear for him in the trauma bay before having to pick up and go back to my other patients with a headache and abdominal pain. Puts everything in perspective. Hard day, but I guess if I can't take it I shouldn't be doing this. No choice but to pick up and carry on.
First patient: 14yo boy in a car accident. Intubated at the scene. Arrives in a c-collar (neck brace) thrashing around because he needs more meds to sedate him/paralyze him/take away his pain. It takes at least 15 minutes to get an IV in him to give him any meds. I felt for this kid the entire way. He ended up having a pretty significant bleed in his head and a number of other things but will hopefully do ok. Naturally it didn't stop there...
Second patient: 20yo man ejected from his car. Intubated at the scene. Helicoptered in. Went into cardiac arrest literally while walking in the door of the ED from the helicopter. His pulse came back for a while, then went away again. About 45 minutes of pushing meds, doing CPR, putting in 2 chest tubes, 2 femoral lines, and finally cracking open his chest and beating his heart for him, he was pronounced dead. If that wasn't bad enough, it was at that point turned into what I'll call a "teaching opportunity" for all the residents, students, and anyone else who wanted to to put their hands in his chest, learn the anatomy, etc. I politely declined to participate, but in reality I am immensely offended that this took place. He did not consent for his body to be donated to science, we were not doing anything to try to save him at that point, and while I understand some people would argue that if he died he might as well be "useful" to teach and learn on I do not agree. I heard stories about this at the beginning of 3rd year (ex. practicing intubating on a patient who had just died, etc.), and always thought "oh that would never happen and I would just say no anyways". Well, it happened today, and I did say no (which I'm proud of), but I'm afraid that it might come back to bite me ("she passed up a great learning opportunity", "she doesn't care about becoming a great doctor", etc.). Even if it does, I'm sticking to my ground and respecting this incredibly unfortunate young kid who died today. I hope everyone will be reasonable and respect my decision.
Didn't really want to tell this story, but it's the first time I've had a patient go from "alive" (with a pulse) to dead right in front of me. It was especially hard with it being a young guy. He was married (wedding band). Just heartbreaking. Definitely shed just one tear for him in the trauma bay before having to pick up and go back to my other patients with a headache and abdominal pain. Puts everything in perspective. Hard day, but I guess if I can't take it I shouldn't be doing this. No choice but to pick up and carry on.
10.20.2010
Excitement
The other day I was already a half-hour over when my shift was supposed to end, just trying to wrap up a few things on my patients, when I heard this over the doc's pager phone system: "Level 1 Trauma alert, LifeFlight ETA 45 min, bear mauling".
!!!!!!!!!!!!!!!!!
Um, hello. Of course I'm staying for that! LifeFlight is the helicopter service here (I get to do a flight shift next week, so excited/scared!). I heard the patch (the conversation on the phone between the doc in the ED and the paramedic on the chopper) shortly afterwards and then stayed for the trauma. This guy was SO lucky! He was bow hunting (quite popular here), where they climb way up in a tree and just sit and wait to hunt something. So he was up there minding his own business when a bear cub started climbing up the tree! He yelled real loud to scare the cub off, which worked, but mama bear was PISSED. She came up the tree, dragged him out of it and then dragged him another 20 feet before being scared off (not sure by what). He didn't have any broken bones (at least as far as I know)! All he had was soft tissue injury where she bit him and some lacerations to his face. Like I said, SO lucky. Pretty cool to see!
In other news, I got two interview offers the other day...phew! I was starting to wonder if my application didn't get sent or something! So that brings my total to 4 so far (2 where I rotated at and 2 others) out of my 29 apps. Most ED programs wait until after November 1st to offer interviews (when my application is complete with my Dean's Letter), so I should have more to come, but I was still starting to worry! After next week my year is essentially over in terms of difficult classes (until April that is...), so all I need to do after that is interview and pick a program. Easier said than done!!
!!!!!!!!!!!!!!!!!
Um, hello. Of course I'm staying for that! LifeFlight is the helicopter service here (I get to do a flight shift next week, so excited/scared!). I heard the patch (the conversation on the phone between the doc in the ED and the paramedic on the chopper) shortly afterwards and then stayed for the trauma. This guy was SO lucky! He was bow hunting (quite popular here), where they climb way up in a tree and just sit and wait to hunt something. So he was up there minding his own business when a bear cub started climbing up the tree! He yelled real loud to scare the cub off, which worked, but mama bear was PISSED. She came up the tree, dragged him out of it and then dragged him another 20 feet before being scared off (not sure by what). He didn't have any broken bones (at least as far as I know)! All he had was soft tissue injury where she bit him and some lacerations to his face. Like I said, SO lucky. Pretty cool to see!
In other news, I got two interview offers the other day...phew! I was starting to wonder if my application didn't get sent or something! So that brings my total to 4 so far (2 where I rotated at and 2 others) out of my 29 apps. Most ED programs wait until after November 1st to offer interviews (when my application is complete with my Dean's Letter), so I should have more to come, but I was still starting to worry! After next week my year is essentially over in terms of difficult classes (until April that is...), so all I need to do after that is interview and pick a program. Easier said than done!!
10.10.2010
One down...
Well, one week down. It went REALLY fast, I think because I didn't really have to do much of anything. No real ED shifts. I had orientation, a day of lectures, a day of "nursing skills" (mostly IV's, 1 NG tube, no Foley's), a day of simulations, and a "fast track" day (suturing, back pain, a guy who maced himself- hilarious). Fast track is where they put people who have very straightforward problems and who should be in-and-out. And then I had this whole weekend off. So my first real shift is Monday. Weird! It was nice to have a week to settle in, but I'm kind of bored, I have to admit. This weekend included watching a TON of TV shows online, reading books (finished Mansfield Park, started The Metamorphosis, looking foward to The Jungle Books soon), calling friends, and basically just bumming around. The internet blocks Netflix, so I can't watch any movies, and there aren't any movie theatres within walking distance, so that's out. Not sure what I'm going to do for the next three weekends here! Hopefully one will be spent with my extended fam if I can find a way to get up there!
I walked around the town a bit this weekend. The weather was SO nice (70 degrees, clear skies), and the town is really cute. Tons of hills, tiny streets, trees, grass, old houses, Halloween/autumn decorations, etc. It definitely brought me back to college (yet again) and I am VERY nostalgic for my college town...still! I thought that feeling would go away but nope, I still miss it a ton. NO idea why, college was not the greatest 4 years of my life (not the worst, but not the best). However, I am missing my actual college buildings, the dorms, certain restaurants, shops, drives I used to go on, parks I used to run at, farmland...I could go on and on. What does all of this mean? I have no idea. I have lots of time to mull it over and maybe figure it out, though!
Even though I just got here, I am anxious to get home so I can do some things. For example- cook, decorate, re-re-discover things to do in the city, reconnect with some friends I haven't had a ton of time to hang out with recently, spend time with my sister and family (this may be the last year we are living in the same city, depending on where I go for residency). I could do a lot of those things here if I was going to be here longer than 3 more weeks, but it just doesn't feel like home (for good reasons, I think) and so everything I do is a bit temporary. I'm having a good time but I want to feel at home!
No good patient stories from this last week...the only kind of funny one was the 50 year old guy that accidentally maced himself in the face while cleaning his garage. Not sure how that happens, but I guess it did. He was laughing about it so I don't feel so bad laughing about it too. Hopefully I'll get at least one good patient in the next week I can talk about!
I walked around the town a bit this weekend. The weather was SO nice (70 degrees, clear skies), and the town is really cute. Tons of hills, tiny streets, trees, grass, old houses, Halloween/autumn decorations, etc. It definitely brought me back to college (yet again) and I am VERY nostalgic for my college town...still! I thought that feeling would go away but nope, I still miss it a ton. NO idea why, college was not the greatest 4 years of my life (not the worst, but not the best). However, I am missing my actual college buildings, the dorms, certain restaurants, shops, drives I used to go on, parks I used to run at, farmland...I could go on and on. What does all of this mean? I have no idea. I have lots of time to mull it over and maybe figure it out, though!
Even though I just got here, I am anxious to get home so I can do some things. For example- cook, decorate, re-re-discover things to do in the city, reconnect with some friends I haven't had a ton of time to hang out with recently, spend time with my sister and family (this may be the last year we are living in the same city, depending on where I go for residency). I could do a lot of those things here if I was going to be here longer than 3 more weeks, but it just doesn't feel like home (for good reasons, I think) and so everything I do is a bit temporary. I'm having a good time but I want to feel at home!
No good patient stories from this last week...the only kind of funny one was the 50 year old guy that accidentally maced himself in the face while cleaning his garage. Not sure how that happens, but I guess it did. He was laughing about it so I don't feel so bad laughing about it too. Hopefully I'll get at least one good patient in the next week I can talk about!
10.04.2010
College?
I am basically back in college...and I LOVE it! Here are some of the similarities:
1. Dorm living in an OLD building, shared bathrooms and all (yup, flip flops in the shower).
2. Cold weather and changing leaves.
3. No car.
4. Cafeteria food, snacks in my room.
5. SMALL town (ok, this is WAY smaller than my college town, but still!)
6. Listening to John Mayer and Coldplay (my iTunes hasn't been updated in a while and the internet blocks Pandora...not that I get internet in my room anyways!!)
7. A twin bed with a bad mattress...complete with my actual sheets from college!
8. Coin operated laundry in a scary basement.
9. Lysoling even the doors in my new room with my mom.
10. Being far from home.
...all that's missing is my roomie!!
I know all of that may sound terrible, but I am seriously LOVING it. I quite literally feel like I'm back in college, with all the freedom, excitement, and irresponsibility that go along with it. I feel like I'm starting a new slate, and that is always exciting. I can't wait to wander around this little town, have the leaves really change color for me, and spend some quality time with myself. So like we said back in high school:
yay college
1. Dorm living in an OLD building, shared bathrooms and all (yup, flip flops in the shower).
2. Cold weather and changing leaves.
3. No car.
4. Cafeteria food, snacks in my room.
5. SMALL town (ok, this is WAY smaller than my college town, but still!)
6. Listening to John Mayer and Coldplay (my iTunes hasn't been updated in a while and the internet blocks Pandora...not that I get internet in my room anyways!!)
7. A twin bed with a bad mattress...complete with my actual sheets from college!
8. Coin operated laundry in a scary basement.
9. Lysoling even the doors in my new room with my mom.
10. Being far from home.
...all that's missing is my roomie!!
I know all of that may sound terrible, but I am seriously LOVING it. I quite literally feel like I'm back in college, with all the freedom, excitement, and irresponsibility that go along with it. I feel like I'm starting a new slate, and that is always exciting. I can't wait to wander around this little town, have the leaves really change color for me, and spend some quality time with myself. So like we said back in high school:
yay college
Subscribe to:
Posts (Atom)