eeewwwwww...

So I officially got puked on last night. Luckily my cat like reflexes allowed me to see what was coming and 1) roll the guy onto his side, and 2) jump out of the way enough that I only got splatter on my shoes and scrubs. It SMELLED! I am so glad that they provide scrubs there. I changed eventually after the trauma was over, but the smell takes a while to leave your nose.

Background on the patient. Young guy...he and his friend hit on a couple of girls at a bar. The girls' guy friends come to their aid and break this guy's face....literally. Open mandible fracture. The kid was wasted. Asked him if he smokes......he says, "cigarettes or weed?" I say, "both". He says, "I smoke a pack a day of cigarettes but I smoke a hell of a lot of weed". Classic. Got to appreciate his honesty. Then I ask him if he drinks. He says "yeah but not a lot." I say, "How much", he says 2 40's 3 times a week"..........and I bet this dumb kid "pours some out for his homies" too. Poor little dumb-ass. I know that kids do stupid things, but I have a feeling that this will not be the last time that we see this guy....or his "bling".....nothing says pimp like a gold pinky ring. This guy doesn't know if he wants to be Tony Soprano or 50 cent........but is leaning the way of 50 I think.

Last night was my first night on nights. I LOVE nights! I love that I don't have to get up so early. I love that it is kind of free-form. I love that I am the one responding to the traumas. I love it all!

Patients lie.....

They tell you this is school, but it really does happen in Trauma especially......a few humorous examples.

Guy I have been following for a while with an ileus and also starting to work on a pneumonia REALLY needs to get up and at least sit up in a chair. This will help his bowels start to move again and will help clear the goop from his lungs. I try to emphasize this every day. Yesterday it was "I was up in the chair 3 times last night"......I am skeptical. Later he tells me "I guess I hallucinated that I was up yesterday. The nurse told me that I never got out of bed." At least he copped to it. He is on some pretty heavy pain meds. Good news is that he was up today and even asked for a cane so that he can try to walk. Good for him.

Guy number 2: Comes in with a blood alcohol in the 300's somewhere. Stab wound to the chest. He is still drunk after surgery that revealed that it only hit the muscle. He goes on with this story, saying, "I'm sorry, a man just can't call another man a bitch. Before I could pound on this dude's face he stabbed me!" (like he was shocked. If he had gotten his hands on the guy we would have seen both of them on our service, no doubt........Later in the day when he is more sober...and a total baby by the way .....most "gangster guys" are when they get on the trauma service. They seem TRULY surprised that a gunshot wound or a stab wound hurts). Anyway, the story after he sobers up is that some dude tried to rob him and take his wallet and stabbed him. He obviously did not recall telling us about the altercation earlier. Classic.

Guy number 3: First of all he is this Asian kid that things he is super gangsta, complete with street slang. Super dramatic. Came in as a "walk in" trauma at 9am or so....at this point his blood alcohol was still 188. Apparently sometime during the night he had gone to another ER, but left. So he had to have been really drunk last night to still have this level. This guy's eyes are swollen shut. He is telling us that he thinks that he got attacked. His injuries are telling us another story. He then proceeds to ask us if the police can call to see if he is in that hospital and if they can get his medical information. He says that he doesn't want his PO to know that he was drinking (another peach). We tell him that only if he were involved in a crime or if there were some reason that they were looking for him could they find this information out. We start putting 2 and 2 together. We had a guy who's face literally got stomped on and this is not looking like that at all. In fact looking at what the physical exam is telling us, his eyes look goopy. We start talking about it and we are thinking that he has chemical burns from an airbag (bases are worse than acids because they break down collagen...aka they liquefy most stuff that skin and eyes are made of).....he likely is remembering that he crashed his car (drunk) and is hoping not to go back to jail. Meanwhile the base that is in his eyes is dissolving the collagen and can likely do serious damage. This idiot does not realize that his trying to save his own ass can blind him. Idiot.

Part of the message here is to trust your physical exam. It will give you the info that you need most of the time. He must know that if we find out that he crashed while he was drunk that we need to notify the cops. Sucks for him. I guarantee that he will bail in the middle of the night when he gets wind that we have an idea of what really happened. Again....idiot. And if that doesn't work you tell him that anyone involved in an altercation and found down needs a rectal exam to make sure that he is not bleeding internally. That gets you more truth telling than you can imagine. ;-) Heehee, I love my job.

There's good news and bad news.....

Bad news: Life support removed from our little girl the other day. Really sad. Brother is not doing so hot either. That family really has a lot to deal with. My thoughts and prayers go out to them and the challenges that await them.

Good news: Trauma kicks ass! I keep working late...until almost 8 last night....which makes for a long day when you get to work at 5:45. But ALWAYS, and I mean always, the trauma pager goes off at right about 6, and I am not one to hand off the trauma pager and go "later". I try to make sure that I am not stepping on Brooke's toes, as she is on nights. Technically it is her trauma, but I still want to see what is going on. So I tend to at least hang around and see what transpires in the trauma before I take off. If there is more than one coming in, I will take one of them, but otherwise, it is Brooke's show and I will just watch. I figure the more I see, the more I will learn and feel comfortable when it is me standing there with nobody telling me what to do.....although Brooke and I are both kind of doing that now, but still, every trauma is unique, and I think that I learn something from each one.

Yesterday got to scrub in on a HUGE diaphragm rupture repair. It took 4 hours and was super difficult for the surgeon, but it was nice to be first assist. I also got to help put in a chest tube, and got to close (as usual). It really is interesting how different surgeons have different methods of closing. I scrubbed in on another procedure earlier that day and I saw a closure that I had never seen before. It was interesting......and not at all what I expected....but this guy really knows his stuff so I am not going to rock that boat. I just consider it another technique learned. Plus, he loves to teach, and is a really great teacher. That is a great combo. I have no life right now, and as I type this I am thinking, "It's an hour past my bed time", but I am learning so much and having a great time, so it is all worth it. I also really like the team that I am working with. There is a recent Pacific grad.....a couple of other Pacific grads and all of the PA's are REALLY knowledgeable. PA students, look for John Van Horn on your schedule. He is who I want to be when I grow up. Emanuel trauma is an example of how skilled, knowledgeable and autonomous PA's can really be. It is the best example of PA's that I have seen, and one that I hope to Emulate. Well, "It's past my bed time". More to come.....

AGAIN......Wear your seatbelts AND BUCKLE IN YOUR KIDS.

First thing this morning. Life flight. 2 month old, ejected from vehicle, unrestrained. I think 3 others dead on the scene. Surprisingly this kid is ok. I don't even think that he broke anything!

Not so good for the others though. Little girl from last night made it through the night/day, but is brain dead. Mom is in the hospital but ok. Brother is stable, and the other one is on it's way to our facility so that the family can be together. The teenagers that caused the accident are all ok and all smiles.......I don't know if they grasp the fact that they just disseminated an entire family. Damn lack of pre-frontal cortex! Teens don't realize the consequences of their actions.....they can't......that part of their brain isn't fully developed yet. I say, at least show some remorse for those that died. My job is not to judge but sometimes it is really hard not to want to. Even with these kids.....their injuries would be vastly different if they were in car seats or in seat belts even. The girl would likely have survived. But the reality is that mom is going to have to live with that for the rest of her life. That is really sad. Again, like I said.......it is hard not to judge. It is easy to point fingers at the mom and the teen, but the reality is that mom needs all the compassion and support that she can get right now. Who am I to judge her or anyone else? Who REALLY thinks that an accident is going to happen to them? Not very many people. Hind sight is 20/20, but this will be a hard thing to look back upon for that family.

On a different note. Pulled chest tube #2 today. Took 5 patients on my own, and felt more competent on rounds. It is a little easier on the weekends though when there isn't a gigantic posse rounding. Got pimped pretty hard today, but in a good, "I want to see what you know, to see what else I can teach you" way. I did really well. I even got a few eyebrow raises as in "I really didn't expect you to know that or get that right" kind of way. That felt good. Mind you, I did not know all the answers, but it felt good to be on the more right than wrong side of the curve.

Kids, wear your seat belts.....

Some lessons from trauma....and I already know this from surgery but was feeling extra lax today. Never eat when you are hungry. ALWAYS anticipate that you are not going to eat for another 6 hours. Hunger should not be in your vocabulary, for it is your enemy. I had a "slow" morning and went upstairs to read my trauma book and had some soup. I was feeling tired and nappish, but thought, "Well it is about noon, I better eat." ....rather than napping...a sure-fire way to get a trauma page. Low-and-behold....I get in the elevator and I get a page.....Level one trauma, life flight, ETA 5 min. I think to myself, "that isn't enough time to get lunch." and figure that I will get some food after that. WELL, it is a 5yo with bilateral femur fractures (open) and some head lacs. Things are calming down then the kid's 6 year old sibling comes in with major injuries. 3 hours later (after the initial trauma page) and we are going to surgery. I REALLY want to go but am feeling the tinge of a low blood sugar. Luckily one of the PA's has a cliff bar that I shove in my mouth in like 20 seconds (which is really hard to do).

So we get this girl into the OR and other than a ruptured AAA I have never seen anything quite like it. There were 3 surgical teams mobilizing and doing their thing at the same time.

This poor little girl had an open femur fracture (might have films....which has not yet been fixed). But that was the least of her worries. She had a splenic artery injury....spleen removed. A liver lac - repaired, her pancreas was torn in half - the head removed. Her brain was herniating - craniotomy done.....pupil back to semi-normal after that........etc. This poor little girl has a long road ahead of her. I hope she makes it through the night. We really worked hard to keep her alive. Amd I hope that if she is alive that she has normal brain function.

The hard part was receiving her mom in the ER after we got out of surgery. Mom looks ok. She lost her husband or boyfriend already on scene. Hopefully she won't lose two of her kids too. Really sad. And is it bad that I really can't wait to get back to work tomorrow to see how everyone is? I guess that means that the job is right for me.

Side note - I pulled my first chest tube today. Simple but cool. It's the small victories. Oh and I saw brain surgery. The brain really does look gelatinous.

Exhausted......back at it at 4:30 am!! Night night.

Trauma

Things I don't like about trauma: getting up at 4:30am for the first 3 weeks

Things I do like about trauma: everything else!

Parents do the darndest things......

Like......have sex in the shower in the hospital room where their 6yo is currently residing. Nurse walked in on it. No joke.

Like......wonder what is wrong with their baby when we get meconium tests back from the baby that are positive for meth and pot and opiates.

Like......tell their kid that they are fat because they took steroids during pregnancy.....not because they drink 4 liters of soda a day.

Like.......bring one of their different 6 kids into the ER EVERY NIGHT for something different. Mind you some of thes "kids" are married and have kids of their own. Last night the one daughter thought that she had passed a tape worm. It is a long, crazy story.....and I mean crazy. She doesn't understand why she poops only every 2 weeks, but the tracks all over her arms tell me why (this is the daughter). Oh and mom's other kid needs a note for school so that he can take longer to write in class because his hand cramped up today while writing. No joke. These are dire emergencies people.

I'm sure I will have more to add to this. I have more Peds clinic and ER tomorrow.