I thought that I was in Pediatrics, and done with Trauma. In fact, I'm pretty sure I just got done with my 6 week stint at Legacy Emanuel Trauma. I shouldn't be seeing broken bones, at least acutely, right? I should be dealing with well child checks, runny noses, and maybe dealing with asthma.
maybe not...
a couple of days ago, I stitched up the toe of a girl who managed to slice it on a mirror. I don't know if she saw her reflection, and like a young kitten, not knowing it was her in the mirror, freaked out.... hissed and batted at it like a flurry of right and left crosses, then somehow in the chaos sliced her toe.
or maybe she was practicing her karate kicks in the mirror, and got a little too close. in any case, I stitched her up.
And on the same day, I stitched up another kiddo's knee after a horrible recess time football accident. It was gruesome.... after three sutures, I realized we were in the clear, and we wouldn't have to amputate.
He was thankful.
Then, just this Monday I saw a 17 year old guy who was in an MVC, going about 30, went into a ditch. He went to the ER that night, Saturday, and got worked up and sent home. They told him to follow up with his PCP on Monday. They gave him a clean bill of health after, what I can gather, a few x-rays. He said that everything came back negative.
He still had low back pain, and noticed a bump on his head. He didn't lose consciousness, nor did he remember smacking his head. He was belted, and there wasn't too much damage to the car.
He didn't have any pain other than in his lower back... he moved around the room slowly and deliberately. He had a limited range of motion as I watched him move.
At Emanuel, they would always feel the spine before sliding the folks into the CT scanner, looking for step-offs and other deformities of the spine, as well as trying to illicit any pain response from the patient. These things being clues for a fracture. What you really look for, as far as the pain response is concerned, is tenderness on the bone, not in the muscles, but right on the bone.
At Emanuel, the surgical resident or the trauma PA did this... not me. So I didn't feel the patient react to pushing on their back, but I saw it.
I've done plenty of back pain exams now, in the ER and in clinic, and that's something you always check for.... that spinal tenderness. I've never had a patient react in such a way that I've been concerned that they have a broken back. Even the whiners.... it's just never been impressive.
"Does it hurt when I push here?"
"OHHHHH... uhhhhh, ahhhhh..... yeaaaa...."
"How about here?"
"Ehhhhhhhhhhh, yes." they'll groan.
No real reaction.
But this kid..... I have him sitting on the exam table and start pushing on his spine.... around L1... working my way down.
"Tell me if it hurts anywhere."
As I'm pushing, and working my way down his spine, I get to about L4, and he doesn't have to say a word... I push, and he JUMPS away from me. He moved faster than he had the entire time he'd been in there with me. I had pushed right on the spinous process of L4 and he was through the roof.
Anywhere else I pressed didn't bother him.... The muscles surrounding L4, the other spinous processes... nothing. No pain, no reaction.
ooooops.
"So, in the ER, did they do any CT's? You know, where you lay down on a table and they slide you into what looks like a huge doughnut?"
"Nope. They did X-rays."
"Well, you're gunna get one today."
He does... and the results came back via phone call from the radiologist.
L4 compression fracture with no posterior involvement (which is good) but with some anterior wedging/displacement.
It's basically stable, and there's not really any worry for this type of fracture paralyzing this kid. But it still warrants a spine-guy consult. Which we get all set up for him.
another little kiddo, well, about 11 years old, strolled in around the same time. He fell playing basketball, and hurt his arm... a quick x-ray later, we found that he had a torus fracture. we splinted him, then sent him off, only to come back in a week so we can cast him up once the swelling dissipates.
so, i've discovered that pediatrics can be more interesting, and varied, than i thought. i should have realized that kids tend to get hurt.
some kids that come in however, are not hurt, but act like it.
we had a teenage girl come in with her mom. She had been seen in the pediatric night clinic... (like urgent care, for kids) and was diagnosed with a sinus infection. she was given antibiotics and sent home. though, at the clinic, she and her mom were asking for an IV.
"I know my kids, they crash fast. and this one, she'll perk right up when she gets filled up. I mean, I know they do it for athletes, it's not a big deal. She did this the last time too, and Lisa gave her an IV, and she popped right back up! We asked for an IV last night, but they wouldn't give her one."
I'm thinking, as she's saying this, "she does NOT need an IV. that's just a waste of time, money and resources. It's an unnecessary risk (albeit a small one) for a placebo effect, and to appease the mother and child. This is NOT a McDonald's... you can't just order what you want!"
Or, i guess you can.
i should have known... well i did know. but it bothers me.
So I present the patient to the preceptor and say that they came in with the hopes of getting an IV, anything less than that will leave them upset. So, we bolus the girl with 1 Liter of NS. the NON-dehydrated girl.... and all was well in their world. It's amazing how a liter of salt water can make a sinus infection better. i guess i should have checked UpToDate... it's the preferred treatment, after all!
well, i've made a short story long, but.... turns out, i like peds more than i thought i would. even despite some of the silliness that is made-to-order medicine. That's just the way it is, in every field. It's not Doctor knows best, it's, "what can I do for you today? no matter if it's unwise, dangerous or just silly, it's your care! let's do it!"
In my practice, I won't fold so easily, I won't enable this kind of behavior. But, I'm just a student in a 6 week rotation. I'm not out to change a practice. I'm just out to practice.
cn
Friday, November 28, 2008
Saturday, November 22, 2008
catlike speed and reflexes...
A naked baby is a dangerous baby. The business end is ready to blow at any time. It's simply frightening to see a diaperless baby for any length of time. When I do well child exams, I make sure to be quick when it comes to diaperless baby time. I'd rather not get pooped or peed on, if at all possible.
I am constantly reminded of the fragility of my non-poop-covered clothes. In pushing on a the belly of a little 2 month old the other day, I created such an uproar inside her, that a gurgle turned into a largre rumble and a quite adult sized fart.
Yes, we all had a good laugh, mom, myself and the child. but the consequenses would have been dire had she not been wearing that huggies. I was right in the line of fire.
But I'm really only fooling myself if I think I'm going to make it out unscathed. I've already been soiled in other rotations, and in this one. So what I should really be practicing (other than my body-washing technique) is my speed and reflexes.
Anticipate that the little baby boy is going to try pee on you when the flippin' thing is aiming right at you like a little flesh colored fire hose. (with seemingly the same amount of power. It could definetely clear a rowdy crowd nearly as well as the conventional fire hose.)
I need to know that blank look of confusion and anticipation that appears on the face of a snot covered three year old just before they sneeze right in your face. Cover up, be damned!
I need to be like Neo, in The Matrix, time needs to slow down, just a bit, for me. I need to recognize the signs of impending disgusting, and maneuver through the air in such a way to avoid all the contaminated fluid flying my way.
So here I come, with my catlike speed an reflexes, I'm betting this kid has strep, but to be sure I need to shove that horrible, long q-tip down his throat and make him gag.
I should get a face shield... like that of a fire-fighter.
I don't.
"Hey there you little germ monger... I"m gunna cram this thing down your throat, and it's gunna make you gag... I know, I know, it sucks. I HATED this as a kid, but it's quick, and then it's all done. Just try not to barf on me."
Now I don't say this, in so many words, but close. I'm definetely thinking it.
In goes the q-tip, and here comes the gag.... and an instantaneous cough... I feel my face peppered with spit.
crap.
shoulda worn the fire-fighter helmet.
4 mintues later, I find out that the cough shrapnal was indeed teeming with strep.
excellent.
I had already washed off my face, and hands.... but, alas, it was too late. the next day... with my sinuses plugged, sore throat, and headache, I headed back for more.
you got me, kid, you got me. if it wasn't you, it was one of the other 20 something i see per day. but you know what... I like it.
I just need to work on my matrix moves. I need to be more like Neo, and less like Chris Farley in 'Tommy Boy'.
"I was checking the a ... specs on the end line.... for the rotary...... girder. I'm retarded."
http://www.youtube.com/watch?v=K9mBn9bMB-g
I am constantly reminded of the fragility of my non-poop-covered clothes. In pushing on a the belly of a little 2 month old the other day, I created such an uproar inside her, that a gurgle turned into a largre rumble and a quite adult sized fart.
Yes, we all had a good laugh, mom, myself and the child. but the consequenses would have been dire had she not been wearing that huggies. I was right in the line of fire.
But I'm really only fooling myself if I think I'm going to make it out unscathed. I've already been soiled in other rotations, and in this one. So what I should really be practicing (other than my body-washing technique) is my speed and reflexes.
Anticipate that the little baby boy is going to try pee on you when the flippin' thing is aiming right at you like a little flesh colored fire hose. (with seemingly the same amount of power. It could definetely clear a rowdy crowd nearly as well as the conventional fire hose.)
I need to know that blank look of confusion and anticipation that appears on the face of a snot covered three year old just before they sneeze right in your face. Cover up, be damned!
I need to be like Neo, in The Matrix, time needs to slow down, just a bit, for me. I need to recognize the signs of impending disgusting, and maneuver through the air in such a way to avoid all the contaminated fluid flying my way.
So here I come, with my catlike speed an reflexes, I'm betting this kid has strep, but to be sure I need to shove that horrible, long q-tip down his throat and make him gag.
I should get a face shield... like that of a fire-fighter.
I don't.
"Hey there you little germ monger... I"m gunna cram this thing down your throat, and it's gunna make you gag... I know, I know, it sucks. I HATED this as a kid, but it's quick, and then it's all done. Just try not to barf on me."
Now I don't say this, in so many words, but close. I'm definetely thinking it.
In goes the q-tip, and here comes the gag.... and an instantaneous cough... I feel my face peppered with spit.
crap.
shoulda worn the fire-fighter helmet.
4 mintues later, I find out that the cough shrapnal was indeed teeming with strep.
excellent.
I had already washed off my face, and hands.... but, alas, it was too late. the next day... with my sinuses plugged, sore throat, and headache, I headed back for more.
you got me, kid, you got me. if it wasn't you, it was one of the other 20 something i see per day. but you know what... I like it.
I just need to work on my matrix moves. I need to be more like Neo, and less like Chris Farley in 'Tommy Boy'.
"I was checking the a ... specs on the end line.... for the rotary...... girder. I'm retarded."
http://www.youtube.com/watch?v=K9mBn9bMB-g
Thursday, October 9, 2008
no use for a name
day off tomorrow... gunna enjoy it.
also, working trauma makes me think of all the ways i could get hurt, and how incredibly lucky i am to NOT be hurt.
so, while i'll be having fun tomorrow... gunna step correctly.
later, monkeys.
cn
also, working trauma makes me think of all the ways i could get hurt, and how incredibly lucky i am to NOT be hurt.
so, while i'll be having fun tomorrow... gunna step correctly.
later, monkeys.
cn
Sunday, October 5, 2008
Vanilla Bear, loose in the hospital
I'm beginning to like hanging in the hospital with the folks in the ICU and TRACU.
Thrown into it on Monday, not knowing anything about the patients other than what I could extract from ridiculously sloppy notes; mostly illegible... well, it was tough. And I felt like I wasn't really taking care of these people, more than just hoping the attending didn't point out my inadequacies as a PA student. Hoping I wouldn't miss something that would hurt them, and make me look like the fool I feel in the process.
But now, I'm starting to get the feel of things here. I'm not making so many wrong turns in the hospital, which makes me look, and feel, less foolish.
I'm understanding how to pick apart the paper chart, and dig through the outdated electronic record, to find the information that I need.
I'm remembering people's names.... staff and patients alike.
I starting to feel like Vanilla Bear. I just need a Brown Bear to pal around with... would love to try world's most giant doctor.
I ran into a patient of mine in the hall... he's a wheeling-machine. He's recently become a paraplegic, which is sad, but he's got such a good attitude, and he's always rolling around the hospital, getting exercise and talking to folks. I stopped and talked with him for a bit, just made me like him more.
Then another patient of mine, a girl who is recovering from a traumatic brain injury.... she's becoming more and more lucent every day, and now has begun talking to me every morning when I round on her. The first day I saw her, she wouldn't say much at all, only a nod and a shake of the head here and there. She's one of my favorites. She can now rememer me... it really makes me happy to see her progressing so well. I saw her today the atrium (a sort of indoor courtyard, next to the coffee shop in the hospital,) as I meandered to the resident call room, and wanted to swing over and say hello... but it looked like she was with some family and friends, so I thought I'd leave them to their own devices. This was the first time she's been out of bed in about a week....
I guess what I've found out during this inpatient trauma rotation, is that I really like getting to know the patients, despite being under such less than ideal circumstances. Though, many of them have few places to go but up, and that's a great ascent to watch.
plus i got to pull a chest tube today, which really isn't anything, but it was fun...
"Mrs. America, are you ready?"
"I suppose...."
"Okay," I say, reassuringly.... "In just a second, I want you to take a deep breath, and hold it in. Then, I'm going to count to three. When I start counting, exhale. On three, I'm going to pull the tube out, okay?"
"Okay..." she says, nervously.
"Deep breath..." I coach.
She inhales as deeply as her broken ribs will allow.
"One........ TWO!" as I simultaneously pull the chest tube.
It sounds bad, right? well, I DID go on two, that's for sure. But that's how I was taught.
"Go on 'two' so they can't bear down, and make it harder to pull out, and do it fast. If you don't get blood on the wall, you pulled too slow." This coming from the resident.
I didn't get blood on the wall, but it was a big room.
cn
Thrown into it on Monday, not knowing anything about the patients other than what I could extract from ridiculously sloppy notes; mostly illegible... well, it was tough. And I felt like I wasn't really taking care of these people, more than just hoping the attending didn't point out my inadequacies as a PA student. Hoping I wouldn't miss something that would hurt them, and make me look like the fool I feel in the process.
But now, I'm starting to get the feel of things here. I'm not making so many wrong turns in the hospital, which makes me look, and feel, less foolish.
I'm understanding how to pick apart the paper chart, and dig through the outdated electronic record, to find the information that I need.
I'm remembering people's names.... staff and patients alike.
I starting to feel like Vanilla Bear. I just need a Brown Bear to pal around with... would love to try world's most giant doctor.
I ran into a patient of mine in the hall... he's a wheeling-machine. He's recently become a paraplegic, which is sad, but he's got such a good attitude, and he's always rolling around the hospital, getting exercise and talking to folks. I stopped and talked with him for a bit, just made me like him more.
Then another patient of mine, a girl who is recovering from a traumatic brain injury.... she's becoming more and more lucent every day, and now has begun talking to me every morning when I round on her. The first day I saw her, she wouldn't say much at all, only a nod and a shake of the head here and there. She's one of my favorites. She can now rememer me... it really makes me happy to see her progressing so well. I saw her today the atrium (a sort of indoor courtyard, next to the coffee shop in the hospital,) as I meandered to the resident call room, and wanted to swing over and say hello... but it looked like she was with some family and friends, so I thought I'd leave them to their own devices. This was the first time she's been out of bed in about a week....
I guess what I've found out during this inpatient trauma rotation, is that I really like getting to know the patients, despite being under such less than ideal circumstances. Though, many of them have few places to go but up, and that's a great ascent to watch.
plus i got to pull a chest tube today, which really isn't anything, but it was fun...
"Mrs. America, are you ready?"
"I suppose...."
"Okay," I say, reassuringly.... "In just a second, I want you to take a deep breath, and hold it in. Then, I'm going to count to three. When I start counting, exhale. On three, I'm going to pull the tube out, okay?"
"Okay..." she says, nervously.
"Deep breath..." I coach.
She inhales as deeply as her broken ribs will allow.
"One........ TWO!" as I simultaneously pull the chest tube.
It sounds bad, right? well, I DID go on two, that's for sure. But that's how I was taught.
"Go on 'two' so they can't bear down, and make it harder to pull out, and do it fast. If you don't get blood on the wall, you pulled too slow." This coming from the resident.
I didn't get blood on the wall, but it was a big room.
cn
Wednesday, October 1, 2008
Wednesday, September 10, 2008
Surf, Turf and Veins
I know it's been a while, I know. I don't feel like it so much, but it must be that I have less free time on this rotation than I did on the last. That being the case, my ramblings have been fewer and lower in quality and length.
don't judge me.
Let's bring you up to speed...
On the slave labor front, I've been in Cardiothoracic Surgery for 3 and a half weeks now, and love it. I'm still getting to do more and more everyday. I had no grand illusions that I would be doing too much during the actual surgery, I mean, it's heart surgery!
I knew I wouldn't be doing much more than watching and helping close at the end, if I was lucky. And I knew for certain that I wouldn't be harvesting the Great Saphenous vein for the graft conduits....
but then again, I've been doing much more than expected these past few weeks. After I finished helping Dr. Gately open, I switched sides to watch Alec take the saphenous vein. He was midway through, about at the point where he'd switch tips on the scope so he can cauterize any side-chains of the vein, and then extract it from the leg...
It was right then, in a moment of silence (save for the music playing in the background) that was shattered by Alec's voice, "Here, you do this. I'm bored." As he hands me the scope.
YES!
He wasn't bored, he was just being nice, giving me an opportunity to become familiar with the equipment. In the process, he made my day.
It came easy to me, it's like playing a video game. Just watch the screen, and react with your hands. It's like the medical nerd's version of Nintendo Wii. And we nerds happen to think it's much more fun.
So, in a nutshell, that's work lately.
On the extended work front, they let me attend a free (St. Jude Medical sponsored) dinner last night, (with a 'pro St. Jude prosthetic valve' lecture, of course.)
WORTH IT.
"I could get used to this." I thought while watching my free Fillet Mignon arrive to the table, preceded by appetizers, a salad, and followed by a wonderful dessert; homemade cheesecake and a chocolate ganash.
Apparently, El Gaucho is the most expensive steak house in the city. I can't tell you if this is true for certain, but the food sure made a case for that argument, as did the service. As soon as I walked into our private room, a man in a tuxedo asked if I'd like something to drink.
"Why yes I would, how about an IPA..."
It was a good evening.
Though I seem to be more busy this rotation, I did carve out time for fun this past weekend. I went surfing with my roommate, Ryan, near Canon beach on Saturday. It was a beautiful day at the coast, at least where we were. It was my first time surfing, and I did manage to catch quite a few waves. I'm hooked.
The only problem is that I must have zipped up my wetsuit with a kink in the neck somewhere, because it managed to rub off a good part of my skin on the back right side of my neck. It looks ridiculous, and kind of hurts still.
I hope it heals up enough by Saturday, cuz I'd love to go again.
That night I met up with a Minneapolis friend who was in town, and got to spend the next day with her too. Had a great time...
I guess that's all for now folks... I'm in need of food, and I think my chicken has got to be thawed by now.
Sorry for the lack of insight, wit, humor and life lesson... but I'm fresh outta those right now. Maybe later.
cn
don't judge me.
Let's bring you up to speed...
On the slave labor front, I've been in Cardiothoracic Surgery for 3 and a half weeks now, and love it. I'm still getting to do more and more everyday. I had no grand illusions that I would be doing too much during the actual surgery, I mean, it's heart surgery!
I knew I wouldn't be doing much more than watching and helping close at the end, if I was lucky. And I knew for certain that I wouldn't be harvesting the Great Saphenous vein for the graft conduits....
but then again, I've been doing much more than expected these past few weeks. After I finished helping Dr. Gately open, I switched sides to watch Alec take the saphenous vein. He was midway through, about at the point where he'd switch tips on the scope so he can cauterize any side-chains of the vein, and then extract it from the leg...
It was right then, in a moment of silence (save for the music playing in the background) that was shattered by Alec's voice, "Here, you do this. I'm bored." As he hands me the scope.
YES!
He wasn't bored, he was just being nice, giving me an opportunity to become familiar with the equipment. In the process, he made my day.
It came easy to me, it's like playing a video game. Just watch the screen, and react with your hands. It's like the medical nerd's version of Nintendo Wii. And we nerds happen to think it's much more fun.
So, in a nutshell, that's work lately.
On the extended work front, they let me attend a free (St. Jude Medical sponsored) dinner last night, (with a 'pro St. Jude prosthetic valve' lecture, of course.)
WORTH IT.
"I could get used to this." I thought while watching my free Fillet Mignon arrive to the table, preceded by appetizers, a salad, and followed by a wonderful dessert; homemade cheesecake and a chocolate ganash.
Apparently, El Gaucho is the most expensive steak house in the city. I can't tell you if this is true for certain, but the food sure made a case for that argument, as did the service. As soon as I walked into our private room, a man in a tuxedo asked if I'd like something to drink.
"Why yes I would, how about an IPA..."
It was a good evening.
Though I seem to be more busy this rotation, I did carve out time for fun this past weekend. I went surfing with my roommate, Ryan, near Canon beach on Saturday. It was a beautiful day at the coast, at least where we were. It was my first time surfing, and I did manage to catch quite a few waves. I'm hooked.
The only problem is that I must have zipped up my wetsuit with a kink in the neck somewhere, because it managed to rub off a good part of my skin on the back right side of my neck. It looks ridiculous, and kind of hurts still.
I hope it heals up enough by Saturday, cuz I'd love to go again.
That night I met up with a Minneapolis friend who was in town, and got to spend the next day with her too. Had a great time...
I guess that's all for now folks... I'm in need of food, and I think my chicken has got to be thawed by now.
Sorry for the lack of insight, wit, humor and life lesson... but I'm fresh outta those right now. Maybe later.
cn
Wednesday, September 3, 2008
it's just not in the air
It's awfully nice out today, or terribly nice out. Neither adjective seems to quite make sense when paired with 'nice' if you think about it. Terribly nice? Terrible? Well, who cares.... I guess I do, since I'm writing about it.
Anywho, it's fantastically nice out, and I'd very much like to be playing some badmitten in the backyard, or throwing a frisbee around in the park. But, as it turns out, we're all too busy to partake in these types of afternoon adventures. Instead our adventures consist of staring out the window from time to time while reading about all the things that we didn't quite grasp during the 'work day'.... or the 'getting WORKED day.'
At least I have some nice scenery to gaze at.
AND
At least I'm still really diggin' my rotation. I could really see myself working here. It's totally radical.
But, man, I really wanna work on my frisbee toss... or my golf swing.
maybe this weekend.
Anywho, it's fantastically nice out, and I'd very much like to be playing some badmitten in the backyard, or throwing a frisbee around in the park. But, as it turns out, we're all too busy to partake in these types of afternoon adventures. Instead our adventures consist of staring out the window from time to time while reading about all the things that we didn't quite grasp during the 'work day'.... or the 'getting WORKED day.'
At least I have some nice scenery to gaze at.
AND
At least I'm still really diggin' my rotation. I could really see myself working here. It's totally radical.
But, man, I really wanna work on my frisbee toss... or my golf swing.
maybe this weekend.
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