Just wanted everyone to hear the extraordinary stories of two orthopaedic patients that came in through the emergency room today.
The first was a thirty-something woman who is 27 weeks pregnant and an abuser of heroin. She had a hemiarthroplasty (half hip replacement) years ago because she broke her hip after she jumped out a third story window while being chased by cops. Over time, she developed an infection in that hip (probably from continually using dirty needles to inject heroin into her veins)...so when she was arrested by the cops last night (do you see a pattern here...?), she had to come to the hospital to be medically cleared before they could cart her off to prison. She might be the only patient who won't complain if there's a long wait in the ER.
The other patient is a ninety-something year old woman who fell at her nursing home 2 weeks ago and sustained a broken hip - she cannot consent for herself to have surgery because she's demented (thus explaining why she is arriving at the ER 2 weeks after suffering a fractured hip) No big deal, right? Her power-of-attorney can consent for her surgery. That wouldn't be a problem, but her power-of-attorney son, who is blind, is en route to Chicago from Canada by bus...and his cell phone number is disconnected.
I can't make this sh*t up!!!
Tuesday, January 13, 2009
Wednesday, November 28, 2007
On this date in 1994, Jeffrey Dahmer was clubbed to death in prison by another inmate
Psychiatric disease fascinates me...that is NOT to say it doesn't frustrate the hell out of me...
I have a patient that I cannot discharge from the hospital. She is a middle aged woman, formerly employed as a registered nurse, who underwent a knee replacement a few years ago. Sounds normal right? Her psych diagnoses include borderline personality disorder and obsessive compulsive disorder. To elaborate on what that means, her compulsion is "picking" - meaning when she gets nervous/depressed/agitated/whatever, she PICKS at her old knee incision...about a year ago, she picked so extensively, she got down to bone and metal (the knee replacement) - requiring extensive reconstructive plastic surgery and a revision of her knee because it obviously got infected with no skin/muscle/fat protecting it from the outside world. She recovered (from the surgeries, not the mental illness) but recently after some family drama, she started picking again (only got halfway down to metal before we admitted her for psychiatric workup and prophylactic casting) Essentially we put a giant fiberglass cast over her whole leg so she physically can't get at the incision to pick at it) So, like I said, we can't discharge her until she's mentally ready to handle it.
Meanwhile, across the hall from her is the guy I've admitted at least 4 separate times in the last month and a half. Quick synopsis: hip replacement, infection, successful revision surgery, dislocation, dislocation, dislocation, revision surgery, infection, multiple surgeries including plastic surgery flaps for covering his giant infected wound - most recently admitted for continued drainage (aka - infection). Sounds like bad luck right? NOPE, only in part - guy's bipolar and got all manic (one of the characteristic feelings during a manic phase is INVINCIBILITY) so he forgot all common sense and dislocation precautions and did stupid stuff to dislocate his hip, thus necessitating the cascade of revision surgeries. Today I was helping the plastic surgery resident (one of my friends) take a bunch of sutures out of his belly (from one of the plastic surgery flaps) - now another hallmark of a manic phase is HYPERSEXUALITY, so I (and the blond southern belle plastics resident) endured a few comments not fit to be recounted here...in the presence of the guy's wife!
After taking out what seemed like yards of suture material, the guy was left with some well-scabbed incisions on his belly, and he calls out "what do I do about all this scabby crap?" In my best professional doctor voice, I explained that with some gentle washing the scabs would fall off in a couple days...but MAN did I ever have a COMPULSION to look him in the eye and retort "Well, the lady across the hall could take care of picking those scabs off for you!"
When in Rome...
I have a patient that I cannot discharge from the hospital. She is a middle aged woman, formerly employed as a registered nurse, who underwent a knee replacement a few years ago. Sounds normal right? Her psych diagnoses include borderline personality disorder and obsessive compulsive disorder. To elaborate on what that means, her compulsion is "picking" - meaning when she gets nervous/depressed/agitated/whatever, she PICKS at her old knee incision...about a year ago, she picked so extensively, she got down to bone and metal (the knee replacement) - requiring extensive reconstructive plastic surgery and a revision of her knee because it obviously got infected with no skin/muscle/fat protecting it from the outside world. She recovered (from the surgeries, not the mental illness) but recently after some family drama, she started picking again (only got halfway down to metal before we admitted her for psychiatric workup and prophylactic casting) Essentially we put a giant fiberglass cast over her whole leg so she physically can't get at the incision to pick at it) So, like I said, we can't discharge her until she's mentally ready to handle it.
Meanwhile, across the hall from her is the guy I've admitted at least 4 separate times in the last month and a half. Quick synopsis: hip replacement, infection, successful revision surgery, dislocation, dislocation, dislocation, revision surgery, infection, multiple surgeries including plastic surgery flaps for covering his giant infected wound - most recently admitted for continued drainage (aka - infection). Sounds like bad luck right? NOPE, only in part - guy's bipolar and got all manic (one of the characteristic feelings during a manic phase is INVINCIBILITY) so he forgot all common sense and dislocation precautions and did stupid stuff to dislocate his hip, thus necessitating the cascade of revision surgeries. Today I was helping the plastic surgery resident (one of my friends) take a bunch of sutures out of his belly (from one of the plastic surgery flaps) - now another hallmark of a manic phase is HYPERSEXUALITY, so I (and the blond southern belle plastics resident) endured a few comments not fit to be recounted here...in the presence of the guy's wife!
After taking out what seemed like yards of suture material, the guy was left with some well-scabbed incisions on his belly, and he calls out "what do I do about all this scabby crap?" In my best professional doctor voice, I explained that with some gentle washing the scabs would fall off in a couple days...but MAN did I ever have a COMPULSION to look him in the eye and retort "Well, the lady across the hall could take care of picking those scabs off for you!"
When in Rome...
Thursday, August 30, 2007
Vladimir Lenin was shot on this day in 1918
There is no modesty in being a patient who undergoes surgery. You are exposed, naked; there are no secrets about the things normally concealed under your garments, not to mention the anesthesiologists who, under the guise of making you more relaxed, administer medication that will lessen your inhibitions...
Let this serve as my warning to those who wish to tattoo themselves...
A respectable gentleman once appeared on my OR table to have a benign tumor removed. After receiving the aforementioned anesthesia "cocktail," he lay on the table with his hospital gown askew (well, really, are hospital gowns ever really NOT askew?) exposing his medial calf where a good-sized tattoo had been emblazoned. It was simply a chicken with a noose around it's neck.
As my mind raced through all of the racy implications this tattoo could represent, the term "choking the chicken" came into my head...and I figured I was entitled to the explanation for such a unique piece of body art. The actual explanation exceeded all expectations, and I must thoroughly commend the patient on his sense of humor and cleverness that far exceeded my wildest imagination...
He stated that he had gotten the tattoo in college, not on a bet, not under any duress or even in an altered state of mind...but he simply had gotten it so that he could say, "I've got a cock hanging below my knees"
Indeed.
Let this serve as my warning to those who wish to tattoo themselves...
A respectable gentleman once appeared on my OR table to have a benign tumor removed. After receiving the aforementioned anesthesia "cocktail," he lay on the table with his hospital gown askew (well, really, are hospital gowns ever really NOT askew?) exposing his medial calf where a good-sized tattoo had been emblazoned. It was simply a chicken with a noose around it's neck.
As my mind raced through all of the racy implications this tattoo could represent, the term "choking the chicken" came into my head...and I figured I was entitled to the explanation for such a unique piece of body art. The actual explanation exceeded all expectations, and I must thoroughly commend the patient on his sense of humor and cleverness that far exceeded my wildest imagination...
He stated that he had gotten the tattoo in college, not on a bet, not under any duress or even in an altered state of mind...but he simply had gotten it so that he could say, "I've got a cock hanging below my knees"
Indeed.
Wednesday, August 29, 2007
On this day in 1982, chemical element 109 (Meitnerium) was discovered
Patients ask a lot of questions...sometimes surprisingly few regarding their own health. More frequently they ask personal questions and queries about how realistically medicine is portrayed on television.
Some of the most frequently asked patient questions (apart from the ones they SHOULD ask):
-How old are you? Are you old enough to be a doctor?
ANSWER: "That's none of your business and yes"
-Are you married? (Frequently followed by "I have this son/friend/nephew who would be perfect for you..." or the ever-reassuring and not-at-all patronizing "Oh, that's ok")
ANSWER: "No" (followed with the polite smile and self-deprecating comment about how young female surgeons are surprisingly not good wife material)
-Is your life just like Grey's Anatomy? (or House or Scrubs or ER...fill in medical show here)
ANSWER: "Unfortunately my hospital life is far less interesting" (but in case you're wondering...medically speaking, the order of most realistic to least realistic goes like this - Scrubs, ER, Grey's Anatomy, House)
But honestly, the aforementioned patient questions were really just a long segue into how my life sometimes IS just like an episode of ER. As today commemorates the anniversary of Hurricane Katrina, I'd like to discuss my dramatic day on the trauma service a week ago (courtesy of a local weather emergency)
The day of covering "the bomb" (the pager designated for all new consults and ER calls) started off with a routine orthopaedic procedure. Pulling off a guy's thumb nail to repair the nailbed injury he sustained by cutting halfway through his finger with a table saw...yes, it's just as medieval torture-esque as it sounds...
Saw a few more consults, put some casts on, repaired an ankle fracture in the OR...was seeing a inpatient with vertebral compression fractures in her 7th floor room, when an announcement came over the hospital PA system "THIS IS A WEATHER EMERGENCY, A TORNADO HAS TOUCHED DOWN WITHIN 5 MILES OF THE HOSPITAL, PLEASE MOVE AWAY FROM WINDOWS AND DOORS" This presented a challenge to my bedridden patient, so I pushed her bed as far from the window as possible and went over to close the curtains on the window (as if the cheap, vinyl hospital curtains would stop some 100mph debris from crashing through the window...but whatever) As I did that, I caught a glimpse of a pretty eerie looking wall of black clouds, some swirling leaves and dust, and an impressive lightning display...then finished talking to the patient (because what else was I going to do...abandon the helpless old lady in the midst of a tornado?)
Half an hour later, the loudspeaker came on again saying "THE TORNADO EMERGENCY IS OVER, BUT SEVERE STORMS ARE STILL IN THE AREA" So I went about changing a splint on a teenaged kid who got shot, and in the midst of doing that, all the lights went out in the hospital. "Shit," I exclaimed as I struggled to finish the splint without grabbing the kid's wounds in the dark. I apologized for the profanity, but the kid laughed as the frequent lightning afforded just enough light to finish the splint change.
A mere minute or so later, the backup generator came on - generously powering only the hallway lights (no room lights or air conditioning) The "bomb" then went off signalling a trauma in the ER. I quickly walked down there (there is comparatively little RUNNING in real life hospitals compared with TV show hospitals - slightly less dramatic, but fewer physician casualties that way) Awaiting me in the trauma bay was a poor woman who thought she'd save herself some hassle by running out to her car in the storm to roll up her windows...when a large tree fell onto her car and gave her quite a nasty open fracture. During the "logroll" (when the trauma team rolls the patient over to inspect for injuries on her back while still protecting her spine from moving) a 5 inch piece of BARK fell out of the open fracture wound - even non-experts should piece together that tree bark falling OUT of a wound is not a good thing.
So needless to say, the patient needed some emergent surgery, but the OR was not operational secondary to running on backup generator power, the radiology suite was not working due to computer short-outs when the electicity went out...complicated further by the fact that the ER was now 90 degrees due to the lack of air conditioning, and that sheets of water had just begun pouring out of the ceiling and flooding the ER hallway. Another casualty of the storm joined our patient in the trauma bay after a tree branch vs. head incident.
To add insult to injury, we couldn't even pass the time until the OR was up and running by eating some dinner, because the vending machines and cash registers were all nonfunctional.
About 2 hours later, the electricty returned, 20 people took wet vacs to the floor of the ER to mop it up, we took the patient to the OR, spent 2 hours cleaning dirt, glass, bark out of her wound, then fixed the fracture. I drove home at 1am (to a fortunately dry and still-standing condo)
Some of the most frequently asked patient questions (apart from the ones they SHOULD ask):
-How old are you? Are you old enough to be a doctor?
ANSWER: "That's none of your business and yes"
-Are you married? (Frequently followed by "I have this son/friend/nephew who would be perfect for you..." or the ever-reassuring and not-at-all patronizing "Oh, that's ok")
ANSWER: "No" (followed with the polite smile and self-deprecating comment about how young female surgeons are surprisingly not good wife material)
-Is your life just like Grey's Anatomy? (or House or Scrubs or ER...fill in medical show here)
ANSWER: "Unfortunately my hospital life is far less interesting" (but in case you're wondering...medically speaking, the order of most realistic to least realistic goes like this - Scrubs, ER, Grey's Anatomy, House)
But honestly, the aforementioned patient questions were really just a long segue into how my life sometimes IS just like an episode of ER. As today commemorates the anniversary of Hurricane Katrina, I'd like to discuss my dramatic day on the trauma service a week ago (courtesy of a local weather emergency)
The day of covering "the bomb" (the pager designated for all new consults and ER calls) started off with a routine orthopaedic procedure. Pulling off a guy's thumb nail to repair the nailbed injury he sustained by cutting halfway through his finger with a table saw...yes, it's just as medieval torture-esque as it sounds...
Saw a few more consults, put some casts on, repaired an ankle fracture in the OR...was seeing a inpatient with vertebral compression fractures in her 7th floor room, when an announcement came over the hospital PA system "THIS IS A WEATHER EMERGENCY, A TORNADO HAS TOUCHED DOWN WITHIN 5 MILES OF THE HOSPITAL, PLEASE MOVE AWAY FROM WINDOWS AND DOORS" This presented a challenge to my bedridden patient, so I pushed her bed as far from the window as possible and went over to close the curtains on the window (as if the cheap, vinyl hospital curtains would stop some 100mph debris from crashing through the window...but whatever) As I did that, I caught a glimpse of a pretty eerie looking wall of black clouds, some swirling leaves and dust, and an impressive lightning display...then finished talking to the patient (because what else was I going to do...abandon the helpless old lady in the midst of a tornado?)
Half an hour later, the loudspeaker came on again saying "THE TORNADO EMERGENCY IS OVER, BUT SEVERE STORMS ARE STILL IN THE AREA" So I went about changing a splint on a teenaged kid who got shot, and in the midst of doing that, all the lights went out in the hospital. "Shit," I exclaimed as I struggled to finish the splint without grabbing the kid's wounds in the dark. I apologized for the profanity, but the kid laughed as the frequent lightning afforded just enough light to finish the splint change.
A mere minute or so later, the backup generator came on - generously powering only the hallway lights (no room lights or air conditioning) The "bomb" then went off signalling a trauma in the ER. I quickly walked down there (there is comparatively little RUNNING in real life hospitals compared with TV show hospitals - slightly less dramatic, but fewer physician casualties that way) Awaiting me in the trauma bay was a poor woman who thought she'd save herself some hassle by running out to her car in the storm to roll up her windows...when a large tree fell onto her car and gave her quite a nasty open fracture. During the "logroll" (when the trauma team rolls the patient over to inspect for injuries on her back while still protecting her spine from moving) a 5 inch piece of BARK fell out of the open fracture wound - even non-experts should piece together that tree bark falling OUT of a wound is not a good thing.
So needless to say, the patient needed some emergent surgery, but the OR was not operational secondary to running on backup generator power, the radiology suite was not working due to computer short-outs when the electicity went out...complicated further by the fact that the ER was now 90 degrees due to the lack of air conditioning, and that sheets of water had just begun pouring out of the ceiling and flooding the ER hallway. Another casualty of the storm joined our patient in the trauma bay after a tree branch vs. head incident.
To add insult to injury, we couldn't even pass the time until the OR was up and running by eating some dinner, because the vending machines and cash registers were all nonfunctional.
About 2 hours later, the electricty returned, 20 people took wet vacs to the floor of the ER to mop it up, we took the patient to the OR, spent 2 hours cleaning dirt, glass, bark out of her wound, then fixed the fracture. I drove home at 1am (to a fortunately dry and still-standing condo)
Thursday, July 12, 2007
Today sunset & sunrise occur along Manhattan's street grid center line
Well, inspired by the written words and worldly insights of a friend of mine, I've decided to join the world of blogging. I'm just beginning year 3 of 5 of a residency training program in Chicago. Those that have experienced it know that surgical residency induces some strong feelings (both good and bad) in people who are, by nature, not the most expressive. There's something cathartic about expressing one's thoughts in a public forum (albeit in semi-anonymous form), so here goes...
Today has been a good day...I'm 12 hours into a 30-hour "day" of being on-call. My hospital is located in a less-than-afluent area of town, and our population of patients tend to be a little rough, sometimes frustrating, and less than appreciative. However, the three patients I have seen and treated in the ER today, have all said "thank you." Amazing what that does to a person's attitude, and somewhat depressing that it's more the exception than the rule to hear an expression of gratitude.
One of today's patients, a city worker who had the misfortune of dislocating his thumb after falling in a sewer, gave me a hug when I reduced (popped back into place) his thumb. Now call me a cynic for being skeptical that the grime-encrusted, semi-edentulous (toothless), but very endearing character lying on the gurney with multiple lacerations and a big cast on his newly-reduced thumb was telling the truth when he told me he was a "PHD." He quickly clarified that he was a "Pot Hole Doctor." The world needs more of those kind of doctors I thought as I strode out of the ER with a smile.
Today has been a good day...I'm 12 hours into a 30-hour "day" of being on-call. My hospital is located in a less-than-afluent area of town, and our population of patients tend to be a little rough, sometimes frustrating, and less than appreciative. However, the three patients I have seen and treated in the ER today, have all said "thank you." Amazing what that does to a person's attitude, and somewhat depressing that it's more the exception than the rule to hear an expression of gratitude.
One of today's patients, a city worker who had the misfortune of dislocating his thumb after falling in a sewer, gave me a hug when I reduced (popped back into place) his thumb. Now call me a cynic for being skeptical that the grime-encrusted, semi-edentulous (toothless), but very endearing character lying on the gurney with multiple lacerations and a big cast on his newly-reduced thumb was telling the truth when he told me he was a "PHD." He quickly clarified that he was a "Pot Hole Doctor." The world needs more of those kind of doctors I thought as I strode out of the ER with a smile.
Subscribe to:
Comments (Atom)