My Israeli husband: I'm taking you on a new bike trail tomorrow.
Me: Will it be crowded?
MIH: No, it was supposed to be a lot of people, but everyone else backed out because they're scared of the kazaam rockets.
Me: Are you worried about the kazaam rockets?
MIH: No.
Okay then.
Friday, February 29, 2008
Overseen on the ward (ob-gyn)
On a box of hospital gloves:
"Shield gloves from sunlight, fluorescent lights, x-rays, moisture, excessive warmth, and ozone."
So these medical gloves cannot be used outside, inside, in hospitals, in human orifices, or at high altitudes.
Useful.
Wednesday, February 13, 2008
overheard in the ward
Ornery older gentleman as a fellow student struggled with an IV insertion:
"First the holocaust, now this."
"First the holocaust, now this."
Saturday, February 9, 2008
things change
(Warning: I'm going to describe some surgery stuff and some real life stuff that might be on the icky/disturbing side.)
For some paradoxical reason, this surgery rotation, rather than desensitizing me, has started to make me more sensitive than I've ever been before. I've never been one to be disturbed by tv violence, by the news, even by the actual trauma I've seen in the ER or working on ambulances.
But despite my rather extensive exposure to blood and guts and pain, recently I find myself haunted by a few scenes. Just more upset than I should have been. For longer than I really should have been.
I've been living in Israel for long enough to have vaguely adjusted to things exploding near me. And car crash after car crash. And shockingly substandard (or different-standard) medical care.
But it's been a weird month for me.
It started with a trauma surgery two weeks ago. We passed a nasty-looking car crash on the way in to the hospital. The driver was being wheeled in to surgery just as we arrived. He was clearly not going to make it- it took nearly 40 minutes to get him to the hospital and into surgery, his heart was not beating upon admission (but revived with CPR), and the medics who brought him in had not made any significant efforts to stop bleeding or provide patient care at all that I could tell. I'll spare boring details, but his blood tests showed levels of lactic acid and carbon dioxide incompatible with life, his pupils were unresponsive, his blood pressure was around 30.
Since his heart was still beating though, we had to go through the motions of doing everything we could. What ensued was a five hour mess of a surgery during which we removed both his legs and cut open both his abdomen and chest (twice). He finally died on the way from the OR to the recovery room.
The surgery itself was punctuated by frequent arguments between the anesthesiologists and surgeons, between the general surgeons and the orthopedist, between everyone and the nurses. For the first 15 minutes the patient's leg was spurting blood, but the orthopedist was unconvinced that this was a problem worthy of his attention- and the general surgeons refused to control the bleeding until the orthopedist had decided whether or not he wanted to amputate. This argument was punctuated by the anesthesiologist pointing out every three minutes that the patient's blood pressure had not risen about 30 this entire time, so they needed to do something. As nothing was decided about the leg, it continued to bleed while the general surgeons went ahead with exploratory abdominal surgery. (I asked the anesthesiologist if we should do something, he said it really didn't matter and went back to arguing with the blood bank on the telephone.)
I can't figure out what was so upsetting to me about all this. For one thing, it was a dramatically violent surgery on a dramatically injured young person. But also, it just felt to me like we were throwing money, supplies, time, blood, energy into this hopeless case. And it felt so deeply disrespectful to me. If he's already dead, and you're treating him as though he's not going to survive, then let him die with his legs intact and organs on the inside. And then of course I had the feeling I always do when patients die where it feels to me like we could have done so much better or more than we did.
But I've seen all that before, I can't figure out why this has been bothering me so much.
Then to follow that up there was our entirely unnecessary and disastrous two-day whipple procedure (another story for another time).
And the recent Israel drama. They've been showing footage on the news of the second Dimona suicide bomber being shot. While he's already down on the ground. And I can't argue that he shouldn't have been shot- it was certainly justified. But after all the trauma of the week, the last thing I want to see while I'm on the treadmill at the gym is a man being shot while he's down. Regardless of the situation. Don't want to see it.
And that's something that wouldn't have bothered me a few months ago. And really bothers me now.
Or maybe it's all just wildly misplaced wedding jitters :-)
For some paradoxical reason, this surgery rotation, rather than desensitizing me, has started to make me more sensitive than I've ever been before. I've never been one to be disturbed by tv violence, by the news, even by the actual trauma I've seen in the ER or working on ambulances.
But despite my rather extensive exposure to blood and guts and pain, recently I find myself haunted by a few scenes. Just more upset than I should have been. For longer than I really should have been.
I've been living in Israel for long enough to have vaguely adjusted to things exploding near me. And car crash after car crash. And shockingly substandard (or different-standard) medical care.
But it's been a weird month for me.
It started with a trauma surgery two weeks ago. We passed a nasty-looking car crash on the way in to the hospital. The driver was being wheeled in to surgery just as we arrived. He was clearly not going to make it- it took nearly 40 minutes to get him to the hospital and into surgery, his heart was not beating upon admission (but revived with CPR), and the medics who brought him in had not made any significant efforts to stop bleeding or provide patient care at all that I could tell. I'll spare boring details, but his blood tests showed levels of lactic acid and carbon dioxide incompatible with life, his pupils were unresponsive, his blood pressure was around 30.
Since his heart was still beating though, we had to go through the motions of doing everything we could. What ensued was a five hour mess of a surgery during which we removed both his legs and cut open both his abdomen and chest (twice). He finally died on the way from the OR to the recovery room.
The surgery itself was punctuated by frequent arguments between the anesthesiologists and surgeons, between the general surgeons and the orthopedist, between everyone and the nurses. For the first 15 minutes the patient's leg was spurting blood, but the orthopedist was unconvinced that this was a problem worthy of his attention- and the general surgeons refused to control the bleeding until the orthopedist had decided whether or not he wanted to amputate. This argument was punctuated by the anesthesiologist pointing out every three minutes that the patient's blood pressure had not risen about 30 this entire time, so they needed to do something. As nothing was decided about the leg, it continued to bleed while the general surgeons went ahead with exploratory abdominal surgery. (I asked the anesthesiologist if we should do something, he said it really didn't matter and went back to arguing with the blood bank on the telephone.)
I can't figure out what was so upsetting to me about all this. For one thing, it was a dramatically violent surgery on a dramatically injured young person. But also, it just felt to me like we were throwing money, supplies, time, blood, energy into this hopeless case. And it felt so deeply disrespectful to me. If he's already dead, and you're treating him as though he's not going to survive, then let him die with his legs intact and organs on the inside. And then of course I had the feeling I always do when patients die where it feels to me like we could have done so much better or more than we did.
But I've seen all that before, I can't figure out why this has been bothering me so much.
Then to follow that up there was our entirely unnecessary and disastrous two-day whipple procedure (another story for another time).
And the recent Israel drama. They've been showing footage on the news of the second Dimona suicide bomber being shot. While he's already down on the ground. And I can't argue that he shouldn't have been shot- it was certainly justified. But after all the trauma of the week, the last thing I want to see while I'm on the treadmill at the gym is a man being shot while he's down. Regardless of the situation. Don't want to see it.
And that's something that wouldn't have bothered me a few months ago. And really bothers me now.
Or maybe it's all just wildly misplaced wedding jitters :-)
Tuesday, February 5, 2008
preop rounds
I believed after my first day of surgery, that nothing could be more awkward, inefficient, or generally unproductive and uncomfortable for everyone that morning rounds.
Day 1 involved a team of literally, I exaggerate not, 27 doctors, students, and nurses. We trooped from bed to bed- well actually we kind of just collectively turned in the direction of the beds because there isn't actually room to move during morning rounds. The doctor of the day looks at the patient, looks confused, looks at the chart, looks again at the patient, checks the name on the bed to confirm that the patient in the bed is at all related to the chart he's holding, and then reads the admission from the chart. Bonus points if they make no eye contact with the patient whatsoever. Double bonus points if they accidentally refer to the patient as the opposite gender than they are during the entire report. (And of course all time high score if they refer to the patient as obese at least three times during the presentation.)
Then about half the doctors poke the relevant body parts, then force all the students to poke said body parts again. Especially if they hurt. Most of the surgeons are Russian, so we get the added benefit of Russians translating Hebrew to English. It's an extraordinary learning environment really. And fun for the sick people!
So I believed I was relatively inured to insensitivity and dehumanization. I had not yet experienced pre-op rounds.
Background: Patients at our hospital are not allowed to know who their surgeon is before surgery. I'm not 100% sure why, but something with socialized health care and being a community hospital. To ensure that this anonymity is maintained, each surgical patient must be examined and interviewed by every single surgeon.
At the same time.
Let's set the scene. You are a person. Probably not feeling your all time best. Perhaps a little bit apprehensive about your upcoming surgery. Possibly your medical condition involves a private or sensitive body part.
You show up to the basement of the hospital and are led into a bomb shelter like room (which is actually a bomb shelter) containing an examining table behind a curtain in the corner, a desk, and a circle of 20 - 30 doctors and students with a chair in the middle.
You sit in the middle of the circle while these 20+ strangers discuss your possibly embarrassing medical condition and fire questions at you from all directions.
You then go over to the examination table behind the curtain, take of the necessary amount of clothing, and squeezing into the tiny examining corner 5-7 at a time, every single doctor examines you.
We students felt a bit odd about it and tried at first to get lost in the crowd and not subject the poor patient to, for example, 27 intimate examinations of their rectal fistula. But the doctors always seem to notice and insist upon every single one of us palpating the testicle until we've all felt the hernias to his satisfaction.
It's absurd. Even more so in practice, I can't seem to describe it right, but the general atmosphere of the whole thing is pretty much what I imagine aliens would do to the first human being they discover.
The strange, and good part I suppose, is that the patients don't seem to mind at all. Or even to find it unusual.
And healthcare goes on. . .
Day 1 involved a team of literally, I exaggerate not, 27 doctors, students, and nurses. We trooped from bed to bed- well actually we kind of just collectively turned in the direction of the beds because there isn't actually room to move during morning rounds. The doctor of the day looks at the patient, looks confused, looks at the chart, looks again at the patient, checks the name on the bed to confirm that the patient in the bed is at all related to the chart he's holding, and then reads the admission from the chart. Bonus points if they make no eye contact with the patient whatsoever. Double bonus points if they accidentally refer to the patient as the opposite gender than they are during the entire report. (And of course all time high score if they refer to the patient as obese at least three times during the presentation.)
Then about half the doctors poke the relevant body parts, then force all the students to poke said body parts again. Especially if they hurt. Most of the surgeons are Russian, so we get the added benefit of Russians translating Hebrew to English. It's an extraordinary learning environment really. And fun for the sick people!
So I believed I was relatively inured to insensitivity and dehumanization. I had not yet experienced pre-op rounds.
Background: Patients at our hospital are not allowed to know who their surgeon is before surgery. I'm not 100% sure why, but something with socialized health care and being a community hospital. To ensure that this anonymity is maintained, each surgical patient must be examined and interviewed by every single surgeon.
At the same time.
Let's set the scene. You are a person. Probably not feeling your all time best. Perhaps a little bit apprehensive about your upcoming surgery. Possibly your medical condition involves a private or sensitive body part.
You show up to the basement of the hospital and are led into a bomb shelter like room (which is actually a bomb shelter) containing an examining table behind a curtain in the corner, a desk, and a circle of 20 - 30 doctors and students with a chair in the middle.
You sit in the middle of the circle while these 20+ strangers discuss your possibly embarrassing medical condition and fire questions at you from all directions.
You then go over to the examination table behind the curtain, take of the necessary amount of clothing, and squeezing into the tiny examining corner 5-7 at a time, every single doctor examines you.
We students felt a bit odd about it and tried at first to get lost in the crowd and not subject the poor patient to, for example, 27 intimate examinations of their rectal fistula. But the doctors always seem to notice and insist upon every single one of us palpating the testicle until we've all felt the hernias to his satisfaction.
It's absurd. Even more so in practice, I can't seem to describe it right, but the general atmosphere of the whole thing is pretty much what I imagine aliens would do to the first human being they discover.
The strange, and good part I suppose, is that the patients don't seem to mind at all. Or even to find it unusual.
And healthcare goes on. . .
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