Mean people suck

My night was filled with sewing up person after person who drank too much and did something stupid ("play-fighting with butcher knives" "drunk cactus-trimming with a machete" "falling out of moving vehicle" "riding bike down main road the wrong way wearing all black with no helmet on").

The running excitement through the shift was provided by my first patient, a twenty-something young man with pretty severe stomach pain, constipation, and vomiting for a day. The twist? He is a 450 pound twenty-something young man with pretty severe stomach pain, constipation, and vomiting for a day. We pretty desperately needed to do a CT scan and he. . . can't fit into the scanner. The surgery team actually called the zoo in the morning to find out if they had a veterinary scanner we could use. I know it should be kind of funny but the guy was just so sweet and I wanted so much to be able to treat him and it was really sad. I was so embarrassed for him and frustrated that we weren't able to give him the care he should have received. We had similar trouble with x-rays, he couldn't fit on the radiology table and his abdomen shape prevented us from getting a good view of the intestines.

Finally, the morning was capped off with an oh so emergent "back pain for two months and peeing a lot," (Yeah, she ended up waiting 15 hours in the waiting room. Yes, literally.) This turned out to be an oh so awkward case of I-may-be-pregnant-but-I'm-in-denial-so-I'm-going-to-ignore-three-months-of-not-having-my-period-and-throwing-up-every-morning-and-my-swollen-breasts-and -rapidly-enlarging-lower-abdomen-and-just-hope-it-all-goes-away-on-its-own-itis.

And of course she came in with her mother. And of course she didn't want her mother to find out. Now she has a new pregnancy and pain so we have to do an ultrasound to make sure the baby is in the uterus. So I had to keep weirdly think up legitimate reasons to ask the mom to leave the room so we could do all these exams for what the mother thinks is just some back pain. Well good luck to her.

Grey's Anatomy moment of the day

Informing a deaf boy that his previously healthy 55 year old grandfather had died using a ballpoint pen and a piece of printer paper. Something about having that conversation in writing made it so much more sad and real.

Tough stuff.

Trauma bay quote of the day

Young man comes in after being stabbed with a butcher knife in the buttocks, both arms, and lower abdomen. Doctor begins a head to toe exam, pushing on his spine, stomach, neck, head etc. to assess for injuries.

Doctor: Tell me where it hurts.
Patient: Ummm, mostly where there are holes in me.


Logical.

Poignant triage note of the month

Patient presents for third time in two days with hornet stings, open sores on foot, and bruise. Needs money to get belongings off Greyhound bus. Also needs help finding an apartment. Also needs someone.

Aww, don't we all.

Back in the game

So after two fly-by dreamy months in big east coast inner city ED, I've moved out westward and am currently in Overcrowded Understaffed University ED. The patients are sicker, the waits are longer, the traumas more traumatic. The waiting room looks like the aftermath of a war zone. Dozens of moaning, bleeding, vomiting, figures strewn about the chairs and the floor, crouching under airplane-sized white blankets in various states of misery. The wait can be eight hours or more.

One of the doctors reassured me that "if they survive the waiting room, they can't be that sick."

Oh, and students are allowed to write orders, meaning that I'm am actually treating my patients essentially on my own. The theoretical one-to-one student to attending ratio flies out the window when seven trauma/resuscitation cases come in the door at once, every single doctor runs off to the trauma room, and I'm left alone managing literally the entire team's patients for four hours. I do my best to make absolutely no decisions of any importance during those times. Although doing nothing is a bold decision as well when one of the patients is an active GI bleeder, and six different nurses implore me to write orders for pain medications I've never heard of for patients I haven't seen.

Once in a while my attending will pop by and rattle off a list of about 20 things to do that I've never done before. It goes much like this: "Order pain meds for the patients in 43, and 47, whatever you want to give them. Change 41's antibiotic to something more broad-spectrum and then discharge her with a laxative. Order procedural sedation and find the sedation cart for 53, look up how to reduce luxatio erecta shoulder dislocations and be ready to do it, put an NG tube down 37 and lavage him to clear once now and once in twenty minutes, look at 39's x-rays, call ortho, and describe her fracture to them." Then he zooms off down the hall and disappears to trauma-land for another three hours.

I imagine this will be a fantastic place to learn once I get my sea-legs. Right now I feel like I've played a simulator game a few times and suddenly find myself piloting a commercial airline with no backup. I theoretically know what to do but. . .

The good news is zero people died under my watch, I did successfully reduce the shoulder dislocation, my GI bleeder stayed stable, and I actually sent three of my patients home feeling better.

Working overnight tonight, I have to go study my pain medication dosages.