We slid the wedding set off the ring finger of a 71 year old woman in hospice care as she was being discontinued from mechanical respiratory support and handed them to her 16 year old granddaughter.
She hadn't taken those rings off that finger in 37 years.
Friday, July 31, 2009
what gets you through the night
1. Keeping track of how many patients point out to you that you're giving their grandmother the medicine that killed Michael Jackson. (7 last night)
2. Watching your sixth code of the night through the window next to a nurse's station and noticing Pandora's playing 'pour some sugar on me'. Bonus points for singing a little inside your head and then feeling bad.
3. Cataloguing the myriad pronunciations of "Au Bon Pain" (our new hospital coffee shop! Yay!)
The most common is "Ow Bone Pain" followed closely by "Oh bone pain." Then there's the French variation which comes out vaguely "Oh Bo Pah" and generally needs to be repeated three to six times before anyone figures out what you're saying. Not quite sure why this amuses me so.
4. These. Shoes.
5. 30 second elevator dance parties. Bonus points if someone catches you as the door opens.
6. Going the long way to the east building so that you can walk through the newborn ward filled with pictures of babies taking baths. Bonus points if your delivery pager goes off while you're there (new babies!).
7. Looking at your watch at 8am and you have not eaten, slept, drunk, peed, caffeinated, or sat down for over 17 hours and didn't even notice.
8. 3am check. 47 out of 53 patients still alive!
9. 5am: the pager operator starts apologizing when she calls you, "wow, you're getting slammed."
10. When the nurses call you with a question thusly: "Hello Dr. SS, I have a patient in room thirteen with "x" problem, usually in this situation the doctor would recommend "y" treatment at 5mg BID, would you like me to write that order that for you?" Yes, yes yes!!!
11. Lavishly detailed bed fantasies.
2. Watching your sixth code of the night through the window next to a nurse's station and noticing Pandora's playing 'pour some sugar on me'. Bonus points for singing a little inside your head and then feeling bad.
3. Cataloguing the myriad pronunciations of "Au Bon Pain" (our new hospital coffee shop! Yay!)
The most common is "Ow Bone Pain" followed closely by "Oh bone pain." Then there's the French variation which comes out vaguely "Oh Bo Pah" and generally needs to be repeated three to six times before anyone figures out what you're saying. Not quite sure why this amuses me so.
4. These. Shoes.
5. 30 second elevator dance parties. Bonus points if someone catches you as the door opens.
6. Going the long way to the east building so that you can walk through the newborn ward filled with pictures of babies taking baths. Bonus points if your delivery pager goes off while you're there (new babies!).
7. Looking at your watch at 8am and you have not eaten, slept, drunk, peed, caffeinated, or sat down for over 17 hours and didn't even notice.
8. 3am check. 47 out of 53 patients still alive!
9. 5am: the pager operator starts apologizing when she calls you, "wow, you're getting slammed."
10. When the nurses call you with a question thusly: "Hello Dr. SS, I have a patient in room thirteen with "x" problem, usually in this situation the doctor would recommend "y" treatment at 5mg BID, would you like me to write that order that for you?" Yes, yes yes!!!
11. Lavishly detailed bed fantasies.
Saturday, July 25, 2009
I wonder when doctors actually start to feel like doctors
Pager: ::beep! beep!::
I answer. "Hi, it's nicest-most-patient-nurse-in-the-universe from the floor. I was wondering if you were going to come up and pronounce Mr. N."
Me: "Like. . . pronounce him dead?"
NN: ::encouraging pause::
Me: "Like . . . 'time of death 1407' pronounce him dead?"
NN: . . . . . . .
Me: "Like. . . you need a doctor to come down and certify the death and you called me. . .?"
NN: ::sigh:: "Yeah, and now please, we actually kind of need the room for another patient. Thanks."
So I get down there and look kind of lost and nervous (theme of the day) until NN takes pity and comes over. "No worries, all you have to do is go in the room, make sure he's really dead and then fill out the paperwork."
So I stroll into the room trying to look terribly authoritative and appropriately grave. And I look at the gentleman. And he doesn't look all that dead. I look around to see if any of the nurses are watching. They are. Waiting. So I reach out and try to feel for a pulse in his neck. Then I have creepy feeling like he's going to jump up and say boo and snap at me so I quickly remove my hand as though satisfied with my thorough assessment of pulselessness.
But they're all still looking. So I pull out my stethoscope and find myself out of habit saying "I'm just going to take a listen to your heart now." The words kind of echo and hang there. I place the diaphragm to the left of his sternum and all I can hear is the echo of my own pulse rushing through my ears and I can't say for 100% that it isn't actually his heart. Maybe it was just so weak the monitor couldn't pick it up right? So I just stand there and listen and listen and listen. Probably for a full minute I listen. And I can't tell. I swear I hear a heartbeat. His hands are freezing and white. He's motionless, her tongue protruding a little, eyes closed, chest still. But I just can't tell for sure.
The nurses have lost interest and wandered off. I kind of pet his cold, dry hand a bit and excuse myself, looking back one more time before I leave, as though to catch him readjusting his head on the pillow.
Then I fill out the form: Respirations Have Ceased 14:07
I answer. "Hi, it's nicest-most-patient-nurse-in-the-universe from the floor. I was wondering if you were going to come up and pronounce Mr. N."
Me: "Like. . . pronounce him dead?"
NN: ::encouraging pause::
Me: "Like . . . 'time of death 1407' pronounce him dead?"
NN: . . . . . . .
Me: "Like. . . you need a doctor to come down and certify the death and you called me. . .?"
NN: ::sigh:: "Yeah, and now please, we actually kind of need the room for another patient. Thanks."
So I get down there and look kind of lost and nervous (theme of the day) until NN takes pity and comes over. "No worries, all you have to do is go in the room, make sure he's really dead and then fill out the paperwork."
So I stroll into the room trying to look terribly authoritative and appropriately grave. And I look at the gentleman. And he doesn't look all that dead. I look around to see if any of the nurses are watching. They are. Waiting. So I reach out and try to feel for a pulse in his neck. Then I have creepy feeling like he's going to jump up and say boo and snap at me so I quickly remove my hand as though satisfied with my thorough assessment of pulselessness.
But they're all still looking. So I pull out my stethoscope and find myself out of habit saying "I'm just going to take a listen to your heart now." The words kind of echo and hang there. I place the diaphragm to the left of his sternum and all I can hear is the echo of my own pulse rushing through my ears and I can't say for 100% that it isn't actually his heart. Maybe it was just so weak the monitor couldn't pick it up right? So I just stand there and listen and listen and listen. Probably for a full minute I listen. And I can't tell. I swear I hear a heartbeat. His hands are freezing and white. He's motionless, her tongue protruding a little, eyes closed, chest still. But I just can't tell for sure.
The nurses have lost interest and wandered off. I kind of pet his cold, dry hand a bit and excuse myself, looking back one more time before I leave, as though to catch him readjusting his head on the pillow.
Then I fill out the form: Respirations Have Ceased 14:07
trial by fire
True story
Nervous 1st day of ICU me: "Good morning Dr. Cranky-and-prone-to-pointless-yelling, I'm your new intern! Yay! So, I just finished orientation, and I was wondering where I should meet you?"
Dr. Crappy: "Actually nervous intern, I strongly suggest you go attend to your patients before worrying about me. I, more specifically, suggest you check on Mr. R as he's going to die."
Me (realizing I have no idea where 27W is; like I'd have any idea what to do when I got there): "Umm. . . ."
Dr. C: "Perhaps I stuttered? Your patient is literally dying right now. Go. Go."
P.S. Yeah, he was right.
Nervous 1st day of ICU me: "Good morning Dr. Cranky-and-prone-to-pointless-yelling, I'm your new intern! Yay! So, I just finished orientation, and I was wondering where I should meet you?"
Dr. Crappy: "Actually nervous intern, I strongly suggest you go attend to your patients before worrying about me. I, more specifically, suggest you check on Mr. R as he's going to die."
Me (realizing I have no idea where 27W is; like I'd have any idea what to do when I got there): "Umm. . . ."
Dr. C: "Perhaps I stuttered? Your patient is literally dying right now. Go. Go."
P.S. Yeah, he was right.
Sunday, July 19, 2009
Mmm. . . not so sure she got it
Thursday night; Emergency Department:
Me: Okay, mom, we got the x-ray results and it looks like L'k's'ha (name obviously changed, but it did have that many apostrophes in it in real life) did break her leg. She has a displaced spiral fracture involving both the tibia and fibula, which means that she broke both the bones of her lower leg and that the pieces of bone aren't lined up right anymore. I'm going to call orthopedics to come down and decide if she's going to get a cast or if they need to do an operation to line the bones up.
Mom: So, will she be cool to go to sports camp next week?
Me: Umm, I imagine it's actually going to take quite a bit longer than that to heal.
Mom: But it's not like she'd have to go Monday. . . camp doesn't start until Wednesday.
Me: Okay, mom, we got the x-ray results and it looks like L'k's'ha (name obviously changed, but it did have that many apostrophes in it in real life) did break her leg. She has a displaced spiral fracture involving both the tibia and fibula, which means that she broke both the bones of her lower leg and that the pieces of bone aren't lined up right anymore. I'm going to call orthopedics to come down and decide if she's going to get a cast or if they need to do an operation to line the bones up.
Mom: So, will she be cool to go to sports camp next week?
Me: Umm, I imagine it's actually going to take quite a bit longer than that to heal.
Mom: But it's not like she'd have to go Monday. . . camp doesn't start until Wednesday.
Chief complaint of the night
"7 year old male was practicing his AWESOME Undertaker wrestling moves when he fell forward onto carpet, hitting his forehead and twisting his neck."
Sure enough, I go into the room.
Me: Hey, Buddy, what kind of wrestling moves were you trying to do when you fell?
Buddy: Awesome ones.
Sure enough, I go into the room.
Me: Hey, Buddy, what kind of wrestling moves were you trying to do when you fell?
Buddy: Awesome ones.
surprise!
I walked in on a rather special family moment in room 29 last night. The young married couple had just returned from a family reunion and were discussing their various and sundry relatives, when they had the simultaneous realization that his Aunt Margie, oh yes, also her Aunt Margie.
They spent my entire physical exam (White-Castle-related-nonspecific-gastroenteritis) on the phone with their parents frantically trying to figure out exactly how related they were.
Though neither seemed terribly disturbed by the news.
After some observation, a dose of Mylanta, and a detailed discussion of why going back to White Castle for dinner might not be the all time best treatment for their nausea, vomiting, and diarrhea, they were discharged home to do some family bonding.
On my way out after the shift, I noticed they had taken my nutrition counseling to heart: There they were, hand in hand, walking out of McDonald's.
They spent my entire physical exam (White-Castle-related-nonspecific-gastroenteritis) on the phone with their parents frantically trying to figure out exactly how related they were.
Though neither seemed terribly disturbed by the news.
After some observation, a dose of Mylanta, and a detailed discussion of why going back to White Castle for dinner might not be the all time best treatment for their nausea, vomiting, and diarrhea, they were discharged home to do some family bonding.
On my way out after the shift, I noticed they had taken my nutrition counseling to heart: There they were, hand in hand, walking out of McDonald's.
Friday, July 10, 2009
You know you're in residency when. . .
you're extremely excited about sleeping in tomorrow morning. . . and sleeping in = 6:15 am.
Apologies if you've seen this before
It's been on youtube for a while. If you've not seen this before humor me. Go over to a couch or pillow and perform CPR compressions on it, try to keep your form good, arms straight and push at about 100 times/minute (the rhythm of "staying alive").
Now keep compressing and push play. Follow the instructions on the video (just count the number of times the white team passes the ball). It's over when there's a pause in the video.
Neat, right? (Of course no-attention-span me was the first person in the history of the program to notice the first time around. I reallly need to work on focusing.)
Now keep compressing and push play. Follow the instructions on the video (just count the number of times the white team passes the ball). It's over when there's a pause in the video.
Neat, right? (Of course no-attention-span me was the first person in the history of the program to notice the first time around. I reallly need to work on focusing.)
Save the bunnies!
Today was wound repair day, the majority of which was spent lacerating and then repairing pig's feet, which I always enjoy more that one might imagine. Somehow, the topic of wound research was raised, and one of the physicians brought up the methodology behind one of the major studies on how the size of injury relates to the risk of infection.
So how was it done? Basically, the researchers dropped heavier and heavier weights onto bunny rabbits, exposed them to bacteria, and observed which bunnies got the most infected.
I would like you to keep in mind, next time you rub on some neosporin, or put on a bandaid, or get stitches, that partially responsible for the healing of your injury, is a squished bunny.
Thank you bunnies.
So how was it done? Basically, the researchers dropped heavier and heavier weights onto bunny rabbits, exposed them to bacteria, and observed which bunnies got the most infected.
I would like you to keep in mind, next time you rub on some neosporin, or put on a bandaid, or get stitches, that partially responsible for the healing of your injury, is a squished bunny.
Thank you bunnies.
Thursday, July 9, 2009
overheard in the ED part two
later that night:
Same resident: My patient in three says her last doctor told her that she had a condom stuck on her ovary once.
Staff physician: Man, I would really love to have a look at her boyfriend.
Same resident: My patient in three says her last doctor told her that she had a condom stuck on her ovary once.
Staff physician: Man, I would really love to have a look at her boyfriend.
overheard in the ED
circa midnight.
Resident: Hey med student, I have a patient in 14 with watery, irritated eyes and copious malodorous vaginal discharge. What do you think's going on with her?
::long pause::
Student: umm. . . maybe she's crying about the copious vaginal discharge?
Resident: Hey med student, I have a patient in 14 with watery, irritated eyes and copious malodorous vaginal discharge. What do you think's going on with her?
::long pause::
Student: umm. . . maybe she's crying about the copious vaginal discharge?
Tuesday, July 7, 2009
The trend continues. .
Tonight I sewed up the faces of three men who were all "just minding their own business" when they, respectively, were pistol whipped in the face, punched in the eye with brass knuckles, and had their throat slashed from behind.
Dangerous stuff.
Dangerous stuff.
did not see that coming
Chief complaint (direct quote): "Back hurts. Oh, and it feels like my butthole is crying."
History revealed nothing. Healthy young woman, a bit on the plus size of plus size, regular periods, no lady-part complaints of any kind, no urinary tract infection symptoms, no history of trauma or back strain, really no complaints at all except the above.
Well my oh-so-lucky male intern friend gamely helped the lass undress to discover what exactly she could mean by this (expecting some kind of sore, abscess maybe?) and discovered, I kid you not, a full term just-born infant. In her pants.
She was surprised, to say the least. As was her husband. And the nurse. And the intern. And all of us.
Both baby and mom are doing fine.
Weird stuff.
History revealed nothing. Healthy young woman, a bit on the plus size of plus size, regular periods, no lady-part complaints of any kind, no urinary tract infection symptoms, no history of trauma or back strain, really no complaints at all except the above.
Well my oh-so-lucky male intern friend gamely helped the lass undress to discover what exactly she could mean by this (expecting some kind of sore, abscess maybe?) and discovered, I kid you not, a full term just-born infant. In her pants.
She was surprised, to say the least. As was her husband. And the nurse. And the intern. And all of us.
Both baby and mom are doing fine.
Weird stuff.
Sunday, July 5, 2009
Ahhhhhhhh!
Most squirm-inducing patient of the week:
Medical student bursts into the call room, runs over to the attending looking super nervous: "excuse me, sir, my patient said her ear hurt and I looked in there with the ear light thing, and I'm pretty sure. . . she's got a bee in there."
A few seconds of silence, and then of course we all had to go take a look. And yes, indeed, full sized honeybee.
Then poor lady had to suffer through the medical student extra-nervously trying and failing to remove the bee in its entirety with a pair of forceps. Half the body ended up sticking to her tympanic membrane. Eventually we rinsed the thing out with about 30 minutes of flowing water.
Not fun.
And yet another addition to my life list of things-I-didn't-think-I-had-to-worry-about-but-really-really-should-be-worrying-about-constantly. Considering permanent skin grafts over my auditory canal.
Medical student bursts into the call room, runs over to the attending looking super nervous: "excuse me, sir, my patient said her ear hurt and I looked in there with the ear light thing, and I'm pretty sure. . . she's got a bee in there."
A few seconds of silence, and then of course we all had to go take a look. And yes, indeed, full sized honeybee.
Then poor lady had to suffer through the medical student extra-nervously trying and failing to remove the bee in its entirety with a pair of forceps. Half the body ended up sticking to her tympanic membrane. Eventually we rinsed the thing out with about 30 minutes of flowing water.
Not fun.
And yet another addition to my life list of things-I-didn't-think-I-had-to-worry-about-but-really-really-should-be-worrying-about-constantly. Considering permanent skin grafts over my auditory canal.
Oh noes
I've discovered the most dangerous thing one can do in this city. Here are three true stories from last night:
-"I was on my front porch, minding my own business, when these three guys came up yelled a bunch of stuff at me and hit me up the back of the head with their gun."
-"I was sitting on the couch minding my own business when my family came in and tried to kill me and cut me and stabbed me in the neck."
"I was just minding my own business when the police started chasing me and sent their dogs after me. Once the dog took me down it bit through my arm; then the police kicked me in the head a bunch of times and arrested me."
Scary stuff! Remind me please to never ever mind my own business ever again.
(Disclosure, that second one was actually a hallucination, but I think even a hallucination of your grandma stabbing you in the neck is a fairly undesirable outcome of just minding your own business.)
-"I was on my front porch, minding my own business, when these three guys came up yelled a bunch of stuff at me and hit me up the back of the head with their gun."
-"I was sitting on the couch minding my own business when my family came in and tried to kill me and cut me and stabbed me in the neck."
"I was just minding my own business when the police started chasing me and sent their dogs after me. Once the dog took me down it bit through my arm; then the police kicked me in the head a bunch of times and arrested me."
Scary stuff! Remind me please to never ever mind my own business ever again.
(Disclosure, that second one was actually a hallucination, but I think even a hallucination of your grandma stabbing you in the neck is a fairly undesirable outcome of just minding your own business.)
chief complaint of the weekend
"25 year old male states he drank some beers last night, now complains of headache (10/10) and vomiting."
And yes, correct, I work in an emergency department.
Taxpayers, this is where the money goes.
Hello. :-)
Yum.
And yes, correct, I work in an emergency department.
Taxpayers, this is where the money goes.
Hello. :-)
Yum.
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