New things I learned on call.......

I had call last night (5 down, 7 more to go) and I learned some interesting things:

- Never try to interview a patient at 1:30am
- I never want to experience a chest tube placement
- I never want to live in a nursing home
- I am going to write a book entitled "Hernia repair: 101 Ways"

Because our night was very busy, our team did not get around to catching up with consults until almost midnight. At 1 am, my resident sent me to interview a patient on the floor with an abscess on her shoulder. So, I proceeded into the patient's room, turned on the overhead light and had the following conversation:

Me: Ms. BL, I'm sorry to wake you but I'm from surgery. I'm here to ask you about the problem you are having with your shoulder.

Ms. BL: WHAT??? You woke me up to ask me about pain. What the hell is wrong with you!!! I'm not talking to you now....get out of my room.....come back tomorrow morning!

So, I proceeded back down to SICU where I told my resident to please never send me to a patient's room again after midnight unless it was an emergency.

I fully recognize that sleep is very important for any person, especially those recovering from sickness or surgery. However, it is rare in the hospital setting to get any decent sleep at all. Nurses...doctors....therapists.....are constantly coming in and out at all hours of the day. I sometimes wonder if patients would recover faster with more sleep (interesting study idea).

Now on to the chest tube.....OUCH!! It started off okay, with some local anesthetic, 2mg of IV morphine and a small incision, but then the patient was having some pain and the resident was having a hard time getting into the chest wall. So, the senior resident turns to the patient and says "This is going to hurt", then proceeds to jab a blunt instrument extremely forceful into this guys chest and into his pleural cavity. All we heard was a loud "Pshhhhhhh" like if you opened a can of soda, and the patient started screaming in pain (although the word screaming does not do justice in fully describing what came out of this guys mouth)....and the screaming lasted for about 10 minutes after this fairly traumatic event. My first chest tube placement made me quickly realize that I never, ever want to go through that procedure....and, in the unfortunate circumstance that I do, I want to be completely knocked out.

While we were placing the chest tube, the paramedics bring in an 80-something year old female resident of a nursing home with a very visible, pulsatile abdominal mass. My senior resident asks the paramedics if she is responsive. The paramedics reply "The patient has been unresponsive for 2 days." What?? 2 days?? They go on to explain to my senior resident that that is the history the nursing home provided. 2 days?? That seems a little extreme to me. Who in their right mind would allow an elderly patient to be unresponsive for that amount of time. Can you say lawsuit??

Other than that, I also scrubbed in on 3 hernia cases, all involving the right inguinal region, and all of them completely different from each other. By the end of the 3rd surgery I realized several key things: the presentation (extent, location, etc) of the hernia can influence the surgery (where to cut, how long to make the incision, etc); each surgeon has their own way of starting a hernia, repairing a hernia, and closing a hernia (using a multitude of differing instruments, meshing, plugs, sutures, etc). I also quickly realized that I can easily pick out the layers of the hernia until they cut open the hernia sack.....then everything gets boggled up and I have no idea what layer is what (I only hope the surgeon knows ;)

Well, it is officially time for bed. Tomorrow is another OR day. Hopefully, I get the chance to see something new (please not another hernia :). Everyone have a good night.