I spent the prior week wondering what my night call on July 4th would be? Nice day + beach + lots of drinking + lots of food + lots of people out and about = drunks, fights, MVAs, and sunburns!!
Saturday started off okay. I spent the first part of the day in SICU managing the sick patients plus helping out on some of the floor patients. I flushed an NG tube, helped the nursing staff change bedding on the 450+ pound patient, changed the dressing on a diabetics amputated foot, changed the dressing on a lower limb fasciotomy (for compartment syndrome following AAA surgery), etc. I also had some down time away from patients where I read all about breast pathology and surgical techniques for fixing said pathology.
By late afternoon, the ER started to pick up so I headed down there with my resident. First up, pneumothorax take 2 guy. He was a young 28 year old man who was involved in an altercation on tuesday and was stabbed. He went to another hospital, was treated for the stab wound and a pneumothorax that had developed. On friday, they took out his chest tube and sent him home. On saturday, he was in our ER with difficulty breathing and alot of pain. Turns out the pneumo was not resolved. So, we had to place another chest tube and since this young gentleman had already had one placed a few days back, he was well informed of the intense amount of pain he was about to feel!!
Next up, 87 year old male from nursing home in respiratory arrest. By the time I was assigned this patient, he was already intubated making the interview process a tad bit hard. My only source was a good physical exam and the nursing home notes which were not detailed at all. My senior resident managed to get a hold of the gentleman's nephew who was of even less help than the nursing home. We stabilized him and sent him to SICU.
During this time the red shirt brigade started piling up. You are asking "what the hell is that?" Well, its a wall of stretchers with patients all wearing a red shirt and handcuffed to the bed. These are all drunk patients who are too intoxicated to be released. They put red shirts on them so they are easy to spot in case they escape. Of course, everytime you walk past them they scream (in a slurred, slowed speech) "Doctor, doctor!!!" And once one starts yelling it, they all start yelling.
An older gentleman came in with really bad chest and abdomen pain. On CT exam, he had a aortic dissection that started at the distal end of the arch of the aorta and traveled down to the common iliacs. Unfortunately for him there was no vascular surgeon on call this particular night so he was immediately transferred to Maimo for treatment.
Our last patient was an 80 year old female who was experiencing some abdominal pain. On CT scan she had an internal hernia (a section of small bowel was protruding through another section of small bowel). We had to rush her immediately to surgery for an exploratory laparotomy. Once the doctors reached the small bowel, they realized she had an ischemic bowel and a portion of the small intestines was dead. So, I got to see my first small bowel resection. 2 feet of distal jejunum and proximal ileum was removed. Then the ends were stapled and sutured back together again. Unfortunately for this patient, her outcome was not that good. While closing the incision her blood pressure suddenly dropped to 35/28 and her heart rate shot up to 130 beats/minute. A central line was placed in the patients jugular and we pumped her full of fluids. That coupled with levophed brought her blood pressure back up but she is currently in SICU in very bad shape. The doctor thinks she may have suffered a pulmonary embolus while on the table (she had a history of prior DVTs).
I scrubbed in for the above surgery, and it started at 2:15am. It didn't finish until almost 5am and I slept for about 30 minutes in a chair. I was exhausted when I got home at 9am, so what did I do??? I walked around Union Square with Dy and Amanda!!! Around 2pm, after extreme exhaustion, I took the subway home and at 3pm I crawled into bed and didn't wake until 4am this morning!!!
These call nights are so tiring!! I hope everyone's 4th of July was as exciting as mine!! Take care.
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1 comment:
It's your favorite sister! I can't believe I've never seen your blog before...so I went back while I'm sitting here bored at work and read a bunch of your old posts. You're so funny :-P Sounds like you had a more eventful Fourth of July than we did! Hope you're having fun in NYC :-)
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