Confessions of an Intern

Week Thirteen

I was supposed to be on Gen Surg this month. I was kind of excited about it, knowing I'd actually get to scrub in on some surgery. I enjoyed surgery, but did not have any desire to live the lifestyle surgery residents and later surgeons have. I love my kids and family and want to see them. I'm not uber competetive, nor do I really love adrenaline rushes. So, I was okay with being in on some run of the mill lap choles (take a gallbladder out with the small incisions), hernia repairs and the occasional bowel resections. But no, the morning I'm to start surgery, I check my pager and realize two things: 1)I've been reassigned to Trauma surgery and 2) I'm already running late. So I fly to the hospital and get to the prearranged meeting area, and wait...and wait. Half an hour goes by, I'm searching for my attending and no one has seen him. I decided to page him, so he would know I was at least there. This was 0730. He calls back, surprised to hear I'm working with him. That now makes two of us. I'm told to meet in the radiology room in ICU at 0900, and to get breakfast and study in the meantime. So I do as I'm told, and then the next awkward moment comes when the surgeon I was going to work with previously comes into the lounge where I'm waiting, and comes over to shake my hand and introduce himself. I kindly stand, graciously accept his introduction and then inform him of the change of plans. He was also surprised, but accepted it without missing a beat.

All of this was arranged with a page that in all fairness came across the previous Friday at 1630 (this is a Monday). "R___, I spoke with Dr. B. He says he would be delighted to have you on his service this month." Huh...Dr. B had no idea who I was. Anyway, I'm okay with the change. It will afford me time to write and study for my first test of Residency. There are two surgery residents and medical students on service with me, so I am way down on the totem pole of who gets picked to do stuff in the OR. I'll deal.

Day 1: the above reported mild fiasco, cut short by my required monthly seminar class. I basically listened to the doc teach a med student how to read a chest xray.

Day 2: I dressed up. If I want the opportunity to get bloody, I should dress up. I walked in (on my clinic day, hence the reason I was dressed up) and met the surgery intern and medical student making their way to the ED for a trauma. Now, I have worked in this ED previously, and never had I seen the nurses lining the bed with the super absorbent pads or putting on the yellow trauma garb. So I followed suit and waited. I did not meet the helicopter, I figured the surgery resident and the surgeon could do that while I helped corral the medical student who seemed to want to fade into the wood work. Besides, I would just be in the way (I had sprained my ankle on my last day at the Children's hospital, an appropriate going away gift from the service that about kicked my ass).

WARNING***Graphic medical details here, Scroll to day three if you have a weak stomach. I see the helicopter team doing CPR in the bird, one of the pilots in fact! I'm thinking this should be good. All I know is it is a motorcycle vs car head on collision. These tend not to go well. I go to the trauma bay as I see them wheel in, with someone doing chest compressions all the way. He's already intubated, and we pull back the cover to see what we have and I'm impressed. You know from my previous posts, I'm not heartless, so just understand, this is clinical detachment here. His left leg is rotated inward, and not all in the same direction, looking upward, his left groin is basically open meat, not really attached by much. His right arm is broken in so many areas it is as if there are no bones there. We try. We really try to resuscitate him. He gets 6 units of blood, a total of 9 liters of saline, we give drugs, we do CPR, we try to stop the bleeding from his leg. It just doesn't work. He died. The whole time, we were trying to dam up the blood that was pouring from the gurney, trying to keep from slipping. It was amazing and sad all at the same time. There was no way this poor guy would have made it, but we tried.

Day 3: Again, nothing. I spend nearly the entire day hanging out in the surgeons lounge, studying for a critical care course I'm to take at the end of the week. No elective surgery for me to participate in. We have an impromptu lesson on how to do an emergent crichothyroidotomy. You know the urban legend about someone sticking a BIC pen in someone's throat so they can breathe? Well I now know how to do it the right way. Good to know, hope I never have to do it though.

Day 4: I am assigned patients to round on. Yay! That takes half an hour... There is trauma clinic and a surgical supply rep lunch. Okay...I end up sitting in the office all afternoon, and just as it is time for me to leave, I am told by the not so friendly nurse practitioner that I need to go and write discharge orders on one of the patients I had seen because he wants to go. I do as told, and when I go in to see the cranky old guy, realize he has eloped. He is nowhere to be found. The nurse panics and takes off to find him and security and the charge nurse find him downstairs by one of the doors. I go have a pleasant chat with the fellow and realize he is a little confused, but per family, that is his baseline. He is what we call alert and oriented to person, place and situation, meaning he is able to make his own decisions. He refused the further testing we want to do, and despite the little niggling in the back of my head that I don't like this, I do as I'm told, and he is discharged. He wants to leave, he has family and a lady friend to look in on him. And he already has a follow up appointment with his doctor scheduled for the next day. He will be closely followed and does not need trauma surgery, so I acquiesce and do the discharge. (It is now week 14 and guess who is back in the hospital?)

Day 5: No surgery, just the first of 2 intense days of Fundamentals of Critical Care...thankfully, I learned most of it as a nurse, I just needed to get some of my old habits updated with the latest and greatest opinion on how to treat sepsis and shock.

So, I was bored much of the week, but did learn a few things. That means, all in all, it was time well spent. Onward and forward.