where my head is

Some of you frequent blog checkers may have noticed a post that isn't here anymore. That's because I began to write the post and then, in my sleep-deprived, stressed-out-about-work-i-have-to-do delirium, I uploaded it in mid-sentence. So here's another try...

My last 36 hours:

- 9am: Started with unusually late rounds at the VA. My attending brought us scones. Since it was a holiday, we rounded casually, changed dressings, conversed (!!!) with the patients. It was remarkably sane and pleasant.

- By 10:30am we were scrubbed in for a surgery (exploratory laparotomy for small bowel obstruction with G-tube insertion...for anyone who cares -haha). I got to hold retraction, cut suture string, and staple the abdomen shut, and that kept me -surprisingly- pretty well entertained. At one point of the surgery, my attending let the second year resident work, and started sketching out the surgery procedure for me on the surgical sheet lining the patients body. "I should be watching him like a hawk," she kidded, and just then he ripped the suture.

- 3pm: Got home, just in time to try to put together a presentation on gastric carcinoma that I have to give in two days.

- 7pm: Diet coke in hand, I enter the ER with a friend of mine, for our 12 hour trauma surgery call.

- 7:15pm: First trauma, well actually 4 of them: a mom and three kids from a car accident. The kids come in first. 3, 4, 7 years old...each EMT holding one of them, like a warm pie taken out of the oven, flattly strapped on a board. One child is screaming, another looks scared, and the third just looks around curiously. We cut off their clothes and try to keep them calm while we assess for injuries. Fortunately, all kids and mom are ok.

- 8pm: A man whose head was grazed by a bullet. Though his injuries are marginal, he comes in as a trauma, and we have to run through our entire protocol with him: establish airway, breathing and circulation, cut off clothes, check entire body for injuires, x-ray abodomen, pelvis and chest, put in IVs. All within minutes. Though it is soon apparent that this man is fine and the large team of doctors and nurses dissolves as quickly as they appeared, it strikes me just how amazingly close this man had come to losing his life.

- 8:30pm: Intoxicated man injured in a slow moving accident. He is unconscious and has thrown up and defecated all over himself. We cut off his clothes, grateful for the gowns, booties, and gloves we have donned. Though I carefully remove all the gear afterwards and wash my hands repeatedly, I can't seem to shake the smell from my body. Unfortunately, this is the least of our worries, since it appears that this man may have a severe head injury.

-8:45: Things calm down. We start doing 'scut' work in the ER. We work with one patient in particular, someone we get pretty attached to throughout the night. The man had been in a motorcycle accident and has multiple traumatic injuries, including an intracranial bleed. We watch as our resident puts in a chest tube to relieve the bleeding in his lungs. We clean his lacerations, sow up a large head wound, and pump -with our hands- blood into his veins so that it gets into his body more quickly. We watch, transfixed, as the neurosurgeon drills into this man's brain --right there in our little curtained-off section of the huge and busy ER -- so as to relieve the pressure that is quickly building in the man's brain. And we try not to stare as the man's wife is informed of what has happened to him and spends the rest of the night standing next to his bed with a horrified and dazed stare in her eyes.

2am - 5am: A man with multiple stab wounds is flown by helicopter to our ER. Within 10 minutes we are taking him into the operating room. I don't scrub in on this operation, but just watch from a few feet away, which becomes very painful. My legs turn to lead.

5am: I take a break from the OR and head back to the ER, just in time to hear that we have another trauma coming in. I race back upstairs to tell my residents, we have a very cool all female team of trauma surgery residents (+ our mellow male attending), and they immediately get into gear. This is our last trauma of the day, and unfortunately, it ends sadly. A 3 year-old boy from a car accident, alive, but with a seriously broken neck.

6:30am: we round with our team, visiting all the trauma patients in the hospital. these are the infamous "lightning rounds", where the attending flies into a patient's room, exchanges less than 4 sentences with his patient, and then flies out of the room again, sometimes even before some of the members on his team bringing up the rear (aka, the medical students) have fully stepped into the room. we race down the hallway from patient room to patient room, literally running at times and occasionally being "pimped" by the attending on such things as neck anatomy, and manage to round on 12 patients within 30 minutes.

8:30 am: i get home and collapse in bed, sleep 5 hours and get back to working on that presentation again.