So last week in trauma. So bittersweet. My last night will be a 24 hour whooh! goin' out with style. also sleep deprivation and a very lonely puppy :(
Another fun observation: If there are a group of doctors on an elevator,
everyone lines up evenly against the wall. I didn't notice this
peculiarity until I found myself starting to conform. Why do i need to
lean against the wall in an evenly spaced pattern? Also why do i
instinctively follow people off the elevator when they are not my
resident? (haha, med students are required to follow residents
everywhere. And it just becomes part of second nature. Tho that's a bit embarrassing to admit.)
As for realizations, there are many new things I've learned about myself and medicine. I got into medicine for so many complicated reasons, many that I don't understand or can't express myself. But I do know that in many ways I entered into medicine for the challenge to push myself to find my limit. And with 4th year starting next week, i have to say I have been more than adequately challenged, mentally, physically and emotionally. And it wasn't what expected, it didn't push me to the edge in a way I thought it would. Whole new edge people. It was very anticlimatic. And I know it wasn't my limit because we are always capable of more. More hours. More studying. More discipline. More effort. Its hard to get used to and its hard to admit that you haven't done all you could.
This above random image is brought to you by an aortic root rupture (the main vessel coming out of your heart that is bleeding out so fast it looks like its exploding) from a person who hit their steering wheel so hard it actually separated the heart from the vessels. Talk about a sad ending for the patient who did not live, but a really awesome CT.
Anyway, many of the stories we get in trauma are only pieces of the full stories. Trauma itself is very anticlimatic because you don't get to know the endings and sometimes even the beginnings (like how it happened or why or even what happened afterward). I find this frustrating sometimes because patient stories is what I really live for. And it makes me fear that one day I might get tired of all these adventures. One day my job that I have invested in so much, will become just another job to me. This thought sucks and it makes me apprehensive that ER is the place for me. If I no longer cared about the story, I don't think I would like it any longer. Good news is for now.... I am still enthralled! Which makes for a better blog for you. So on with it!
I am kicking myself for not taking more pictures this rotation, because i've seen some really amazing things, but in the heat of the moment you don't think about your camera until its too late.
As is the case with this awesome tongue laceration. This is a 19y.o. drunk guy who came having bit straight through his tongue (and smashed several teeth). The amount of blood was so copious that he was having trouble maintaining his airway. Not only was he swallowing it, it was gushing from his mouth in little pulsitile spurts all over his clothes, yours, the ceiling, whatever.
Tho your tongue is not the strongest nor most vascular muscle in your body, it is on the top three. And it is probably the most used. And when something is bleeding so fast you cannot even see the wound itself, its probably time to admit. We gave him suction, debated intubating... and hoped it would clot. When it didn't after 8 hours, they pulled a bunch of strings and used about 5 residents and 3 medical students to suture it. The inner muscle of the tongue started herniating out, looking like very bloody ground hamburger. I was only able to take a picture after we finally sewed it. I am constantly surprised by how good these horrible wounds look after suturing. In this picture you can still see some of the herniation of the tongue muscles, but it doesn't look so bad as it did before. I wish i would have thought of a before picture.
Another interesting random happenstance, a drunk lesbian girl who got into a car because drinking and driving is ALWAYS a good idea and crashed. She 'degloved' her knee. This is a particularly apt medical term because the injury peeled back her skin over her knee so much that all that was left was the bone. So she had a flap of muscle, skin, and fat that just hung there. It was somewhat how I imagine scalping someone would be only at the knee. This is a pretty serious injury but luckily my resident was tired and had more important things to do. So i got to sew it back up. It only took me 3 hours! Despite looking nice and pretty in this picture (yeah check out my skillz!), it was a giant mess. Again no before picture. Most of the stitches were underneath the skin. I had to sew all the muscles back to their avulsed tendons and even got to sew a tiny lac up in the artery. And wha... la.... a pretty neat scar and a fancy new knee. Now you may wonder how exactly I knew she was a lesbian, so let's just say that during this 3 hour and approx 32 stitches job, she decided in her drunk wisdom to give me a full evaluation of all my physical features: the best and the worst. This was nothing if not incredibly awkward and tried as i might, i could not get her to stop. And I neither could my resident who could only bear to listen to about a minute before he became too embarrassed to stay. So yeah. Fun times.... or something.
More to come.
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