It's interesting how the trauma surgeon attendings are the most callous, jaded, no-nonsense people i've ever met. They will tell you exactly what they think about any topic and trust me they have opinions on EVERYTHING. I have never felt my self worth wane as much as it has this year, this rotation with these attendings, these residents. That said the most jaded attendings, the ones who don't really care about the patients, are the ones with some of the most insightful comments into understanding patients, situations and my skills. They see past the bullshit. They make it so obvious and they are teaching me the most about medicine, people and myself. I think that is why I take their comments so hard, because no matter how hard I try, I begrudgingly respect them.
And Its hard to be berrated beyond what you deserve for getting questions wrong, its happened on every surgical rotation I've experienced and i've seen it happen to other students. But its hardest to be given a quiet, condesending smile, a quick scoff and then abruptly dismissed, because you know then that your answer, your thought process and yes, even your self worth is so disgustingly wrong that they won't even bother berrating you. They quit listening to my comments, quit answering my questions, and being to pawn me off to other residents while I'm standing right there. "No, you take her, I'll take him" "What? No way. I want him, YOU take HER." It is this 'silent diregard' that degrades me the most, especially when other students are paid attention to and while still being berrated are being taught in these surgeons own special loving way. I feel left out and often feel as if I shouldn't have shown up that day, then wonder how I get stuck with the 17 hour shifts. I never thought it would happen to me but somehow, my self worth has started to hang on these surgeon's opinions. And it SUCKS because i have no idea how to handle this.
ha. anyhow. sort of awkward. So on to other stories. The first, well, is
a case I have been expecting since my very first day. As it inevitably
does in all ER's, it was the 45y.o. M who comes in to the ER with a
'forgeign body' in his rectum that he 'obviously' fell on. Yes, that's
right. This is his xray. Now you might ask, why was trauma consulted, which is a great question. Its because not just multiple ER docs but also the surgery residents and surgery attendings had tried everything to get this object out of this man's rectum and failed, but also because they had called down ob/gyn (think about it large objects out of small holes) who also failed. So who you gunna call? Trauma. By the time we get down there everyone is sitting around a big blue bucket with a portable white board making tallies. There is candy, snacks, pop, and even cash in this bucket, because everyone in the ER had bets about what exactly this thing was. So we go in and spend about a good hour, realizing we can touch it but it just won't come out. We debate surgery, which usually happens if it is this difficult to get out, but because of where it was in the rectum and his other medical issues we were unable to consider that option. So we decide to tag team it. One person holds the butt cheeks back, the other the rectum open. The other person pushes his knees up to his chest and holds them (this is very painful and there is quite a bit of blood). The last person grabs the object with two pilers and pulls. And after a very labored extensive Mcgyver manuver, we get it out. It turns out to have a condom over it (yeah... fell on it... right) and its a giant.... wait for it!.... dog chew toy. Yeah. Freakin weird. The pot ended up going to the 'regular plastic household item' person. Anyhow, we were pretty sure that he perforated his rectum with all the tugging and blood but he absolutely refused to stay. He signed an AMA form (against medical advice) and stormed out. Guess embarrassment took over. So the residents decided that they were going to invent a line of sex toys with handles on them, so we didn't have to pull them out so traumatically.
The next story is a little more tragic. A young woman was walking around in the dark in her basement trying to go down the steps and fell. She knew immediately something was wrong and had to scream until her husband got home from work. She was not able to feel anything below the nipple line and could not move her legs. This is her CT. It shows a complete fracture of the spinal cord that pushes into the spine. This woman is now a paraplegic, she will never be able to move her legs or feel her stomach, or pee by herself. She was surprisingly together and unharmed except she happened to fall in exactly the right place in exactly the right way to snap it. I never met the husband who called 911 for her, but i cannot imagine what he's going to have to go through now. She'll be in a nursing home most likely for the rest of her very long life. When asked why she was trying to go down the stairs without the light on, she says she's done it a million times and just never thought twice about it. You can see from the full spine how awkwardly bent it is and you can see from the close up how one whole vertebra is missing and pushing into the cord! Bad news. We also had a guy who needed a shower, was very thin and who had 13 abscesses on his buttocks. 13! And I guess he sorta had some pain there but never really thought much about it. And it was ridiculous. The pus was starting to push on his rectum and cause him problems while pooping, which is why he came in. But these abscesses were such a problem because they kept healing up instead of draining that we used a skin punch biopsy (probably the size of a pencil) to cut open holes in his skin so they would drain. And of course later it came out that he did a few 'iv drugs' but he never thought that anything like this would ever happen to him.
So moral of the story. If you think it won't happen to you, you're fooling yourself. Wear you seatbelts, don't do drugs and use your BRAINS. For those of you who don't, thanks for the job security.
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