reflections on thanksgivings past

I will never forget my Thanksgiving on trauma as a 3rd year. I was on call for thanksgiving day. I was really mad too cuz I wanted to be with my family. Lucky for me though, my family came to LA and we had thanksgiving the day after. Anyways the day of thanksgiving there were a lot of car accidents. There was the elderly asian couple that crashed into a young latino guy. Forunatly everyone was ok. Just a long night in the ER. Another couple was riding home on their motorcycle. The guy ended up very badly injured, with the c collar and his girlfriend a little scratched looking on him. Her parents arrived very concerned. But by far the worst of the accidents. A 50 year old African-American man who was changing the tire on his van on the side of the freeway. He was changing the rear tire on the side with the railings when another car side swiped his van leaving his legs trapped between the railing and his van resulting in mangling of both of his legs. When he arrived to the ER he was conscous and completely unaware of the state of his legs. Everyone assumed their places around the beg checking airway, breathing circulation. THey FAST scanned his abdomen. Stripped off his clothes. And tried to get his name. All this as blood oozed of the table and his legs lay in a dissarray - sideways straight curved twisted, mangled like strips of ground beef and bone. "Can you feel your legs, sir?" He said that he could. Well quite obviously there is no way he could feel it. They quickly morphined him up and knocked him out. Vascular and ortho were called to determine if there was any intact circulation. In these situations they use the MES score (Mangled Extremity Score), who knew? I just kept thinking why do these people keep calling his legs a mess? Thats so mean. Unfortunatly for this man there was no intact circulation and both of his legs had to be amputated above the knee. I didn't see him the day after but I can't imagine how he felt when he woke up and realized he no longer had legs. So this Thanksgiving I am thankful for my legs and good health. You never know when they'll be taken away from you.

Goethe

A wise attending quoted Goethe today, he said, "we can only see what we know how to see." or something along those lines. Essentially what I learned is that don't take every opinion. Question always. Don't accept. We had a patient for which we were considering CABG vs Stent placement for a very bad heart. The CT surgeons, interventional radiologist, and whichever cardiologist was the attending of the moment agreed that CABG was not an option. My attending said - well how do you know they were right? are u sure? this could dramatically change the number of years this man has to live. Certainly as a medstudent my opinion doesn't ever matter much, and i personally really had no idea, but I never stopped to question the opinion of these experts. Maybe the experts were right - but what if they weren't. The worst part is that we as a team never stopped to consider that maybe they were wrong. I guess its true what they say in medicine - you can never trust anyone but yourself. this is why you double check labs, findings, make sure you wrote your orders correctly, review and review to make sure you dont' miss something and if someone tells you something you go back and check it again for your self. And it goes the same for any expert opinion you ask for. always do your own research. always push for more answers, i mean it could be your only family members life on the line.

fear

i was thinking today after hearing this woman, who is an intern in family med after completing three years of a general surgery residency - that fear at this point has stopped me from being great. She said, "if you hide in the call room, no one is going to come looking for you, you have to get out there." And i realized that I have been hiding in a metaphorical call room. Cowering away from questions, procedures, opportunity. why? because I am afraid of not knowing the answer, fumbling, looking dumb in front of my peers. Because its really not a fun feeling - looking dumb in front of your colleagues, your residents, your attending. Maybe one of our practice cases or standarized patient experiences should be practicing not knowing, fumbling around, looking dumb in front of everyone. i have escaped most humiliation but maybe its not a good thing.

angry surgeons

Most people either love or hate surgery. These people are so busy that they don'' have time to have lives outside of the hospital. My first day of peds surgery I was told to show up at this vague computer and find the "list " of patients. The team consisted of myself, R3 and the surgeon, who we only saw on the day of surgery. Once I found the list i was to update it with vitals, labs, and new info for each patient. I couldn't find the computer. I tried calling the previous med student to find out but she was not answering. I asked the nursed and they had no idea what I was talking about. I found a computer with a paper list next to it from earlier in the week with the names of patients. So I went ahead and used that one. A half and hour passed and my resident still wasn't there. So i just kept reading my review book. I didn't' want to page him as I know a lot of times the residents show up late. Finally he came in red faced and angry. "What have you been doing this whole time? I've been calling you." "Reading, I updated the old list. I couldn't find the computer." "SO you've just been sitting here? Why didn't' you ask, see all these nurses here, you have to ask? Keep looking around? I already filled out the list for today. " That was our first encounter. Then i had to follow him around and help him with each patients note. I felt like crying. I felt like melting away. I tried not to make peep so as not to make him more mad. I felt so incompetent. Felt so small. I looked for every way that I could help to make up for the time i had wasted him. All day i was on my toes. Replaying the moment in my mind. I even stayed extra late that day to do an H and P on a patient to help him out. He didn't yell at me again but he certainly wasn't very nice. The next day he semi apologized for yelling at me, and in good med student form i said, "oh i guess i deserved it. I should have been more proactive." Even though in my mind I thought you bastard! It was my first day how was i supposed to know, huh? and I'm a med student not ur intern, interns do all the stuff you are asking gme to do. But that's how it is, you put ur best face forward and just suck it up, especially on surgery.

here's looking at you kid

I'm not sure if every young doctor experiences this sort of thing, but I certainly do, mainly because I'm petite and have young face i guess. I recently interviewed a patient who is 71 years old, lives in a motor home, alone, and eats once a day at the salvation army. He suffered a stroke about three years ago and since then has weakness on his left side as well as short term memory loss. He said he was luck that he was even at the appointment since he usually can't remember. This man was clearly frustrated at the world, at his situation, at life. He was pissed at his brothers for not supporting him even though he had for them. And I think he even had pissed himself, in reality. Maybe there is no shower in his mobile home. maybe he couldn't remember to change his clothes? regardless he was a grumpy old man to say the least. I tried to do a SIGECAPS assesment for depression. I got to suicadility and he said, "Listen carefully before you start writing any of this down. I want to die. I'm dying means I will be in heaven and not here then I want to die. I still take my pills, excercise, watch my weight and do as I am told, but I want to die." I comisserated with his sentiment and told him I didn't blame him for being pissed off and grumpy, not in those words of course. I asked him what we could do for him, physical therapy? counseling? start an antidepressant? All of which he turned down, and said, "Thanks for trying, sweetie." and Pinched my cheek the way my uncle would. He pinched my fatty little cheeks. He went into my space. I wasn't mad but I did feel belittled. For a second I thought i was sitting with my grandpa and not as a doctor sitting with her patient. I know he didn't mean anything by it but it was a strange feeling. As physicians we frequently push our hands into the space of others but remain untouched ourselves, with an imaginary shield that protects our space. When my shield was broken I felt strange.

people in white coats

its weird how when you see us in our white coats we look important - nurses defer, pts defer, and who are we really? what do we really know? we don't really know anything. its just a coat. underneath we're just kids. people with regular lives, problems, people who make bad decisions, party it up on the weekend with friends, act irresponsibly. its just a white coat. i never realized that before and now that i have to wear i feel like its so unnecessary and builds us up to be something we're not.

trials

i have so much to catch up - life as a surgeon, characters, peds, delivering babies later.
for now i just can't help but feel like a kid. Its fourth year, you're supposed to know stuff, right? I feel like I'm just a scribe who takes notes, reports, and has no idea what they're doing unless you tell them. its hard to take charge when you don't even feel like an adult outside the hospital.
my patient came into today with acute on chronic kidney failure, full out uremia, possibly secondary to infection - now what? or my frail bedridden patient with chronic RA that has pretty much incapacitated her and left her hooked on morphine tablets that just give her constipation and a bowel that doesn't want to move. at times you just don't want to deal with those types, they whine, they plead, they demand, they do more ordering than the doctor, and you get irritated and say wait a minute, who's the doctor? how do you know what pain meds you should get and when and how. So many times we encounter these people that we cant stand - but we have to take care of. and its so hard to not be annoyed by them. nothing is unbias, even an umpire.
after i finished the hand p on my patient my resident went over the case with me - line by line. you shoudlna written this, you should write this. why do you think that is? why is that? secondary to what? how do you calculate this? what does it mean? what are the different causes of that? what else do you want to do? and on and on. each question caused by whole body to get a giant heat wave, sweat, and just feel so on edge. and its a completely no pressure situation. there is just such a pressure to be smart, to know the answer, to not look dumb in front of others. i feel like i won't ever know any of the answers. i just know that intern year is going to be a HUGE learning curve. there is so much information, not enough ttime to sift thru it and make all the right decisions for every patient. that is scary.