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.