Been Busy
First post in a long time... I'm post-call and don't want to sleep so my internal clock doesn't get screwed up (more than it already is).
As the title suggests, I have been busy, though you probably knew that since I'm a second-year resident and those tend to be busy people. But the best part of it is what I've been busy doing: operating.
Finally I've been getting to do some real stuff in the O.R. Hip fractures, joint replacements, carpal tunnels, arthroscopies. I was on call a few weeks ago and got to do my first hip fracture case, pretty much on my own, with some supervision from the attending. It's fun.
I've also had some pretty wild experiences. I was on call during a recent holiday celebration, when I was called into the ER for a patient with a small finger partial amputation. The ED doctors neglected to mention the guy's other injury, though. Imagine my surprise when I get down there and the guy has brain herniating through his newly split nose and mouth, because he had been slashed in the face by a machete. Unfortunately, and also unsurprisingly, he didn't make it. But you better believe I fixed his finger.
A more recent story. I was on call at another hospital when a Level 1 trauma was called overhead at about 3AM. As I made my way to the stairs from the call room, I heard it again, "Level one trauma, repeat level one trauma stat in the ER." That was unusual. But I didn't give it much thought. Then my pager and phone started to go off. I got 3 pages and 2 phone calls in the span of 2 minutes asking where I was and why I wasn't there yet for this level one trauma who has some sort of "open femur fracture" (side note: very few people who are not Orthopedic surgeons seem to understand what "open fracture" means).
I told these people to chillax, and that I was on my way, and give him some Ancef in the meantime, thinking that it was probably some poke-hole wound somewhere in the foot or hand but definitely not the femur, because the main thing to remember about people who call you for consults (specifically ED and Internal Medicine) is that they do NOT know Orthopedics and the situation is usually not nearly as bad as they are trying to tell you that it is - except when it's a LOT worse. I got down there and there he was. Without a blood pressure, and with a massive soft tissue avulsion injury to his flank. Pelvis was unstable. Trauma attending was running the show and resuscitation efforts were underway. I made the decision to call my attending and let him know that we'd probably have to put an external fixator on this guy, and within 2 hours I was in the OR putting 6mm threaded pins into this guy's pelvis and applying an external fixator. Very cool stuff. As a second year resident... many of my colleagues haven't even SEEN one of these cases yet, let alone done one. And I'm not saying it was done perfectly, but it didn't really truly matter in this case. This man's injuries were unfortunately way too extensive to survive.
Final story I guess since I need to go study, I was talking to someone who has been doing this kind of thing for 30 years, and he was telling me about how "it used to be" back in the days of 120-hour work weeks, "power-60 weekends," and interns who know how to operate... it sounds like they had a lot of fun, and got great training, but I'm glad to be training in this environment and not back then.
I don't feel bad for the docs who trained in those days either, since they enjoyed practicing in the "golden era" of medicine, when patients still respected doctors and insurance companies paid better (not to mention the biotech/drug companies taking surgeons out on their private jet to their private island to play private golf while drinking private scotch).For better or worse, the world has changed. If things still ran the way things were run back then, reporters would be exposing hospitals for lack of trainee supervision and the public would enraged. The amazing thing to me is that I work in some hospitals where the environment is more or less unchanged in that regard, even today. It's a matter of time until even these holdovers change.
As the title suggests, I have been busy, though you probably knew that since I'm a second-year resident and those tend to be busy people. But the best part of it is what I've been busy doing: operating.
Finally I've been getting to do some real stuff in the O.R. Hip fractures, joint replacements, carpal tunnels, arthroscopies. I was on call a few weeks ago and got to do my first hip fracture case, pretty much on my own, with some supervision from the attending. It's fun.
I've also had some pretty wild experiences. I was on call during a recent holiday celebration, when I was called into the ER for a patient with a small finger partial amputation. The ED doctors neglected to mention the guy's other injury, though. Imagine my surprise when I get down there and the guy has brain herniating through his newly split nose and mouth, because he had been slashed in the face by a machete. Unfortunately, and also unsurprisingly, he didn't make it. But you better believe I fixed his finger.
A more recent story. I was on call at another hospital when a Level 1 trauma was called overhead at about 3AM. As I made my way to the stairs from the call room, I heard it again, "Level one trauma, repeat level one trauma stat in the ER." That was unusual. But I didn't give it much thought. Then my pager and phone started to go off. I got 3 pages and 2 phone calls in the span of 2 minutes asking where I was and why I wasn't there yet for this level one trauma who has some sort of "open femur fracture" (side note: very few people who are not Orthopedic surgeons seem to understand what "open fracture" means).
I told these people to chillax, and that I was on my way, and give him some Ancef in the meantime, thinking that it was probably some poke-hole wound somewhere in the foot or hand but definitely not the femur, because the main thing to remember about people who call you for consults (specifically ED and Internal Medicine) is that they do NOT know Orthopedics and the situation is usually not nearly as bad as they are trying to tell you that it is - except when it's a LOT worse. I got down there and there he was. Without a blood pressure, and with a massive soft tissue avulsion injury to his flank. Pelvis was unstable. Trauma attending was running the show and resuscitation efforts were underway. I made the decision to call my attending and let him know that we'd probably have to put an external fixator on this guy, and within 2 hours I was in the OR putting 6mm threaded pins into this guy's pelvis and applying an external fixator. Very cool stuff. As a second year resident... many of my colleagues haven't even SEEN one of these cases yet, let alone done one. And I'm not saying it was done perfectly, but it didn't really truly matter in this case. This man's injuries were unfortunately way too extensive to survive.
Final story I guess since I need to go study, I was talking to someone who has been doing this kind of thing for 30 years, and he was telling me about how "it used to be" back in the days of 120-hour work weeks, "power-60 weekends," and interns who know how to operate... it sounds like they had a lot of fun, and got great training, but I'm glad to be training in this environment and not back then.
I don't feel bad for the docs who trained in those days either, since they enjoyed practicing in the "golden era" of medicine, when patients still respected doctors and insurance companies paid better (not to mention the biotech/drug companies taking surgeons out on their private jet to their private island to play private golf while drinking private scotch).For better or worse, the world has changed. If things still ran the way things were run back then, reporters would be exposing hospitals for lack of trainee supervision and the public would enraged. The amazing thing to me is that I work in some hospitals where the environment is more or less unchanged in that regard, even today. It's a matter of time until even these holdovers change.
Thank G-D you don't work 120 hour weeks. I see what a "regular" week does to you and a person needs to recharge for the next challenge. I love reading about your curious scalpel. Very interesting. stuff to the layman.
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