Big Cases, Small Cases
Updates:
1) I'm currently a third year resident.
2) I still love what I do.
3) I'm planning on going into Hand surgery.
Anyway, I thought about this blog for the first time in a long time today, and here's what reminded me of it: I was on the phone with my father, telling him what cases I had done today (which has become a pretty regular occurrence now). I mentioned the bigger cases of the day - femur fracture, hip fractures, and even some hand cases. Then, almost as an afterthought, I mentioned the relatively uneventful case (in my opinion, anyway) which was an exploration of a forearm laceration.
Warning, gore ahead:
The patient had sustained a cut to their forearm which nicked an artery. This means the blood was pumping out rather briskly, and so she was brought to the OR for exploration. We washed it out and found the source of the bleeding, which was a partially cut radial artery.
The hand has dual vascularization, one arterial source being the radial artery and the other the ulnar, and so the hand was actually still getting a good blood supply. In fact, the ulnar artery is often the dominant artery, so losing the radial is typically not a horrible thing.
Anyway, we identified this laceration, applied the tourniquet to control the bleeding, and then tied off the artery. Both cut ends need to be tied off because if you don't tie off the far end, the patient will still bleed from it as it gets refilled from the collateral circulation provided through the hand by the ulnar artery. So we did that. Checked that the hand still got good blood flow with the tourniquet down, and then closed it up.
It was a pretty simple case, really. Took about 25 minutes. But it seemed pretty incredible to my father. He wondered how I even go about doing this stuff every day. Meanwhile, during the other cases of the day, I hammered metal rods down the central canal of two people's femurs and this case seemed pretty mundane to me in comparison. But it made me remember how unique and interesting the things I get to do every day really are.
I'll try to post here with some more regularity, but honestly, it seems unlikely.
1) I'm currently a third year resident.
2) I still love what I do.
3) I'm planning on going into Hand surgery.
Anyway, I thought about this blog for the first time in a long time today, and here's what reminded me of it: I was on the phone with my father, telling him what cases I had done today (which has become a pretty regular occurrence now). I mentioned the bigger cases of the day - femur fracture, hip fractures, and even some hand cases. Then, almost as an afterthought, I mentioned the relatively uneventful case (in my opinion, anyway) which was an exploration of a forearm laceration.
Warning, gore ahead:
The patient had sustained a cut to their forearm which nicked an artery. This means the blood was pumping out rather briskly, and so she was brought to the OR for exploration. We washed it out and found the source of the bleeding, which was a partially cut radial artery.
The hand has dual vascularization, one arterial source being the radial artery and the other the ulnar, and so the hand was actually still getting a good blood supply. In fact, the ulnar artery is often the dominant artery, so losing the radial is typically not a horrible thing.
Anyway, we identified this laceration, applied the tourniquet to control the bleeding, and then tied off the artery. Both cut ends need to be tied off because if you don't tie off the far end, the patient will still bleed from it as it gets refilled from the collateral circulation provided through the hand by the ulnar artery. So we did that. Checked that the hand still got good blood flow with the tourniquet down, and then closed it up.
It was a pretty simple case, really. Took about 25 minutes. But it seemed pretty incredible to my father. He wondered how I even go about doing this stuff every day. Meanwhile, during the other cases of the day, I hammered metal rods down the central canal of two people's femurs and this case seemed pretty mundane to me in comparison. But it made me remember how unique and interesting the things I get to do every day really are.
I'll try to post here with some more regularity, but honestly, it seems unlikely.
What you do everyday is amazing. You give people back their lives. Yes, the details gross me out, but that's okay. I hope you always have great enthusiasm and appreciation for the job that has been put into your hands. So proud of you ...always.
ReplyDelete