All in a Day's Work

Just a quick note. We seemed to have a theme on the ortho consults we received from the E.D. today. All of them seemed to start with the history of...."Patient was at work doing ______ when they ______, and now they're in the E.D. with a broken ______."

We had a pressman working with a machine that came down on his finger, and now he's missing a piece of it and broke the little bone at the end. He's scheduled for surgery.

We had a construction worker on the roof of a building who was hit by a piece of sheet metal and knocked off of it. He has two broken wrists and a broken foot. He'll most likely be going for surgery.

We had a pipe worker who was loading a pipe into a grinder which then exploded sending a piece of metal flying that cut his hand and broke several bones in it almost cutting off a finger. He's going for surgery.

In addition to the laborers we had a number of other consults most of which were bread and butter broken bones. Tomorrow is Grand Rounds Wednesday and then two more days on the day shift before I become a vampire for a month. But, at least I get 2 days off this weekend to make the transition...!

The Ortho Bomb Exploded

Yesterday was my weekend 24 hour call on the orthopedic service. And, it was a long one. In fact, the resident I was working with told me this morning that he had never had so many consults in one call. So much for my white cloud.

The day started of somewhat auspiciously. There had been 4 shootings during the prior overnight; mass trauma, and the E.D. was still feeling the effects. After rounding on my patients at 0630, "the Bomb" was passed off to the ortho resident I would be working with for the next 24 hours. I felt somewhat relieved. At least I wouldn't be getting annoying floor calls all day. However, the amount of consult calls we got all day more than made up for it....

"Humpty Dumpty" - we started off the day with the worst ortho case that would continue to haunt us for the rest of the call. A rollover, partial ejection. A young 24 year old that will most likely never walk again, and who will be lucky if they survive at all. They were driving and crashed their car. Most likely alcohol was involved even though it was still very early in the morning. A partial list of the injuries includes a spinal fracture that damaged their spinal cord, a broken jaw, a broken shoulder that will need to be replaced, broken ribs with underlying lung damage, abdominal injuries, a broken hip, a broken knee and a broken ankle. I went with him to the OR to watch the spinal surgery. After the opening of the case, I got paged back to the E.D. to take care of...

"Shot in the Butt" - another shooting victim who got shot... well, the name says it all. Unfortunately, the bullet went through the lower part of his hip bones, missing major blood vessels and nerves, and lodges just to the outside of his abdominal cavity. However, there was bleeding in the retroperitoneum (just outside and to the back of the abdominal cavity) so he was taken to surgery by the trauma service to explore the damage. After I finished with him, I grabbed something to eat and then was called back to the E.D. to help the Ortho resident splint...

"Motorcycle Man" - broke his wrist after dropping his motorcycle when he collided with another vehicle that didn't see him. He had a great attitude and joked through the pain of the splinting. His motorcycle friends were all decked out in their riding gear hanging out in the waiting area causing quite a sensation. We finished with him and had to run to the O.R. for..

"Humpty Dumpty" - their spinal surgery was finished and we had to rewrap their broken knee. Problem was that the fracture was constricting the blood vessel down to their foot, and it wasn't flowing properly causing problems. We splinted the leg as best we could to help with the blood flow and rushed the patient to the trauma ICU. As we were getting them settled in, we got another page to the E.D. for...

humerus fracture - woman hanging her potted plants outside and fell off her stepladder and ended up with a broken arm

wrist fracture dislocation - young man who was drinking and fell, dislocated his wrist and it had to be put back in place

bilateral wrist fractures - woman playing with her friend's children who fell backward and put her hands back to stop her fall, broke both her wrists

shoulder lac - man wrestling with a friend who cut his arm on a sharp object on the floor, Ortho was consulted because there was concern the cut went into his joint, it didn't...

cut wrist - former milk farmer changing a piece of glass on his barn. The top of the glass broke and fell slicing his wrist on the way down. He has nerve damage to his last two fingers and may need surgery. I sewed him up and sent him home. I will see if he comes to clinic this week.

revisit hardware wound check - patient with broken elbow wearing external fixation which is like a medival torture device. They were concerned that the wound wasn't healing properly and came into the E.D. to be checked out. I rewrapped her device and sent her on her way.

revisit hip pain - patient who was discharged home because he "felt better" who now returned with continued pain. I actually had seen him two days before when he was admitted. The circle of patient continuity continues.

This was close to midnight, and I think was having dinner around this time. I know I'm missing a consult or two because we were joking about having done a dozen by this time... well, you get the gist of the day so far...

clavicle fracture - I had just gone to the call room and had gotten settled when I got this call. Back to the E.D. for a patient who rolled over his ATV. I wrote the consult and went back to the call room as the patient was admitted and sent off for x-rays.

Three hours' later...

wrist fracture - young girl who fell down some stairs while intoxicated. We sedated her and put her wrist back in place. She was added to the growing list of surgeries for this next week.

ankle fracture - older gentleman who was drunk and fell breaking his ankle, it needed to be set and he was going to surgery when I left this morning since there were already a number of patients on the list due to all the consults we'd had during the day.

arm lac - guy fighting with guy gets cut with a box cutter. There was concern because there was muscle involved. Luckily, the damage did not appear to be significant and the patient was sewed up this morning.

finger lac - guy who fought previous guy and got his finger cut by a broken flying plate. He had a bleeder that I was having issues suturing, but I finally got it under control and spent the last hour of my call sewing his finger back together.

Whew! What a night. I was considering a lot of what happened. I was sad for the family of the young patient who is probably paraplegic. I know people who have children of that age. Children who often don't make the best decisions sometimes. The look of heartbreak on the mother's face haunted me throughout the day. I'll see how they're doing in the morning.

I was also realizing that this might be my last 24 hour call... ever? I have straight shifts pretty much from this time forward. I don't have another off-service rotation in my residency. Unless I decide to do a fellowship, I really won't be in a position to have to have another long shift... wow. Another milestone passed.

Now, I am off for some good sleep, in my own bed, that won't be interrupted by any pagers or phone calls. At least none expecting me to crawl out of my warm, cat covered bed to work with plaster casting materials...

Accidents Do Happen

So, I have been working on the orthopedic service, and I am seeing a lot of trauma. Today was a day of accidents of one sort or another:

20-something who drank and drove his his car right into the back of a semi. He had a nasty scalp laceration which was fixed by one of the E.D. medical students. I was there because of his broken hand. We casted it and sent him on his merry, albeit under arrest for DUI, way.

40-something who likes to get high and is already on disability for a prior back injury (that's you and me paying for him to stay home and toke up, but I digress), who was fixing a golf cart on a lift. Said cart was in gear when he started it up and it fell off the lift and fell on his leg breaking it. You might remember the backward foot from one of my earlier posts. His leg looked like this but because the lower part of his leg was broken in half. We splinted it, and he was on his way to surgery when I left.

60-something female who was making a shelf. She was using a circular saw to cut some wood. She says she "looked away for just a second." You can guess what happened. Although she properly wrapped and iced her cut fingers, there would be no reattachment for her. The fingers would not survive. We cleaned what remained of her first 2 fingers on her hand and oversewed the exposed bone. She had a great attitude and was already asking when she would be able to go back to work. I'll see if I can follow up with her next week in clinic to see how she's healing, and doing.

That was today... Tuesday we had a patient who crossed the median and ran head on into another car. They're still alive in the ICU but have a broken knee and ankle on one side and a broken leg on the other side; plus, a broken pelvis, broken insides, etc. We'll see how they do.

Back to work tomorrow, and I am on 24 hour hospital call over the weekend. With nice weather headed our way, it's definitely going to be the start of the trauma season... eek!

p.s. click on the picture to see the animation

Ortho Flying ScutMonkey

For those who would like to know what a surgical rotation is really like, I would recommend The Underwear Drawer. Medical student turned cartoonist depicts the life of a medical student in a humerous fashion with a series of cartoons. Having been there, I can totally understand.

I started the first day of my rotation on the Orthopedic Surgery service at ECMC kinda like a medical student. I didn't know any of the patients, and I was pretty much following the Ortho residents around as we rushed from room to room. We took about 2 minutes per patient, and rounded on everyone on our list within about 30 minutes. I then spent the next 20 minutes helping to cast a patient with a broken ankle.

By the time we were done, I was wishing for some Advil and wondering if I would have time this rotation to start lifting weights at the gym. Seriously, this was a big guy, and I think his leg weighed 50 pounds. Because of the pain, he wasn't able to support the weight of his own leg, so I had to do the majority of the work.

Then we rushed downstairs to "run the board" which consisted of looking at films with the attendings from the previous evenings' consults. Then everyone took off for the O.R. Now, as many of you know, I spent 3 years as a surgical resident. I did an internship. My partner on the Ortho service is the Ortho intern. He carries "the Bomb."

"The Bomb" is the Ortho service pager. Anyone trying to get a hold of Ortho calls this pager. It goes off all the time. And, 75% of the calls are for patient scutwork. Scut is all the little tasks that go along with patient care - writing for medications, ordering tests, following up on tests, ordering labs, following up on labs, ordering xyz, following up on xyz, etc. If a patient has pain, they call "the Bomb." If a patient can't poop, they call "the Bomb."

As an E.D. resident, I carry the tradition set forth by my predecessors, that we DO NOT carry "the Bomb." However, from time to time, it becomes necessary to do so. I carried it this morning while the intern scrubbed in on a case with the promise that he would take it back when he was done. About 15 minutes into carrying it, I wanted to chuck it against the wall.

I was all too happy to give the pager back when the intern got out of surgery. We had a light early afternoon, and then I got called, by one of my colleagues, into the emergency department for a consult. I didn't leave for the rest of my shift as injury after injury started coming into the E.D. I got to do a tendon repair on someone's hand who got it smashed under a piece of machinery. The intern then splinted the patient's hand due to a bone fracture. Several other consults came in, but those got signed out to the oncoming night team.

Now it's time to go to sleep... 0430 comes much too soon... until tomorrow....

Quilting Updates and the Community Photo Challenge

Please visit my other blog site for the latest:

Veronica's Paper Cuts

I start my new rotation on the Orthopedic Surgical Service tomorrow at ECMC. I am sure that I will have some interesting stories, and photos, to share....

Until then!

A Cold Day in Buffalo

Because of the Easter Holy Days, I had a few days off from my current rotation on the Hand Surgery service. I also had a friend come into town, so I did a bit of the tourist thing. Since there isn't much else of interest going on, I thought I would share some of the photos from this weekend. I hope the Easter Bunny was good to you and yours, cheers!

From the Right Side of My Brain

For those of you that don't know, I have another blog site "Veronica's Paper Cuts" which shows off my more creative side. I just bought a sewing machine so now I guess I will have to add "& Fabric" to the title. Here's the first entry discussing the new toy. Enjoy! Back to the medical madness soon...

Veronica's Paper Cuts

I've Been a Bad, Bad Blogger....

All right. So it's been a while.

Let's recap:
I finished my time in the pediatric ICU. While controversial, I still maintain the idea that sometimes just because we can do something to prolong life doesn't mean we should. Also, I did get to see one child placed on ECMO (extracorporeal membrane oxidation); sort of a mini-heart/lung bypass machine but not within the sterile confines of the O.R. Big and scary.

I completed my month-long rotation at the main hospital BGH. This time, not so bad. If you remember back to last year, I was rating my days in the number of beers I needed to get over the shift. This time, I don't know... maybe it was the responsibility. Maybe it was knowing more than I did last year. I actually sort of enjoyed it. And, I learned a lot. Maybe I'm just growing up academically.

After three weeks at the "General", I took my vacation, and tonight just returned from the Miami area of Florida were I spent the last week. A couple of things that I learned: the Everglades are awesome, alligators are an important part of the ecosystem of the Everglades, I continue to not like foreigners who travel because they're just rude, and I think I would be suicidal on a cruise if I had to be on the boat for longer than a day. Oh, yeah, and Key Lime Pie... tasty!

So, tomorrow I start my two months on the Orthopedics' service. It starts with two weeks of Hand Surgery. I'll have a better idea in the morning of what that entails. Hopefully, something new and interesting to blog about. It will take some time to catch up with everyone else's blogs, so forgive me if I haven't posted recently.