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26 May 2009

Dem Bones, Dem Bones...

So, I continue on the night ortho service. It was quite a week back following my wonderful time in New Orleans. I can't even begin to list all of the injuries I have seen so far, but suffice it to say that I have told my husband he's not allowed to pick up any powertools, chainsaws, table saws or use a lawnmower. He's not allowed to ride on a bike, in a car, or on a motorcycle. He's definitely not allowed on a horse. And, he can't go up or down any stairs, any ladders, and under no circumstances is he allowed up on the roof. Seriously, the world doesn't seem very dangerous until you're up all night tending to people's injuries.

Of course, I haven't even begun to list injuries caused by other people... gunshots and stabbings, assaults with hammers, baseball bats, and other metal objects.

I have had a lot of fun, for some odd reason, with amputations. I took off someone's finger this evening and then sewed their hand back together after an encounter they had with a table saw. I had another gentleman on Friday who caught his hand between a chain and the tailgate of a dump truck. It took me almost 2 hours to make his finger look like a finger again. Maybe it's the surgeon in me that keeps popping up. I get a lot of satisfaction in seeing something put back together and knowing that they are going to have a good result.

I have one more week left on this service then I start my elective. For anyone actually reading this, I am going to leave it as a surprise. Let's just say I will probably be doing some cutting... off to go do morning rounds... maybe if I figure out how to post from my iphone I will send tidbits during the next several shifts. It's hard to post because most nights I am too busy, and I spend 7 out of my 10 hours off between shifts sleeping. We'll see if the experiment works. Until then!

18 May 2009

A Little Quickie

Hello, all... just got back from the Big Easy, the Crescent City, Nawlins' to some. It was a fun business mixed with some pleasure trip. I did get to tour and see a lot of the city.

I thought I would post a link to a small fraction of the almost 300 pics I took. Most were of work colleagues, but those I am saving for future blackmail ;) I am back on the Orthopedics' Night Service for another two weeks, so I will blog later about that.

Here are the links, enjoy!
Around Town

I did want to share a photo of the fire that hit Bourbon Street on our last night there. A Four Alarm fire that hit a night club. You can see one of NOFD's finest climbing the ladder up to the upper floor:

12 May 2009

A Shot in the Dark

So, I just spent the last two hours sewing together a hand which had gone through a glass window. It wasn't the first time this drunken patient had done this. It was their third.

As I did so, I listened to the exchange between my patient and their spouse. They got married when they were 18 and she was pregnant. They had a son. They separated a year later when she says she stopped loving him romantically. He now lives with his girlfriend and their daughter. She lives with her boyfriend of 9 years.

They see each other daily because of their shared child. She says she loves him, and that they are still "family." She says they won't get divorced because he won't divorce her, and it would cost her too much money to divorce him. So, they live this way and everyone is in agreement and happy. If only he would stop drinking and punching things harder than his hand.

Wow. As for me, I am on my last shift before heading out to a national conference. I put up the gun picture because during the prior two shifts I had not one, but two patients shot in the arm that had broken bones. Both patients were "walking down the street minding my own business" when shots rang out. Both had what looked to be entrance and exit wounds with no severe damage. Both had broken bones that needed setting. Both could have been brothers. Both handled things in very different ways.

The first patient I can only describe as "a real jerk." The kind of patient that cusses out everyone, moves around screaming for pain medication while you are trying to do an exam, and who finally settles down when security gets called and stands outside the door. He told the police that showed up where they could "(*^&!" themselves. He tried to sass the nurse who showed him and told him in no uncertain terms who the boss was now. We cleaned out his wounds and splinted his arm. He was admitted and taken to the OR that morning. He's now got a metal rod where his radius bone used to be.

The second patient was very polite; asked questions about taking care of his wounds. Asked about his medications and how he should take his antibiotics. He was concerned about how his mother was going to take the news and if he should worry her or not. He needed cleaning and a cast. His bone will heal without surgery. He said "thank you" as I was giving him his follow-up instructions.

So now I am counting down the last 2 hours before the end of my shift. A couple of more hours, and I will be on a plane. Hopefully, that hand is the last torn flesh I will see until next week. Pics, etc. when I get back!

10 May 2009

Happy Mother's Day

Here's the link to the entry I posted on my other blog...
Happy Mother's Day!

Happy Mother's Day Quilt

Mom's dog Peppy

A review of this week's ortho madness tomorrow....

05 May 2009

Bambi Meets The Motorcyle

I don't know why I started thinking of the famous short film, "Bambi Meets Godzilla" while on-call last night. I was just finishing up a couple of other consults in the Emergency Department when I was told by one of my colleagues that Mercy Flight was bringing in "deer vs motorcycle."
It's usually not a good thing for either party involved. And the same held true for this unfortunate patient. He had a broken arm and a nearly amputated leg. The arm is fixable; the leg, not so much. He had to go straight to the OR last night for a completion amputation.
We get a lot of motorcycle vs. deer accidents. When I was in Minnesota I had a week on trauma call where it seemed we were seeing one to two a day. I was convinced there was a rampant herd of deer jumping out on unsuspecting motorcyclists at every turn. You know, kinda getting even for the hunting season.
Last night, though, as I held what was left of this gentleman's leg hoping against all practical hope that there was anything left to salvage of his lower leg, for some reason the short film came to mind. Maybe because of the humor behind the utter senselessness of how Bambi meets Godzilla. Maybe I needed that to help myself continue to help my patient as he went through a series of raw emotions after being told that he would be losing his leg. I don't know...
He was doing fine this morning. He went for his arm surgery today to try to put it back together again. I will find out tomorrow morning how he's doing. I guess I can say they do great things with prostheses these days. He'll actually do better functionally in the long run. I don't know if he'll ever ride a motorcycle again, but at least he's alive to ride again.
Here's the film... there was a subsequent, "Bambi's Revenge." Doesn't quite have the impact of the original, but still kinda funny.... I'm back in the hospital tonight. We'll see what tonight brings!

02 May 2009

Sew Far, Sew Good

Ok, so I finished my last "day" shift on the Ortho service, and I spent the last part of my day sewing up 2 patients...

One was an inmate who decided to end his life by taking a whole mix of pills he had stored up, and then, for good measure, cutting his wrists with a razor blade. Well, not so much his wrists but the majority of his forearms.

I put in about 50 stitches including a repair of his muscle fascia and some deeper layers of tissue but not a repair of his palmarus muscle tendon which was what the o
riginal consult was for. About 16% of the population don't even have a palmarus muscle. Do you have one? To check, hold your arm out and clench your fist. Now bring your fist toward you like you are flexing your muscles... if you see a long band pop up around the middle of your arm like in the picture below, you have one. If not, no big deal, you've been living without one and don't miss it. Just like this patient won't miss not having his attached any more.

The second patient was involved in a fight with another person wielding a knife. He had several cuts to his right hand including a deep cut at the webspace of his thumb for which we were consulted. Luckily, there were no nerve or muscle defects, and I was able to sew the laceration closed, plus put in a few stitches on his finger lacerations.

And, so ends the first month of my Orthopedics rotation. On Monday, I transform into a month-long vampire mode as I am on the Ortho Nights service. Fourteen hours of fun in the middle of the beginning of trauma season! Should be interesting!

As for this weekend, I will spend it still sewing... but of a more calming and artistic nature.... Quilting...