Isn't Sunday a Day of Rest...?

So I knew things were going to be bad when I woke up late for work this morning.  I was able to grab a pair of clean scrubs and run out the door.  All I could think about was getting sign out from the night team and heading downstairs to get a cup of coffee.  Little did I know...  I rushed to get to work quickly.  Made it in the door just at 0700, change of shift.  Before I even had a chance to take off my coat, the senior from the night shift told me that there were three victims from a house fire coming in;  one was a child and unresponsive and the other was an adult in respiratory distress.

I quickly took off my outer coat, grabbed my lab coat and stethoscope, figured out who my junior resident was going to be and got ready.  We got the adult patient first.  They were not responding coherently, so the decision was made to put a breathing tube in.  I left my junior resident to handle that while I took off to the next room as the child was being brought in.

She was brought in barely conscious but breathing.  She had soot around her nose, and we knew she probably had inhalation injuries.  We quickly made the decision to intubate her, and I put a breathing tube in.  We got her stabilized and started arranging transport to Children's Hospital.  We had no names for either of the patients, so we would just have to wait to name our little Jane Doe.

About this time, a third victim from the fire was brought in.  We asked if they had a little girl.  They immediately started crying but could not give us a name.  Carbon monoxide poisoning from a fire can make you goofy and delirious which they were.  They became argumentative and refusing treatment, but it quickly became apparent that they were not breathing well and would quickly be needing to be intubated.

After a quick sign-out from the night team that had patiently waited while we stabilized the fire victims, I talked to the patient who was starting to complain of a sore throat.  I told them what I was about to do and got some feeling that they understood.  We sedated the patient and placed the breathing tube... three patients intubated and it wasn't even 0930.

Somewhere around here time started to speed up.  I know from time to time I asked if it was Sunday and was anyone going downstairs for coffee.  Seriously, it was a cold snowy day.  A Sunday.  Why were we so busy?

Things that also happened during my shift, sometimes at the same time or right after each other:

 - alcoholic who vomited a liter and half of blood and needed a blood transfusion and admission to the ICU

  - a patient who heard voiced telling them to stab themselves in the chest, so they did, and then ate kitty litter in an attempt to kill themselves, they also needed a breathing tube

 - a possible stroke that turned out to be worsening heart and kidney failure

 - a teenager shot while driving with a friend "minding their own business" who initially went to Children's and then needed to be transfered to us

 - a teenager who decided to drink and drive and had a head-on collision with another vehicle;  they and their passenger forgot to wear their seatbelts and both had head injuries

 - an older driver who should have known better and drove while under the influence.  They had a head-on collision too, with a tree.  Again, no seatbelt.  Again, major face trauma

 - a very sick elderly patient that was transferred from another hospital and brought in by the helicopter.  I'll have to see if they're still alive when I go in tomorrow

 - another patient "minding their own business" who was stopping at a convenience store and was shot;  they came in just at the end of my shift which just about rounded out my day.  I will find out in the morning what the extent of their injuries were.

Wow.  What a Sunday.  And, tomorrow is Monday;  traditionally the busiest day of the week.  I better get to sleep early and double set my alarms... I think being late starts the day off on the wrong foot... yeah, we'll blame it on that!

Humpty Dumpty, et al...

Today I have been mentally thanking God for allowing me to have so many interesting and unusual experiences throughout my life. I have been allowed the privilege of participating in some events that most people never will.

This morning while in the ME's office, I was able to participate in the post-mortems of several patients. Due to confidentiality issues, I can't say what I did, but let me just express again how thankful I am to be a physician and how awed I continue to be at times with the complexity of the human body. I am also saddened by those who don't appreciate the miracles that we all are.

Having said that, yesterday was Grand Rounds Wednesday, so no ME's office. These are the some of the cases from this morning... it was a full board and all three tables were going at once:

Prisoner with Lung Cancer
Motorcycle accident
Fire Starter

I try to find articles that don't list the person's name, however since I am using public media sources I can't help what gets put in print.

Until tomorrow!

Everyone Has a Story to Tell

I know that I haven't written in a while. Despite my best efforts, I caught the "Pedi Flu." Pronounced Pee-dee, as in pee-dee-atric medicine. So, I have been snuffling and coughing along with my patients. I finally started feeling better this weekend, just in time to start my new rotation tomorrow... the Pediatric ICU. I've heard a lot of things from my colleagues, not a lot of which are positive, so we'll have to see.

I thought I would take the time tonight to wrap up this last month by talking about some of my more interesting cases. Interesting in this aspect - in college I was a journalism major because I found people's lives fascinating, and I wanted to write about them. I get to learn a tiny bit about my patients in the 5 minutes I have to interview and examine my patients. Sometimes I am just left to wonder what their home life must be like... or maybe I don't want to know... still...

Dx: CO exposure
So, we've had a flurry of these as the weather temps dip, and people start burning stuff in their fireplaces or wood-burning stoves to keep warm. Also, kerosene generators and space heaters can add to the problem. I had a mom come in with her three boys. She said the boys had been getting sick off and on over the last 2 weeks. The day before she thought she had smelled gas. She didn't know who to call, and that morning, she called her mother who told her to call the gas company.

When the gas company man arrived, he found two gas leaks. He told her to call her landlord and then get herself and the kids to the E.D. to be evaluated. While I examined her children, she told me about all the phone calls she had made to her landlord, and how she was still trying to get him to fix the leaky ceiling and clogged toilets. I turned and asked her about flushing the toilets, and she said that you had to use the plunger every time and that they were usually backing up.

Now she didn't know how long it was going to be before he would get the gas fixed. I put the two smaller kids on oxygen and wondered if I was going to have to do a social admit for the kids. After I came back in an hour and rechecked their levels, I asked her about her kids' safety and where they were going to be spending the night, she assured me that she would be going to her mother's until the gas could be fixed. She also said she had recently qualified for Section 8 and would be able to get another apartment.

I found the kids knitted hats that had been donated to the E.D. I counseled the mother about stopping smoking. (Smoking will elevate your CO level.) And, I sent them off into the night.

Dx: acute stress reaction
A mom brings her 5 year old son who has been acting strange, hearing voices, acting out in school, and falling behind because the school sent home a note. In the course of my interview and the subsequent psych interview, we learn that the mother had her mother and a sister die in a violent manner in Philadelphia.

The mom had a cousin who lived in Buffalo and was planning on getting married. She asked the mom to be in her wedding, and the mom felt the need to get away. So mom moves to Buffalo with her cousin and brings her two young sons. Five year old son misses dad and cries on the phone every night when he's talking to him.

So cousin gets into a fight with her fiance, and in the course of "needing my space" she kicks the mom and the kids out. So, mom goes to live in a homeless shelter with her two boys and ends up there for about 6 weeks. Somehow, mom manages to get Section 8 which helps her to find a new apartment, but locks her into a lease. Mom can't break the lease or she loses a lot of money. She can't get back to Philadelphia. And, now her five year old is hearing voices.

When I talk to him and ask about his friends in school, he tells me that no one wants to be friends with him. When I ask him if the voice in his head is an imaginary friend, he tells me that who would want to be friends with him. That's about the time that I felt a CT scan wasn't going to do this kid as much help as a psych consult would. Psych was able to hook the mom up with social services who would see about assisting her in getting out of her lease and moving back to Philly. That will ultimately be the cure this young boy will be needing.

Well, it's bedtime for me. I'll be rounding on a new set of patients in the ICU in the morning, and I am sure that there will be many more stories to share. Until then...