Sophomore Stories

I thought I would take my time tonight and post some comments on my second year of residency. Last year I wrote a post on my original blog "Do They Have Squirrels in Buffalo?" wrapping up my first year. So here we go through the second year:

Essentially, I started off my second year in July as an "unofficial, but acting in the capacity of" second year. Since I was hired late in the medical year, I still owed another month of internship. But, in essence I was acting as a second year. I spent the majority of the month getting ready for all the activities of second year, such as taking ATLS (advance trauma life support), a base station course (where we learn to give medical direction to EMS providers, learning about Mercy Flight, and learning to drive real fast in our SMART (specialized medical assistance team) vehicles, while at the same time dealing with summertime pediatric dramas. Oh, and I became a vegetarian "For the Animals!" in a 30 day pledge.

The next month I was on my EMS (Emergency Medical Services) rotation. I spent my time with firefighters, doing several runs with the EMT supervisors, and I got to fly in a helicopter for the first time with Mercy Flight. The other part of this rotation is being the resident for the local Poison Control Center. Whenever there's a drug overdose, we get called. We then call our attending who guides us through the correct treatment for all the drug overdoses we're going to face as E.D. physicians. It's learning through experience.

The next month had me reliving life as a surgical resident. During your second year of surgery, you spend a great deal of time in the ICU. Emergency medicine residents spend a month in the trauma ICU at ECMC. It was fun going back to the pimping, and the early morning rounds. I really enjoy the ICU and had for a time considered a fellowship (an extra time after residency for more advanced training) in critical care. But, I think by the end of the month, I really did look forward to getting back to the E.D. and did not regret my change in careers at all.

The next month was spent learning about ophthalmology, dentistry and radiology. Mornings were spent with the dentists learning to provide anesthesia to the mouth, and afternoons were spent looking in people's eyes. Not a very exciting month, but a nice 9 - 5 kind of month with weekends off and no call. I did get to work a Buffalo Bills' game providing medical support to the fans in one of the clinics at the stadium, so not an overall bad month.

Of course, October is when we made the move from J-land to, for the most part, Blogger. I had been chosen as the representative to the national residency organization (EMRA), and I was able to attend my first national conference back in my old stomping grounds of Chicago. I then spent the next month working at one of the suburban hospitals in the area. I learned a lot, and I got a new pair of shoes!

My next rotation took me back to the drama that is ECMC. I know I have mentioned several times that most of us really enjoy our rotations there. The system is a lot easier to deal with, and the patients are a lot less medically critical. So, let's see, what happened...? Thanksgiving came and went. I continued to be a vegetarian. I worked 5 days straight and had some interesting tales to tell. I went home to California for an early holiday.

I then did the "Swing Month" which is not as exciting as it sounds. Basically, we split our time between ECMC and Buffalo General. I spent 15 of my shifts at ECMC and 2 shifts at Buffalo General. Sounds about evenly split. Oh, yeah, and snow came to Buffalo and started the winter off with a bang. Christmas came and went, and I made you all take the Resolutions for New Year's Oath.

I then started my official second year rotation at the Children's Hospital and tried the best that I could not to catch the RSV and other bugs children were flocking to the E.D. with at the time. I failed miserably and took it into my next rotation in the Pediatric ICU where I spent a great deal of time writing notes, and not so much time doing anything else.

Of course, I must take a moment to remember the 50 who died when Flight 3407 crashed on final approach to Buffalo Niagara International Airport. I was on scene as a member of SMART providing support for the workers who had the dangerous task of removing the wreckage as others worked to collect their remains.

My husband and I celebrated our first wedding anniversary at a great little B&B in Pennsylvania near Gettysburg. We then spent the next couple of days exploring the battlefields (mostly on the Confederate side since my hubby is a Son of the South), followed by a trip to Lancaster where my interest in quilting began to develop. Who knew it would blossom into a new hobby?

I finished my rotation at Buffalo General and spent my vacation that month in Florida visiting the Everglades and the Florida Keys. A very nice way to take a break from things medical which was good because my next two months were going to be purely hellishish.

The Ortho Service: two months of pure immersion into orthopedic surgery. You spend two weeks on the Hand Service working in the clinic and going to the O.R. Then you spend five days on the service, take a 24 hour call, and then another 5 days on the service. After that marathon 2 weeks you flip over to nights and become a vampire for a month. I learned to set a lot of broken bones, and I learned to sew a lot of messed up hands and feet. I learned how to complete an amputation. I did get to go to the second national conference in New Orleans which broke up the month very nicely. And, I was already used to staying up during the night which played into the festivities nicely.

My final month was spent as an elective in the Medical Examiner's office, and I have shared a lot of the tales and stories which were encountered during my month there. It was a light relaxing month, and I even had time to do some additional ride along time with Buffalo's Finest on Rescue 1, and to provide back-up in the SMART car.

Wow, what a year. This year, I will spend 90% of my time in the emergency departments of Buffalo General, ECMC, and Women and Children's hospitals. I do have spend one more month, a "make up month" which is a carry over from my second year at the suburban hospital again. I'll be looking for a real job this first part of the year. By the time 2010 begins, I will be looking forward to my graduation, my new job, and a new and exciting chapter in my life... Hope we all make it there together, and thanks for being here for the journey!

Another Month Did and Done

Well, it's Sunday. Officially, the last day of the module, and the last day of the medical year. Tomorrow morning I start as a senior resident in the Emergency Department. Fifteen more months and I will be done. I am going to put a counter on the sideline to count down the days.

After the excitement and interesting tales from this last rotation and the two months of Orthopedics before this, my husband was telling me that I was going back to the usual "boring stuff." I reminded him that I would be doing this "boring stuff" for the rest of my career; unless, of course, he lets me return to surgery and be a resident for another three years. By the groans and threats of moving to live in an RV on a beach in Florida I take it he is about ready for this to be over too.

My last case at the ME's office on Friday was a sad tale of a massive thunderstorm and downpour, a car out of control and hitting the curb at about 75 mph, jumping the curb and over a about a 3 foot wall and slamming into a church. The driver had major trauma to his head and lower legs. His passenger died.

Again, while I can't discuss the specific findings, I can say that this was the most trauma I had ever seen on one person. That the driver survived at all is incredible. I was in amazement throughout the entire post-mortem exam. I couldn't even begin to think of what I would do had this patient come into the emergency department. Where to even start. But, this is one of the reasons I did this rotation. To make you think about the traumas. To make you understand more fully the traumas. And, to realize that there are some things that can't be fixed.

What I'll be missing tomorrow: a second child has died of the H1N1 flu virus. We had been following her condition very closely throughout the last week. And, a victim of a train accident has died. I heard the radio call out when he was first injured and was amazed that he survived to make it to ECMC. I heard about his progress in the ICU. They will probably be posted tomorrow. With tongue in cheek, this just goes to show that even at the ME's office, life goes on.

Passing Gentle Into That Good Night

Yesterday (Monday), we had the autopsy of the first case of H1N1 Flu to die in our area. It was very sad because the young man was so young and previously healthy. I wasn't present at the post-mortem because of the high level of precautions being taken. However, I did hear about the case during morning report, and one of my colleagues is on their PICU (Pediatric ICU) rotation, and I heard some information from them.

Today we had three cases. Three people who died in their sleep and were found after a friend, relative, or neighbor grew concerned enough about them that they sent someone to check on their welfare. In one way, I think most people would like to just pass from this life in their sleep. A simple blink from existence. However, I found myself somewhat saddened by their stories, because to me they died alone. Although someone checked on them, thought enough about them to be concerned, no one was actually with them when they passed.

I think I've only been at the bedside of one or two patients when they've died. Both of which I later had to deal with guilty feelings for turning off the ventilator. Medically, I knew that they were brain dead. I knew that the best thing I could do for them was to let them go. Emotionally, though, I still felt as though I was the one ultimately responsible for their death. I talked to their families and got them to understand that their loved one wasn't going to recover. I signed the orders for morphine and to stop medications to keep their hearts going and their blood pressure up. I turned off the breathing machine. I pronounced them when they flatlined.

I thought a lot about Dylan Thomas' poem today. As a physician, and especially one who works the "front line" in the E.D. , I can't help but daily think I "rage, rage against the dying of the light." And, when we lose the fight, I am glad that someone was there to witness and to pray.

Do Not Go Gentle Into That Good Night
by Dylan Thomas

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Not Newsworthy

I have been working at the ME's office for the last three weeks. Wow. While I can't talk about the specifics of what I see every day down in the autopsy suites, at least I can post the local news stories about the cases that are coming down to the morgue.

I attempt to find stories that don't list the names, but some stories are so widespread that names have already gotten out. Most of those are the locally high profile killings and deaths. While I might list that we did a suicide on a particular day, although I know the person's name, I don't list the obituary because I think that would be disrespectful to the person, and especially to the surviving family.

Some deaths, though, no one reads about. The prisoners who die while serving their sentences. The single overdoses that are found by friends or family members. I add the suicides in here, because they sometimes don't even get an obituary. Children are in here because SIDs, suicides and sudden deaths, for the most part, don't get reported. And the tiny victims of drug-influenced mothers who never live to take their first breaths, mostly because they are too premature or died before they were born, they generate no print as well.

We had a full room today. Three tables all going at once. No news stories on any of them. They were simply: The Overdose, The Accidental Overdose, and The Found in Woods.

Stories that did make the news from earlier this week:

Hot Dog Death
Shooting on Porch

Until next week!

Young Lives Cut Short

It's been sort of a bad week at the ME's office. Even moreso for some of the local EMT's.

Seems there's been a rash of teen deaths over the last two weeks, and there's nothing as disheartening for these first responders than arriving at a scene, doing everything they can, and then having someone young die on their watch.

When I run into some of the EMT's I get asked about how some cases ended up. Those that know I am in the ME's office ask for outcomes, causes of death. I tell them what I legally can. Sometimes the news gets a press release and then preliminary causes of death are released. Sometimes I can offer a little comfort that the person was going to die despite rescucitative efforts. Still, the EMT's take these young deaths personally. For the most part, young people aren't supposed to die.

Teen dies unexpectedly at home
Teen dies from shooting
Teen found, suspected homocide
Teen dies while playing soccer

Other cases these last couple of days:
Teen dies after choking
3 separate men complain of chest pain and collapse
Motorcyclist killed

Grand rounds tomorrow... until Thursday!

The Brain Box

Ok, so I am still rotating through the Medical Examiner's Office. The cases from the last couple of days have included several suicides and several mass traumas. We talked about how the patients that don't make it to the Emergency Department end up at the ME's office.

This is why I am doing this rotation. Nowhere else am I going to be able to be elbow deep in someone's chest looking for the traumatic aortic rupture, or holding someone's brain following the path of a bullet with my finger. (By the way, the pic is a Jello mold not a real brain.)

I wanted to quickly respond to some questions I received from Betty:
- The ME's office gets cases that warrant a forensic medical examinination as deemed by the County Coroner (there's a difference between coroner and medical examiner), and cases that fall under certain protocols - an unwitnessed death in a person who has not been under a doctor's care for a certain period of time, any death involving an inmate, an unexplained or unnatural death (murder, suicide, accident), deaths involving children or infants, and several other specific circumstances.

- We have a protocol sheet we follow in the E.D. and in the hospital when there's a death. We have to call the M.E.'s office, and they "sign-off" or take the case. If there is an autopsy that's not the same thing... a family can ask for an autopsy and that is performed by the hospital pathologist.

- I usually don't participate in autopsies, but I occasionally get to cut something or dissect an organ, and I get to touch most things after the official examination is done, which is a good thing because I am not a "spectator"

Tomorrow is an off day, so I will be back at the ME's on Thursday. Here's the case list from the last few days, including 3 suicides -
Homocide
MVC Fatality

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!

I See Dead People

Ok, so this week I started my new rotation: Forensic Pathology. I get to spend every morning with the Erie County Medical Examiner. Now, you might ask what would make this a good rotation for an E.D. Doc. Well, let me tell you...

1. You get a great review of anatomy. No where else do you get the chance to see organs up close and personal. You get back to your first year of medical school when you were learning how things were connected and where everything went. And, you get to touch things again... I love lungs... they're crunchy like Rice Krispies!

2. You can see what happens to the insides of those patients that never make it to the Emergency Department. I remember doing the rotation in medical school and seeing the dissected aorta that instantly killed a victim of a car crash. You could imagine the shearing force that it would take to rip the aorta in half. You see the routes that bullets and knives take as they make their deadly way through the human body. You learn to recognize entry and exit wounds and how to follow their paths.

3. You can see the natural progression of disease. You see the lungs of a young person, and then those of an older person who has spent their life smoking. You see the clean coronaries of a 20 year old, and the beginnings of atherosclerosis in a 40 year old.

4. You gain a different perspective on your living patients. A lot of the M.E. patients come with crime scene photos. You see how they live, how they died, and you can better understand where your patients are coming from.

5. You see life differently. No matter who you are, everyone dies. I think it make you appreciate your life and that of those around you just that much more.

Since I can't talk specifically about the findings on the cases we are doing, I can at least let you know the cases we worked on:

Yesterday's and today's cases that I saw the "posts" (post-mortems) on:
Lake Floater
Car Crash
Drug Overdoses

Grand Rounds tomorrow and then back to the action on Thursday!