Blood on My Scrubs

I can't say I've honestly thought about what happens to my scrubs throughout the course of my medical career. Until last night. I don't know why I had this surreal moment in the middle of a trauma code. I was handing a chest tube to one of the surgery residents to place in this patient's chest, and I looked down to step back as a puddle of blood had formed on the floor.

I noticed the blood spattered on my scrubs, and my first thought was, "Darn, I don't have a clean pair and it's the middle of the shift." Then, I started thinking about all the bloody, vomited on, amniotic-fluid covered scrubs I have worn during my medical training.

In medical school, most of the scrubs worn in the anatomy labs were new, bought excitedly in anticipation of starting your medical training. By the end of the year, we had a mass burning of these soiled clothes that had spent countless hours, literally elbow-deep at times, working to understand and learn the intricacies of the human body. I threw my shoes out too.

In your third year when you start your clinical rotation, you grabbed scrubs whenever you could. The residents had access to the scrubs machines and some hospitals had a general pile. We didn't have access to the machines so you stocked up when you could. Sometimes your scrubs got soiled midshift, and you had to have some kind of backup. I kept an extra pair in my "on-call bag." So, by the end of your medical school training you had this mixed bag of scrubs sporting the "not to leave the premises" or "property of" imprinting from the various hospitals.

These became a badge of honor in a way when I started my internship. You'd go to work in your home scrubs some nights on call. Everyone would look at your scrubs and say, "Oh, you worked there?" or "Oh, do you know so and so at that hospital?" We had access to the scrub machines there when we had to go to the OR, but you were only allotted 3 sets at a time. Sometimes you just didn't have time to run to the machine (or most likely the machine was empty), so it was more convenient to always have a pile of scrubs in your locker. We learned ingenious ways of getting more scrubs (including timing your visit to the locker room when the filler of the scrub machine was loading the machine... "Geesh, I don't have my card right now and I've got to get to the OR, can you help me out?") so that you had quite the surplus too by the end of the year.

Of course, the bloody, messed up ones went into the dirty bin. So all the scrubs you kept were nice and clean. At this point in my life, I have a pile of scrubs from all the places I've been. Most of them are blue in some shade or other. Some are what I call OR green. I have a cool teal green pair from a hospital in Rhode Island where we went on a transplant run while I was in Boston. We had to wear their scrubs to go to the OR for the harvest, and we didn't change out on our way home since time is of the essence in transplants.

But, when I became an Emergency Medicine resident, we didn't get scrubs. So we all had to go back to grabbing them when we could while on other off-service rotations.

Last year, our residency bought us these cool black "Ninja" scrubs. I don't like to think about what collection of body fluids accumulates on my shoes and the bottom of my scrubs by the end of the night. And, like last night, you can't help but get something on you.

Because we got a limited amount, they go right in the dirty bin when I get home. They get washed with the super-extra strength detergent after an Oxy-Clean soak. You just don't know what's hiding on them....

Under Pressure

I never thought about the change that would happen in six months.

I just started my next rotation at Women and Children's Hospital. After almost two months working at ECMC, I think I was ready for the change. However, I didn't expect quite the change.

If you've been following my blog, you know that I have already done two rotations as an intern at WCHOB. And, despite the fact that I really don't like kids, I actually enjoyed them. It gave me a chance to do some preventative medicine - which I think is very important, a chance to teach - which I love to do, and, for the most part, I learned a lot about pediatric acute (and some not so acute) emergency medicine.

However, starting on Monday morning, I was the "senior" emergency medicine resident. Suddenly, it wasn't about "what does this child have?" it was about "how are you going to fix them?" Having not seen anyone under the age of 16 for the last 6 months, I really found myself rusty in my diagnostic skills, and with the added pressure of making more complex decisions about their health care, I was really at a loss my first shift.

What did not help was the fact that it was Monday. In January. At the height of RSV and flu season. And, I had an intern that had never been to WCHOB before. And, we started the morning with a trauma. A sixteen year old girl T-boned on her way to school at 45 mph. She ended up with a subdural hemorrhage. By the time we finished assessing her, we had four new patients on the board, and the fun was just starting.

I felt like an intern, trying to get used to the system again. Trying to manage the patients. Trying to just feel like I wasn't sinking. We got more residents in over the next 4 hours, but the whole system was just overloaded.

At one point we had all 26 rooms full. They opened another section of rooms (+6). And the waiting room had about 20 people waiting. The computers crashed, the nurses were surly as they were being pushed to their limits, and ambulances kept bringing people in.

We had the comic "E.R." moment when everyone was running around, a barely-breathing baby is brought into the back and starts being coded, the ambulance rolls in with another child turning blue despite ventilation, and the noise level rises to fever pitch. The baby is taken to another room so that the blue child can be rolled across the work station to the now vacant code room, and there's the rush and flurry of the respiratory therapists pushing ventilators as the radiology techs push around their giraffe-painted x-ray machines.

I left that night with 4 patients waiting to go to the Pediatric ICU (PICU), another 5 or waiting for admission, and a full board (20+) in the waiting room to be seen. You don't learn in that environment. You just try to survive and not let anyone else get hurt.

My next shift was a little better. At least I was able to think about my patients more. Review my disease processess. Come up with a plan before presenting to the attending. Not to mention, I actually knew the attendings. One of our complaints about WCHOB is that we're working with pediatric attendings who have completed a fellowship in Pediatric emergency medicine. We're guests in their house.

They've hired a whole group of new graduates, none of which I had worked with before. Not that it makes a whole lot of difference, but you get used to how an attending likes their work-up and presentation. You know who lets you fly and who keeps a close rein. I guess I could have almost called this posting "Out of my comfort zone."

Sigh. It was just the first two days. I work tonight (which is another problem, since we don't schedule our residents we get whatever schedule the pediatric chiefs come up with which doesn't always make sense or take into account shift time changes.) I know I will be able to get back into a rhythm. And, I know that by the end of the month, I will be a lot more comfortable with what I am doing in my new role.

Just in time to start my PICU month when the fun begins anew!

Until then, we'll see what interesting stories that don't involve coughs, colds, vomit, diarrhea and parents that should need a license before they're allowed to procreate we can come up with.

As for the video above. I like the way they combined two of my favorite shows "Grey's Anatomy" and "Scrubs" And, I like the song....

Takotsubo Troubles

There's a medical condition in the literature known as Takotsubo Cardiomyopathy. It's basically broken heart cardiomyopathy where extreme grief or stress can actually lead to heart failure. It's been well documented in elderly widows who have chest pain or pressure at some point after losing their spouses. One of my favorite shows, "Scrubs," actually had the diagnosis as one of their story lines.



I think I might have written about the multitude of OD's we were seeing in the days following Thanksgiving (60 Hours), but lately it's seemed like I'm seeing a lot of depressed patients who come into the E.D. just for some companionship, or to have someone to talk to for a while. I did have two women who came in that made me think of Takotsubo's.

The first was a woman whose chief complaint was: chest pain. About 2 minutes after I started talking to her, I realized that her heartache was more of the emotional kind than the physical kind. She made a comment about all the "pressures" in her life at this time. When I pressed about them, she started crying and told me about how her fiance had died the year before, and how the holidays had always been a very special time for the both of them. They had been together for 8 years. She had family she wasn't really close to, and he had no one. They had each other.

She told me how she had seen him die right in front of her in a freak accident. One minute they were walking along, joking and laughing; the next, he had fallen down an embankment and died as a result of the fall. They had just gotten engaged and had not even gotten around to setting a date. I still had to work her up as a potential Acute Coronary Syndrome, but I ended up discharging her home with follow-up to counseling and psychiatry.

The second little lady came in this evening as I was trying to wrap things up at the end of my shift. Her chief complaint was "weakness." As I talked to her, she had some very non-specific symptoms: some nausea but no vomiting, some general feelings of "just being sick," and a feeling in her stomach that wasn't pain, and wasn't related to anything else. When I pushed her on it, she stated that she thought she might be lonely.

She lives in Senior Apartments. She doesn't like seeing ambulances coming and going at all hours. She's proud of her children and their accomplishments but calls them "work a holics" who don't have time to visit. She says her apartment is by the lake, but too much moisture which makes her bones ache. She said just being in the E.D. made her feel better. She told me that her physician told her that "loneliness will make you sick" and maybe that's all that is going on with her now.

When I signed her out at the end of my shift, I brought up Takotsubo's. My colleagues chuckled, but I'll think of this scene in "Scrubs" as I go to bed tonight; lying on a bed surrounded by three warm and purring kitties. Charles Schultz in "Peanuts" once said that "Happiness is a warm puppy." Too bad I can't write a prescription for a box of kittens or a warm puppy.