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!

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!

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 original 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...

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!

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.

Slippin' and a Slidin'

Last night I started a string of nights at ECMC. Aside from my resolutions for my patients from a prior entry, I made my own resolution to not be so cynical of patients and expect the best. Kind of hard to do when you read some of the presenting complaints at the top of the patient forms, but I was going to make an effort. That lasted just about 1/2 way into my shift , and then I just gave up all hope... sigh.

Anyway, last night I drove to work in a freezing rain. It was just hovering about 33 degree F. We came into an almost empty board, at 7 p.m., and we had hopes of clearing it. Then came 11 p.m. All of that freezing rain turned to ice as the temps dropped down into the high 20's. Suddenly, there were sheets of black ice everywhere. And, then the fun began.

Four employees leaving the hospital slipped and fell in the parking lot. A police officer slipped and fell on the ice - broken leg. Another police officer crashed his car into a tree when he hit a patch of ice - concussion. A young man was carrying a porcelain toilet and it slipped out of his hands - he severed one of the major arteries to his hand and cut several tendons and an important nerve. He was going to surgery.

By 1 a.m. I counted 15 patients on the board, and 8 of them were ortho consults for fractures, dislocations, etc. And the night continued on steadily busy. One little 78 year old lady produced a similar film to the one I posted here. She'd slipped and fallen on her oxygen hosing. Her bone cut through her skin, so she was considered an open fracture necessitating immediate surgery. She was on the board to go to the O.R. when I was leaving this morning.

Well, ok. Time to head off for another shift. It's Monday, so there should be quite the crowd. Will let you know what I see tomorrow! Cheers!