In the Life of a Fickle Intern

July 24, 2011

Survived

Filed under: Daily Lowdown — dailymedicine @ 10:37

I survived my first month of intern year! It started off a bit rocky and I had a few patches here and there, but by my last shift yesterday, I felt pretty ok. Maybe it was a false confidence due to repetition or maybe I really did learn something in med school or even that I just learned a sh*t load of stuff this month, I ended my month with an awesome shift, mostly because we caught a disease process that saved a patient’s life.

Ok, for those of you who believe that real life ER is like the TV show, brace yourself for the truth. The majority of the patients I have seen this month, especially at the Veterans Affairs hospital, are chronic patients, meaning they come in for mundane complaints of toe pain or back pain for 10 years. Many veterans use the VA ED as a clinic rather than an emergency room. However, there are always some sporadic cases of really sick patients. I’ve admitted a fair amount of people to the hospital for care and they were acute, but not super acute on the brink of death without further treatment.

When I got to work yesterday morning, my attending told me to take over this case for a gentleman who just got there probably thirty minutes before I came in. It was a guy with the complaint of an abdominal pain. On top of that, we have been experiencing a heat wave and he did not have air conditioner at home. Pretty typical complaint. However, he had an interesting story. He recently went down to Mexico to have a gastric reduction surgery to lose weight. No symptoms really other than new abdominal pain for the last two or so days. No fevers, no chills, no signs of infection. I went over to introduce myself and he was very pleasant, appears to be in pain but no significant finding on physical exam. I updated him about what we were doing, getting some labs and some basic imaging to make sure nothing was going on.

And then it got serious. He was still doing well, getting pain medications and fluids, but his labs slowly trinkled back showing these ridiculous numbers that you learn about but don’t really see. Without any further information, I went ahead and called surgery. They were mildly impressed, but agreed to see him anyways. First the residents came down; they were more impressed but like us, wasn’t sure of the cause. We had ideas. We all just knew that something was terribly wrong. The surgery attending came down. She was definitely impressed with the story, but no final say on what was causing all this. Three hours later, he goes to the operating room for exploratory laparotomy, meaning they opened up his abdomen to…explore. During the surgery, his cat scan came back and my attending made the diagnosis of ischemic bowel, meaning that there is decreased blood flow to the bowels and they were dying or already dead.

I get a call from the surgery intern hours later. The poor guy had over six feet of bowel removed because it was already dead. He was still in critical condition after the surgery and they are taking him back to the OR for more exploration.

So yea I survived; I hope my patient also survives. What a way to end my month!

Tomorrow I start cardiac intensive care unit. Back to square one.

 

July 17, 2011

My Emergency

Filed under: Personal Ramble — dailymedicine @ 21:35

I had an emergency. A technology emergency to be exact. As I attempted to multitask before work, my klutziness was magnified and I accidentally  spilt my coffee  all over the coffee table. Because I have not had a chance to completely unpack and organize, my coffee table is a little (a lot) cluttered with books and papers and whatnot, and as if it was intentionally set up for the perfect mishap, the stacks of books formed a nice stair case allowing the spilt coffee to rapidly reach my computer across the length of the table, a good two or so feet away, before I even realized what happened. As I kicked myself while cleaning up the mess, I was optimistic that Maggie, my computer, was going to be ok. It didn’t seem like a lot of coffee got to her and she appeared to be functioning normally. However, after working thirteen hours, I come home  at 1 am to a dead computer.

I was not a happy camper. As luck would have it, today was my one day off this week so as soon as the Apple Store opened this morning, I was ready and waiting. However, being a novice Apple Store attendee, I was blown away by how many OTHER people were also ready and waiting. It felt like I was at work again, just on the other side this time. After making a reservation, I sauntered around the mall trying to waste time. At the allotted appointment, I came back to wait some more. Finally, it was my turn.

A little background for those of you who don’t already know. I cannot lie worth crap and worse yet, I have very little filter with telling the truth. My plan of action was to not lie but at the same time, not to confess my utter klutziness either. However, that plan was much harder to pull off when they took the cover off to find coffee stains underneath. I went with Plan B, which was to play dumb. In my mind, I was cursing my bad luck, also known as my own carelessness, and trying to calculate whether I can afford a new computer right now. I felt my sympathetic system in full blast with face flushing, heart racing, the whole works as I told him that I was not exactly sure what happened, and DESPITE the obvious situation, he “fixed” my computer anyways. I am a very grateful person in general, but when he told me, I really wanted to jump up and give him a huge hug and a kiss, but I refrained due to social etiquette. Though I wasn’t physically able to show him how I felt, I hoped that he knew how appreciative I was considering that every other phrase out of my mouth was a thank you.

Maggie is no longer with us, but thankfully, I now have her twin, Jester. I will be much more overprotective with Jester than Maggie, if that is even possible. I have set a lot more ground rules this time around including no more liquids on the same surface as the computer.

On a lighter note, in addition to leaving the Apple store with Jester, I also left with a personal phone number and an email. I am so very tempted to email him and thank him again for today, but because this whole ordeal already started off on a partial lie, I’m not sure how this would all turn out. We will see. I haven’t decided.

Though I have never been to an Emergency Room for a health reason, knock on wood, I don’t think this experience is that much different. I was concerned about something and I needed help. A good reminder to continue being nice to people! Karma really does exist!

 

July 9, 2011

Initiated

Filed under: Daily Lowdown — dailymedicine @ 08:02

Two weeks in and I think I have been fully initiated into the EM world.

– Got yelled at by a nurse. He apparently has a reputation of picking on the female physicians, but he has been nice since.

– Detoxed one too many drunks, one of whom told me that if he had a gun, he would hold it to my head until I gave him twenty dollars. And…I left to get my big, tall attending who told the person to stop messing around and to answer my questions. Ha! I felt like a 2nd grader, but it’s ok because the guy probably didn’t even remember.

– Had a patient threaten to sue me and the “fucking stupid VA hospital” because he didn’t want to be discharged home.

– Activated security for the same patient mentioned above because he was belligerent and yelling at the top of his lungs. He came in for shortness of breath. I think he’ll be ok.

– Saw a patient try to swing at a nurse. Had to write an order to place the person in restraints.

– Got tricked by a drug seeker for narcotics! I didn’t realize it until I was writing up my note and reading her notes from previous visits. I don’t think it was the first time either. Oh well. For the other percentage of people who are in pain, I will continue to give everyone the benefit of the doubt.

Biggest lesson learned so far: don’t take anything personally.

Fun times. 🙂

July 4, 2011

Independence Day

Filed under: Personal Ramble — dailymedicine @ 08:39

Happy 4th of July! This was sent to us by one of our attendings. I thought it was interesting enough to share. Be safe! Avoid the Emergency Department!!

 

Have you ever wondered what happened to the 56 men

who signed the Declaration of Independence?

Five signers were captured by the British as

traitors, and tortured before they died.

Twelve had their homes ransacked and burned.

Two lost their sons serving in the Revolutionary Army;

another had two sons captured.

Nine of the 56 fought and died from wounds or

hardships of the Revolutionary War.

They signed and they pledged their lives, their fortunes,

and their sacred honor.

What kind of men were they?

Twenty-four were lawyers and jurists.

Eleven were merchants, nine were farmers and large

plantation owners; men of means, well educated,

but they signed the Declaration of Independence

knowing full well that the penalty would be death if

they were captured. Carter Braxton of Virginia, a wealthy planter

and trader, saw his ships swept from the seas by the

British Navy. He sold his home and properties to

pay his debts, and died in rags.

Thomas McKeam was so hounded by the British

that he was forced to move his family almost constantly.

He served in the Congress without pay, and his family

was kept in hiding. His possessions were taken from him,

and poverty was his reward.

Vandals or soldiers looted the properties of Dillery, Hall,

Clymer,Walton, Gwinnett, Heyward, Ruttledge, and Middleton.

At the battle of Yorktown , Thomas Nelson, Jr., noted that

the British General Cornwallis had taken over the Nelson

home for his headquarters. He quietly urged General

George Washington to open fire. The home was destroyed,

and Nelson died bankrupt.

Francis Lewis had his home and properties destroyed.

The enemy jailed his wife, and she died within a few months.

John Hart was driven from his wife’s bedside as she was

dying. Their 13 children fled for their lives. His fields and his

gristmill were laid to waste. For more than a year he lived in

forests and caves, returning home to find his wife

dead and his children vanished.

So, take a few minutes while enjoying your 4th of July holiday and

silently thank these patriots. It’s not much to ask for the price they paid.

Remember: freedom is never free!


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