Hooray for mutts!
The editors thank Darron Evans of Huntington Beach, CA for contributing this article.
May 28, 2009
May 15, 2009
CABG
CABG stands for "coronary artery bypass graft." I watched a patient's heart beating during a bypass surgery today. It was pretty cool, but not as awe-inspiring as I thought it might be. Am I too jaded, or too educated now to be stricken with awe? The weird thing was that the most memorable part of that surgery was when I told the surgeon the three standard expressions of Japanese surprise were: "Eeeeh?" "Waaaa!" and "Oooooh!" The whole room burst into laughter while the dude's heart was hanging out in the open. And THAT, to me, was the most remarkable part - that they were all so at ease even while elbow-deep in some guy's chest cavity that they could have a belly laugh during bypass surgery.
Ah, I so miss being at ease and good at what I do. People used to think this about ME as I stabilized and packaged multiple gunshot wounds, did CPR on heart attacks, and dragged myself half-asleep to put out car fires. Now I get excited about drawing blood. "Someday" can't come soon enough.
Ah, I so miss being at ease and good at what I do. People used to think this about ME as I stabilized and packaged multiple gunshot wounds, did CPR on heart attacks, and dragged myself half-asleep to put out car fires. Now I get excited about drawing blood. "Someday" can't come soon enough.
May 12, 2009
Unplanned
Just as we were sitting down to morning rounds to discuss our patients' treatment plans for the day, the traumas started rolling in. With five back to back, it was crazy - kind of like you see on TV, in fact. The most critical of the five was a girl in her early twenties, hit on the freeway during the morning commute. She had been extricated from her car by the FD and was unresponsive but with a pulse and breathing. All sorts of stuff was done to stabilize her cardiovascular system. Once it was stable she was taken for scans and tests, but she deteriorated again into unstable condition, so they finally decided to do an exploratory laparotomy. Basically, they sliced her open virtually from neck to pubis, a good 2-foot incision, and just started looking around for the source of bleeding. They found it - it was her spleen - and at the end of the day, she had: half her hair shaved off presumably to put a tube in her head to relieve the swelling or bleeding of her brain, a collapsed lung, a shredded spleen, 12 units of blood, a shattered pelvis, and major abdominal surgery. And no one knew who she was, so no one could contact her family.
The humane thought: I'm sure she didn't mean for this to happen when she woke up today. I hope they figure out who she is soon and call her family.
The med student insight: this must be the satisfaction of surgery, to see a patient from crash to fix, the beginning to end. But I still like being in the ER more than the OR.
The cynical side note: do not worry whether you wore clean underwear or not when you crash your car. We really don't care or look when we cut them off, and you probably will have peed or pooped in them by the time you get to us anyway.
The humane thought: I'm sure she didn't mean for this to happen when she woke up today. I hope they figure out who she is soon and call her family.
The med student insight: this must be the satisfaction of surgery, to see a patient from crash to fix, the beginning to end. But I still like being in the ER more than the OR.
The cynical side note: do not worry whether you wore clean underwear or not when you crash your car. We really don't care or look when we cut them off, and you probably will have peed or pooped in them by the time you get to us anyway.
May 10, 2009
Sad and Happy
We had a sad case today and a happy one.
A 17 year old kid was brought in after hanging himself because he wasn't getting along with his girlfriend and his mom. His mom found him on the floor of his closet, unconscious, because the belt broke. She of course followed the ambulance to the hospital, but he had regained consciousness by that time and was insisting he didn't want to see her. Some mother's day.
In another case, we had a post-operative guy (I'm on the surgery rotation now, on the trauma surgery team) whose pneumonia I found. So now we can treat it early before it turns into something really bad. The team gave me kudos, which was unexpected, as they usually just ignore the med students. I also get to do some things now that is not in the paramedic scope of practice. I got an arterial blood gas out of someone's groin and took out a chest tube, and helped staple a stabbing victim back up.
Paradoxically, I'm feeling better so far on surgery than I was on pediatrics. I say paradoxically, because peds is supposed to be all nice and fluffy and warm, and surgery is supposed to be harsh and unpleasant. The only hard part for me is waking up at the crack of dawn... I will never get used to that!
Well, Happy Mother's Day to my mommy and all the other mommies out there! May your children never bring you pain like the sad case today.
A 17 year old kid was brought in after hanging himself because he wasn't getting along with his girlfriend and his mom. His mom found him on the floor of his closet, unconscious, because the belt broke. She of course followed the ambulance to the hospital, but he had regained consciousness by that time and was insisting he didn't want to see her. Some mother's day.
In another case, we had a post-operative guy (I'm on the surgery rotation now, on the trauma surgery team) whose pneumonia I found. So now we can treat it early before it turns into something really bad. The team gave me kudos, which was unexpected, as they usually just ignore the med students. I also get to do some things now that is not in the paramedic scope of practice. I got an arterial blood gas out of someone's groin and took out a chest tube, and helped staple a stabbing victim back up.
Paradoxically, I'm feeling better so far on surgery than I was on pediatrics. I say paradoxically, because peds is supposed to be all nice and fluffy and warm, and surgery is supposed to be harsh and unpleasant. The only hard part for me is waking up at the crack of dawn... I will never get used to that!
Well, Happy Mother's Day to my mommy and all the other mommies out there! May your children never bring you pain like the sad case today.
April 26, 2009
Phoenix
What does it mean to have self-esteem? Parents think their children having enough of it will prevent them from doing stupid things to mess up their lives. Books are written on how to acquire or nuture it. But what is it, really? Who has it? What happens when you wake up and realize you don't have much of it?
Medical school is designed, much like fire academy, to show you your lowly place. That you know nothing, or that the work you do is so worthless it is always repeated by someone else. There is a never-ending parade of exams, all orchestrated to assess how much you don't know. Rounds are structured so that people ask you questions you can't answer, or they ask you harder or more questions until you can't answer, then they provide the answer to show you that you don't know enough. Occasionally you get lucky and get it right, but usually the question is set up so the asker can deliver the answer, like a joke. And virtually without exception, your intellectual emasculation is in the presence of witnesses. There's a name for this: pimping. Rotations are scheduled so that every month or two weeks you are sent to a different hospital or neighborhood clinic - sometimes every day for two weeks - with different people, hospital hallways, security codes, computer systems, equipment, storage, forms, at times you even have to switch your brain over to the predominant language of the new locale. Even the antibiotics used for an infection with the same bacteria might have different resistances depending on the institution or geographical area you are in, so you could find that what you knew last Friday at Hospital A is the wrong answer on Monday at Hospital B. Or that what works for adults, due to whatever random biochemical reason, doesn't work for kids. I want to shout, same species! same species! all the time.
If you can imagine changing jobs every month or two weeks and having to learn a whole new set of skills under pimping supervisors who you can't tell where to go, you are on your way to imagining a med student's life. To add insult to injury, you are paying for the uplifting experience of being everyone's bitch. Or maybe someone else is paying for it, be it your spouse or your family or the bank, then you are not only everyone's bitch who pays to be mistreated, you are also everyone's bitch who goes into debt to be mistreated. That certainly doesn't bolster confidence in your own intelligence. Even the fire academy was only for three months, and I was paid $10/hr for my daily beatings. It is a wonder to me that medical students ever smile.
Medical school is designed, much like fire academy, to show you your lowly place. That you know nothing, or that the work you do is so worthless it is always repeated by someone else. There is a never-ending parade of exams, all orchestrated to assess how much you don't know. Rounds are structured so that people ask you questions you can't answer, or they ask you harder or more questions until you can't answer, then they provide the answer to show you that you don't know enough. Occasionally you get lucky and get it right, but usually the question is set up so the asker can deliver the answer, like a joke. And virtually without exception, your intellectual emasculation is in the presence of witnesses. There's a name for this: pimping. Rotations are scheduled so that every month or two weeks you are sent to a different hospital or neighborhood clinic - sometimes every day for two weeks - with different people, hospital hallways, security codes, computer systems, equipment, storage, forms, at times you even have to switch your brain over to the predominant language of the new locale. Even the antibiotics used for an infection with the same bacteria might have different resistances depending on the institution or geographical area you are in, so you could find that what you knew last Friday at Hospital A is the wrong answer on Monday at Hospital B. Or that what works for adults, due to whatever random biochemical reason, doesn't work for kids. I want to shout, same species! same species! all the time.
If you can imagine changing jobs every month or two weeks and having to learn a whole new set of skills under pimping supervisors who you can't tell where to go, you are on your way to imagining a med student's life. To add insult to injury, you are paying for the uplifting experience of being everyone's bitch. Or maybe someone else is paying for it, be it your spouse or your family or the bank, then you are not only everyone's bitch who pays to be mistreated, you are also everyone's bitch who goes into debt to be mistreated. That certainly doesn't bolster confidence in your own intelligence. Even the fire academy was only for three months, and I was paid $10/hr for my daily beatings. It is a wonder to me that medical students ever smile.
Some of us have incredibly supportive, nurturing, caring significant others who don't take advantage of our state of constant humiliation to make us feel worse. Others maybe have friends or family outside of medicine who can provide perspective that outside life isn't quite as punishing - it may be to some degree, but not at the steady pace of Chinese water torture as in medicine. And then there are those whose inner Phoenix gives them strength from within, that reminds them that they are intelligent, accomplished, rational, sensitive, caring, and good. That the mental torture may be pretty bad at times, but can be survived as long as one doesn't lose the broader sense of one's self.
Maybe self-esteem is really a little firey bird in your soul that rises out of the ashes of your emotional beatings to remind you who you really are, when you are led to doubt your own perceptions of yourself.
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