General Surgery: Monday Call (MLK)

After two glorious days off, it was back to JPS on Monday morning. BR pointed out that it was also MLK Day, and commented on how sad it would be if a fight broke out between blacks and whites today. I certainly hoped that wouldn't be the case. The morning started out with a lap chole, and once again I got to hold the camera. I think I'm getting better at it =) The second surgery was a twofer: an umbilical hernia repair and a lap chole. BB got called away to do a colonoscopy ("Great, I have to leave surgery to look up someone's ass") so JB told me that I might get to do actual surgery now. My job: poke a needle through the mesh in the abdomen and help sew it back into place. I got the needle in on the first try and got excited to do more; JB noticed and said, "You looked like you were about to yank that needle from me there, that's good!" He must be glad I'm being more proactive. We get free lunches from drug reps in the surgery offices, but today's lunch was probably the nastiest take-out Chinese I've ever had. The ice tea itself tasted like there was algae in it; talk about gross. After that there was another incisional hernia repair (a woman went to Mexico for lipo and ended up with a hernia; there was even HAIR in the hernia from the surgeon in Mexico) and an ileostomy removal. Fortunately we went to dinner after that b/c I was getting really hungry. JB, BR, and I sat down briefly for dinner when the trauma pager went off.

The trauma: 81-year-old female fell backwards and hit her head. Because it was a non-operative trauma, JB sent BR to see what was going on, so JB and I got to finish our dinner. It was a sad case; the woman's brain was bleeding so badly that the midline of her brain had shifted over about 2 cm and was herniating into the brainstem as well. JB called her son and his wife and explained to them (in the dreaded private talk room) that his mother was essentially brain dead. Her son asked many questions and asked for a repeat CT, saying that his mother didn't have a DNR and he wanted to give her until morning to see how she fares. I watched JB and BR testing her cranial nerves; she had no gag reflex, and when her eyes were lightly poked with a cotton swab, she didn't blink (but she did have tears form). Later, during the night, she would regain her gag reflex and would spontaneously move her legs, but those were not purposeful movements. In the long run, the outcome will not change.

BB was doing a surgery and needed help, so JB sent me ("the med student") to the OR to see what could be done. It turns out RB had admitted a patient complaining of a recently incarcerated inguinal hernia that had been there for eight years, and it was so huge that BB and the attending ("Mac") were having trouble finding the hernia sac and other cord structures. It was possibly the worst hernia BB had ever seen; even Mac said it was ugly. When they finally found the sac and sliced it open, a huge amount of small bowel tumbled out (at least 2 feet) BB and Mac had to struggle to shove all that bowel back through the incision into the abdomen, but since it'd been hanging out for 8 years it kept coming back. Stubborn piece of bowel. In the middle of the surgery, the trauma pager went off three times in the span of 30 min, with the 1st two close together. The first: GSW to the head, GCS (Glasgow coma scale) 5 /15. The second: GSW to the head, GCS 15/15 (lucky). The third came thirty minutes later: GSW to chest and buttocks. Mac stuck around for the hard parts of fixing the hernia (they had to find a way to recreate the floor and isolate the hernia sac) before joining JB, BR, and RB in the ER; that left BB and me to sew up the hernia. We didn't finish until close to 10:30 pm.

Sadly, the shooting incident in the ER was racially motivated; some white guy randomly went to a predominately-black apartment complex and started shooting, hurting a young couple (the first two victims) in the process. Somehow that same white guy got shot too (the third victim), but his wounds were superficial as crap so the police were waiting to take him to jail. The boyfriend had the 15/15 GCS so he was all right, but the girlfriend (she was only 19) was not in good shape. The bullet had fragmented into many little pieces across her brain, and she, too, was almost brain dead. Around midnight, her family members started coming to the ICU, some refusing to enter the room, others leaving in tears. It was hard to watch. No parent wants to see their child on the verge of death in a hospital bed, especially when the reason for it was because someone wanted to commit a senseless crime. At 1:00 a.m. RB told me to get some rest; there was nothing else I could do but watch.

I slept until 6 a.m. (I had a roommate, a 4th year doing her ICU rotation; she snored a little so it was hard to fall asleep) and then got up to round on patients. Somewhere on the 3rd floor, I saw Blakely's medicine team, and her attending mentioned BR's name and something about how "interns have no right to talk that way." I wondered what the heck BR did to piss someone off this time (JB nicknamed him "Road Rage BR" for a reason), and I was alarmed when the medicine attending said he planned to write a note in BR's file which could possibly affect his prospects of finding a job after residency. Later I asked RB what happened, and he said apparently BR took a patient's file from the attending's stack without permission, and when the attending said he was still using that file, BR had replied something along the lines of, "So what?" *sigh* You just don't do that. A great deal of medicine is about being respectful to those above you. This morning JB told me, "Call me J!" when I called him Dr. B, and I had replied, "I can't do that." Mac (the attending), who was nearby, had said, "That's right." Likewise, BR has said I could call him by his first name, and RB is only two years older than me, but I still call them Dr. The gap between a med student and an intern is still pretty broad.