A middle-aged chronic ethanol-abuser (alcoholic, for you folks at home) came in after a nasty fall. He was wheeled in as he couldn't stand, and his knee, elbow and ankle were swollen beyond belief. He got x-rays of all three joints, which I took to my consultant (boss).
"Boss, I can see a definite fracture in the ankle, maybe a fracture in the elbow and the knee is intact..."
"Yes, the knee is intact, there IS a fracture in the elbow, but... I don't know about the ankle. I think what you're seeing is an old fracture."
O, but I was sure. I argued my point, demonstrating the interrupted cortical bone, the exquisite tenderness of the medial malleolus, the massive swelling of the ankle.
Finally, my boss agreed, and I put the man in a plaster from knee to toe.
He also needed a sling, which meant he couldn't use crutches, and so we had to admit him so we could keep him safe. (Alcoholics are not very well people, and definitely not good using one crutch with two broken limbs). Admitting him meant I had to I call the Orthopaedic surgeon to let him know about the broken boned patient.
Let's call him Bruce.
"G'day, Bruce here, I've had a squiz at the X-ray and there's no new fracture. It's an old fracture."
"But, we're admitting him to hospital..."
"Nah, he's fine. He can go with a walking boot."
"But...I already put him in a plaster!"
...silence....
"Are you one of the new interns?"
"Er. Yessir."
Hysterical laughter down the line.
"Look, love. Take the plaster off, find him a boot, send him home. He's not coming into hospital"
The only upside was that my patient had serious DT's by now and really wanted to go home, where he could drink in peace. I cut the plaster off, found him a boot and sent him home.
Another fine day for intern medicine.
Friday, January 29, 2010
Tuesday, January 26, 2010
rite of passage
I stand over the ironing board, steam curling up into my eyes. I am thinking about yesterdays shift. Specifically, the moment when the nurse taking an ECG on my patient said, "He's in VT."
I have been trained for this scenario over and over. Vincent, our state-of-the-art mechanical patient, goes into VT all the time. I know what to do when Vincent goes into VT.
Call for help.
Oxygen on.
2 large IV access points established, fast.
Paddles on.
Read the rhythm again. Still VT? Shock.
etc etc
When Mr Smith went into VT, I froze. Luckily, no one else did. The nurses around me flew into action like the proverbial well-oiled machine. Within minutes lines were in, aspirin given, oxygen on, the paddles were tracking his heart and we watched as he flipped from runs of VT to bradycardia...
It was my first real emergency. Next time, I'm hoping to actually participate in the code. By my 25th time, I'm hoping it will feel natural.
As the steam rises up and I burn my shirt, I am re-living that sick feeling of panic. I no longer have nightmares about ex-boyfriends. One week in the ED brings a whole new set of nightmares.
That said, I have a beautiful new bed in which to have said nightmares, so being a working Doc isn't all bad. More tales to follow - ask me about the chick on LSD.
I have been trained for this scenario over and over. Vincent, our state-of-the-art mechanical patient, goes into VT all the time. I know what to do when Vincent goes into VT.
Call for help.
Oxygen on.
2 large IV access points established, fast.
Paddles on.
Read the rhythm again. Still VT? Shock.
etc etc
When Mr Smith went into VT, I froze. Luckily, no one else did. The nurses around me flew into action like the proverbial well-oiled machine. Within minutes lines were in, aspirin given, oxygen on, the paddles were tracking his heart and we watched as he flipped from runs of VT to bradycardia...
It was my first real emergency. Next time, I'm hoping to actually participate in the code. By my 25th time, I'm hoping it will feel natural.
As the steam rises up and I burn my shirt, I am re-living that sick feeling of panic. I no longer have nightmares about ex-boyfriends. One week in the ED brings a whole new set of nightmares.
That said, I have a beautiful new bed in which to have said nightmares, so being a working Doc isn't all bad. More tales to follow - ask me about the chick on LSD.
Wednesday, January 20, 2010
What I did wrong (today)...
I have just completed my first week of intern medicine.
I can't really differentiate one day from another, as there was a great deal of panic (is this a heart attack or gas?) and terror (so much bleeding!) and moments of utter elation (drip in! catheter in!). But so far, I've survived.
On this, my first day off, I woke up really early. In fact, I rose from my bed in half-sleeping panic, reaching for my phone, the words pouring from my mouth; "I didn't give him any antibiotics!!!"
Yesterday I saw a nice young man who works as a stone cutter. He was using an angle-grinder to hew some marble, and some of the dust flew up into his eyes. He used one hand to wipe his eyes and the grinder got away from him.
Into his thigh. Very, very deep into his thigh. Luckily, the grinder was hot and cauterized the wound, otherwise he could have bled to death. As it was, I could see deep into his leg and admire the many layers of muscle, fat and...is that a tendon?
He needed a surgeon. I called the surgeon. He said, "I'll be there soon, give him some morphine, call the registrar, set up A, B and C. And give him some cephazolin IV."
No worries, right? But I got called to look at my other patient's ECG which was showing changes that could have been a heart attack and...
Long story short, I forgot to give the antis.
In the end, after several heart-wrenching phone calls (your fellow interns are your greatest resource) I figured out that the surgeon had picked this up when he'd done the stitching and given the ceph. But for a good hour I was convinced that I'd killed a man with my stupidity.
That's why days off are better.
I can't really differentiate one day from another, as there was a great deal of panic (is this a heart attack or gas?) and terror (so much bleeding!) and moments of utter elation (drip in! catheter in!). But so far, I've survived.
On this, my first day off, I woke up really early. In fact, I rose from my bed in half-sleeping panic, reaching for my phone, the words pouring from my mouth; "I didn't give him any antibiotics!!!"
Yesterday I saw a nice young man who works as a stone cutter. He was using an angle-grinder to hew some marble, and some of the dust flew up into his eyes. He used one hand to wipe his eyes and the grinder got away from him.
Into his thigh. Very, very deep into his thigh. Luckily, the grinder was hot and cauterized the wound, otherwise he could have bled to death. As it was, I could see deep into his leg and admire the many layers of muscle, fat and...is that a tendon?
He needed a surgeon. I called the surgeon. He said, "I'll be there soon, give him some morphine, call the registrar, set up A, B and C. And give him some cephazolin IV."
No worries, right? But I got called to look at my other patient's ECG which was showing changes that could have been a heart attack and...
Long story short, I forgot to give the antis.
In the end, after several heart-wrenching phone calls (your fellow interns are your greatest resource) I figured out that the surgeon had picked this up when he'd done the stitching and given the ceph. But for a good hour I was convinced that I'd killed a man with my stupidity.
That's why days off are better.
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