ndab Ah Yes, Medical School: September 2005

Friday, September 30, 2005

Thanks For The Memories

Having just completed a painful series of written and practical exams that mark the end of my surgery rotation, I would like to take a moment and reflect on what these last three months have meant to me. The passionate learning. The racing heartbeats in the OR. The patients whos lives I have impacted forever. Curing afflictions with the stroke of a scalpal. Noting the look of joy, happiness, and, dare I say it, freedom evident in patients suddenly free of the burden of their disease. Yes, ladies and gentlemen, there is so much to look back on, so much to absorb, so much to ponder about the state of the universe as it relates to the slick blade of emancipation, slicing away at the layers of fat, fascia, muscle, and bone to reach their ultimate desti-

Ah, fuck this. I'm getting wasted. Pray for my liver, and I promise I'll have something profound to say soon.

Tuesday, September 20, 2005

Tits & Ass

Now that I have your attention, I'd like to discuss a side of surgery that often goes unnoticed, but as I have recently discovered, takes up a big chunk of time on a surgery rotation. (Don't worry, T&A will actually be discussed shortly. Pervert.) No, I don't mean OR time, hospital wards time, or even, dare I say it, Hammer Time. Sorry, that was terrible. I'm referring to clinic time, that endless struggle where general internists are banished for eternity but surgeons only visit intermittently, where patients file in and out of exam rooms (often utterly clueless as to why they are there, which I find utterly mind-blowing...more on this some other time) to be thoroughly examined, considered for potential surgery, or checked post-operatively to make sure everything has gone as planned.

However, as I have quickly learned, not all clinics are created equal. For example, my general surgery rotation consists of many specific types of clinics, each with its own character, flavor, and uniquely horrific odor. There's vascular clinic (gangrenous foot odor), pre-op clinic (straight poo), general surgery clinic (a pouperri of rectal abscess with colostomy bag undigested poo), and so on. Today consisted of eight solid hours of two very special clinics, so special that I wanted to devote a little time to each and share what I have learned:

Proctology Clinic

Yes, there really is a clinic with this name, and yes, I have to be there. Having previously examined the role the rectum has played in my life (both here and there), I would instead like to share some of the pathology I have discovered in this delightful clinic, which, if nothing else, should at least convince some of you pre-meds out there that there are better ways to spend your life instead of being, quite literally, elbow-deep in shit. To begin, I should point out that if doing digital rectal exams (DREs) were all this clinic was about, it wouldn't be that big a deal. After all, I've developed so much as a fake doctor over the last two months that, when confronted by another medical student on my team who was in disbelief that I had gone and done a DRE on the first patient I saw without any initial suggestion by a superior to do so, I responded, quite poetically, "Ya dude, you just gotta jump right in, embrace the anus." Surely, these are words to live by. I even said that with a straight face. ("Embrace The Anus" t-shirts anyone?)

Anyways, proctology clinic is far more painful than that, because this clinic is concerned less with what's deep inside the butthole (colon, prostate, etc.) than with what is immediately inside and outside the anus (hemorrhoids, abscesses, fistulas, fissures, leprechauns, spare change, and banana residue). To top things off, in order to examine this area more completely than with visual and tactile inspection alone, some twisted genuis has developed the anoscope (I'm not sure what's funnier/more pathetic: this website, the fact that this and not any real medical site was the only place where I could find a picture of this real medical device, or the fact that my mom is going to freak when she finds out I've been frequenting anal fetish websites...Hi Mom!). This device allows the trained medical professional to not only see all of the lovely anal ridges, folds, and associated pathology in and around the rectum, but also allows us to visualize what you ate for dinner yesterday, the brand of corn you bought at Safeway last week, and, for some patients who make their way through this clinic, your current condom preferences. Needless to say, in proctology clinic time flies by faster than you can say "Did he really stick a gerbil up there?". In fact, the only thing more fun than getting to do anoscopies five times this morning was getting to do a final one on a woman with a rectal prolapse, meaning the inside of her ass had fallen out and was literally hanging on the outside. (Note: the link for the rectal prolapse is to a picture that is not for the faint of heart...that is, if you're a pussy.) And that's about all I have to say about that.

Breast Clinic

In this clinic, I have not only learned a vast amount about breast pathology (what, you were expecting me to say someting like "I JUST TOUCHED SOME TITTIES!"? I guess it's not that much of a stretch.), I have also learned a valuable lesson about lowering one's expectations whenever possible. While there is nothing inherently sexual about any medical or clinical exam (while I cannot remember which post this is in, I know I have previously commented on the nature of this idea as it relates to the pelvic exam), I'm not going to pretend that me or any other guy sent to work at a breast clinic isn't always hoping and praying that the next patient who walks in the exam room has breasts that resemble the breasts attached to Lindsay Lohan (ok, well, at least before she became anorexic) much more so than the breasts attached to her great-grandmother Mildred. Shockingly, this dream has yet to be realized. However, I have had the chance to examine many an older woman's breasts in this clinic and have come to a conclusion that will startle and disappoint Breast Men* everywhere, even potentially shaking this nation's moral fabric and the foundation of years of marketing research: Massive breasts may not be as spectacular as they are currently valued to be in today's society**.

OK, Breast Men, breath.

So why is that? Well, the obvious answer, one universally known, is gravity***. I've already had the pleasure of examining some older large chested women whose breasts are closer to their knees than their feet are, and let me tell you, no bra, stool, or forklift will make those things get to where they are supposed to be.

Yet, a more important second factor comes into play, one that may not be initially obvious to the amateur breast inspector. What you may not know is that, at least for county hospital patients who have often not been informed of the latest breakthroughs in personal hygiene, the bigger the breast, the bigger the fold between breast and abdomen, which means the more potential space there is for any number of foreign objects, bacteria, mold, or any other atrocious thing to fester in between this area for days, months, and even years at a time. You think I'm joking? You are mistaken, my friend, because I bear witness to many of the horrors I have just described, and let me tell you, it ain't pretty. Does this mean that smaller breasts are better than bigger breasts, going against conventional wisdom and pornographic standards that reach back decades, if not millenia? Tough question, one that I'd feel more comfortable opening up for comments rather than deciding on my own. Also, given my current boob-free status, I'm not about to alienate any ladies out there who haven't already been offended by the nonense I write here and suggest a personal preference one way or the other. I'll only add that when it comes down to it, boobs...umm...boobs are boobs.

Please feel free to take a moment to digest this intellectually complex postulate.

While I am tempted to end this post with that profound statement, I feel obligated to mention that in both these clinics, we can do a lot of things to really help people with their problems, however small they may appear to those of us used to doing (or, in my case, observing from afar) complex surgeries involving life and death. I'm talking about quality of life problems that may not seem as fancy as open-heart surgery, but if you've ever had these problems, they can be very big to you: reassuring women that the breast masses they feel are absolutely not cancer, removing irritating hemorrhoids, and so on. Blah blah blah helping people blah blah whatever. You get the picture.

I think I've rambled on enough, but I hope you enjoyed this glimpse into the world of the surgical clinic. Feel free to resume your lives, your breast hygeine, and your self-exploration with the extra long, rigid anoscope you just ordered from ExtremeRestraints.com.

*It is a universal truth that all men can be classified into one of three groups: Breast Man, Ass Man, or Legs Man. This is a fact. The only other acceptable category known to prowl the wild and select bars is I'll Take What I Can Get Man. And, I'm sorry, but you guys out there who claim to be Eyes Man ("The most important physical feature I look for in a woman are definitely her eyes.")...stop lying already. Nobody believes you.

**Of course, this assumes you plan on spending more than one night with these breasts, like in some sort of longterm relationship, or at least a few casual hookups spread out over the course of some amount of years. This may not apply to some or all of you, but as someone who does not adhere to the one-night-only school of relationships, I regretfully suggest that this applies to me. Excuse me for a moment while I reconsider my values.

***Actually, I have nothing worth adding here. I just don't remember ever seeing a triple star footnote marker anywhere before, and I thought I'd be a trendsetter. But if you're interested in learning more about gravity as it relates to breasts, or other obscure breast topics, I highly recommend this public service announcement.

Sunday, September 18, 2005

Where's The Love?

During the process of pre-rounding and recording vitals for sixteen (yes, sixteen) of our team's patients yesterday morning (what, you have something better to do between 5 AM and 6:30 AM on a Saturday after having been up the whole night?), I found myself incredibly frustrated trying to decipher what the nurses had written in the chart over the course of the last 24 hours. 300 cc urine at 4AM, with the 3 crossed out, a 0 added in front, a 2.7 thrown in the middle, and a drop of espresso covering the remainder of the corrections. Unreadable abbreviations for things that make no sense, like BRP X F (I know the BRP is for "bathroom privileges", but that's about it) and JPDNC (not even going to try with that one). Of course, this is ignoring all of the times where there is absolutely nothing recorded for an entire shift (no BP, no pulse, no ins/outs...nada), leaving me with nothing to report when we round. This then leads to the chief checking the chart during rounds and often finding vitals recorded at "5:30AM", with a full set of vitals that has miraculously appeared during a time vortex somewhere between 5:30 and 7:00 AM that allowed the nurse to travel back through time, take the vitals, record them, and return just in time to watch me look like a total idiot in front of everyone.

Add to this the frustration of being screamed at by scrub nurses for the cursed sin of taking up space, being given attitude for going so far as to ask a nurse how a patient was doing, and being accused by one nurse of being a prank caller when I asked about one patient's antibiotics over the local phone system from a floor below ("How do I really know you are a medical student and not some prank caller?" I mean, c'mon now, if that's what prank calling has actually come to these days, Haywood Jablomie and Mike Rotch must be rolling in their graves), and it's pretty clear that my introduction to the doctor-nurse divide has not been that smooth.

Of course, if this was just a one-sided battle, I would be ignoring half of the truth. Let's put aside for a moment the fact that the previous sentence, if you really starting thinking about it, makes no sense at all. From what I have observed regarding the nursing perspective (and to any nurses out there, please feel free to chime in with stories of your own), it goes without saying that they put up with a serious wad of shit on a daily basis, and not just from patients code brown-ing* all over the place. They have to deal with doctors barking orders at them all the time, demanding instant gratification of said orders, and then getting upset half the time if the nurses do the orders written down because the doctor had since changed his or her mind and was expecting the nurse to read minds and change the plan accordingly. There's surgeons who tell the scrub nurse to do five different things at the same time, and then ask why nothing is ready to go that second. Between ward time and OR time, I've seen plenty of doctors scream at nurses on a daily basis in a horrific condescending tone, with one doctor getting so infuriated with a nurse over something that was not even her fault he called up the administration people and demanded that she be fired on the spot. Ouch.

A downward spiral has been created, with doctors hating nurses and nurses hating doctors. Doctors start screaming at nurses automatically, and nurses respond by not even doing what the doctors order until the last possible second for no reason other than pure, unadulterated spite. Doctors telling me about how nurses are "all a bunch of lazy fat cows, those damn cows." (Yes, that exact analogy has been used on multiple occasions). Nurses confiding in me that "the chief resident is the most awful human being I have ever met." And so on, and so forth. It has become evident to me over the past few months that, going against all those classic porn movies I was brought up on that invoked the sacred and genuine love between doctors and nurses, there is actually a lot of animosity between these two parts of the medical establishment.

So the question remains, how to remedy this situation, this tussle, this eternal struggle between two war-torn factions eager to tear each other apart limb from limb? This is a tough question, because it seems as if a distance has developed between these two groups, and there is simply not enough communication going on. This is compounded by a lack of continuinty, as doctors and nurses do not even know each other most of the time because the teams and shifts change so often.

Given the demands of modern health care delivery and this need to constantly change things up, how can we as professionals tear down this metaphorical wall of hatred as efficiently as possible? The answer, my friends, is quite simple. What we need to do is just collectively get over ourselves, get over our positions, our responsibilities, and our backgrounds...and have one big, massive, sweaty orgy. Right at the nurses station. In front of all the patients. Lasting as long as possible (which means until one of the many junkie patients calls the nurses desk with a request like "I'm in so much pain, can you please just give me another ten vicodin?"). Look, I'll be willing to overlook the fact that you're very likely to be a morbidly obese Philipino woman in her 50's with more facial hair above your lip than I have on my entire body, if you can ignore the fact that I am probably going to be about as good at pleasing you in bed as I am at collecting the aforementioned patient vitals (i.e. not that good). I think this will go a long way towards helping everyone just relax, do their jobs, and work harmoniously together.

Barring this development, the least we could do is stop pretending like we are fighting each other over all of these rather petty details and territorial concerns, but instead become united around the fact that we share a common enemy, one so vile, so terrible, so fearful, that we must do all we can to protect each other from this creature. Who am I referring to? The patients, of course.

*Much like Code Blue (patient dying) and Code Red (fire in hospital), Code Brown has earned its way into hospital lore by signifying when a patient has managed to crap his or her pants, except since they aren't wearing any pants and are instead wearing a hospital gown with an exposed back, all of the poo gets on the sheets, bed, floor, hallway, and, sometimes, if you're really lucky, your white coat.

Monday, September 12, 2005

Not Quite That Stupid

It has become obvious to me over the past few weeks that you, the lay people, think doctors are complete idiots. That is the only explanation I have for some of lines I've been fed by various patients I have encountered over the last few weeks. Rather than fess up the actual reason(s) why they are in the hospital, many of these patients come up with extravagant lies that are so absurd, you'd have to be a complete and utter moron to believe them. What do I mean by all this? Let me submit these three case studies as examples, with dialogue as closely verbatim to what happened in real life as I can remember, and I’ll let you draw your own conclusions:

Case Study 1:
[Frail, emaciated patient sitting in her hospital bed, bug-eyed and awaiting our help]

Patient: It’s the strangest thing. I just woke up one morning, and I had these two huge spider bites on my arms, one on my left and one on my right. They kept getting bigger and redder, and I guess they got infected, so now I’m here.

[A quick inspection of her arms reveals two quarter-sized lesions on opposite sides of her arm, mirror images of one-another]

Me: So you say you got these two spider bites in the exact same place on each arm at the exact same time?

[Patient begins scratching her neck]

Patient: Yep. Strangest thing, eh doc?

[Toxicology Screen: Positive for cocaine, heroin, etc.]

Me: Ya, I guess there’s some crazy spiders running around LA these days.

Case Study 2:
[Patient in the ER, in an immense amount of pain]

Patient: I don’t know what happened. I was fine and all, and then suddenly I lost my strength and just fell down. I didn’t see it as I was falling, but I guess it was there the whole time. I fell right on it, and it went right through me. I am in a lot of pain, doc. It hurts so bad.

Trauma Team: OK, so we’re going to take a few X-ray’s and get to the bottom of this. Hopefully the pain medications will kick in soon.

[Trauma Team reviews the abdominal X-ray, which reveals an approximately 5-inch long metal object, clearly resembling a nail file, lodged partially in the sigmoid colon and rectum, and partially outside this space. It has perforated the colon.]

Team: Sir, it appears as if you have a nail file stuck in your anus and colon.

Patient [in feigned disbelief]: You mean to tell me I fell on a nail file? And it went through my butt into my colon?

Team: Umm…do you mean to tell us you fell on a nail file and it ended up in your colon?

Case Study 3:
[Patient presents to ER, blunt head trauma, but still conscious, awake, alert, and oriented. A team of medical students is called to evaluate this patient. Time: Approximately 5 AM]

Team: Do you remember what happened?

Patient: Ya, so, I was just setting up a bed, putting the frame together, and something went wrong.

Team: What happened?

Patient: I don't remember how it happened, but the next thing I know, my head is being propelled right into the wall. My head went through the drywall, and it got stuck there. I was just trying to put the bed together for my friend, he just got a new mattress and everything. Oh, man, it hurts so bad.

Team: So let me get this straight: you were putting a bed together at 4 AM?

Patient: Umm…ya so-

[We receive a tap on the shoulder by an ER nurse, who shows us the patient’s original history he gave to the ER doctor, apparently after intensive interrogation:

“Patient was performing a sexual act with his partner involving repeated back flips. Patient did a back flip and accidentally propelled his head into the drywall.”

We leave the patient's bed.]

Right. So anyways, I just thought I’d share these brief tales as a cautionary piece of advice for any of you who might think you can get away with not telling us the real reason why you’re in the hospital. In general, it will be painfully obvious, and your lying to us will only make you look like a bigger idiot. And if you think the doctors don't sit around the doctor lounge telling everyone about the massive deuce you tried to feed them, then you've got another thing coming. And by "another thing" I mean a nail file right up your rectum.

As an aside, if anyone can explain to me how doing backflips while having sex enhances the sexual experience, I’d love to hear it. Then try it out, of course.

Welcome Back, Chandler!

Dating back to that fateful November morning in 10th grade, when a substitute teacher, so flabbergasted by my given name (which is admittedly pretty long, intimidating, and even contains a "Z"), looked up to see what freakshow could possibly have such a name and uttered what would be one of the defining characteristics of my adult life: "Has anyone ever told you that you look a lot like Chandler?", I have had numerous similar experiences in my life*. Many a family member, friend, complete stranger, random W Hotel valet, drunk tourists in Vegas at 3 AM on New Years Eve (I even posed for pictures with them, faking myself as Matthew Perry) has made this similar observation, but it had been at least three to four months since the last random person told me I beared a strange resemblence to the famously neurotic and, until he shacked up with Courtney Cox, potentially ambigously gay sitcom character. However, all that changed today, my first day on my new surgery rotation at a different county hospital on the general surgery team, when after charming a lovely middle-aged Israeli women and her hernia-containing son, she stopped me and said with a thick accent: "Ehhhh...has anyone ever told you you look ehhh exactly like ehhh Chandler?"

Now, you may be thinking to yourself, "Why on Earth doesn't this woman-deprived young man use this celebrity resemblance to his advantage, since there has to be at least some women who find Chandler attractive (at least more so than Ross)?" Well, I'll provide a cautionary tale as to what happens when you try this maneuver and it goes wrong, as it did one fateful Saturday evening at an undergraduate party my sophomore year, and see if you can discern why I have chosen not to pursue this line of female pursuit. My friend wanted to introduce me to some girl at this party, so I saunter up there and introduce myself, after which my friend goes to the girl, "Hey, guess which TV character he looks like!". She looked at me for a moment, became suddenly disinterested, and responded, "Uhh...George Costanza?"

And that, ladies and gentlemen, is getting shot down.

Apologies for the complete lack of medical school-related content in this post - I just felt like sharing.

*That has to be a record for me and run-on sentences.

Friday, September 09, 2005

County Potential

Three patients. Three stories. One consistent path. All roads leading towards the same end-game, each in a different way, but each with a similar final tragedy that has already revealed itself, or will do so very soon more likely than not. As I reflect on my last three weeks on the vascular and trauma surgery teams at one of my school's county hospitals, I would like to set aside my usual mildly humorous ranting and excessive self-parody, and in it’s place write about three patients that affected me deeply, each serving to teach me about what doctors (and society for that matter) really face on a daily basis:

During the first week of my service, our team was called to consult on a four year old female patient who has been sporadically and incompletely treated for childhood leukemia, presenting to the emergency department during a blast crisis at the sickest time, in the most precarious position, and with the least chance for survival. When we saw her, she was in the pediatric ICU, with at least four different tubes running in and out of her, and her mom sitting anxiously at her bedside. She had just survived a crisis with the quick administration of blood pressure drugs, but an unfortunate side effect was that the persistent blood vessel constriction so severely decreased the blood flow to her extremities that her petite legs were darkened up to the knees, her hands darkened to the wrists...

I was assigned to one patient a few days ago, a 17 year old male who ripped apart his radial artery and some of the tendons to his hand after punching through a glass window. When I first met him, he was in the ICU, having been operated on throughout the night to restore and preserve as much hand function as possible. He was mildly sedated, but not so much that I couldn't sit down with him and talk about what had happened. He had a bad day. He could not find his keys to the house. He had to use the restroom extremely badly. So what happened next? I punched through the window. After being transferred to a regular bed and being reunited with his family and girlfriend, this patient became a lot more animated, now proudly displaying a beaming smile plastered across his face, much more glimmering than the soft cast plastered across his arm. He could not move his thumb, he could not sense touch on his thumb or first finger, but with the attention he was receiving, he hardly noticed...

The ER bell rang and a cacophony of pagers went off. "GSW [Gun shot wound] times two to the back, times one to the neck." An urgent trauma was on its way, and the trauma team and its adopted medical students for that night's call began preparing the tools necessary to resuscitate this patient. Then came the next message. "ETA [Estimated time of arrival] 15 minutes." 15 minutes? The man had been "found" on the street after a supposed gang altercation, brought to our trauma center because the previously closest center to him had been shut down recently due to cost concerns. After that second message sprayed through the room, everyone's tension level decreased. No chance. No stress about messing up the opportunity to save someone’s life, because this life had already passed. About 15 minutes later, he finally arrived, and the standard resuscitation procedures ensued. Chest compressions, breathing, two attempts to shock the heart. The attending physician pointed out to us the abrasions all over this man's legs, indicating that he had likely been run over by a car multiple times. This man's blood started pooling on the floor of the ER, seeping out his back while a nurse frantically pushed on his heart, one beat at a time...

After examining the extremities on the four year old with leukemia, the attending physician looked at us, then said rather bluntly, "It's all coming off." Auto-amputation. This child's legs, blackened by an acute case of severe lack of blood flow, were becoming necrotic. Her body would soon recognize this process and wall off the dead tissue over the course of the next few weeks, culminating in this poor child’s extremities literally falling off, without the aid of any knife, scalpel, or blunt object. This child, sedated and unaware of her fate, slept peacefully in her bed. Her mother, upon hearing the news, looked out the window and cried, too ashamed and afraid to look any of us in the eye while the tears rolled quickly across her tired eyes, knowing full well that had she been able to take her sick daughter to the hospital more frequently, more urgently, this fate might have been prevented. The attending walked out of the room, and our chief resident instructed us to clean the dead legs and arms still attached to her body and bandage these wounds as if there was still a fighting chance for their survival. What choice did we have? What chance does a leukemic child with no legs have? We carried out these orders, more for our own peace of mind than for the patient or her mother.

The next day, I went to sit down with my window-breaking friend one more time. Except when I walked in, I found his girlfriend in bed with him. They were cuddling. I apologized for the intrusion, but explained that I needed to do a quick exam as part of my daily routine. While doing the exam, I asked this 17 year old what he was planning on doing with himself. Finishing high school? Plans for college? Any ideas to avoid punching out windows in frustration again? None. He had everything he needed: his friends, his girl, his right hand in due time. Discharged that afternoon, he was back on the street that evening.

20 years old and three bullets to the back and neck. It didn’t take long before the attending physician waved his hand in a back and forth motion across his own neck. This man was dead. Likely dead on arrival, surely dead shortly thereafter, and absolutely the first person I have ever witnessed die right before my eyes. However, it was his eyes that struck me most – his eyelids were still open and I could see for the first time that glazed look of death, with one eye rolled in one direction, the other pointed in a completely different direction, and neither with any purpose whatsoever. The doctors quickly scrubbed out and moved on to see the next potential surgical patient in the ER, but I stayed to watch as the nurses carefully removed the tubes forced through this man’s body in an attempt to save his life just minutes before. They then took off the blood-soaked sheet under him and replaced it with a clean white sheet, which they draped over his body and face before wheeling him out of the ER and into a storage room. Unidentified upon arrival, he was just another pulseless John Doe, lying forever peacefully while waiting for a tearful family to discover him one last time.

Three weeks at a county hospital on a surgical rotation and I can finally say that I have received my first taste of what real life medicine is all about. There have been plenty of funny moments, some that would be more than appropriate to share in this forum. There have been some truly touching moments for me personally, as I have followed some patients from surgery to complete recovery. But thinking about these last three weeks, I could not shake the lasting impression these three patients made on me, because each was young, and each came to the hospital in a state that would have been totally preventable had the circumstances of their lives that led them to this point been even slightly different. Instead, their potential was cut short, or would most likely lead them down a shortened path in due time.

So many people think that medical professionals have a simple goal to make people who are sick become healthy again, but as I am just beginning to appreciate, it is far more complicated than that. How do you change someone who shows up almost literally on a deathbead, having never seeked out medical care before, with no means or access to any basic health care in the past? Where does one’s own potential, developed from years of upbringing in a certain environment, around certain people, and with certain predispositions, come into play, regardless of any intervention the best doctors in the world could come up with? I am not going to pretend that I have any clue what the answers to these questions are, and I am not even convinced I am asking any or all of the right questions in the first place. Perhaps it is a complete lack of sleep that has taxed my brain in this way and led to this rambling of a post, but I find that I can only sit here and vent my frustrations about what I have seen, that I cannot even go to sleep in spite of my exhaustion until I get my anger out in words.

As it stands, I can only hope that in a public health care system so obviously set up for failure, there are enough successes to make us feel good enough to continue treating these patients and get through the day. That there are enough treatable patients to make us feel like we are actually helping people reach their full potential.

Saturday, September 03, 2005


Before I plunge into a glorious sleep known as the post-call nap, I thought I'd share an anecdote from what I saw last night taking trauma call. Now, one of my goals during my surgery rotation was to take a night call shift during a weekend night (i.e. Friday or Saturday) to see what kind of crazy stuff goes down at an urban trauma center in a county hospital. I imagined all sorts of chaos, including hordes of patients, cops following patients to the floor, and drunk patients assaulting anyone who might be in the way. It turns out, however, that things aren't really that exciting, and that 'er' is a rather grand overdramatization of the chaos that occurs in the ER at your average hopsital.

That said, if you are lucky, you still get to see things that a select few will ever get to witness, things that are so undescribeably awful that no words really do them justice, other than to say that it must really suck to be the guy that shows up the ER with that. What do I mean by all this? Let me put it this way: there are a select few phrases that will absolutely strike fear, horror, and despair into the hearts of all men all across the world. Samples include "I'm pregnant", "I want to cuddle", and the classic "I didn't know it could be that small." I would like to submit another phrase, one that was annouced in the ER doctor's waiting area (where the ER docs, trauma surgeons, and lowly medical students await incoming victims) last night while I was on call, to this glorious list:

"Gunshot wound, right scrotum."

I'll let you digest that for a second.

Basically, there are no words to describe the sight of a man being wheeled into the ER, initially calm, on pain medications, and totally unaware of the ball-bleeding occuring under the sheets the EMTs placed over his wound, right at that moment when he is placed on the bed, the sheets are removed, and we all see the perforated scrotum and the bleeding that has ensued. Rather than wax philosophical on this now (frankly, I couldn't do this topic justice in my totally sleep-deprived anyways), I'll just say that, as a fellow ball-possessing individual, it was one of the more painful things I think I could ever witness. I regret that I could not follow what happened with him (he was admitted to another service), but I hope you all have learned a valuable lesson from this: Don't get shot in the nuts.