My first and last trauma at JPS

Throughout third year of med school, I have had a couple of memorable moments that I probably will remember the rest of my life, such as my first delivery of a baby, the bizarre delusions and hallucinations of some psychiatry patients that I interviewed, but nothing stands close to your first patient death. Last night was a rainy Tuesday night at JPS, relatively slow trauma night, until about 1:00 am my intern wakes me up for a level 1 trauma (the most serious trauma you can get at JPS) a 41 yo AAM with gunshot wound to the chest and was also involved in a MVC (motor vehicle accident). How do you top that..it was a 2 for 1.

Here was the story: Police found the man on the ground at scene of the accident with patient semiconscious laying face down near his car. Witnesses heard 10 gun shots and saw the man crash his car into a tree.

He arrives at about 1:10am Wed in JPS, he has a gun shot to his left lateral chest with no exit wounds. He also has a open abrasion ,you can see his patella (bone) on his right knee. BP is 130/80 pulse is 130. He gets intubated, a chest tube bilaterally-bloody effusions drain into the chest tube, a femoral line, and a foley that is empty, even after 4L of Lactate ringer's solution. All this time he also gets 2 chest x-rays and he is sent to the OR immediately.

In the OR, it was the biggest team I have worked with there was 1 anesthesiologist, and 4 CRNAs 3 scrub techs and 3 RNS running around gathering supplies and prepping. So my 2 residents begin cutting. This patient's body habitus quite big I would say 280lbs with a large belly and maybe 6'2. The attending rushes in and takes over the entire surgery, we open his entire belly, the attending takes over, and takes out bowel and cradles it in his gown and the table while the residents are frantically searching for a bleeding source. Meanwhile I was standing near the surgical tech getting instruments ready. I was then told to squeeze next to the head of the bed and retract with all my life this man's chest cavity while they continue to dig into the chest wall. Blood is filling his entire chest cavity, and neither my attending nor the residents can find the bleeding source. Six units of blood was tranfused and more LR was given. Suddenly the part of the electricity in the OR began to short fuse. My resident's head lamp went off, the Bone saw wasn't working because of an electrical fuse. More blood is spilling. More blood is ordered from the blood bank, but there isn't any more blood of this man's blood type, they ran out. So my attending yells and tells the anesthesiologist to get any F-ing blood you can. He also F-ing requests a special type of Epi-injection- cardiac epi. He injects it directly into the patients heart. This entire time I am retracting this guy with all my body weight leaned away. My attending now is manually squeezing the man's heart.

They finally see the source it was the aorta, vena cavae, and liver that was bleeding. This also find a approximately 5 mm bullet still intact in his liver. Everything became grim. There was no point of return, when my attending noticed the blood was getting thinner and thinner in consistency. He say's okay we're going to "call it". It was the end of the trauma at 3:42am. The bullet travelled from his left chest wall through his aorta into his vena cava and lodged into his liver, where it was very difficult to see and contain the bleeding. After my residents sewed up the belly, I stayed behind to help the scrub tech clean the body. Here is the story in FW Star Telegram:
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Man dies after being shot, crashing car in Arlington

ARLINGTON -- Arlington police are investigating the death of a man who crashed his car into a tree after being shot.

Police dispatchers said they received calls of shots being fired about 12:30 a.m. in the 1000 block of East Arkansas Lane.

About five minutes later they received a call that a car had crashed into a tree on eastbound East Arkansas Lane near Collins Street.

When police arrived they found the driver had been shot.

He was transported to John Peter Smith Hospital where he died about two hours later.

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That was the fastest 2 hours that passed by in my life. It all felt like it was 30mins. Who knew so much could happen in 2hrs. Here is what I found out later that morning. The man was a drug dealer. He was shot and was trying to get away by driving, he lost consciousness and crashed his car into a tree where police and paramedics found him.

This was my last call night at JPS for general and trauma surgery . It was memorable closing and reminder of how fragile life can be.

Methodist is Awesome

I'm at the end of my 1st week at Methodist and I love it. I owe my good time to my all male residents & attending. Male teams are so much more laid back. They joke all the time and just procrastinate and don't have a fit if something doesn't get done. Everything can always be done tomorrow. So my attending recently finished residency and is really young. He reminds me of a Erwin, and my upper level resident remind me of Ben. My attending is really cool, non intimidating and very willing to teach. Upper level resident, just like Ben, so nice I mean he words everything in the nicest way so that it doesn't feel like he is ever telling you do do something only that he is suggesting that you do something. I have learned more in 1 week that I would say me entire month at JPS. Seriously how did I get so lucky? Too bad my team changes this Sunday after call I'm going to miss all of them. Best part of Methodist are free lunches, snacks in the library, and good looking residents. :)

Medicine at JPS is stressful

After my intern talked with my attending, I am now less of a scut monkey and get actual real pts to follow. I got to do admission H&P's and write orders and follow through until discharge. However all of this does not come without a lot of stress. My extra duties came about after the intern pulled my attending aside at a pharm dinner and told him I wanted to do IM and I wanted more hands on experience without me knowing. The second day to my shock I was called out by my attending in front of the entire team telling them I wanted to do more. I knew these people less than a week and alot was already happening.
Over time my attending became less scary and I realized he just is really likes discipline among his residents and students. He wants them efficient, persistent, and just to follow through on all studies on each patient. Yes all attending are asking for the above qualities, its just that he asks that of each resident to the 10th degree. With two weeks into medicine, its definitely my most stressful and hardest rotation so far. I felt like I have never been so aggressive and anal than this medicine rotation. I have never been grilled so hard and questions are just way beyond what I can answer. JPS on top of it is just frustrating because orders are partially carried out or extremely slow. On top of that, my intern and I were bearing the grunt of things my upper level failed to do or orders he changed. I wanted to say so badly "looks your senior resident changed your orders" to my attending but, that would have just caused more trouble for me so I suck it up and say yes, I am sorry that order was not accomplished. Other than that medicine at JPS is quite cool, you see real pathology. I now realize what other med students are saying about my attending, he actually isn't bad, I just dont understand the bad rep. Nurses told me that she has witnessed him yelling at residents at one point. I think you have it made if you just go to his pharm rep dinners. Tell me what you think?

The Biggest Scut Monkey Roaming JPS

Last night was my first Medicine call night. Before I delve into how call night played out, I'm going to fill you in on the dynamics of my team. I am on team Medicine team C. I am paired with a notorious attending who is is from Eastern Europe and thinks women's place in society is barefoot and pregnant wearing an apron much less a doctor. So it doesn't sound like a good start. Well first of all I have a ob-gyn intern and psych intern and senior family resident on my team. Its quite a bunch. On the first day I was told to stay away and do not listen to the ob-gyn intern b/c he is known to be a slacker. The other two residents are nice and helpful. On my first day of rounds still in my nice business clothes, I listen to glimpses of my attending's bedside manner. This a conversation to a patient: " You have a arteriovenous malformation" you will need to see neurosurgery. The patients eyes just ballooned three times bigger and my attending walked out the door. So as you can see he doesn't have the best bedside manner.

Lets move on to call night. Ok call starts at 3:00pm at JPS and patients trickle in for admission. While all the other med students I talked to on Medicine already have their own patient load to follow, I have ZERO. I hoped and hoped that I would get a patient on call night so that I can follow, but my senior resident insisted that he and the other residents do everything themselves. So no patients for me, and I spent the rest of the night shadowing interns. This was such a bummer especially since I was so excited about doing medicine and hoping to really force me to think of good A/P. I am like excesses baggage that constantly runs around JPS hunting down VS, xrays, doppler, and echo reports. I'm on call again Sunday with new resident's on my team I hope they will let me have a patient.

Its also really disappointing to see how jaded JPS residents act. They are really pessimistic labeling all pts some name or another "drug seeking", "hispanic panic"-[chest pain in a hispanic woman who is not having an MI], and others. Another problem around JPS is getting help around here. Can you believe JPS does not weight pts as part of their intake vitals, it has to be specially ordered. On the bright side, my senior resident says my attending likes me so I should not have a problem on this rotation. Haha the irony , how could someone like me I haven't done a single thing that is worth evaluating.

About time for a New Entry!

Well I took a long blogging vacation. I think I should get back to this thing. Like any first day. It starts out with orientation:all the necessary information, phone numbers, books, preceptors. I like my assignment. Preceptors are laid back, teach alot, and I get a lot of time off---> what more can I ask for? I saw lot of colds, and good variety of stuff I have never seen before.

time to sleep: I 'll write a better entry next time.

Cook's Children's is the Best!!!

I finished 2 wks of inpatient service at Cooks. It was the best time I have had my entire time here during Peds. The new hospital wing has a Castle Theme, the lobby and the pt rooms look like castle walls. When I walked into the lobby I felt like I walked into a fairy tale , everything is so shiny, the glass and windows and when I looked up from the lobby to the ceiling there were bright sky lights. Everything at Cooks is so efficient and all the Peds Dr.s & nurses are super nice. I saw some of the cutest kids there. Cook's is where I also actually Learned. I mean I gave formal presentations of my patients, followed their labs, care, orders, ect. I got to interview my patients in the ER. I saw a CT of cysticercosis- Pork tape worm cyst.

O but now back to PCC- where slowness, inefficiency, and no learning occurs. After my enjoyable experience at Cook's, I tried talking myself into liking Peds. The more I thought about it, the more I believe that I can't endure a 3 year residency in Peds. Ah well :)

Just for laughs check out this website: specifically : "medical hierarchy" and "12 types of medical speciality sterotypes" comics from the same person who came up with "12 types of med students" This site always gives me the chuckles. ;)

http://theunderweardrawer.blogspot.com/

Kids are Like Puppies : )

Kids are like puppies in a pet store, they are really cute and fun to play with at the store but I wouldn't want to take one home with me.

In the mist of the mundane activities of outpatient clinic, cute- well behaved kids just bring a big fat smile to me. Lately kids are coming in droves to squeeze in their school physical & shots before the start of school this Monday. There were all sorts of cute puppies, I mean kids this week. We had quiet ones who read books while waiting for me & the Dr., 4th grade girls who dressed like their moms, who dressed like they were 18, and then we had the kids who are completely nuts and can't sit still for a second for me to examine them ie ADHD kids. Trying to examine ADHD kids is like trying examine a kid at the jungle gym all the while chasing after them with with your otoscope and stethoscope. I would have one ADHD kid sitting on the table and 1 s later that get distracted by their parents or other siblings and are just bouncing from wall to wall. Mom later explained to me that during vacation, the kids are off the ADHD medicine. In the mist of this playground aka Peds clinic I also saw some sick babies. Yea babies are cute too but man they are just big fat petri dishes.

I examined 2 babies with URI [upper respiratory tract infections] using a tongue blade and they just laid a big cough right in my face. I felt like was just sprayed with 10^14 colonies of bacteria all on me. Well to no surprise I woke up the next day with a big headache and a sore throat. OH NO! I was getting sick. Luckily I take my vitamins regularly, supplemented with Extra Vitamin C when I feel like I coming down with some cold. So my minor cold lasted 2 days, but during those days I just felt dizzy and weak and massively sleepy--those darn cytokines & TNF were kicking in.

Kids also are super excited about stickers they get at the Dr.'s office. I mean I would be too. You guys should see these cool looking stickers the Dr.'s got. There's Shrek, Dora, Ratioulle, Spiderman, Barbie, Sponge Bob, I mean they're pretty big and some are really shiny and glittery,and even 2D looking. So a neat trick I like to use when I examine kids, is that I tell them if they don't behave they won't get stickers. Yea so some of you may think that's mean, but its really an empty threat, but really all Kids get stickers before they leave.

Another thing to be careful of when you examine them, is too be careful not to drop the "S-bomb." I mean "Shots" they totally freak out and some start crying even before the needles arrive if you even mention the word in front of them.

Well I'm heading to Costco this weekend to stock up on some more Vitamin C. It really works!!! Hope you guys who just took the shelf have a good weekend. :)