That was so cool!

Well, I was on call last night, and it was incredible. It was not easy. It was not neat. It was, however, the kind of shit that I went into medicine to do. It started off with a man who had been in a head-on motorcycle accident without a helmet. Amazingly enough, he had no skull fracture. He did have a traumatic amputation of his foot, and fractures everywhere else. There was blood everywhere. By the time morning came,he had gone through almost 30 units of blood.

And that was just the beginning. After he rolled through the doors, I got zero sleep until I was released home. We had all kinds of injuries. Horse related injuries actually were over represented since we had two of them. One was a patient who fell off a horse. Another was one who had a horse fall onto them. Things got crazy enough that I was given a field promotion to intern. We were running at capacity when we got word of two more cases inbound. He turned to me and said "We don't have the people to handle all of these cases. You are now an intern, and this is now your patient, don't let him die on you, or anything bad like that."

So, I looked over at this patient with fixed and dilated pupils, and just replied "aye aye, sir." This particular patient ended up teaching me a new word; pneumorachus. Virtual beer for the reader who knows what that is without looking it up. I got him worked up and admitted to the neuro unit. He had a pulse when he left, and I am going to leave it at that. Granted, I think he had the worst suture job ever done by yours truly, but that is really small potato(e)s in the grand scheme of things. I also got to deal with the family along with the ER doc. I think the ER doc was generous in her prognosis, but when you are dealing with someone who is dealing with this kind of an event happening to their spouse, then I do think it is appropriate to let the reality of what has happened sink in before divulging the full reality of what is most likely will most likely happen.

Something that really is driven home after nights like the last is how fragile we are. How suddenly misfortune can devastate. A lot of the people who suffered my tender mercies last night never expected to be where they ended up. They were doing simple things like riding a horse. working on an A/C unit, riding in a go-cart, or going fishing. These are things that one does not associate with being dangerous. They are just going along and then something goes wrong, and then they find themselves waking up in an emergency room without a foot, or waking up in a hospital missing half of their pancreas, duodenum, and a couple feet of small bowel. And, yes, some of them died. Bearing witness to this, I found myself thinking about life. Not the big questions like "why are we here?",  "what is the meaning of it all?", and "is there anything good on TV?" but the small answers. Small answers like holding your wife close to you, and right there, in that room, for those five minutes, as you feel her soft, gentle, and warm skin against you, you are as close to heaven as mortal man can ever aspire. Life is both fleeting and fragile, true believers; revel in it.

The night was just a long train of the broken, bleeding and braindead. It was, to borrow a phrase, murderous and grand. Looking back, it was  blur of discrete moments.  And I did a lot. I don't know how many stitches I threw, but about the time I was stitching up some rather noisome hispanic's neck, I figured that I had found my stride. NG tubes, OG tubes, foley's...I put tubes into just about every oriface of the human body last night, and almost started making new ones.

And the nurses! I have, at times, been hard on nurses, but the women working last night were Godsends. Totally unflappable. Not only did they move heaven and earth looking after their patients, they also occasionally covered my six, as well. Even at the height of the chaos and confusion, the nurses were steely-eyed professionals who we leaned on hard, and they came through for us every last time. I tried, in all the hustle and bustle to let them know that their efforts were both noticed and appreciated, but I don't know how many of them had the time, as they scurried around, to understand that the med student trying to squeeze in a  "thank you" or "outstanding job" really, really meant it.

I guess that the short version is that last night was what it was all about. Exciting. Terrifying. Meaningful. Profane. Desperate. Glorious. It was why I went into medicine. It was trying to heal the broken places in peoples lives'. It was hard, extreme, and fulfilling work.

The only bad spot was rounding in the morning. I think that it should be illegal for a faculty member at a teaching hospital to mumble while rounding. Mumbling faster also doesn't help. In fact, it makes it worse. I had been sitting standing through twenty minutes of rambling mumbling when the director turns to me and asks me a question. I only could make out that he was asking about the cause of an electrolyte imbalance. Not really sure what electrolyte or whether it was too much or too little. So, I just said "dehydration" and he turned to another student, started mumbling on again, and asked another question of them. I don't know if he was satisfied with my answer, or if he had uttered some profanity at me. Rounds went on and on for an intolerable length of time until the chief took pity on me and let me go home.

Still, taken as a whole, it was about the coolest night of call I had ever taken, and I am kind of looking forward to doing it again (Shh! don't tell anyone that last part, or I will be committed).

Respectfully submitted,

doc Russia