Patient Passed Away

Well, this wasn't really a patient I was following closely, but definitely a patient with whom I had some contact with.  It was a very sad case of end stage muscular dystrophy and unknown sepsis.  It was strange finding out the patient passed away.  It was kind of a shock, but since I had only helped change the wound vac, I didn't feel that impacted.  Is this a sign that I'm getting jaded?  I hope not!

Then not long after that, I found that a patient I had helped rub sulfadiazine on for burns also passed away.  This time, this was someone for which I had no expectation of passing away at all.  He was doing well, but unfortunately got burned because he wasn't able to express that his bathing water was too hot.  Such horrible luck!  But the burns themselves weren't terrible, and I had expected a complete recovery.  Ah, so unexpected.  Seemingly perfectly fine, then all of a sudden, passed away.  Can't imagine what guilt the caregiver must be feeling! 

Memorable Trauma Surgery Cases

Memorable Trauma Surgery Cases:

• Lung herniation after biopsy- yup, it popped out with valsalva!
• Foot amputation - I sawed off the fibula!
• Self-inflicted gun-shot wound (GSW) - unsuccessful suicide attempt + VATS (video assisted thoracoscopic surgery)
• Suicide by cops: got cops to go on high speed car chase, then pointed gun at cops so they would shoot him.
• Complete retrograde amnesia after motor vehicle crash (MVC)
• Complete humerus head fracture (humerus head in socket, but rest anterior to shoulder)
• Getting to be first assist on a colostomy (Bovie to clean off colon, manipulate the sigmoid colon, suture opening of colostomy to skin, mayo's to cut, subq umbilicus, cauterize vessels...) Simple but fun stuff!
• GSW to abdomen through liver, transverse colon, small bowel (3 resections), sigmoid colon, bladder, landed in leg)
• Extensive groin/thigh wound about 2'x1.5'x1' triangle.  See muscle, tendons, and all.
• Never been more physically touched by a patient before: when asked how abd pain felt, she closed her hands into fists and gave my stomach a double nuggie.  
• Sewing a skin graft down (okay...mini one that was gonna be thrown away any ways)
• Muscular dystrophy + wound vac - very sad case :(
• First encounter with 2nd degree burns: removing/debriding the bullae. 
• Retired football player.
• Cop getting shot by two 18 year olds & on news
• Appendiceal mucinous cystadenocarcinoma + right hemicolectomy

Sawed off a FOOT!

That was a pretty darn good b-day present - well, unintentionally.  But it was still pretty awesome (not for the patient, obviously).  It's of course very sad that the patient had to lose a foot, but in the long run, it's for the best.  It was already causing or associated with so many issues (sepsis, altered mental status, acute kidney injury, cardiomyopathy,  arrhythmia), that it was a necessary procedure.
Anyhow, I used a Gigli Saw! (put wire saw under the bone, hold the handles, and shimmy the saw under the bone with a force upwards).
 

My Old Lady

Just took a break from studying to watch Scrubs: My Old Lady (s1e4).  Here's the setting: The three interns are each assigned patients with various illnesses. Statistically speaking, one of the three is going to die. J.D.'s patient is 74-year-old Mrs. Tanner, who is in renal failure. 20-year-old David Morrison is Turk's hernia patient and Elliot's patient Mrs. Guerrero only speaks Spanish and might have lupus.

After studying like mad for the last couple of days and reading on my computer till my eyes go red, I don't feel guilty watching this episode.  Spoiler alert!  It really reminded me of the important things to also remember while going through medical school: to take charge and take responsibility, to care for my patients as friends, and to take time for myself outside of medicine.