A better end to last week, followed by another crazy Monday

Last week ended really well - I was seeing my own patients and writing notes on them, and most people were easy post-ops who ended up going home. On Friday, I even got out over an hour early because everything was done! I can see how the job would be rewarding (and even fun) on those lighter days.

Mondays are another story. Traumas from the weekend are in, and weekend traumas are usually the worst traumas. Car accidents involving young drivers, falls down stairs caused by alcohol intoxication, drunken assaults...you get the idea. And, today we had another consult from the ER for a man who had been drinking and had seriously uncontrolled high blood pressure - a terrible combination. He hit his head on a shelf while drunk, and because his blood vessels in his brain were already stretched to the max from his hypertension, they ruptured and he had a huge bleed in his brain. We actually went down to the ER right when he came in to evaluate him, and we saw him get intubated and whisked away to the OR for an emergency shunt placement to redirect the extra spinal fluid and blood caused by the trauma and bleeding. He had a GCS (coma score) of only 9, where 15 is perfect and anything below 10 is basically not good. The worst part was that he was only middle-aged, and that we had to tell his wife and daughter (who was around the same age as me) what had happened and what was likely going to happen next. I don't know what his status was when I left, since he was likely still in the OR. I really, really hope he does well, even though I know deep down that he probably won't.

Another patient who probably won't do well is a teenage boy who was in a car accident over the weekend. He has some serious bleeding on the brain, too, and even after bilateral craniotomies his brain is very swollen. So...I'm not optimistic. But, he's young, so you never know!

Hopefully the rest of the week calms down like last week did!

Don't drink and drive...

One patient learned a good lesson the (very) hard way today. She's in her early twenties, and was driving home from a night on the town with a BAC of around 0.24. She ended up going the wrong way on the highway and hit four cars. She broke her odontoid process (part of the second vertebra in the neck), her collarbone, her wrist, and her leg. She woke up (still intoxicated) in the ICU this morning in what I can only assume to be crazy amounts of pain, and she was put in a halo this afternoon. Halos are these huge contraptions that literally screw into the skull and attach to a vest to keep the neck extra stabilized while the fracture heals. In her case, the bone fragment was too displaced for surgery to fixate it, so the halo was the only/best option. You have to wear the halo for 8-12 weeks, and as you can imagine, showering, getting dressed, and going out in public are pretty difficult with one of these things on. Not to mention the permanent scars in your forehead! She's lucky to be alive, and I obviously don't condone her actions at all, but I still feel bad for her. Hopefully she learned her lesson.

Another interesting/horrifying patient today was one who was trapped in a burning building last night and had to jump out from the third floor to survive. He ended up with a completely shattered pelvis, an L5 compression fracture, and a ruptured bladder. I'm not even sure how they fix the bladder...or his pelvis, really, since from what I saw on the images, it was completely destroyed. But hopefully they can! We are only involved for his L5 compression fracture, which is definitely the least of his worries right now. They won't even surgically repair it until his pelvis is taken care of, because without an intact pelvis there's nothing to fuse the lower spine to.

So! That was my Monday. I also saw a bunch of other (less awful) inpatients and took out some drains. I've started seeing people on my own and writing their notes, which is nice because I feel like I'm helping the PAs a little bit. Overall, I think I don't love this rotation, even though I'm learning a lot from it and I think brains are cool. The cases are interesting, but also sad. We spend way more time in the ICU than I would have thought, and the ICU is probably the saddest place on Earth. It's full of people who, for the most part, were doing just fine, and then something happened to land them in the ICU. For older people, it's usually a fall. For younger people, it's a car accident or some other sort of trauma. Either way, the patients (in most cases) were doing totally fine before the accident, and then, due almost completely to chance, they end up in the ICU and their lives are changed forever.

Attitude adjustment

Okay, so my first day of neurosurgery wasn't stellar. But, as I suspected, it got much better during the rest of the week. Still not ideal, but better!

Being there for rounds in the early morning made a huge difference, since I could see each patient and know what they were there for, and therefore just be more informed when my preceptor and the other PA were talking about them later in the day.

So, a typical day starts with sitting with my preceptor and looking up all of our patients in the computer to see how they did overnight. This includes looking to see if we need to order any labs or do any procedures (like remove a drain) that day. Then, at about 8:00, we round on all the patients with the other PA and an attending from the neurosurgery department. We see all patients on the Neuro Trauma floor, then go see our patients in the Trauma/Burn unit, the ICU, and other medical floors in the hospital. After seeing all of them and deciding what else needs to be done for each (usually about 25-30 people total), the PAs sit down to write their notes on each while the attending goes to the OR to operate. Note-writing usually gets interrupted by questions that arise from other consulting departments, consults from the emergency department, or who knows what. As of right now, I haven't been writing many notes, since the PAs said they usually have students just shadow the first week, but they said that next week they'll put me to work!

After the notes get finished (or at least mostly finished), the PAs go down to their on-call room to "run the list" - meaning they tell each other about each patient, so they both know everything that's going on with all of the patients. Then we eat lunch, and after lunch we just finish notes and see any other consults that came up during the day. The earlier shift (which is what I've been doing this week) is over at 2:30pm, so I go home after that!

The PAs on this service are incredibly overworked right now. Normally, there are five of them, but two are on maternity leave and one left for a different job. Hopefully I'll be able to help them more next week and relieve some stress! I hate having to just stand by and not be able to do much to help them. But, they're both really nice and easy to talk to. It's refreshing to finally see a PA in action, and so encouraging to know that I'll be doing what they're doing in less than a year!

An underwhelming first day of neurosurgery

So, today wasn't very exciting. At all. This morning, I had orientation for about an hour and a half, and apparently that was during the most exciting time of my preceptor's day (pre-rounds and rounds). So, by the time I got up to the neuro trauma unit, my preceptor and the other PA were basically just doing documentation and putting in orders. Since I obviously hadn't actually seen any of the patients they were writing about, it was hard to learn much from watching, and I obviously couldn't help them by writing any notes myself. So, overall, today was definitely underwhelming. I saw exactly two patients for a grand total of....three minutes. My preceptor was basically just checking in to see how they were doing (both were post-op). Not too exciting.

I really, really hope being there in the morning on every other day makes it more interesting...we will see! And I'm definitely going to ask about getting in on some surgeries if nobody asks me about it by the end of the week! Doing inpatient things for the entire six weeks of this rotation that I thought was going to be a surgery rotation (I mean, it's a neurosurgery rotation!) would be frustrating and, while I would still probably learn a lot, not as fun.

Getting ready for neurosurgery!

Well, my emergency medicine rotation is over, and tomorrow I start neurosurgery at another hospital in Pittsburgh. This is one of my elective rotations, and I'm so excited!! I've always loved brains and found them fascinating, so I'm really excited to get a sense of what working in something in that area would be like. From what I can tell so far, it's going to be a good rotation, though it doesn't sound like I will necessarily get to see a lot of surgeries, which is a little disappointing. But, my preceptor (who's a PA!) said that the surgeons are normally pretty good about letting students come in on cases, so hopefully I'll get to see at least a couple while I'm there. At least I'll get a lot of experience with patient care before and after surgeries!

My last two shifts in the ER were more or less uneventful, though I did see one patient come in with a heart attack and get rushed away quickly to the cath lab, and I found out later that she arrested and died right outside the lab. So that was sad, of course. I also saw a couple of other codes, but they all ended successfully (with a living patient). While I liked emergency medicine, I'm glad I'm done with that rotation. It was strange working with a different doctor/PA every day, and I'm so glad I'll just be with one person on this next rotation, and that I'll have a consistent, weekdays-only schedule. I'll post tomorrow with an update on my first day!