|
|
Summers in San Francisco are generally characterized by foggy cold days. Not today. Today it's beautiful outside - sunny and 75 degrees. I'm on second call. That means that if there are two emergency cases in the OR I get called in to do the second case. My chances of spending the day away from the hospital are roughly 50-50. I have my beeper strapped to me like a time bomb. BEEP BEEP - I'm dead.
Yesterday, however, I spent the day in the ER (moonlighting), filling in for a friend who had a family emergency. It was gomer day. I don't think I saw anyone under the age of 68. Most were in their 80's. Everyone had at least one critical medical problem. One woman had CHF, new onset renal failure, pericarditis, digoxin toxicity, and over-anticoagulation with coumadin (INR 5.8). I intubated an 86 year-old demented nursing home patient in respiratory failure. One woman a week post-op from a total hip arthroplasty had a DVT. The few remaining cases I saw were minor traumas - head laceration, motor vehicle accident (uninjured but looking for a work release), and minor abrasions and lacerations in a variety of places. Anyway, twelve hours flew by in what seemed like only two or three days. Usually a half-day shift in the ER seems more like a week. What I love most about working the ER is that I really don't need to know anything about the patients I'm seeing. All I have to do is determine if they have a potentially fatal illness, an illness which may result in litigation, or an illness best cared for in an inpatient setting. Otherwise, I can meet them and street them and spend the majority of my time filling out paperwork to cover my ass in case I figured wrong on the above three assumptions.
Anyway, overall it's been a good week. My daughter is visiting my folks in Baltimore and I've had the opportunity to spend time alone with my wife. We've actually been able to go out to restaurants without saying things like "Katie, please don't pick your nose and eat it - your dinner is coming soon." Nevertheless, we spend the entire meal talking about how much we miss her. I've even had time to read a little - a novel and a few chapters of my anesthesia textbook. The novel was called "Critical Care" by Richard Dooling. It's about a medical resident during his ICU rotation caught in the middle of a family's battle over a dying relative. The anesthesia textbook had the desired effect - inducing sleep. I think we should just skip the laughing gas and read our patients the chapter on "uptake and distribution of inhaled anesthetic agents" - they'll be numb in no time. Basically, the bottom line is you turn the vaporizer dial counterclockwise to put the patient to sleep and clockwise to wake him up.(I hope the department chairman doesn't read this entry).
I better go before I incriminate myself further. Talk to you soon.
-Mo
|
|
|
|
|
|
|
[ T o n y | M a r c u
s | J a m e s | J a s o
n | R a v i | D a n i e l |
M o | P e t e r ] |
||