This morning I placed my first (and probably last) ventriculostomy catheter. Actually I didn’t place it, the chief had to, because I confess that the internal 3-D anatomy of the skull rather escapes me, and I was unable to correctly guess the location of the lateral ventricle based on the nose and ear (draped). But I made all the holes, and sewed things in – and got my clothes completely covered in blood, also for the first time. The patient, rather to my surprise, improved dramatically.
M&M was a real firecracker session. One of my friends got rather unfairly involved in a multi-target disaster; in true stoic fashion, she actually objected to the sympathetic comments afterwards more than to the attack itself. I am not looking forward to the month next year when I’ll have to present at M&M.
Our new medical students are here. You can tell them because they’re the sharply dressed ones in the hallway trying to find scrubs so they can start looking for the OR. It feels extremely good to finally know more about where things are located than at least a few other people in the hospital. This set of students will be fun because the interns have got their feet under them and are ready to teach and be helpful, and these students are still early enough in the year that they’re seriously considering surgery. (Actually my inconquerable habit of blunt honesty leads me into warning them against surgery, but I try not to talk like that too much.)
The day ended with a bang when the ER started calling us consults every five minutes (literally) around 5pm. The one resident and I went down to see, and every time we turned around, someone else would walk up to inform us of yet another patient. The difficulty was compounded by the fact that on this evening, the ER was splitting at the seams. Usually there are a few people scattered in the hallways; but tonight, they were simply stacked along all the walls. The patients had to be giving us directions about which one of them had which complaint, and which person had left to go to CT (it was difficult to tell when someone was gone, because the walls were so crowded, you couldn’t tell whether a space had been occupied, or was still open for someone else). The resident told me to “go see the spinal injury.” I asked him whether he meant the woman, or one of the two men. He said, “the woman.” I asked what her name was, and where he had been told she was. He waved down the hall: “Across from room 3.” There were three demented elderly ladies with cervical collars sitting along the hall across from room 3. I was very frustrated. Before I could ask which of the three we needed to see, someone else came up to announce that a helicopter was coming in with a major head injury. I am clearly not cut out to work in an ER. Actually, if the resident could have spoken coherently enough to hand a few of his consults to me, rather than turning in circles and never really delegating anything, I wouldn’t have been as frustrated. The fact that a psych patient was howling in the waiting room loud enough to be heard through the whole department, and someone else was vomiting profusely next to us did not really contribute to clear thought, or communication.
(Just in case you’re wondering, that last paragraph was not exaggerated.)