Jesus, I am so grateful to be doing this. Answering pages tonight, I was just happy that I get to be answering pages about surgery patients. In general, I am interested in what’s happening with them, and I’m familiar enough with most surgical situations to be able to give glib answers to questions. I am glad I get to take care of surgery patients. Life is good.
And then, of course, I get to sew people up, too. I had a guy with the most complicated facial lacerations I’ve seen yet. It took me an hour and a half to finish. I think I did the best possible job with them. As messy as they were, he’s not going to be pretty, but hopefully not too horrible either. I bit my tongue and managed not to console him with the observation that scars look good on guys. He was the nicest trauma patient I’ve met in a while – apologizing for giving us trouble, promising to turn his head however I needed him to, not complaining the least bit about the needles, and saying thank you every couple of minutes.
I learned something else about professionalism this week: it doesn’t mean just staying late when you have an assigned service to finish taking care of, but also even when you’re on call and there’s still something to finish. I haven’t been that late this week, just late enough to have to be sure that I’m not rushing through a job because I want to get out. I keep remembering earlier in the year, when I saw one of the senior residents whom I respect the most stay four hours late after a call shift to keep an eye on an ICU patient whom he was afraid might get overlooked and crash without continued TLC.
I also remember, ashamedly, one of my patients who died early in the summer, after I’d only been on the service for a couple of days. Back then, I didn’t feel too bad about it. I mean, I was sorry he was dead, but it didn’t seem particularly related to me, because I’d only been seeing him for a day or two. Now, I would feel personally responsible if someone dies on the first day of the month after I join a service. They’re my patients.
Oh – I got my first radial arterial line in. My senior this month is so great. He keeps finding patients for me to try on, and this time he stood there with his arms folded, refusing to put on sterile gloves, saying, “This is your line. You’re not leaving till you get it in.” And it did go in, eventually. I think I’ve been overestimating how deep the radial artery lies. It’s really just under the skin, in a normal-sized person.
Cut On The Dotted Line 
March 31, 2008 at 11:33 pm
I knew it was just under the skin in normal-sized babies (ie full-term) pretty much visible in some of our smaller preemies. I didn’t realize it was that shallow in normal-sized adults, but it makes sense.
Our NNP’s use 24g IV catheters to place radial arterial lines. I’ve seen slightly larger catheters placed in older kids. Do you use IV catheters for adults, or is there something specially designed for that?
April 1, 2008 at 7:09 pm
I’m sure it’s not as shallow in adults, but it seems that way to me, compared to how deep I expect it to be.
There are specially designed catheters for adult arterial lines: a simple contraption called an arrow for radial lines, and a whole box full of needles and catheters for a femoral line. The final catheter is about the diameter of a 22g iv, but a good deal longer.