Sunday, September 16, 2012

DO YOU LIKE THAT?

*beep*beep*beep*beep*beep*

     Every person in the medical field knows the sound. It is the dreaded pager. More importantly, nearly every person in the medical field shudders when they hear it. Usually, it means that some menial paperwork needs to be completed. Or that Mrs. Smith, the 45 year old woman who just had a ruptured appendix removed the day before wants to know if she can get up and walk around. *Yes, for the love of all that is Holy, yes! Please walk around and jump start your bowels again. You need to eat so we can send you home. We want to send you home as bad as you want to go home. Rarely is the extended hospital stay a good one for a patient. There are just too many complications that arise from merely being in the building.* But on the trauma service, that sound can mean something entirely different. As a medical student on the trauma service, one finds themselves to be an accessory when it comes to traumas. Thank goodness.

     At our institution, the chief resident runs the traumas as they arrive in the trauma bay. The attending physician is typically just outside or watching from the door, depending on the chief resident and the attending. The midlevel tends to find themselves at the head of the bed to manage airways, and the the interns fill in as needed. One intern usually starts documenting the encounter so that the history and physical exam can be documented and the rest of the team can focus on evaluation and stabilization of the patient. And the students find themselves cutting off clothes, putting in foley catheters, and  just fill-in as we are told. Don't get me wrong, we are given that much responsibility and I think are generally thankful for it but sometimes you realize you are doing the job nobody else wants to do.

     Back on track, one rainy morning in the last several weeks, as the trauma team was gathering for rounds, the familiar beep sounded. In unison, almost as though we were all tethered together, we reached for our pagers. Ped vs. MVC, 28 y/o male, LLE injury, L shoulder disloc, L elbow lac, VSS. ETA 17 mins. All of that tells us approximately what will be coming through the door. In this case, it was a 28 year old male with an injury to his left leg, a dislocated left shoulder, a laceration on his left elbow, and his vital signs (heart rate, blood pressure, respiratory rate, temperature, and his oxygen saturation) were all stable. When the patient arrived, the paramedics who flew him in told his story. He was running and was hit by a car. A moment of pause ensued in my brain. I thought "This guy was hit by a car! How is he doing this well? He should be in much worse shape!" Not that I was wishing that on him, but I expected him to have been looking much rougher after being on the receiving end of a Buick doing 40 mph. And thankfully, he was not. As the paramedic told more of his story, he mentioned that in the helicopter, he was given some ketamine. A collective "What the hell?" was given by the chief resident and mid-level resident. Ketamine, or Special K as it is sometimes known, has a nasty habit of producing visual and  auditory hallucinations. And just generally giving patients a touch of the cray-cray. I don't mean to make light of psychiatric illness, but ketamine can make a person whose mental function is perfect just lose their minds. And lose his mind this guy did. He was screaming nonsense. He was asking why he was so fucked. He wanted to know if he would lose his leg. He wanted to know why we had taken his leg. The funniest part was while he was being evaluated by the mid-level resident, an attractive young female, sticks his tongue out. And in sticking his tongue out, he starts flicking his tongue up and down. Repeatedly. Yep, this guy was laying on the stretcher, broken leg and dislocated shoulder still very much present, mimicking oral sex. And after 25 or 30 seconds, he screams at the top of his lungs "DO YOU LIKE THAT?" Oh yeah, that happened. And in the middle of a very tense time, like say evaluation a patient for a traumatic injury, it can really cut through the tension. And it did. We were to the point that we were pretty sure that he was going to be okay. And this just put the icing on the cake.

     When we went back to rounds, after having made sure this guy was okay, the attending asked what we'd learned. Several answers popped up. Someone said they had put in their first foley. Another said that they learned something about the FAST exam. I said I learned two things. One, don't give ketamine if you don't want the PACU nurses to hate you, and two, remember to have a chat with your air medics and find out what makes them happy. And do it.


*beep*beep*beep*beep*beep*

Gotta run!


- The Anesthetized Student

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