Sunday, July 02, 2006

i-Trauma

As I have said before, I really prefer to have good music playing in the OR --- at least, what I would call good music. I have finally caught up with the rest of civilization and bought an i-Pod, one of those huge 60 gigabyte monsters that will play at random for days on end. So far, I have loaded about 8 days worth of music, which pretty much assures a wide range of songs to play as we while away our time in the room with no windows. Don't like the song that's playing? Just wait a few minutes.

I have to admit that much of my misspent youth was devoted to listening to music, something which has carried over to the present day. Records, cassette tapes, and concerts (including the requisite t-shirts) consumed a lot of the cash I generated in high school. I’m sure that engendered a severe character flaw, or at least a personality quirk the size of Gibraltar, that compels me to “connect” everyday things to song titles and lyrics (and also makes me quote movie lines, and obliges me to fill in any crossword puzzle in sight, etc…). If you want to know how my brain sometime’s ticks, I’d like to take you on a musical tour of a shift on trauma call, courtesy of some of the songs on my i-Pod (yes, all of these are on my "OR Music" playlist --bonus points for those who know the songs without hitting the links) ---without further ado, If You Want Blood (You've Got It):

Morning has broken, and the first page of the day leaves my pager all shook up. “I’ve still got the night in my veins,” I tell The Doctor in the ED. What's the matter here? It turns out it’s a typical situation; she was only sixteen, and decided to try drive the new roundabout at the speed of sound. Trouble is…. she had also been drinking a bit of some strange brew all through the long night. “A bit banged up, black and blue,” says the ED doc, “but watch out. She’s a piece of work. So’s her mother -- who wanted me to make sure you knew she’s waiting.” Hold on! I’m comin’!” I tell him, knowing I need to get some java in my system to stop the Shakin’ shakin’ shakes before heading to the ED.

In the trauma room, I find a blubbering teenager who has just enough of a concussion to perseverate like an alcoholic on a three day bender. O my God,” she says, over and over. Mercy mercy me,” says her mother, “does she have brain damage?” I assure her that her daughter has a minimal concussion, and needs to be with us for just another day. For now, it’s all over but the crying, and after looking her over I leave the two of them, her mother searching for divine intervention.

Seeing my half-empty cup, the ED doc asks “How bad’s the coffee? “Oh, man, bottom of the barrel mud here – it’s powerful stuff. Drink it too fast and you’ll get a rush of blood to the head.” Truth be told, I had lost my appetite for the coffee; this scenario always carries a sickening sense of déjà vu for me, and I fear this girl may be stupid enough to do it again. Love is the drug” I want to tell her mother, but am never too sure that is the right thing to do. Perhaps what they need now is A little less conversation, and a little Time in front of the deep dark truthful mirror. “Admitting orders are written,” I tell the clerk. I think I’ll disappear now.”

So off I go, thinking I can finish morning rounds. What a brilliant mistake! I guess I couldn’t call it unexpected, as the day was shaping up to be black friday. Tell the truth” says the ED doc, “you didn’t think you’d get one clear moment today, did you?” “I’m tired of the waiting,” I tell him, “just give me the Lowdown.” Turns out we have our second MVA of the day, but this one’s a bit worse. Two passengers rockin’ down the highway after a large time in the wild west end. “The driver is All F**ked Up, and we’re walking a tight rope with his respiratory status. His spooky girlfriend is more stable, and is on the road to find out what’s wrong with her over in CT.”

Sigh. Inside I let out a silent scream. Sure enough, the driver is a whiter shade of pale when I arrive, not moving much air, looking like he’s knockin’ on heaven’s door. One thing leads to another, and soon he’s intubated and lined, and we are the proud recipients of a chest X-Ray demonstrating a hemopneumothorax. Feeling like the king of pain, I put in a big chest tube. BP is better, but not great, and we’re doing the trauma room Lido shuffle, pushing fluids and then blood. By this time, we have a great ultrasound image of a bucket of blood in his belly. “It’s the end of the line down here,” I tell the ED crew. “Let’s head to the OR or we’ll be dead in the water.”

I decide to take a shortcut through the CT scanner to take a quick look at the girlfriend‘s wonderful, a repeat customer! Hello old friend,” I say upon recognizing her – this would be the third time I would admit her after a DUI incident. What’s wrong with this picture?” “Oh, doc, I’m crapped out again!” Typical Junkie’s Lament. “Look,” I say, “I just need to know what you, your Little Toy Brain, and your boyfriend were drinking or taking last night.” “Honest, doc, all he had was one bourbon, one scotch, one beer!”

Upstairs in the OR the room is hot, the lights are bright, and the scrub is ready with the Freezing Steel. Young Mr. Spaceman has a nice collection of trauma Souvenirs – a shattered spleen, a perinephric hematoma, and a segment of devascularized small bowel. The spleen hits the bucket, the kidney looks OK, and the anesthesiologists asks “What’cha gonna do about the small bowel?” “I’m going to do what is the least complicated – take out the bad piece and then staple it together. Then it will be time for this case to be over.”

By now I’m (un)comfortably numb. One of these days, I’m going to have to find some other career opportunities, as I’m not sure I’m tuff enuff to keep doing this for much longer. Fortunately, after tucking the two lovebirds into bed the trauma gods let me catch up for the rest of the day, even catch a few Zs in my sleeping bag. When I roll over and catch a glimpse of the clock at 5AM, I think it’s all over now, baby blue. No Such Thing, says my pager. Why get up, I wonder; getting up at this hour is always the hardest part of trauma call for me.

After a wild night of drinking, my newest customer is a middle aged guy who just found out what it feels like when the bullet hits the bone. But he’s the lucky man, because although the bullet busted up his femur, all of the nerves and vessels are intact. By the time I have arranged for the orthopod to see him, it’s time to start making morning rounds again! “Try to get the bullet,” I tell the pod. “The cops would like the evidence.”

And so it goes. The rest of the morning is spent playing catch-up, checking on all of the patients in the hospital, and then a day in the office. By the time 5PM rolls around Swimbo pages me to give me one last message for the day: "You better be home soon." I guess I'd better -- or I get to be the next patient in the trauma room.