Thursday, July 10, 2008

Bullets and Bones

Two more call nights down, both much busier than the first. The vast majority of the time was spent doing floor work, but I also got to sew several lacerations and remove a bullet from a man's chest (learning point: when removing bullets, never touch them with a metal instrument, otherwise you can mess up forensics/ballistics).

We had a lot of really tragic traumas. One was a pedestrian struck by a car who came in intubated and unresponsive. I performed the primary and secondary survey, and actually picked up all her injuries (brain injury, rib fractures, pelvic fracture, ankle fracture) on my physical exam. I went with her to the CT scan while my senior went to the OR--we did the head CT first which showed a very large bleed between her brain and her skull that was pushing much of her brain into the other side of the skull. It was large and obvious enough that I called neurosurgery immediately without needing to talk to the radiologist or my senior first. The neurosurgeon came quickly and whisked her away to the OR for a craniotomy.

That night, I went up to one of the floors to talk to a patient with pancreatitis who was very upset that we weren't allowing him to eat. He stated adamantly that he was going to go home--I let him rant for a while, acknowledged his frustration, and then talked him into staying. I have discovered that the best way to deal with people like this is to try to agree with them as much as possible, then use their own words to change their minds. Getting defensive or arguing just makes it worse.

When I left his room, a nurse came up to me and asked if I had any new orders for an appendectomy patient--problem was, we signed the discharge orders that morning, and had assumed (fatal error) that the patient had gone home. When I expressed my surprise that the patient was still here, the nurse cheerfully explained that the patient had decided she wanted to stay another night. Uh...yeah....what with hospitals not being hotels and all, patients don't actually get to decide whether or not they stay--that is a doctor's decision. Struck speechless, I went to talk to the patient. Her mother was in the room, and told me that they hadn't wanted to leave earlier in the day because the patient was dizzy, and that the nurses had told them they could stay the night and that "the doctors" would see them in the morning. The patient then walked cheerfully out of the bathroom, and told me she was feeling much better. I explained to them that I was one of "the doctors" and that she could go home. I sent them out around 11pm. I probably should have had a gentle conversation with the nurse about this, but since I didn't know the details and I'm sure there was miscommunication from someone on my team at some point that day I didn't pursue it. Bottom line was that the patient we wanted to stay stayed, and the patient we wanted to leave left.


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