Saturday, November 15, 2008


I just finished a month of vascular surgery. I saw and smelled more foot ulcers than I ever cared to see or smell, and amputated more limbs than I cared to amputate. People, if you have diabetes, please, please take your medications. And if you have neuropathies that have taken away the sensation in your feet, you MUST check your feet EVERY day. If you smoke, stop. There are few sadder sights than a 50 year old man with both legs missing sitting in a wheelchair puffing away, especially when you realize that he'll be dead from heart disease within five years.

I'm on pediatric surgery this month--it's been quite interesting, though taking care of kids is not my cup of tea. It's by far the busiest rotation at my program, I'm on in-house call every second or third night. It is a great rotation though, with a lot of OR time. The attendings are great too. They have two fellows, and in order to give the senior fellow more operative time, they only make him take in house call about twice a month. To do this, the attendings themselves actually take in house call in his place a couple times a month. A bit intimidating for the junior resident, if as happened to me, he or she ends up on call with the chairman of the program instead of a senior resident, but I think it says a lot about their dedication to the fellows' education.

Most of the cases I've been in are pretty straightforward, lots of abscesses, appendicitis, and pyloric stenosis, but we also get all the rare cases as well, biliary atresia, gastroschisis, etc. The worst case I've seen was a trauma that came in last week--a one year old boy who came in without a pulse. He had been beaten by his aunt that evening. He didn't have any external marks, but you could tell the second he rolled in the door he wasn't going to live. We did the whole resuscitation anyway, and got his pulse back for a while, but when I shined a light in his eyes his pupils were completely blown and did not respond at all. The CT scan showed what we all knew, a huge hemorrhage in his brain. He went to the ICU and died a few hours later. What makes it worse is that the police brought his two year old sister in a few hours later after taking the aunt into custody. She had burn marks and sores all over her body, including circumferential wounds around her ankles and wrists consistent with having been tied down for a long time, and an old scar encircling her neck. We did xrays of her entire body and found several fractures that had already started healing in malalignment. She's doing well now, but still starts uncontrollably shaking every once in a while. Her aunt was her foster parent since her biological mother is mentally incompetent, even though she (the aunt) was a known child abuser. Yet the state still allowed her to keep the children. And now one of them is dead. The extended family has been in the little girl's room, and acts very concerned and worried. I've been polite to them, but not especially empathetic, because frankly I don't think any of them should even be allowed to enter the hospital.