Monday, August 15, 2011

A Night in the Hospital

I'm writing this from UC Davis Medical Center. No, I don't have my laptop out, or even here with me. That would be rude, not to mention hell to carry around. It's three a.m. and I'm shadowing a trauma surgeon on overnight service. She is currently putting in notes for all of her 25 patients, so she doesn't mind that I'm busying myself with other things. She's a surgery intern, meaning that this is her first year and she is still nice. Who knows, maybe she will continue to be nice as her career goes on, but I don't think it's a coincidence that all of the 1st years I've encountered have been bright eyed and helpful while the Chief Resident...well, it's best to just stay out of their way.

Trauma is interesting. It's the unexpected to the extreme. Most illnesses give the patient and the family (and, for that matter, the physician) time to accept and understand what's going on. Even the ailments that strike relatively fast will still allow some time for transition. Trauma strikes fast. One minute you're planning your vacation for summer and then the next you're being stripped of you clothes by an ER doctor and having needles poking all over you.

As you get past a certain age in life, there is an expectancy of getting ill. If you are obese, don't exercise, and eat Twinkies everyday, becoming diabetic isn't necessarily a shock. Nor is a heart attack. It's rattling, and life changing, and sad, and tragic, but inevitably we all have to go someway, somehow.

But traumatic accidents don't hold the same bias that common diseases do. We just came back from visiting a patient who was in a bike accident. He's a 41 year old male who looks 31. He had multiple broken rips and a tube in his chest to drain excess fluid from his lungs. "You have a biker's heart," the surgeon said as she listened with her stethoscope. He was inquisitive, and interested, and she explained how the hearts of athletes are used to pushing out large amounts of blood, and the sound is different. Overall, his prognosis looked good. He was a little beaten up, but he'd go home soon. At least, that was my impression.

Earlier tonight I saw a 23 year old get a neck scan because she was in a car accident. I remember looking at her information and noticing she was born in 1988, just a year after me. A 6 year old deformed child hit his head after falling 10 feet from the top of a slide. He came in with a Glasgow Coma Scale (GCS) of 7, which is pretty bad. They intubated him and did x-rays and CT scans. The mother was the calmest I've ever seen a parent in the ER. It was obvious that she was not new to rushing her son to the hospital. I don't know what happened to the kid.

Life hits fast here. And then sometimes it is depressing for other reasons. There was a a 15-year old stab wound victim. He was Latino, and had one hell of a mouth on him. He cursed out whoever he could, was uncooperative, and told his mother to 'get the fuck away from me' several times.

In case you didn't notice by my picture in the two right hand corner, I'm a black guy. Can you guess what race most of the gunshot and stab wound victims that come in are? Latino and African American. On one hand I feel that I can relate to these youth more than the white attendings, residents, and nurses who are administering care. I'm a minority, I grew up in DC, my cousin was gunned down in its streets. I can't totally relate to their lifestyle: I can't say I was on the edge of going down the wrong path, because honestly I never was. But I've been around people who were.

Yet at the same time I couldn't help but feel a little uncomfortable. And, yes, ashamed. Embarrassed. There were times when I wondered how many people in the room were thinking that me and the patient were cut from the same tree. I wondered if anyone held back a comment or a joke they would have normally said if there wasn't a minority around. There's just a big disconnect between patient and doctor in these situations.  What makes it worse is the white, educated doctor taking care of the ignorant, foul-mouthed street thug who has little chances of ever amounting to anything. Or, at least, I'm sure that's how most would perceive it to be. It makes me think that maybe, one day, I'd be able to make a difference in such a patient's life. Perhaps that's naive, to think they would listen to me any better just because I'm black.

There was this one patient who had been hit by a car while biking. He'd recently had a tracheostomy, so he couldn't talk. He had been bedridden for some time and had developed a bad sore on his buttocks. Over time, laying in one spot can put more pressure on the capillaries than they are designed to handle and it causes the skin to die really slowly. Apparently, even when we sleep normally and think we are perfectly still, we wiggle around enough to keep this from happening. Not this patient. There was a hole above his anus large enough to stick two fists through. It looked painful. His entire back was tattooed, and he was missing rows of teeth. He was skinny and his skin hung off like rags. After the surgeon checked his wound, I asked her how old the patient was while taking a guess of my own: 87.

He was 52. When we went back later to change the dressing, he had shat himself. He couldn't talk, he couldn't get out of bed, and he didn't have control over his own bowels. He had effectively been aged 40 years. I felt sorry for him.

We went over to pediatrics next. I could tell the kid had been in there for a long time as soon as I stepped into the room. Posters on the wall. Balloons in every corner. The surgeon knew his name without having to think about it. And I guess now I do, too.

The visit was brief. It was around 4 am and the kid was sleep. The doctor quickly listened to his heart and lungs and then we left. She then told me he has been in a boating accident. He was being pulled on a small raft down a river on a leisurely family outing when he hit a rock, and, just like that, his spinal cord suffered irreparable damage. He's paralyzed from the waste down. He's currently learning how to deal with his condition. He has to use a self-administered catheter to urinate. His bowels also don't work as voluntarily as they used to. Specialists came in just to help him understand the fact that he would never walk again.

I can only imagine. I have a hard time accepting it myself. I asked about three times in three different ways if the kid would ever have a hope. Even now, after three no's, a part of me feels like something should be possible for the kid, somewhere down the line. But I'm no doctor. Not yet.

The kid was 15.

There were other interesting patients throughout the night. An older psych patient wanted to sleep on the floor of the waiting room and the police were called to deal with her. She was on 24-hour superveillance, and she didn't like the idea of eyes always watching her. She wanted to be discharged, and wanted to have a man's company again. The surgeon sat down and talked to her for about thirty minutes, explaining the conditions of her stay and assuring that she would try her best to get her discharged. It was truly a display of patience.

There was another psych patient who had beat up a couple nurses just a few days before, leaving them hospitalized. He had just been taken off restraints again and, apparently, he was off his psych meds. Sounds fun, right? He looked just like Mel Gibson in Braveheart, only hairier, and bigger.

I stayed with the intern all night while she checked on patients, administered physical exams, updated notes in the computer system, and responded to the many, many questions the nurses continued to have. At about 6am she presented her patients to her attending and the rest of the trauma surgery team, and then went home to get some rest before coming back that night to do it all over again. When she presented, she was an intern again, a little nervous and hesitant about the questions asked of her, and constantly being grilled on hypothetical situations by the attending. But during the night she was the one everyone looked to--from nurses to patients--to have the answers, to know what to do. And she did. It was inspiring, to say the least.

That, and a tad bit tiring.

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