Friday, April 17, 2015

24-Hour Call on L&D: A Breath of Fresh Air

This post conforms to the blog rules.This minipost started during an away and was never written. It's the story of two 24-hour L&D shifts in the middle of a urogynecology rotation. The attending belittled me and taught me nothing, and I missed obstetrics. So when I heard that "acting interns usually take the Thursday 24-hour shifts," I was ecstatic. So, as an escape from my attending (and away to see more of the residency program, because this was an audition rotation), I took call. It was wonderful to be with laboring women, L&D nurses, infants, and fathers. I saw a D&C for retained placenta, a sacral dystocia (yeah, weird), and a few sections (at one of which I legitimately impressed the resident with my running subcuticular, which I have been perfecting since the summer after M1). It was wonderful.

Sunday, April 12, 2015

Stories from the ER: Bedbugs

This post conforms to the blog rules.In college, I devoured books written by medical trainees. I read Singular Intimacies, Complications, and A Not Entirely Benign Procedure (and others) as a college student. Having read these, I think I could've said about medical school what St. Therese said about the convent: I went in with my eyes open, and I was right.

When I read Danielle Ofri's story of a homeless, bug-covered man who came in through Bellevue's emergency department, I thought, "I know med school is an experience, but that's too crazy to happen to anyone but people who write books." Crazy books about crazy NYC hospitals.


A disclaimer: this story contains a few nasty things, including bedbugs and elder abuse. There will be no exaggeration. There's a happy ending.

During my ER rotation, a woman was brought in covered in bedbugs. The attending sent me in to see her and I went into the room at my usual busy pace. One of the EMTs, still packing up his stretcher, halted my progress with a few words. "You might want to...." the EMT started, then tried again: "She's sort of...covered."

Then my eyes registered the hundreds of mini-M&M sized insects swarming in and out of her clothes, around her arms and legs and fingers, on her neck, and on her sheets. I stopped short, my shoes almost squeaking on the lineoleum with the abruptness of my deceleration.

The woman herself was moaning.

"What's the story?" I asked the EMT.

"She called about pain. We had to break the door down. Found her in a chair, in feces and urine and--" he gestured to the insects "--those. Vitals were stable in transport."

With that, he left. From a safe distance, I took a history as best as I could. (I was a little disgusted.) The woman lived alone. She was unable to get out of her chair. She didn't eat or drink. Everyone once in a while a neighbor brought a sandwich. The last time he'd come was three days ago. The neighbor doesn't get too close. Nobody cleans her. Nobody cleans her house. She had home health, but they didn't come too close. She had had pain "in her seat" for a while, but didn't talk to anyone about it. She called 911 about it today.

I left the room without doing a physical exam, as the ER nurse was posting a "DECONTAMINATION" sign on the door. I was angry; elder abuse is something I feel very strongly about. I went to my attending and told him the situation.

"Someone's going to get sued," he said, meaning the home health organization.

"I'd like to help decontaminate," I said.

"Be my guest," he replied.

Outside her door, nurses were gowning up as if the patient had Ebola. I joined in: boots, cap, two gowns (the flimsy ones that only cover half of you; one for each half), and mask with face shield. None of us were wanting to take bedbugs home. We were already itchy.

I turned my anger into zeal and worked alongside the nurses, overcoming my disgust and turning myself into Love to this woman. We brought in large trash bags and a dozen packets of moist skin towelettes. Then we took off and threw away the woman's clothing and all the sheet's she'd touched. We wiped bugs and bug carcasses off her body. I cleaned where the nurses didn't. It turned out she had two decubitus ulcers from sitting so long.

It was a terrible day (that patient, plus a death, plus family troubles). That night I told Jesus all about it. "What was Your day like?" I asked, in a slightly complainy tone. And He answered, in my imagination. (This is the happy ending.)

"Someone cleaned Me."

Tuesday, April 7, 2015

Stories from the ER: Motherhood

This post conforms to the blog rules.While working in the ER last semester, I met a woman who surprised me by her reverence for motherhood. Because there was real concern that she might have colon cancer (like classic-history, I-was-actually-scared-for-her concern), a CT scan was being ordered.

But one of the CT scanners was broken, so there was a long line for the other one. Worse, trauma cases kept rolling in that night. This woman had been in the ER for seven hours, and she was still awaiting her scan. She threatened to leave. The attending talked to her and came back. The nurse returned twenty minutes later. "She says she's gonna go," the nurse said. Her (perfectly acceptable) facial expression said, "And I'm resigned about it."

"I'll talk to her," I said. Talking to upset people is one of my favorite things to do, ever since I deescalated a potential emotional explosion in the psych ER waiting room and someone told me I was good at it. My theory is: it can't get any worse, and you can only make it better!

The attending was busy, so he let me. I went in and sat down, preparing for a long haul. My intention was to sit with that woman and talk with her until a radiology tech came to take her to the CT scanner. It was something I was uniquely poised to do, because I didn't have true clinical responsibility and I could be functionally absent for whole hours, if necessary. It would be good for this patient and our ER if she stayed--she'd know more about her colon (cancer?) and the ER wouldn't have her back in two months with inoperable disease. So the attending let me go, and I plopped down at her bedside, hoping to distract her.

It worked beautifully.

After a few minutes of expressing her displeasure about the wait, I got her talking about all kinds of things. TV shows, her day, traffic, weather, her old jobs, her family. Her favorite topic was her grandchildren. Her voice changed from unpleasant to soft and full of fondness. When she started talking about when she first became a mother, something peculiar happened.

Alfred Gilbert: Mother Teaching Child
"Oh," she said, looking at me with something between mischievousness and envy, "when you find your man and have a baby...! There ain't nothing like it, no where in this world. Nothing like giving birth, it's--tch!--can't be described a'tall. Miraculous."

Our roles suddenly reversed. I was no longer in power, pinning her down as one who knew better. She was instantly a queen, telling a little girl about magic.

"Really?" I asked.

"People say it's painful. I say 'ha!' Pain is nothin' compared to what you have. Your baby growin' inside you, then your baby in your hands. Just you wait, you're gonna be a good one. Now," she said, pragmatically, "how long I gotta wait for this CT?"

I grinned enormously. She'd taken me off my guard and my silver-tongued attempts to keep her in bed were suddenly exposed. I have a feeling she knew what I was up to the entire time, and was letting me win.

"I'm being honest," she said. "I still want to go."

"I'll ask," I said. I found out she was third in line and went back to her. "Number three!" I said, like we'd both won the lottery.

"Three?" she said, smiling. "Guess I'll stay, then."

I have no idea what the results of the CT were (it was read after my shift was over), but I got her to stay until she was in the scanner. She stands out in my mind as someone who values motherhood; even if she knew what I was up to, she was serious when she described how marvelous it is. I think of her frequently now and I try to have that esteem for motherhood, too.