A sterile delivery
1 week ago
Wednesday, February 10, 2010
Attack the Day!!
Wednesday, January 27, 2010
Coffee and Horchata
This song, and a good cup of coffee, have really made my morning today...makes sitting in front of the computer for hours on end not so bad...
Tuesday, January 26, 2010
Organic
On my last night on call in the SICU one of our patients died. This wasn't the first time I have had a patient on my service die, and not the first time one has died while I've been on call in the SICU. However, this death was such a long and drawn out process - he still made it onto our list for rounds in the morning as he teetered on the edge of death for hours...moving towards it and away, over and over again, but never far enough away from it not to make it inevitable.
His story was this; he was a 71 year old man, dialysis dependent as he had CRF (chronic renal failure). He also had significant liver disease, due to Hepatitis C, and a long history of alcohol abuse that had resulted in cirrhosis. He came into the ED complaining of severe belly pain x2 days - first noticed at his last dialysis appt. and which had only worsened since then. After exams and tests, he was quickly brought to the OR for an exploratory laparotomy, which revealed an extensive amount of necrotic bowel. Due to a number of variables, the surgery was difficult and lengthy. Eventually, the patient was found to be acidotic - a blood gas done by the anesthesiologist showed that his pH was 6.9 (we are all supposed to be happily churning along at a pH of 7.4 or so. Under 7.2 the proteins that your body needs to function don't work so well. They actually partially denature (think "human western blot", at least that's what I think about!) and obviously don't function in this state, i.e. all things start to go to shit. Fast.). We got news in the SICU that the surgery was being aborted, and that the patient was coming to us vac'd (meaning a wound vac had been put in place over his open abdomen), intubated, and sedated. We would be in charge of resuscitation.
It soon became clear that resuscitation was simply not going to happen. The patient received, innumerable liters of IV colloid solution, as well as 20 units of pRBC's (packed red blood cells), approximately 16 units of FFP (fresh frozen plasma), and also received multiple units of cryo (cryoprecipitate) and albumin. The dialysis unit was brought in and started. He was hooked up to an A-line (arterial line) for better BP monitoring, and a flotrac to monitor his CO (cardiac output) and his SVV (stroke volume variation), which is a good indicator of his volume status, as well as his responsiveness to fluids. A heating blanket was placed on him, and the temperature of the room was raised as his body temp continued to go down. He was given pain medication for comfort, and further medication to keep him sedated. The SICU team, especially the nurses, were all business - working together almost without the need to speak; they understood their roles in this critical situation so completely, as if they had done this hundreds of times, which - truth be told - they have. Everything was fast paced, but orderly, and my only role, really, was to stay out of the way.
We knew this man was going to die, and it became more evident, hour after hour, as blood was pumped into him and you could virtually see the line on the wound vac canister rise with a bright red fluid fluid we knew, almost certainly, was primarily arterial blood. His liver was so dysfunctional (it makes the majority of the clotting factors involved in the blood's clotting cascade) he was not able to clot or stop bleeding. His abdomen - which was distended with ascitic fluid on admit to the ED, had initially been flat when brought up to the SICU. It was packed tightly in the OR and sealed with a large dressing. But, over the course of the night it filled up again, and you could see his belly swelling underneath the pile of blankets he lay beneath. We knew that this was mostly blood, leaking from all the oozing areas that could not be cauterized or tied off during surgery. Additionally, we were pouring bicarb into him, yet he still remained acidotic, barely reaching 7.25 before his pH would drop down to 7.0. We tried to keep him above 7.25, a number we knew would allow for all of the other fluids filled with proteins to actually work inside his body, rather than just take up space...ironically, something he did actually need - volume resuscitation - however, that was just the tip of the ice berg.
What I found striking about this whole case was the fact that his fate - both his life and his death - depended solely on the basic function of his body on a cellular and microscopic level, which I know is not a new phenomenon (obviously!), but is something I have never thought about so distinctly when faced with a death of a patient. Now, I always marvel when I am able see organs working - the small bowel peristalsing, or the aorta pumping, the heart pumping! - during surgeries. I never get tired of it. Ever. It is mindboggling to think of the amount of things that have to come together to work in harmony inside our bodies in order for us to exist, and essentially so we don't even have to pay attention to our bodies on a day to day, or even minute to minute basis, i.e. if everything is working a-ok most people probably don't give too much thought to what is going on underneath their skin. But I have to admit, I do not always think so avidly about cellular mechanics, things like the krebs cycle, or glucose metabolism for example. And this guy...man! He was a perfect example - sadly - of the complexities of our existence, on a basic, and almost organic level, beyond all those organs I am entranced by. His cells in his liver and in his kidneys were broken, they didn't work....he couldn't clear ammonia, lactate, or clot his blood. As he lost blood, his BP went down and his cardiac output diminished - his brain began to receive less and less oxygen as the volume of blood it received decreased. There was nothing to do, short of receiving a liver transplant, something this gentleman most likely would not have been a candidate for, and we certainly couldn't go in and fix each cell one by one. So, all night we watched him, and we watched the monitors attached to him. His body was true and honest - it was broken, and it did not lie.
It was strange to drive home after this on call night and realize that - at least in terms of his death, or his loss of life - it didn't matter what type of person this patient was, that his wife was sitting at his bedside loving him and not wanting him to leave, that his son would not make it back from CA before he died; it didn't matter. What mattered was that - biologically and physiologically - he was beyond fixing, despite the life he led, the things he had accomplished and experienced, the people he loved, or who loved him. I thought about what this meant in terms of treating my body well, taking care of myself - realizing that the consequences of how we live are metered out at even the most minute and cellular level. I also thought about the idea of living life fully, to the best of my ability, and without as many regrets as possible, making each moment count; all of this because I realized that we cannot cheat biology, we cannot deny the "machines" that are chugging away inside each and every one of our cells. With hope, we exist in the state, most days, where things are working harmoniously, and we give very little thought to what is going on in our oh so complicated innards, but sometimes you just never know. I thought about death, and how it is a given, and about how, sometimes thinking about death, and feeling more connected to our bodies, can lend itself to better living, or maybe just living more completely within the moment.
His story was this; he was a 71 year old man, dialysis dependent as he had CRF (chronic renal failure). He also had significant liver disease, due to Hepatitis C, and a long history of alcohol abuse that had resulted in cirrhosis. He came into the ED complaining of severe belly pain x2 days - first noticed at his last dialysis appt. and which had only worsened since then. After exams and tests, he was quickly brought to the OR for an exploratory laparotomy, which revealed an extensive amount of necrotic bowel. Due to a number of variables, the surgery was difficult and lengthy. Eventually, the patient was found to be acidotic - a blood gas done by the anesthesiologist showed that his pH was 6.9 (we are all supposed to be happily churning along at a pH of 7.4 or so. Under 7.2 the proteins that your body needs to function don't work so well. They actually partially denature (think "human western blot", at least that's what I think about!) and obviously don't function in this state, i.e. all things start to go to shit. Fast.). We got news in the SICU that the surgery was being aborted, and that the patient was coming to us vac'd (meaning a wound vac had been put in place over his open abdomen), intubated, and sedated. We would be in charge of resuscitation.
It soon became clear that resuscitation was simply not going to happen. The patient received, innumerable liters of IV colloid solution, as well as 20 units of pRBC's (packed red blood cells), approximately 16 units of FFP (fresh frozen plasma), and also received multiple units of cryo (cryoprecipitate) and albumin. The dialysis unit was brought in and started. He was hooked up to an A-line (arterial line) for better BP monitoring, and a flotrac to monitor his CO (cardiac output) and his SVV (stroke volume variation), which is a good indicator of his volume status, as well as his responsiveness to fluids. A heating blanket was placed on him, and the temperature of the room was raised as his body temp continued to go down. He was given pain medication for comfort, and further medication to keep him sedated. The SICU team, especially the nurses, were all business - working together almost without the need to speak; they understood their roles in this critical situation so completely, as if they had done this hundreds of times, which - truth be told - they have. Everything was fast paced, but orderly, and my only role, really, was to stay out of the way.
We knew this man was going to die, and it became more evident, hour after hour, as blood was pumped into him and you could virtually see the line on the wound vac canister rise with a bright red fluid fluid we knew, almost certainly, was primarily arterial blood. His liver was so dysfunctional (it makes the majority of the clotting factors involved in the blood's clotting cascade) he was not able to clot or stop bleeding. His abdomen - which was distended with ascitic fluid on admit to the ED, had initially been flat when brought up to the SICU. It was packed tightly in the OR and sealed with a large dressing. But, over the course of the night it filled up again, and you could see his belly swelling underneath the pile of blankets he lay beneath. We knew that this was mostly blood, leaking from all the oozing areas that could not be cauterized or tied off during surgery. Additionally, we were pouring bicarb into him, yet he still remained acidotic, barely reaching 7.25 before his pH would drop down to 7.0. We tried to keep him above 7.25, a number we knew would allow for all of the other fluids filled with proteins to actually work inside his body, rather than just take up space...ironically, something he did actually need - volume resuscitation - however, that was just the tip of the ice berg.
What I found striking about this whole case was the fact that his fate - both his life and his death - depended solely on the basic function of his body on a cellular and microscopic level, which I know is not a new phenomenon (obviously!), but is something I have never thought about so distinctly when faced with a death of a patient. Now, I always marvel when I am able see organs working - the small bowel peristalsing, or the aorta pumping, the heart pumping! - during surgeries. I never get tired of it. Ever. It is mindboggling to think of the amount of things that have to come together to work in harmony inside our bodies in order for us to exist, and essentially so we don't even have to pay attention to our bodies on a day to day, or even minute to minute basis, i.e. if everything is working a-ok most people probably don't give too much thought to what is going on underneath their skin. But I have to admit, I do not always think so avidly about cellular mechanics, things like the krebs cycle, or glucose metabolism for example. And this guy...man! He was a perfect example - sadly - of the complexities of our existence, on a basic, and almost organic level, beyond all those organs I am entranced by. His cells in his liver and in his kidneys were broken, they didn't work....he couldn't clear ammonia, lactate, or clot his blood. As he lost blood, his BP went down and his cardiac output diminished - his brain began to receive less and less oxygen as the volume of blood it received decreased. There was nothing to do, short of receiving a liver transplant, something this gentleman most likely would not have been a candidate for, and we certainly couldn't go in and fix each cell one by one. So, all night we watched him, and we watched the monitors attached to him. His body was true and honest - it was broken, and it did not lie.
It was strange to drive home after this on call night and realize that - at least in terms of his death, or his loss of life - it didn't matter what type of person this patient was, that his wife was sitting at his bedside loving him and not wanting him to leave, that his son would not make it back from CA before he died; it didn't matter. What mattered was that - biologically and physiologically - he was beyond fixing, despite the life he led, the things he had accomplished and experienced, the people he loved, or who loved him. I thought about what this meant in terms of treating my body well, taking care of myself - realizing that the consequences of how we live are metered out at even the most minute and cellular level. I also thought about the idea of living life fully, to the best of my ability, and without as many regrets as possible, making each moment count; all of this because I realized that we cannot cheat biology, we cannot deny the "machines" that are chugging away inside each and every one of our cells. With hope, we exist in the state, most days, where things are working harmoniously, and we give very little thought to what is going on in our oh so complicated innards, but sometimes you just never know. I thought about death, and how it is a given, and about how, sometimes thinking about death, and feeling more connected to our bodies, can lend itself to better living, or maybe just living more completely within the moment.
Saturday, January 16, 2010
Post Holiday Musings
You know, I hate Christmas, I really do. I feel bad writing that statement out...am cringing a little seeing it sitting there in black and white; but it's the truth. When my sister and I were growing up and my parents divorce seemed to take center stage for so many years, or at least it's subsequent fall outs and aftermath did, many of our most painful moments were played out at this time of year. I actually was reminded of the Christmas season this year - not by my family, but by the Christmas decorations going up around the hospital, and the free candy canes at the starbucks counter where, admittedly, I did enjoy more than a month of their great holiday blend coffee. This holiday, for me, just brings up bad memories of fighting parents, crying parents, my sister and I crying, and then the holidays where we were shuttled back and forth from extraneous step-relative homes, where people tried, graciously...at least most of the time, to fit us into their already established holiday festivities. Those years put a big stop to the childlike happiness of decorating the Christmas tree, the delight in turning on the lights every night when it got dark, and spending a morning in pj's with family while opening presents and listening to Christmas music. This is further heightened by the fact that earlier and earlier each year Christmas decorations are present in stores, and everywhere I look there are ads pushing things to buy...useless things...a level of overt conspicuous consumption that I just find, well - GROSS. Every year, I try, in some small way, to feel what I felt as a child, to feel that happiness and joy in the season. But, really. This year I actually had the feeling, as I rushed to get coffee, calculating if I could actually afford to drink a whole cup because I would be in the OR for most of the day (i.e. sans bathroom breaks!), and looked at the giant dish of free candy canes at the starbuck's counter, that it really sucked that I am always going to have to deal with Christmas, or at least what it has turned into, every year! I probably was just exhausted, or having a rotten start to the day, who knows. I was in the midst of sub-I #1 and it vacillated between being pretty awesome to crap; even though the crap was very few and far between. I do know however, that despite having these feelings, I do try to take stock of my life at Christmas, mainly because the new year is looming, and I want, very much, to make my moments count.
Last year I wanted to be more present in my life, in everything I was experiencing, and that is a goal I will carry with me into 2010. I realized too, as I finish up these months and moths of surgical rotations, that I am heading in the right direction, albeit slowly. But as my aunt Janice always says, "slow and steady wins the race", and I try to remember that when I remind myself that I am making progress, despite a long road ahead, and that it is sometimes the journey that holds the biggest rewards. In 2010 I will spend months in Mexico, something I feel will be one of those "big" experiences in life. My research is moving along, and little by little I am enrolling patients, plus, hopefully!, I will have the papers, that have long been in the works, published. My friends will match on March 18th this year, and I am torn - excited for what I have planned for myself, excited for them, but sad to see them go, and sad to be separated from them in what has been an intense 4 year journey. But, I myself will have to embark on applications and interviews - all awaiting me on my return. Overall, exciting stuff, and a great deal to look forward to in 2010!
Last year I wanted to be more present in my life, in everything I was experiencing, and that is a goal I will carry with me into 2010. I realized too, as I finish up these months and moths of surgical rotations, that I am heading in the right direction, albeit slowly. But as my aunt Janice always says, "slow and steady wins the race", and I try to remember that when I remind myself that I am making progress, despite a long road ahead, and that it is sometimes the journey that holds the biggest rewards. In 2010 I will spend months in Mexico, something I feel will be one of those "big" experiences in life. My research is moving along, and little by little I am enrolling patients, plus, hopefully!, I will have the papers, that have long been in the works, published. My friends will match on March 18th this year, and I am torn - excited for what I have planned for myself, excited for them, but sad to see them go, and sad to be separated from them in what has been an intense 4 year journey. But, I myself will have to embark on applications and interviews - all awaiting me on my return. Overall, exciting stuff, and a great deal to look forward to in 2010!
Thursday, December 24, 2009
Candy Cane Cookies and Chest Tubes
Saturday, November 28, 2009
Lost in translation.
Don't even get me started on the language issue. The amount of times I have told attendings and residents that I don't feel comfortable translating for them with their spanish patients during critical visits, or when they are trying to consent them (kind of an important thing!! - consent for a surgery, a procedure of any sort, anesthesia...you name it!) is innumerable at this point. We are busy and pulled in many different directions and no one wants to waste precious time calling a translator, or even using the translator phones. I have really strong feelings about this. Some docs actually don't use these services for no other reason than an arrogant type of pride - thinking that their spanish skills, or portuguese, or french, what have you, is strong enough to convey the medical message they are trying to impart. It is one of the most frustrating aspects of this work that I see on a daily basis. One of my uncles and I were talking about this issue last Christmas, and he was telling me how the hospital that he is on the board of directors for is trying to spear-head this problem. One administrator had given him a list of problems that occur over and over - for example, in telling a patient to take a dose of their medication once a day, a provider had written out the word "once". The patient was spanish speaking and in spanish "once" is eleven (pronounced ON-say). So, the patient promptly went home and took his medication 11 times per day instead of one. The result is that his hospital seems to be making a big push for spanish speaking providers, over expanding their translator services. I think this is a really unrealistic goal, but then I don't know what else should be done. I mean, my hospital has one of the most extensive resources in terms of human translators, as well as translator phone services that can be plugged into any room, and we still do not, on a regular basis, take advantage of it. It is a shame, but also a kind of injustice in services as well. If a patient is at your hospital, and you are the care provider, I believe it is your responsibility to provide them with the same type of care and benefits that they would receive if they spoke english. Many times that is simply not the case. Patients are given instructions in some sort of half ass version of their language, along with miming and pantomiming on both the part of the doctor and the patient.
Just recently, I had a patient, Mr. M, a 76 year old Puerto Rican man, while I was on my anesthesia rotation. He was having surgery for his cataracts, and was awake during the entire procedure. The anesthesiologists said the same thing a lot of people say to me, "You speak spanish right? With that last name you should!, do you want to talk to Mr. M?" OK. Yes, I want to talk to Mr. M, but do I want to translate the consent for his surgery? Ummm. NO. But, Mr. M and I did talk a bit, and we had a great conversation - he was from the same neighborhood that my grandfather grew up in, and my father had lived in. After his surgery I saw him waiting for his daughter to come and pick him up. I went over to wish him good luck, and to tell him to stop touching his eye (it was covered, but his hand kept sliding up to the finger the tape and the dressing, over and over again). He talked with me again about Puerto Rico, and my spanish. I told him I needed to continue to practice, and that I was glad that he and I could talk for a moment. He stood up, and hugged me, kissed me on the cheek and patted my back, and told me in spanish that he wished me good luck, and that he was glad I was studying to be a doctor. Honestly, I love interactions like this, and I have had them time and time again with my hispanic patients. I have been hugged and thanked by first time mothers, and patients on my family medicine rotation. Grandmothers in various offices for follow up appointments with their own grown children because they needed a translator during their visit. A mom getting breast reduction surgery after losing 100 pounds, and visiting the office with her 10 year old daughter who speaks better english than she does. These are always the patients who see me, see my blue eyes, and then look at my name tag, look at my eyes, and then back at the name tag again. They ask me in spanish if I speak spanish. I speak back. The ask me about my name, my family, and I explain. More times than not, this familiar cultural background makes their tension ease, and they become relaxed and smile at me. But, the one caveat in all of this is that I say, right up front, that my spanish is not the best, and that translators are available if and when they want one because I want to make sure they understand everything I and the doctors have to say. Being able to establish this connection with this subset of patients is something that is really special to me; these interactions have been some of the most memorable I have had over the past few years. However, it makes me nervous to simply rely on language skills that are not as good as they can be, and I try always to be aware of that. Thus, my decision to make my trip to Mexico this spring. Tickets have been bought, and the classes and volunteer work is planned. I hope that after it, I can comfortably and honestly say that I speak spanish fluently, something I would never say now, because it is simply not the truth. After I return home, I can only imagine and hope that these interactions with my spanish speaking patients will be even better.
And another reason that this seems so pertinent now - just last week I was a patient myself. I was at a different hospital, and while waiting to register I saw a sign that said (in english) "If you need a translator, we will provide one. Simply take a pamphlet below that corresponds with the language you need. Thank you." Does anyone else find it ironic and totally stupid that this sign was written in english, and that none of the pamphlets below had any visible words on it in the language they were trying to advertise?? I was trying to take a picture of it with my phone, but the women at the registration desk were giving me the evil eye. Ironic, stupid, funny...but also a great example of how this problem is so poorly dealt with.
Just recently, I had a patient, Mr. M, a 76 year old Puerto Rican man, while I was on my anesthesia rotation. He was having surgery for his cataracts, and was awake during the entire procedure. The anesthesiologists said the same thing a lot of people say to me, "You speak spanish right? With that last name you should!, do you want to talk to Mr. M?" OK. Yes, I want to talk to Mr. M, but do I want to translate the consent for his surgery? Ummm. NO. But, Mr. M and I did talk a bit, and we had a great conversation - he was from the same neighborhood that my grandfather grew up in, and my father had lived in. After his surgery I saw him waiting for his daughter to come and pick him up. I went over to wish him good luck, and to tell him to stop touching his eye (it was covered, but his hand kept sliding up to the finger the tape and the dressing, over and over again). He talked with me again about Puerto Rico, and my spanish. I told him I needed to continue to practice, and that I was glad that he and I could talk for a moment. He stood up, and hugged me, kissed me on the cheek and patted my back, and told me in spanish that he wished me good luck, and that he was glad I was studying to be a doctor. Honestly, I love interactions like this, and I have had them time and time again with my hispanic patients. I have been hugged and thanked by first time mothers, and patients on my family medicine rotation. Grandmothers in various offices for follow up appointments with their own grown children because they needed a translator during their visit. A mom getting breast reduction surgery after losing 100 pounds, and visiting the office with her 10 year old daughter who speaks better english than she does. These are always the patients who see me, see my blue eyes, and then look at my name tag, look at my eyes, and then back at the name tag again. They ask me in spanish if I speak spanish. I speak back. The ask me about my name, my family, and I explain. More times than not, this familiar cultural background makes their tension ease, and they become relaxed and smile at me. But, the one caveat in all of this is that I say, right up front, that my spanish is not the best, and that translators are available if and when they want one because I want to make sure they understand everything I and the doctors have to say. Being able to establish this connection with this subset of patients is something that is really special to me; these interactions have been some of the most memorable I have had over the past few years. However, it makes me nervous to simply rely on language skills that are not as good as they can be, and I try always to be aware of that. Thus, my decision to make my trip to Mexico this spring. Tickets have been bought, and the classes and volunteer work is planned. I hope that after it, I can comfortably and honestly say that I speak spanish fluently, something I would never say now, because it is simply not the truth. After I return home, I can only imagine and hope that these interactions with my spanish speaking patients will be even better.
And another reason that this seems so pertinent now - just last week I was a patient myself. I was at a different hospital, and while waiting to register I saw a sign that said (in english) "If you need a translator, we will provide one. Simply take a pamphlet below that corresponds with the language you need. Thank you." Does anyone else find it ironic and totally stupid that this sign was written in english, and that none of the pamphlets below had any visible words on it in the language they were trying to advertise?? I was trying to take a picture of it with my phone, but the women at the registration desk were giving me the evil eye. Ironic, stupid, funny...but also a great example of how this problem is so poorly dealt with.
Monday, November 16, 2009
Edentulous
Anesthesia has rolled into its second week. The people are nice, laid back, and some of them are just amazingly smart. It makes sense when you think about the fact that managing a person's "internal workings" - so to speak - during surgery, is essentially just being a superfreak master of all that is physiology. So, when someone is willing to teach during a complicated case it can be pretty interesting. Overall though, I am drawn time and time again, case after case, and day after day, to the other side of the curtain. I want to watch the surgeries...even the ones I have seen before, like hernia repairs (I watched a lap hernia repair, both ventral and inguinal, and it is crazy the amount of dexterity that is required in order to place the mesh, unroll it, and suture it in, all by only using long armed grasping devices!). And, by rotating through different OR rooms every day I am getting to see other types of surgeries that I have not yet been exposed to. Last Friday I watched a craniectomy, to remove a tumor from a 30 year old woman's brain...today I watched a CABG, and it was amazing to see the heart pumping right in front of me, to see the TEE (transesophageal ultrasound) (I have read about them, suggested ordering them for patients, but have never seen the real time picture of the valves working like that!), and to see how when the heart was stopped, the perfusionist ran the bypass system, all while the surgery team harvested a vein and used it as a graft for 3 different coronary vessels, and then restarted the heart and had it pacing back to normal. Needless to say, I recognize the value of knowing and understanding what the anesthesiologist does (especially as a future surgeon), but I am never as interested in what they are doing, as what is happening only a few feet away.
I do like intubating and placing oro-gastric tubes, and and other types of tubes and lines. Not that I am allowed to do anything as serious as say - a central line, but I am encouraged to do and try as much as possible. The first few people I tried to intubate were fairly easy, but one woman had the fattest tongue I had ever seen and I could not see my way around it! Even the resident and attending were saying how extraordinarily fat her tongue was. However, talking about her fat tongue or her mouth in general was just run of the mill for them, as discussing mouths and airways is just part of what they do. The next day that I attempted intubating it seemed fairly easy - a view of the cords, slide the tube in, insuflate the balloon, but something was off, I just couldn't figure out what it was. Finally I realized that all of the patients had teeth! (vs. all my patients the day before who had none, or who are called "edentulous"). So ridiculous. And so strange because that is not something I would ever really pay too much attention to. I was reminded of a case I scrubbed in on last year that was delayed because the anesthesiologists thought it would be too much of a risk to intubate the patient due to a loose tooth (it could fall completely out, and get lodged in his airway). So, they paged the dentists to come directly to the pre-op area to pull it out, after getting the "ok" from the patient. While we waited, the patient kept on shaking his head, and mumbling. I asked him if he was ok, and he said that he was, but he was just angry at himself. I asked him why, and he told me that he should have just pulled this tooth out with the rest of his teeth, which he had pulled out himself, only a few days before. Apparently, he had noticed that he had 3-4 loose teeth in his mouth, so he got his pliers and some beers, and pulled the teeth out, one by one. He left one lone tooth (the one that the dentists would now be pulling) because it did not seem as loose to him, and he thought he should have at least one tooth that was his own!
I do like intubating and placing oro-gastric tubes, and and other types of tubes and lines. Not that I am allowed to do anything as serious as say - a central line, but I am encouraged to do and try as much as possible. The first few people I tried to intubate were fairly easy, but one woman had the fattest tongue I had ever seen and I could not see my way around it! Even the resident and attending were saying how extraordinarily fat her tongue was. However, talking about her fat tongue or her mouth in general was just run of the mill for them, as discussing mouths and airways is just part of what they do. The next day that I attempted intubating it seemed fairly easy - a view of the cords, slide the tube in, insuflate the balloon, but something was off, I just couldn't figure out what it was. Finally I realized that all of the patients had teeth! (vs. all my patients the day before who had none, or who are called "edentulous"). So ridiculous. And so strange because that is not something I would ever really pay too much attention to. I was reminded of a case I scrubbed in on last year that was delayed because the anesthesiologists thought it would be too much of a risk to intubate the patient due to a loose tooth (it could fall completely out, and get lodged in his airway). So, they paged the dentists to come directly to the pre-op area to pull it out, after getting the "ok" from the patient. While we waited, the patient kept on shaking his head, and mumbling. I asked him if he was ok, and he said that he was, but he was just angry at himself. I asked him why, and he told me that he should have just pulled this tooth out with the rest of his teeth, which he had pulled out himself, only a few days before. Apparently, he had noticed that he had 3-4 loose teeth in his mouth, so he got his pliers and some beers, and pulled the teeth out, one by one. He left one lone tooth (the one that the dentists would now be pulling) because it did not seem as loose to him, and he thought he should have at least one tooth that was his own!
Subscribe to:
Posts (Atom)