Summertime

From July 2007

Some time now has passed by since I last put anything down here for people to peruse. I always have liked the sound of that word, just been a while since I have been able to do it or use it.
Since I last wrote something down, Kristi, Alec, and Anne have all celebrated birthdays. We have four new fangs in Pati's mouth, the northwest has been blessed with our presence as we returned for a family reunion and wedding anniversary, and because some of our wonderful family paid the way for us to go. We had a great time out there and it felt like a real summer to be able to spend time with family, play frisbee and eat watermelon.

On the work front, I have been doing the upgraded duties and schedule of a second-year resident, which includes lots more work when I am on call, and I am on call much more, or so it seems. Now a days, I am quite proficient at putting in central venous catheters, thoracostomy tubes, and just last week I removed my first gallbladder as the operator (not the assistant), which means from start to finish I did the entire case myself. Most likely doesn't mean all that much to you, because you can't appreciate the difference, and in a year or so I suppose it won't mean much to me either, as I will be doing that more than assisting, but for now it is a pretty big milestone in my mind.
We have also enjoyed relative good health this summer, with only some fevers and minor illnesses to account for. Jan is getting quite old it seems, and is more of a help to mom than ever. She is much more interested in school things, and even writes "cursive," and I think by the looks of her "writing" she may have some medical potential there.
Alec is now without training wheels, is still working on his "R's," and "L'S" because they both come out "W" still. He is getting to be a help to mom as well, and is pretty interested in "boy" stuff.
Anne is the life of the party, and alternates from being the most entertaining and sweet child to a real challenge if she is crossed or corrected and doesn't appreciate it. She has quite the wit and vocabulary, and uses both prolifically. Her eczema is much more controlled now that she is on the strict and rotating diet, and I think it just might work for Anne's health, but not for Kristi's mental health. I am not sure how she manages to keep a home, raise a family, and see to the needs of a husband like she does. She is amazing and I know she has the hard end of this deal for sure. She has stuck with me though, and still says she loves me, so I guess it is worth it. I am so grateful to have her, and could not do this residency thing without her.

At work we have been dealing with all of the greatest members of society, who seem to save up their tricks and fancy moves for when they are drunk and tired. I think working on the trauma service is sort of like a box of chocolates, "cause you never know what you will get next." Usually one common denominator is alcohol, and a very low I.Q., which may be redundant as I am not really sure which one comes first.
Some of the more interesting cases lately have been those that I had a "strange feeling about." It is the not very scientific part of medicine, and I seem to recall a book I had started reading with Kristi called "Blink." There are these cases I get where I get one story, and then things just don't feel right, so I start following my sense of what isn't right and have ended up with some bad stuff. The first one was a couple of weeks ago, when I was called to go evaluate a patient who had just completed open heart surgery 4 days prior to my seeing him. His abdomen was distended and he was breathing sort of fast and shallow, and just didn't look right, but he refused to acknowledge anything going on, or any real pain.
I didn't believe him and went to look at the CT scan he just had that the radiologist read as "negative." I stared at it and something just didn't seem right, so I played around with it for a while and then started to see some air that wasn't in his bowels. This means you have ruptured a hole in the bowel somewhere between stem and stern, so I showed it to my attending, and told him my concerns. He agreed with my analysis that something was up, and so we went down to radiology to have them explain to us how this gas was read initially as not outside of the bowel... Anyhow to make a long story short, he had ruptured his colon and we had caught it early enough to hopefully catch him before he got really sick.
The next case was a lady who came into the emergency room looking like she was going to die, pale, sweaty, heart rate fast, and writhing in pain. The emergency room told me they thought she had a ruptured aneurysm, or at least a dissecting one, and when they sent her to the CT scanner, told me they were going to call me about her. I was curious, so I went down and watched her CT scan, and her Aorta was fine, but her bowel looked goofy to me. The radiologist told me that she was just breathing too much and the CT was too poor quality to make any diagnosis, but he didn't think anything was wrong. I disagreed, and went and showed it to my attending who was in surgery at the time. He went on my intuition and scheduled her for the OR. I was starting to feel like maybe I would look really stupid if he opened her up and didn't find anything, so I started second-guessing myself, especially since she was much more comfortable with the pain medication on board. To shorten it up again, we decided to go to surgery anyway, based on my bad vibes, and the attending called me into the OR 45 minutes later. I was thinking, "here it comes, I am going to get reemed out for making him operate on a perfectly normal and healthy lady." As I walked in the door, I could smell this unmistakeable smell of death, and looked on the table and he says, "you think we should have operated?" "I guess so," as I look at 3 feet of dead small bowel sticking out of her belly. Normal small bowel is pink. Dead small bowel is very dark red/black color. She had an internal hernia of her small bowel and it strangulated the blood supply, killing off a loop of her bowel.

Well, enough of the stories for now. I have to run study for my board exam next week, see Alec's new bike kickstand and bell, and put the kids to bed.

Take care and write if you get a chance to tell me how you are doing.

David