Wednesday, October 27, 2010

News I Think is Interesting

So, I've done this before, and I'm doing it again. Mostly, I'm doing it because the "link" feature on Facebook seems to be malfunctioning, and I found a bunch of interesting news stories today that I want to share! If anyone likes this, let me know, and I'll probably keep doing it.

Here's an interesting article on psychological "disorders" and their beginnings in youth. Not particularly NEW news, but a good overall insight into how complicated it can be to discern what is normal fluctuation of mood/handling of the world in a child, versus what is abnormal, and potential ways to push young minds in the right direction.

Caffeine + Alcohol...in the same bottle? Yeah, THAT'S a good idea. Especially with it's energy-drink-style can and fruity flavors, it's a recipe for disaster with teens and young adults. The FDA has been asked to review them. Caffeine blunts your body's natural response to alcohol, and makes you feel as if you aren't as intoxicated as you are. Energy drinks alone are bad, but throw alcohol into the mix, and it's really bad.

Girl's Want to Talk About Sex- With Dad?" is the title of this article. And yep, Dads, we need to get with the program! Daughters want the "guy's" perspective on sex. Studies show that teen girls who talk with their dads openly about it have sex later, with fewer partners, and safer. I like that this article stresses that this needs to not be just a one-time conversation, but an ongoing openness. The same can be said of a lot of things!

This amount of sleep is too much, this amount of sleep is too little, this amount of sleep is just right. This article references a study on sleep that researched age of death of over a million Americans, and looked into how that correlated with reported hours of sleep a night. It appears the magic number is 6.5-7.5 hours a night. I wish!

Yuck. We already knew this was happening, but the official reports are that from 2007 to 2009, Insurance claim denials rose by 50%. Disgusting! Sure, that'll be against the law come 2014, but insurance companies will (and already are) finding ways around it. I've only been in direct patient care for 4 months and I'm already fed up with insurance companies, and the limbo we have to go through to satisfy their requirements. If I go into a specialty where I can do so, I'll probably avoid insurance companies altogether and engage in direct contracts with my patients.

That's all I've got for now. I'm taking the surgery shelf exam on Friday, and then I'll write a post about my surgery rotation experience! Have a wonderful week.

Thursday, October 21, 2010

On Call During a Full Moon

My alarm jolts me into consciousness at 4am. I hit the power button on the coffee maker (Dad always said I'd pick up the coffee habit once med school started), take a quick shower, throw on my scrubs, grab the bag of pumpkin muffins I made last night, whisper a goodbye to my sleeping family and head off to the hospital. Hmm, it's starting to get chilly. I think I'll grab a jacket.

I toss my backpack in the callroom with everyone else's and trade my black jacket for the white coat with my name on it and my patients' information in the pockets. I head up to the floor and spend the next hour or so seeing patients and writing down vitals, lab values and reports from the night shift. I head over to a conference room to hear sign-out from the night team, and the next 2 hours is spent seeing patients with the entire team.

When rounds are over, I find a free computer and get to work updating orders and notes. I gobble a couple muffins down and head to the OR where we open up a man's abdomen to drain a pocket of pus. We decide to hold off on repairing his hernia until his wound heals up, so it won't get infected. It's now 5pm, and the day team heads home. I'm on call tonight, though, so I grab a bite to eat from the cafeteria and focus on studying for the surgery exam I'm taking in a week. I try not to drink too much, because you never know when you'll have to go the operating room, and you never want to have a full bladder in the OR.

It's 10pm...BEDTIME! I turn off the lights, kick off my shoes and close my eyes. Immediately, I hear the BUZZZZZ!!!! of my pager vibrating on the desk! "Med student needed in OR 15, STAT!" I throw my shoes back on and race upstairs, throwing on a scrub cap and mask. I hear the story: Man who had abdominal surgery 3 weeks ago was found by his son with altered mental status, distended and very painful abdomen. Apparently it's been bothering him for a week now, but he didn't want to come in and have it looked at. A CT scan shows what we never want to see: free air in his abdomen, meaning he has a bowel perforation. I quickly remove the staples from his old belly incision while anesthesia puts him under. We "scrub in" and open up his belly quickly but carefully. The surgeon tells me, "Have suction ready." Understatement. Of. The. Century. The last layer of tissue was cut, and approximately 3 liters of...fluid, let's say...erupted from his abdominal cavity. Everywhere. As Han Solo famously said, "What an incredible smell you've discovered!" His abdominal organs had been sitting in feces and digestive juices for a week, and he had actually eaten away much of them. His liver looked like cottage cheese. We patched him up and took him to the Surgical Intensive Care Unit (SICU).

I head back to my call room and take a fast shower. I'm covered in abdominal fluids. Ah, much better. The other students on call are covering the 2 emergent appendix removal surgeries. My hip is buzzing again. Trauma, Level II, 2 minutes. Please, people, if you must ride a motorcycle, where a helmet! This guy got lucky and should be able to leave in a day or two. Ok, maybe I can actually get a wink or two of sleep?

I close my eyes again. BUZZZZ!!!! "Trauma, Level II, 3 minutes." We have a skeleton team since one of the appendectomies is still going on. The patient rolls in and the paramedics give their report. "20-something year old male found unconscious in a restroom at McDonald's." We don't know much else about him, except that he REEKS; he's wet his pants, he hasn't bathed in...a long time, and he is covered in what looks like mold. The emergency room doctor recognizes him as a "frequent flyer" who abuses a few different drugs, and we realize that he has overdosed on one of them. He's coming in and out of consciousness. "Don't worry, you're at the hospital," we tell him. With his left hand, he flips us off, and he makes a fist with his right hand and starts flailing at the staff. I have to hold him down to keep everyone safe, and I think I may gag from the smell that is now inches from my nostrils. I wonder about what we can do to really help people like this, from doing this to themselves.

As I hold down this guy, I hear "Ah-OOGA!" I glance at the clock. It's 4am. Time to "wake up". When he's stable, I wash my hands and grab a big cup of coffee from the "Cafe Oasis" and head back upstairs to do my morning routine of checking up on my patients. This morning is much like the last. Sign-out, see patients, updates notes and orders. I ask the intern how else I can help him. He must recognize that look of exhaustion in my half-closed eyes. "Are you post-call?" he asks. "I am!" "Ok, thanks for everything, why don't you go home?" I hesitate a moment before asking him if he's sure. It's 10am. I've been awake for 30 hours.

I stagger down to my truck. I turn the key in the ignition. Nothing happens. My "Service Engine Soon" light has been on for 9 months...has it finally caught up with me? I pop the hood, and thank God, I'm able to coax the engine into starting.

I get home, and my 2 year old screams "DADA!! You're home!!" My dear wife asks "Are you hungry?" and I realize I haven't eaten since last night. She makes me steak, mashed potatoes and spinach. Oh, YEAH. It's good to be home. I take a shower and read a book to my son. My wife whispers those sweet words, "Now go to bed." I trudge upstairs and am asleep before my head hits the pillow.

It's 12:30pm.