The Freakin Cable Guy finally Came! If you have been following Thumper, Max and Buddah's blogs you know we have spent the last week and a half moving. We are completely out of the old place and we turned over the keys yesterday. The new place has stacks of boxes everywhere but we are slowly getting things set up. The cable company was supposed to set us up for TV and internet access on Monday. They never showed and when I called them I was told the tech came by the house but no one was home. In his notes he even described our house as white with a brown door. I don't know whose house he went to but ours is not white with a brown door. So next we were scheduled for Wednesday afternoon and again no one showed up. When I called on Wednesday I got bucked up to a supervisor. I felt a little better after I chewed him out for a few minutes. Fortunately the cable guy arrived today as promised so I don't have to call and scream at anyone today. I work my third of five nights in a row tonight. Wednesday I was pretty busy all night with three different cases. One involved a lady with an abscess in her breast. A patient who had a pancreas/kidney transplant several days before had to go back to the OR to stop some bleeding. The last case of the night was a young man who needed an appendectomy. Last night I only did one case involving a 14 year old boy who was hit by a car while riding his bicycle. The neurosurgeons had to place a monitor to measure the pressures in his brain. Fortunately he was opening his eyes after the case which is a good sign. Well I better hit the shower and get ready for work.

Pedestrian VS Car I only did one case last night and as the title of this entry says it involved a man getting hit by a car. He was unconscious and had a breathing tube already in place when he was brought up to the OR. He appeared to be in his fifties and we had no health history on him at all. We didn't even know his name. At our hospital when an emergency case comes into the OR they are assigned a Doe name until their identity can be established. This man will be called Ken Doe until his real name is determined. His right lung was collapsed by broken ribs so the first thing the surgeons did was place a chest tube to reinflate it. Next they worked on his right arm and shoulder which were torn open and bleeding. They also opened his belly and repaired a laceration on his liver. I gave him four units of blood and other fluids during the four hours we worked on him. He will be returned to the OR later to work on his broken legs. We have a little saying in the OR. When it comes to pedestrian vs car, the car always wins.

Long Night, Weird Night Last night was both a long night and a weird night. I did three cases last night and with the exception of a lunch break was in the OR all night long. The first case involved a 55 year old man who had fallen in his garage and hit his head. He had a subderal hematoma which means he was bleeding in his brain. He already had a breathing tube in place when he was brought up. The surgeons opened his skull and removed clotted blood. He should recover fully. My second case of the night was to finish a case started by the evening shift. A 48 year old women was receiving a kidney transplant. She was diabetic and had heart problems but she did well during the case. My last case of the night was the weird case of the night. I wasn't sure whether I should blog about this case but Thumper said I should. Fair warning this case will be rather graphic. The case involved a 55 year old man. He told the doctors in the ER that his girl friend drugged him and inserted a 12 inch vibrator up his anus and he couldn't get it out. This had occurred 6 weeks ago. Today he had suddenly experienced severe abdominal pain. The Xray showed that the vibrator had perforated his large intestine. After I put the man to sleep the surgeons made an incision from 2 inches below his sternum down almost to his pubic bone. When the surgeons spread the incision open about 4 inches of hot pink colored vibrator could be seen sticking straight up out of his colon. The surgeons removed the vibrator and repaired the hole in the colon. Because of extensive swelling of the large intestine the surgeons created a colostomy. The patient will probably have the colostomy for 3 to 6 months. As I said a weird night.

Busy Third Night Last night was another good learning night for my student. We did two cases. The first involved a 56 year old lady who had neck surgery two days before. She had a cervical neck fusion done for chronic neck pain. Because of a history of heart problems she takes blood thinner medications. These meds were stopped prior to her surgery and then they were restarted on the second postop day. Most of the time this works well but in this case the women had some bleeding deep in her incision. A pocket of blood called a hematoma formed and put pressure on her spinal cord. Over a couple of hours the lady went from normal function to paralyzed from the neck down. She was emergently intubated and rushed to the OR. When the surgeons reopened the three inch incision on the back of her neck blood actually shot out about a foot because of the pressure. They explored the wound, put in a drain and reclosed it. We left the breathing tube in and returned her to the neuro ICU. Hopefully she will get full function back but it was to soon to tell at the end of the case. I will go up to the ICU tonight and see how she is doing. The second case of the night involved a 17 year old boy with a gunshot wound to the belly. The bullet had actually gone all the way through his body. He had several holes in his small intestine but fortunately none of the big abdominal blood vessels were hit. He should fully recover but my question is what was a 17 year old kid doing out at 3 in the morning to get shot in the first place? One more night to go.

2nd Night Last night was the second of four nights at work. My student and I only did one case but it was a good learning case for him. The case involved a 20 something year old man who was in a bad car accident. He was bleeding badly internally and they had to open his chest in the ER to massage his heart. In the OR we gave him 12 units of blood and lots of other fluids while the surgeons stopped the bleeding. We worked on him for about two hours. He was stable as we took him to the ICU. Hopefully he will fully recover.

Gearing up to Move Well the moving process has begun. Two weeks from tomorrow we will be moving to the new house. In the meantime we have started filling boxes and cleaning the current house. It is amazing how much stuff that accumulates over time. We are going through an trying to get of things we really don't use or need. Moving is always a pain but I think we will be happier in the new place. I worked the first of four nights last night. Only did one case involving a 20 something year old man with a deep stab wound to his right arm in the biceps area. Fortunately no major arteries or nerves were hit so he should recover fully. Another student started working with me last night. He will be on nights with me for a month to get experience doing trauma cases. Three more to go.