Sometimes my Job Pisses me Off! A couple of weeks ago I blog how I hate my job occasionally like when doing an organ harvest on a fifteen year old. Occasionally aspects of my job also piss me off. I worked three nights in a row this weekend. The first two nights were perfect. I did not do a single case Friday or Saturday night! I don't think I have ever gone two nights in a row without doing a case. After all I work in a trauma center. Instead I had my portable DVD player out and watched 11 episodes of Battlestar Galactica (The new one from the Sci Fi Channel it's a great show) and two movies. Sunday night I ended up doing two cases. The first involved a 50 year old man with a perirectal abscess. That's butt puss in laymans terms. It was about a 20 minute case while the surgeons opened the abscess up and let it drain. The second case of the night is the tragic one that pissed me off. It involved an 11 year old boy. He was at some sort of "organized" youth bird hunting competition. We were told that an 8 year old boy while attempting to shoot a bird accidently shot the 11 year old with bird shot. The eleven year old got hit on his left hand but caught most of the birdshot in the face. His face was badly damaged. His left eye was unsalvagable. His right eye was hit by three pellets. The eye surgeons worked on that eye for about 5 hours. They think he will retain "some" vision in the eye but only time will tell us how much. Now I have never been hunting. My father and I were fisherman. I am not against hunting. Some good friends of mine over the years have been hunters. However I do not think an eight year old should be hunting especially with a shot gun! I don't know who I pity more the now most likely blind 11 year old or the 8 year old who has to live with the memory of shooting him.

Average Weekend I realized I had not blogged about work this weekend. It was a fairly average four nights at work. Here are a few highlights of what my student and I did. On Thursday we did two cases an appendectomy on a nine year old boy and irrigation/debridement on a lady with an infection in her leg. Friday night had us doing a kidney transplant until about 4 in the morning. Saturday we did the first "real" trauma of the weekend. A 22 year old man was brought in with 11 stab wounds to the wrist, abdomen chest and neck. One of the neck wounds was the most significant because a major vein had been hit and had to be repaired. Fortunately it was a vein and not an artery or the man would probably have bleed to death before getting to the hospital. It was a good case for my student. Finally Sunday night we did a case involving a 20 year old women who was found down along a bicycle path. It was unknown how she had fallen from her bike but she had hit her head causing a subderal hematoma (bleeding in her brain). She was still conscious and coherent when she arrived at the OR which is always a good sign. the surgeons opened up her skull, stopped the bleeding and removed a rather large blood clot. She should fully recover. Overall a pretty average weekend.

Sometimes I hate my job. It is 8:20 in the morning and I am home from my 3rd nightshift in a row. I really love my job. Getting to do anesthesia is the best job in the hospital, most of the time. However every once in a while I hate what I do. Last night I hated my job. On Saturday a girl whose name I won't write here turned 15 years old. I have no idea how she celebrated her birthday. I do know that she went horseback riding. Unfortunately her horse tripped and she was thrown from its back. In the fall she suffered several skull fractures and intercranial bleeding which caused severe brain damage. By the time she was brought to the hospital it was to late. Sunday afternoon she was declared brain dead. Her parents generously decided to allow the surgeons to harvest her organs for transplanting. She was brought up to the OR at 10:00 last night. She already had a breathing tube in place in her mouth and another tube through her nose into her stomach. Even with the tubes in place I could see that she had been a pretty girl with long black hair. For an organ harvest my job is to maintain the vital signs as close to normal as I can. This ensures that the organs are getting the oxygen they need right up to the point when they are removed. The surgeons made an incision from the base of her neck down to below her navel. They then prepared her liver, pancreas and both kidneys for removal. It took about two hours for them to be ready to remove the organs. This is when the worst part of an organ harvest for me occurs. The surgeons place a large clamp on the aorta to stop bloodflow out of the heart right before they finally remove the organs. As soon as that clamp is placed my job is done. I turn off the ventilator and all the monitors and leave the room. It never feels right doing that. Logically I know that this poor child died shortly after she fell from the horse on Saturday. But it is still very difficult to just turn everything off and walk away. I had a student with me last night. This was her very first organ harvest and she handled it very well. Fortunately there were no other cases for the rest of the night.

Long Night Last night was the first of three nights at work. I took over a case in progress that lasted all night long. a 74 year old man had a vascular repair to restore the circulation to his left leg about two months ago. As part of that repair a segment of artificial artery was used. Now two months later the artificial artery segment was grossly infected and had to be removed. When I took over the case the surgeons had already removed vein segments from both of his arms. These vein segments would be used to replace the segment of artificial artery in his leg and hopefully maintain circulation to the leg. The man's left thigh was red and swollen like a tennis ball was under the skin. All the infected materials were removed first and the whole incision from hip to knee was cleaned out. The process of taking a vein segment and using it to replace an artery is a long slow one. The day shift nurse anesthetist replaced me with several hours of work left to go. In all the patients surgery probably will be 12 to 14 hours long. The sad thing is that there is no guarantee that the infection will not return or that adequate leg circulation will be restored. In either case the patient could still end up loosing his leg.

Another Gunshot wound Last night was busy at work. My student and I did two cases. The first was a 36 year old women with acute abdominal pain. It turned out that the women had an ovary with a cystic mass on it. The ovary was removed and she should fully recover. The second case of the night involved a 23 year old man who was found slumped over in his car. He had a gunshot wound to the head. The bullet entered just below his right eye and ended up in the back of his skull. He arrived at the OR with a breathing tube already in place. We put him to sleep and he was placed on his left side. The surgeons were just getting started with the case when I was relieved by the dayshift. I checked up on the young women with the gunshot wound from Thursday night. The good news is that she is awake and alert and will have her breathing tube removed tomorrow. The bad news is she is now paraplegic. Two more nights to go.

It was a Quiet Night until... Last night was the first of four at work. It was unusually quiet when I got there. Normally there is at least a couple of cases still going when I get to work and I end up finishing whichever one is going to go the longest. I was told that the last case had finished about 9:00 and there was nothing else scheduled to start. I am sure my student for the night was disappointed but I don't mind the occasional quiet night. I set up my little DVD player and settled in to watch. It remained quiet until 3 in the morning when a 20 something year old girl was brought up with a gunshot wound to the chest. She was still conscious but her blood pressure was dropping when she was rushed up to the OR. We quickly put her to sleep and the surgeons started working. It turned out the bullet passed through her left kidney and her spleen as well as causing her right lung to collapse. The surgeons put in a chest tube to reexpand her lung, removed her spleen and removed part of her kidney. She received 5 units of blood and other fluids during the case and we left her breathing tube in at the end of the case. We took her to the ICU at the end of the case. She should fully recover. My shift was over once we finished her case. Three more to go.