Blue Light Special for Abscesses My student and I had a long night last night. We ended up doing 4 cases all involving people with an abscess that needed to be drained. Three of the cases were on heroin users. A 45 year old man with one on his hip, a 52 year old women with one on her shoulder and a 55 year old also with one on her hip. These are usually short cases. The surgeon makes a deep incision over the abscess allowing pus to escape. The wound is cleaned out with sterile saline and then the open wound is packed with gauze which will be changed several times a day until it heals. The last case involved a women with a small abscess on her left breast. It was unclear what had caused her abscess but it was treated in the same way as the other three. Hopefully we will get something a little more interesting for my student tonight.

Blue Light Special on Appy's My student and I just finished two night shifts. I think we must have been running a blue light special on appendectomies. We did a total of four of them over two nights. the youngest patient was a 16 year old boy and the oldest was a 70 year old women. I know the day shift did at least one on an 8 year old child as well. In addition to the appy's we also took out the gall bladder of a 25 year old women. Finally we drained a 45 year old heroin users shoulder abscess. I am sure my student was hoping for trauma cases but he has another week before he returns to Hawaii. We will be back at it on Monday night.

Bullets and Fishhooks Last night was my second of four nights. It turned out to be an average night with my student and I doing two cases. The first case came up from the ER a little after midnight. It involved a 16 year old kid with a gunshot wound. The bullet hit him in the small of his back and ended up just under the skin of his right shoulder. Fortunately the only real damage was to his right lung. He will fully recover. The second case of the night came up about 5 in the morning. It involved a 46 year old man who was transferred from another hospital. We were told that he had a fishhook in his eye. It turned out to be a Mepps spinner with a treble hook (yes I am a fisherman so I know fishing lures) that was firmly lodged in his right eye. We were relieved by the day shift before the case was finished but the surgeons did not think the outcome would be very good. Two more nights to go.

Impressive Case Every once in a while I do a case that when I look back at it I just want to say "Wow that was Impressive". Last night my student and I did a case like that. It involved a 48 year old man who was brought up from the ER. He was lying on his side because he couldn't lay on his back. The reason he couldn't lay on his back was the knife that was buried up to its hilt just below his right shoulder blade. He was awake and able to talk though obviously scared and in pain. We took him to the operating room and carefully moved him to the OR table . The table was configured with a hole in it that allowed the man to lay on his back while we put him to sleep. We then positioned him on his side. The surgeon then carefully and slowly pulled the knife out of his back. It was a kitchen knife with about a 7 inch blade! I think it was a "wow" moment for everyone when we saw that knife. It turned out the patients right lung was damaged but there was no other damage. We heard that it was the man's girlfriend who stabbed him. We didn't hear why she did it. Three more nights to go.

Nice Normal Cases Most of the time I work the night shift at a trauma center. Many of my patients already have a breathing tube in place when they arrive. If they don't we are rushing to the operating room and I have about a minute to ask a few key questions before I put them to sleep. I work one or two day shifts a month at another hospital just so I can do a few "normal" cases. I did five cases yesterday on five mostly healthy patients. None of them were bleeding or having difficulty breathing. Not a single one was using heroin or methamphetamine. I was able to spend time talking to each patient before their case. The first case was a shoulder arthroscopy. This is where the surgeon looks into the shoulder joint with a camera and uses small instruments to repair things. We followed with two knee arthroscopies. The last two cases were minor hand surgeries. I did both of these cases with Beir blocks. A Beir block is where a tourniquet is placed on the patients arm and local anesthetic is then given intravenously. The tourniquet holds the local in the arm which goes numb and stays numb until the tourniquet is released. The patient is sedated for their surgery but remain awake. I go back to the trauma center Friday night but it is nice doing routine cases every once and a while.

Sometimes it's quiet and sometimes it's not!!! Home now from my third night shift and it wasn't a good one. First let me tell you about Saturday night. It was relatively quiet with me only doing one 2 hour case involving an 18 year old boy with a gunshot wound to his abdomen. The bullet hit both his liver and his right kidney. The surgeons removed the kidney and stopped the bleeding in the liver. He lost allot of blood but being young and healthy (and stupid enough to get shot??) he should fully recover. I spent the rest of the night watching episodes of season two of "The Closer" on my little DVD player. It is a really good show if you haven't seen it. Last night started out looking like another good night. Then everything went down hill fast. About 10:30 last night I started a case on a 74 year old man. He had an aortic graft done sometime in the past. This is where they replace a segment of the largest artery in your body with an artificial one. Unfortunately in this case the man's graft had gotten infected and would have to be removed. Before they could remove the infected graft the surgeons placed a different graft that started in his left shoulder below the clavicle and ran down to his groin. This part of the operation went smoothly and took about 4 hours. Next they opened his abdomen to remove the infected graft. He had allot of scar tissue from his prior surgery and the aorta runs behind the intestines making it difficult to get to. Because of the infection the blood vessel was weakened and there was allot of bleeding. At one point the patient lost about 5 liters of blood in about an hour before the bleeding could be controlled. I gave the patient 15 units of blood during that time as well as lots of other fluids. I was replaced by the day shift before the surgery was completed so I don't know the final outcome. When I left there was probably 4-6 hours left to go until they would be finished. All in all it was a long night. It didn't help that the main surgeon for this case is one of my least favorite to work with. He is a good surgeon but he can be very grumpy and hard to work with especially in the middle of the night. The good news is I am now off for a few days!

All Alone For the last month I have had an Army student from Trippler Army base in Hawaii working with me. He was a senior student here to get some experience doing trauma. He got to do some really good trauma cases including several gunshot wounds, car wrecks, a kidney transplant and others. He did a good job and I hope he learned a little from me. I briefly met his replacement last night but that student doesn't officially start for a few days. That means I will be all by myself this weekend. Last night I did two cases. The first was on a 15 year old boy. He had been filling a plastic bottle with an air compressor, I don't know why, when the bottle blew up in his face. A piece of the bottle struck his left eye, splitting the eyelid and damaging the eye itself. It took about two hours for the surgeons to sew up his eye and eyelid. They will not know for a week or two how much vision he will have in that eye. My second case involved a 55 year old healthy man. On Thursday he had a routine colonoscopy done at another facility. Unfortunately his colon was unknowingly perforated during the procedure. He went home feeling fine until He started having pain and fever late Friday afternoon. The surgeons opened his abdomen and repaired the hole in his large intestine. He should fully recover. That was it for the night and I better get some sleep.