Rode Hard and Put Away Wet That is another of my grandfather's sayings. It refers to a horse being worked hard, kind of like I was last night. I did three cases last night that kept me in the Operating room pretty much the whole night. The first involved a 19 year old women with an ectopic pregnancy. In a normal pregnancy an egg is released from the women's ovary. It travels through the fallopian tube, where it is fertilized, and implants on the inside wall of the uterus and starts to grow into a baby. In an ectopic pregnancy the fertilized egg never reaches the uterus. Often it attaches to the inside wall of the fallopian tube. Within a few weeks it grows to big for the narrow diameter of the tube and gets very painful. If not treated soon enough it can burst through the tube with increased pain and potential for bleeding. The surgeons did the case laprascopically. They ended up having to remove the damaged fallopian tube. My patient will recover and will still be able to get pregnant again in the future if she wants to. My second case of the night involved a 49 year old man who was hit by a car. His left leg was badly broken and very swollen. The surgeons did a fasciotomy to relieve internal pressure and then placed an external fixator on the leg to hold the bones in place. He will require another surgery in a week or two once the swelling has gone down. My final case of the night involved a 39 year old women who also had an ectopic pregnancy. The surgeons started the case laprascopically. However once they got the camera inside we saw that her abdomen was full of blood. They opened her abdomen and had to remove the ruptured fallopian tube that was bleeding. She had about a liter of blood in her abdomen. I gave her two units of blood. She will recover fully. She had not even known she was pregnant. We finished the last case around 5:30 this morning. I have two more nights to go.

You can't Choose your Family My grandfather had many sayings about different things in life. One that I remember was that, "you can choose your friends but not your family." Last night at work was a good example of that saying. I did two cases during the night. the first involved a 38 year old woman with multiple gunshot wounds. she had two chest wounds, one in the abdomen, her right earlobe had been shot off and a bullet had passed through her right hand in a classic "defensive wound." She needed a chest tube to re inflate her right lung and some of her damaged small intestine had to be removed. they retrieved one of the bullets from her abdomen. It was a 45 caliber bullet about as big around as my thumb. She will recover from her wounds but will be in the hospital for a week to 10 days. The really sad part of this story is that we heard it was her husband who had shot her. The second case of the night involved, in my opinion, a really stupid father. A man was driving somewhere with his 6 year old son in the car with him. We heard that his car's brakes failed. He continued to drive 40 miles using his emergency brake to stop the car. Unfortunately his plan didn't work out to well and he wrecked the car. The 6 year old boy had a large laceration along the corner of his mouth with glass embedded in the wound. the surgeons repaired his face but he will probably always have a scar. That was my Sunday night.

Long Night Last night was the first of four. It started out with a 23 year old man with a stab wound to the abdomen. In some cases with a stab wound there is a hole created by the knife but not much visible damage on the outside. In this case the stab wound had slashed open his abdomen and a loop of small intestine was hanging out. After I put the man to sleep the surgeons opened his abdomen and carefully inspected his intestines. It turned out that there were no injuries to any internal organs and the surgeons were able to close his abdomen. I woke him up and we took him to the recovery room. The second case was on a 35 year old man who needed to have his appendix removed. The surgeons did the case laprascopically and things went smoothly. The third case of the night was on a 46 year old man with a rectal abscess. The only hard part of this kind of case is positioning the patient. After I put the man to sleep his legs were put up in stirrups and the bed is tilted head down. These kind of cases are usually do not take very long. the surgeons open the abscess, drain them of pus, and pack the wound with gauze. the man did well with no complications. My last case of the night is one I do allot of. A 43 year old women with an abscess on her hip that was caused by her injecting heroin with a dirty needle. She told me that she had last used heroin yesterday and that she also uses methamphetamine. As is true with most drug users that I work with she looked much older than her actual age. Her hair was grey and she only had a few teeth left. I was relieved by the day shift before her case was completed. Three more nights to go.