Weekend Summary It is 03:30 in the morning on my fourth night in a row at work. Overall it has not been a bad 4 nights. Thursday night (Christmas Day Night) was quiet except for a 23 year old lady who needed her appendix removed. Friday night was the busy night of the four. We put a pin in to fix a 26 year old mans broken leg. A 28 year old women had a fallopian tube removed because of an ectopic pregnancy. The last case involved a 61 year old with a history of metastatic prostate cancer. He had experienced a sudden weakness in his legs and loss of bladder control. An MRI showed that he had a mass that was compressing his spinal cord in his lower back. I put the patient to sleep on a gurney, placed a breathing tube into his lungs and then we turned him onto his stomach. The surgeons opened up his lower back and removed the mass and hopefully relieved the pressure on the man's spine. It will be several days before they know if he will get the use of his legs back as well as control of his bladder. Unfortunately he will eventually probably die of the cancer but hopefully this surgery will give him more time and a better quality of life. Saturday night looked like another quiet night until about 3 in the morning when they brought up a 25 year old man with a single stab wound to the chest. We heard that he got stabbed by his girlfriend while arguing about a Christmas present. He was very stable but the surgeons needed to look inside with a laprascope to see if there was any internal damage. It turned out that there was no internal damage and the patient should fully recover. Tonight I did the case of an extremely lucky 7 year old boy. He had been riding a friends bike when he crashed. A jagged edge on a hand brake handle had slashed his neck just below his jaw on the right side. It was not bleeding badly so none of the major blood vessels had been hit but the surgeons needed to carefully exam the wound for nerve or airway damage and then clean it out and close it. Fortunately after I had him asleep they found no serious damage and were able to clean out and close the wound which was about 1.5 inches long. They said that if one of the major blood vessels had been hit the young man probably would have bled to death in minutes. As I said a very lucky young man. That is it so far and the day shift will be here in a few hours. On a very happy note Thumper and I meet with our realtor this afternoon for a final walk through the house and should have "keys in hand" on Tuesday! Then we just have to get moved in!

It was Just an Appendectomy, Not! Thursday night was the first of 4 nights in a row. I started out by taking over a case that was started by the evening shift nurse anesthetist. The patient was 38 years old and he was having his appendix remove laprascopically. I was told he had been having pain since the day before Thanksgiving but it had gotten significantly worse today. He had no medical problems but had admitted to being a methamphetamine user on a regular basis. When I took over the case the ports for the laprascope were in place and the surgeons were trying to get a look at his appendix. They were having difficulty as it appeared that the appendix may have perforated and they could not get a good look at it. They finally abandoned the laprascope and made an incision to take out the appendix "the old fashioned way". They were finally able to get a good look and it turned out that instead of an inflamed appendix they found a rather large mass that was probably cancerous. They removed the mass as well as a large section of small intestine. They closed him up, and I woke him up and took him to the recovery room. They will have to wait for a pathology report to know for sure whether or not the mass was cancer. Later that night another patient was brought to the operating room to get his appendix removed. He was 58 and had a significant history of heart and lung disease. His lungs were bad enough that he routinely used supplemental oxygen at home and was short of breath with minimal exertion. I explained to him that it was highly probable that I would leave his breathing tube in at the end of the case. His appendix was easily removed by the surgeons and I did indeed leave the breathing tube in place at the end of the case. The plan was to leave the tube in for several hours until the man was completely awake before the tube would be removed. Tonight has been mostly quiet. I did one short case involving a 55 year old man. He has diabetes and like many long term diabetics had developed an open wound on his left foot caused by poor circulation. I sedated the man and the surgeon injected local anesthetic to numb his foot. She then debrided and cleaned the wound and bandaged it. The whole case took less than an hour. Two more nights to go.

Light Weekend This weekend turned out to be a light one at work. Friday night there were no cases at all. I spent the night reading, BSing with the rest of the operating room staff and watching the classic Scifi movie "When The Earth Stood Still". Saturday night I did only one case that lasted about 4 hours. A 37 year old man had been run over by a train. He had been stabilized at another hospital and then rushed to us. Both of his legs had been traumatically amputated by the train, the left just above the knee and the right just below the knee. His right hand was severely damaged. He had lost a lot of blood. The surgeons worked to stop the bleeding from what was left of his legs. They also worked on his hand. I gave the man 18 units of blood products as well as other fluids. I left the breathing tube in at the end of the case and took him to the ICU. Last night I again only did one case. It involved an 83 year old man with a cancerous tumor obstructing his small intestine. The cancer had spread to his liver. The surgeons removed the intestinal mass and reopened his blocked small intestine. The masses in his liver were inoperable unfortunately. The surgeons said that the man probably has 6 months to a year left to live. If we had not reopened his small intestine he would have died within a week or two and it would have been very painful. He should be much more comfortable after the surgery and should go home in 4 or 5 days. That was it for the weekend.

Drunken Baby As I have mentioned before I work an occasional day shift at another hospital. I like these day shifts because I get to do types of cases and anesthetics that I don't get to do on the night shift. Today I was doing anesthesia for ENT cases. The first case involved placing ear tubes in a 10 month old boy. I spent about 15 minutes holding the little guy prior to taking him to the operating room. With mom standing right there he was fine with me holding him and he seemed to enjoy running his little hands through my beard. I distracted him by making funny noises as I carried him to the operating room and by the time he realized that mom was no longer there I had him half asleep. The case took only about 10 minutes and the little guy woke up fine. The second case involved a 3 year old girl who was to have her tonsils removed. In this case we had the mom give the little girl a mixture of Tylenol and Versed. Versed is a wonderful drug. In adults it relieves anxiety, causes sleepiness and forgetfulness. In little children it causes them to laugh and giggle often at everything or nothing. They often act like they have been drinking. Ten minutes after taking the Versed we had a very drunk baby on our hands. She could not stand by her self and everything around her was funny. I carried her to the operating room and put her to sleep without any problems. The third case involved removing the tonsils of a 27 year old women. It went without difficulty. My last case involved a 38 year old man. He had been taking alot of aspirin for headaches over several months. An unfortunate side effect of aspirin is that it can interfere with blood clotting. This man had a nose bleed that had been going on intermittently for almost 3 weeks. He had lost enough blood that he had already been given a transfusion. After I put the man to sleep the surgeon looked in his nose with a scope. She found the source of the bleeding and was able to stop it. Overall it was a very nice day.