Yep... if you want to go somewhere new with someone and get lost? Bring me. It'll happen.
So far the "lost count" is 6. These aren't just little fuck ups either, these are times I've gotten lost for at least an hour, wandered aimlessly and had to get a cab back to safety.
I decided to take a bus from Brigham back to my apt in Brookline; a fairly simple journey. But, being Captain Lostalot, I was determined to screw it up in any way possible. I hopped on the bus and began my ride. I was on it for about 20 mins when I saw a 7Eleven. I thought, "Oh, I better get off here because that looks like the 7Eleven where I got my Slurpee this morning." Nope. It was one of the other 75 7Elevens in Boston. I wasn't even in the same town as I started out in. I saw my bus circling back around to go the other way, but being too full of pride I walked on by it like I knew exactly where I was going. I forgot to mention that it was 28 degrees out. And, I was wearing a tie. And, I had our monstrous bookbag on. I was gross. I kept walking and ended up in no other place but Chinatown. I stopped into a store to ask directions and I left more confused. So, I called a cab to bring me home. $27.
Today, I figured what better a way to spend my day off than by going to a nice mall in Cambridge! It's so nice there. Harvard and MIT were next door (their campuses are unreal!). There was a nice river where all the Harvard boys (heller der!) practiced their rowing and MIT guys (haii!) did their sailing. It was just really nice. But, first I should probably tell you about how I got here...
I debated getting a cab, but figured I would save the $20 and get the T (after getting a slurpee, of course!). I hopped on the T and made it to my first destination without trouble. But, here's where Captain Lostalot decided he would burst on the effing scene. Got on the wrong T line and ended up so far out of town that I had to get off the train. Where do you think I was? No other place than the motha effing "HOOD." Here I was, 'very' white boy, bright and colourful t-shirt, and a dumb look on his face parading around the hood looking for a cab. After seeing a group of very angry looking men with shorts down to their ankles and "do rags" on, I fled like a wild chicken back to the T station and desperately asked for help to get to Cambridge. But, of course there was no one there. So, I hopped on another train that took me even further away. Anyways, I ended up getting a cab while watching a girl fight another girl (I believe one of their names were "Shawty" or "Shanty" not sure). She called me a "kracker" as I was getting into the cab. Thank Eff U C K that I didn't get tangled up in her weave. $50 cab to Cambridge.
So, I celebrated my new birth by shopping. It was fun. I looked around MIT's campus and cabbed (yes I took the effing cab this time) and came back to my apt. My BP is down from about 360/220.
It's good to be alive!
Coming home a little earlier now because I couldn't get anything scheduled past July 7th! So, I'll be home on the 6th after I see an aortic repair in the cardiac OR Wednesday AM.
Look forward to some interesting blogs after tomorrow night and an overnight in "Acute MGH" on the 4th of July! AHHH!!! (that's me being excited to see "Shawty" again).
Later!
Saturday, July 2, 2011
"Oh! Canada"
Happy post-Canada Day everyone!
Did a shift at Brigham and Women's yesterday - it was great!
I arrived at the hospital after a short cab ride and entered the Charlie unit. Today I would be on team Orange1. The ER is very new, upgraded a couple years ago and is unreal! All patient rooms are equipped to deal with everything from a runny nose to a full blown trauma. The layout has given me many ideas for the emergency department I plan on opening in town (a few years down the road).
I am hanging around the nursing and MD stations when I am introduced to a resident, Dr. A. Turns out, she's from Canada! (we also find out later that one of the nurses trained in Acadia). We wish each other Happy Canada Day, and begin to see patients.
Our first patient complained of chest + abdo pain and had a significant history of gastritis for which he had many previous hospital visits. During our initial H&P (history and physical) we find out that he had been self-medicating with... cocaine. Yes, what better way to relieve your bad guts... Anyways, I later would realize that this is not something that is too uncommon here. Since his crack did not help, he decided to come to emerg. We ordered labs and some scans to determine whether this was his usual gastritis or whether it could be something more serious such as a dissection, inferior MI, or pancreatitis. His EKG did show a flipped T wave in lead III, but all other diagnostics were completely normal. So, after a little bit of discussion with the senior resident and attending, we admitted him to a medicine floor.
Our next patient had a very peculiar chief complaint - "bat exposure." At first I was wondering whether this meant a baseball bat or animal, as bats (like vampire bats) are not all that common in NL. Apparently it's a very well known rule that if you wake up and there is a bat in your room you need to go to the ER. This is because they are disgusting animals that carry rabies. So, we gave the girl a rabies IgG and tetanus vaccine and prescribed 3 further vaccines at days 3, 7, and 11. The girl said something that caught me off guard as she was leaving: "Where do I pay?" It sounds weird, but it sent chills down my spine to think that someone would have to pay to ensure they do not develop rabies. Weird...
One thing that I found really different about their emerg was that they do rounds on their patients every hour or two so that everyone is on the same page. Also, they do team interviews with patients that usually includes the primary physician, attending, and nurse responsible for the patient. This way, the patient doesn't need to give their story to 4 or 5 different people. Something maybe we should consider?
P.s. our attending looked just like "Carter" off ER (Tracey, you would have died!).
One other patient I'll describe was a young lady who had been out drinking the night before and woke up the next morning with tremendous pain in her left hip. Important to note that she has a drinking problem and can drink about two 26Oz per night. She said she had been dancing all night and must have twisted or something. Picturing her dancing made me giggle a little, but I contained myself. We tried to do some physical exam on her, but when we attempted to get her up and walking she screamed and cried like an evil child. (note: I saw her walking in and then we saw her walking to the bathroom, with very little effort). After xraying her hip and determining there was nothing wrong with the joint, we informed her that she must have injured a nerve in her leg while she passed out for the night. We tried to discharge her, but she refused to leave and wanted some "oxy" for the road. Needless to say, we were close to calling security to have her escorted away.
Also of note is the fact that the Brigham ED has its own radiology department. Excuse me, what did you say? Yes, their very own CT scanner and multiple xray suites. They also have "teaching radiologists" on 24/7 who review the scans with clerks, residents, and attendings and teach them about the findings. It's not hard to tell that these hospitals are Harvard affiliated!
Oh yeah and the average wait time to be seen during my shift was: 0 mins. Yep, as soon as they arrived, they got a bed. Nuts.
That's enough about that shift! It was awesome and I saw some really cool things that I probably won't see too often at the HSC. And, a huge shout-out to Dr. A! You did a great job and taught me so much! I know you feel like you don't know anything, but (at least to me) you know lots!
I'm gonna write a separate post now about my travels to the mall today.
Zack
Did a shift at Brigham and Women's yesterday - it was great!
I arrived at the hospital after a short cab ride and entered the Charlie unit. Today I would be on team Orange1. The ER is very new, upgraded a couple years ago and is unreal! All patient rooms are equipped to deal with everything from a runny nose to a full blown trauma. The layout has given me many ideas for the emergency department I plan on opening in town (a few years down the road).
I am hanging around the nursing and MD stations when I am introduced to a resident, Dr. A. Turns out, she's from Canada! (we also find out later that one of the nurses trained in Acadia). We wish each other Happy Canada Day, and begin to see patients.
Our first patient complained of chest + abdo pain and had a significant history of gastritis for which he had many previous hospital visits. During our initial H&P (history and physical) we find out that he had been self-medicating with... cocaine. Yes, what better way to relieve your bad guts... Anyways, I later would realize that this is not something that is too uncommon here. Since his crack did not help, he decided to come to emerg. We ordered labs and some scans to determine whether this was his usual gastritis or whether it could be something more serious such as a dissection, inferior MI, or pancreatitis. His EKG did show a flipped T wave in lead III, but all other diagnostics were completely normal. So, after a little bit of discussion with the senior resident and attending, we admitted him to a medicine floor.
Our next patient had a very peculiar chief complaint - "bat exposure." At first I was wondering whether this meant a baseball bat or animal, as bats (like vampire bats) are not all that common in NL. Apparently it's a very well known rule that if you wake up and there is a bat in your room you need to go to the ER. This is because they are disgusting animals that carry rabies. So, we gave the girl a rabies IgG and tetanus vaccine and prescribed 3 further vaccines at days 3, 7, and 11. The girl said something that caught me off guard as she was leaving: "Where do I pay?" It sounds weird, but it sent chills down my spine to think that someone would have to pay to ensure they do not develop rabies. Weird...
One thing that I found really different about their emerg was that they do rounds on their patients every hour or two so that everyone is on the same page. Also, they do team interviews with patients that usually includes the primary physician, attending, and nurse responsible for the patient. This way, the patient doesn't need to give their story to 4 or 5 different people. Something maybe we should consider?
P.s. our attending looked just like "Carter" off ER (Tracey, you would have died!).
One other patient I'll describe was a young lady who had been out drinking the night before and woke up the next morning with tremendous pain in her left hip. Important to note that she has a drinking problem and can drink about two 26Oz per night. She said she had been dancing all night and must have twisted or something. Picturing her dancing made me giggle a little, but I contained myself. We tried to do some physical exam on her, but when we attempted to get her up and walking she screamed and cried like an evil child. (note: I saw her walking in and then we saw her walking to the bathroom, with very little effort). After xraying her hip and determining there was nothing wrong with the joint, we informed her that she must have injured a nerve in her leg while she passed out for the night. We tried to discharge her, but she refused to leave and wanted some "oxy" for the road. Needless to say, we were close to calling security to have her escorted away.
Also of note is the fact that the Brigham ED has its own radiology department. Excuse me, what did you say? Yes, their very own CT scanner and multiple xray suites. They also have "teaching radiologists" on 24/7 who review the scans with clerks, residents, and attendings and teach them about the findings. It's not hard to tell that these hospitals are Harvard affiliated!
Oh yeah and the average wait time to be seen during my shift was: 0 mins. Yep, as soon as they arrived, they got a bed. Nuts.
That's enough about that shift! It was awesome and I saw some really cool things that I probably won't see too often at the HSC. And, a huge shout-out to Dr. A! You did a great job and taught me so much! I know you feel like you don't know anything, but (at least to me) you know lots!
I'm gonna write a separate post now about my travels to the mall today.
Zack
Thursday, June 30, 2011
"I really am sorry, Mmhmmm.."
What is up with people in this city making weird noises like "Mmmhmmm" and "Yaaa...unhuh..."??
Anyways, so this post will not include anything medical because my shift today was cancelled. Awesome? No. So, I get up at 5:30am, get a cab to Brigham and walk into the ER with (I'll call her) "Shelly." She is the observation coordinator. We go into Charlie Pod to find team Orange1, who I'll be with today. We get there and we find out that my attending had switched shifts the day before and now there was a new attending who already had a student. This was scheduled by "Shelly." She apologized awkwardly, literally about 20-30 times, always followed by "Mmmhmmm." We walked back to her office where she scheduled me in for a double shift tomorrow. Yay? Yes.
This ER has just undergone some massive renovations - it's like something out of the future. It's hard to describe, but it's all glass and computers are everywhere, built into the walls, etc. The nursing staff seemed really friendly, so I am hoping for a good time tomorrow.
Shelly is kinda weird. I met her in the lobby to get my "Observer" badge she handmade for me. I figured she would look professional, wearing a skirt or dress pants with a blazer. Nope, she was wearing a HUMUNGOUS straw hat with jeans up to her ta ta's and above her ankles. As we went outside she places a mask over her face (a homemade beige cloth one) because she said there are too many toxins in the air for her. Well Jesus H, save me now.
So, I try and find my way home. I got lost twice. Not just a little lost, but so lost that I wasn't sure if I was even in Boston anymore. I saw something which looked familiar to me, a 7Eleven. So, I anxiously hopped off the bus and started walking to it. Nope, not the same 7Eleven. So I get on another bus and it takes me even further away. So, I got off at some random residential area and awkwardly called a cab. I took me 45 mins to get home in the cab, which amounted to a total travel home time of about 3 hours. Awesome day.
I came home and slept for 6 hours. Now I will watch funny youtube videos to pass the time until I can actually get into the ER tomorrow! Hopefully some exciting stories for you tomorrow!
Later!
Anyways, so this post will not include anything medical because my shift today was cancelled. Awesome? No. So, I get up at 5:30am, get a cab to Brigham and walk into the ER with (I'll call her) "Shelly." She is the observation coordinator. We go into Charlie Pod to find team Orange1, who I'll be with today. We get there and we find out that my attending had switched shifts the day before and now there was a new attending who already had a student. This was scheduled by "Shelly." She apologized awkwardly, literally about 20-30 times, always followed by "Mmmhmmm." We walked back to her office where she scheduled me in for a double shift tomorrow. Yay? Yes.
This ER has just undergone some massive renovations - it's like something out of the future. It's hard to describe, but it's all glass and computers are everywhere, built into the walls, etc. The nursing staff seemed really friendly, so I am hoping for a good time tomorrow.
Shelly is kinda weird. I met her in the lobby to get my "Observer" badge she handmade for me. I figured she would look professional, wearing a skirt or dress pants with a blazer. Nope, she was wearing a HUMUNGOUS straw hat with jeans up to her ta ta's and above her ankles. As we went outside she places a mask over her face (a homemade beige cloth one) because she said there are too many toxins in the air for her. Well Jesus H, save me now.
So, I try and find my way home. I got lost twice. Not just a little lost, but so lost that I wasn't sure if I was even in Boston anymore. I saw something which looked familiar to me, a 7Eleven. So, I anxiously hopped off the bus and started walking to it. Nope, not the same 7Eleven. So I get on another bus and it takes me even further away. So, I got off at some random residential area and awkwardly called a cab. I took me 45 mins to get home in the cab, which amounted to a total travel home time of about 3 hours. Awesome day.
I came home and slept for 6 hours. Now I will watch funny youtube videos to pass the time until I can actually get into the ER tomorrow! Hopefully some exciting stories for you tomorrow!
Later!
Wednesday, June 29, 2011
"Yep, unhuh, yaaaa.."
Hi again!
So most of you know how annoyed I can get with stupid people. 4th year Harvard med students are no exception to this rule. Here's how my day began...
Woke up around 6am to get the T to MGH for Trauma Rounds at 8am. Basically we meet in the conference room and go over all patients that got referred due to trauma. They talked about how the people got injured and the treatment protocol for each. I found this really interesting. However, after each and every sentence I would hear, "oh yaaa...unhuh.... yeppp." I was trying to figure out where this absurd sound was coming from. I almost cracked off my neck looking around. So, I figured this needs some sort of strategy. I would pick a different person after each sentence and watch their mouth. Finally I found the culprit, a 4th year Harvard med student. The way her eye's went while she was saying the "yaaaa"s made me want to vomit. Just. So. Annoying.
Anyways, after trauma rounds we went to do normal rounds with Dr. W. All was well until Dr. W introduced the group to.... guess who? "Yaaaaa." For confidentiality sakes, I'll call her "Augusta." I have no idea what was going on in rounds because all I could hear was "Yaaa.. unhuh..yeppp." It turns out that I was not the only one who noticed this. After the 2nd or 3rd time on rounds, Dr. W kept looking at Augusta and did this thing with her eyes... as if to say "WTF are you doing with your voice?" Naturally I shit my pants laughing and had to turn away each time. The sweat was pouring off me so much that Dr. W asked if I was OK.
After rounds we got called to the cardiac intensive care unit to remove a patient off ventilation. The family had decided to terminate life support after a long and hard battle. It was certainly a tough thing to see for the first time. However, the family seemed relieved that their husband/father would not have to suffer any more.
Dr. W had meetings all after lunch so I decided to take an early day and come home, but of course not before seeing security guards tackle a crazy man in the main lobby. God I am nosey. I pretty much followed them to the emerg department until we got to the point where I couldn't go in. I need to give it up. Seriously.
Tomorrow morning is my first shift in the emergency room at Brigham and Women's... should be entertaining! I have to meet "Susan" in the lobby to get my big fat "Clinical Observer" badge before I go in. I also have to wear a shirt and tie. Awesome. I'll fit right in.
Good night everyone! And, happy anniversary to my wonderful parents! :)
Zack
So most of you know how annoyed I can get with stupid people. 4th year Harvard med students are no exception to this rule. Here's how my day began...
Woke up around 6am to get the T to MGH for Trauma Rounds at 8am. Basically we meet in the conference room and go over all patients that got referred due to trauma. They talked about how the people got injured and the treatment protocol for each. I found this really interesting. However, after each and every sentence I would hear, "oh yaaa...unhuh.... yeppp." I was trying to figure out where this absurd sound was coming from. I almost cracked off my neck looking around. So, I figured this needs some sort of strategy. I would pick a different person after each sentence and watch their mouth. Finally I found the culprit, a 4th year Harvard med student. The way her eye's went while she was saying the "yaaaa"s made me want to vomit. Just. So. Annoying.
Anyways, after trauma rounds we went to do normal rounds with Dr. W. All was well until Dr. W introduced the group to.... guess who? "Yaaaaa." For confidentiality sakes, I'll call her "Augusta." I have no idea what was going on in rounds because all I could hear was "Yaaa.. unhuh..yeppp." It turns out that I was not the only one who noticed this. After the 2nd or 3rd time on rounds, Dr. W kept looking at Augusta and did this thing with her eyes... as if to say "WTF are you doing with your voice?" Naturally I shit my pants laughing and had to turn away each time. The sweat was pouring off me so much that Dr. W asked if I was OK.
After rounds we got called to the cardiac intensive care unit to remove a patient off ventilation. The family had decided to terminate life support after a long and hard battle. It was certainly a tough thing to see for the first time. However, the family seemed relieved that their husband/father would not have to suffer any more.
Dr. W had meetings all after lunch so I decided to take an early day and come home, but of course not before seeing security guards tackle a crazy man in the main lobby. God I am nosey. I pretty much followed them to the emerg department until we got to the point where I couldn't go in. I need to give it up. Seriously.
Tomorrow morning is my first shift in the emergency room at Brigham and Women's... should be entertaining! I have to meet "Susan" in the lobby to get my big fat "Clinical Observer" badge before I go in. I also have to wear a shirt and tie. Awesome. I'll fit right in.
Good night everyone! And, happy anniversary to my wonderful parents! :)
Zack
Tuesday, June 28, 2011
Beep Beep Beep!
So, this is my first time blogging. I actually had to google how to blog - sad. Regardless, here I am. I apologize in advance for those reading this blog, as I tend to be tremendously scatterbrained. I hope you find this entertaining, or at the very least I hope I give you some ammo to make fun of me in the future. This will also be very long as I just woke up from a 5 hour nap and am now wired.
To start, I'm in Boston. Why? Well, good question... I am crazy. That's pretty much the reason. Further to that I am obsessed with everything emergency medicine and was inspired to come here after watching Boston Med on ABC (you should definitely check it out if you haven't watched it yet). So, after just finishing my first year of medical school (holy shat) I decided I would like to go somewhere and see very raw emergency medicine. I mean, I see amazing things in our ERs, but, as you'll see, (I like to use commas, a lot), this is a little different.
I'm spending the majority of my time at Massachusetts General Hospital, one of the top hospitals in the US. I'll also be spending some time at Brigham and Women's Hospital. I will be in the Emergency Departments, Trauma units, and Intensive Care Units while I am here for 2 weeks. But, that's enough introductory stuff... besides thanking everyone who helped get me here! Oh, and to "honest.opinion" and "medstudent" a royal "F you!" :)
So, my first day in Boston was yesterday - 2 days ago for those of you reading this on Wednesday. Nothing much happened on Monday besides I travelled for 12 hours to get here and almost died with the heat here (28 degrees?). I almost sweat as much as Nikita when she thinks about Sugar Momma's... and, that's a lot.
I got on the T (like a mix between a subway and train) and left my apartment at 5:30am to try and find my way to MGH. I was worried I wouldn't make it for my shift at 7 and that I would have a hard time finding the hospital. It's 24 floors. 24. Needless to say, it wasn't hard to find. The hospital is sort of like a huge complex of buildings, all specializing in something fancy.
Today was my first real day of shadowing. I spent it with Dr. W in the Surgical ICU, one of many ICUs in MGH where pre- and post-surgical patients come if they're 'really' sick. I think there was only one patient not on a ventilator and that patient was prescribed "Comfort Measures Only," not something I ever want to be prescribed. The unit consists of about 20 high-tech rooms that really do look like the hospitals on TV. They have glass sliding doors like on House and big screen TVs outside every room displaying their vitals and pt info. Unreal. I guess that's what private health care gets out (more on that later).
So, I was a little early and asked to be buzzed into the unit. I sat awkwardly at a desk in front, only to find out that it was for attending physicians - I was wondering everyone kept asking me if I was there for a consult. Apparently one of the neurosurg guys looks just like me. Weird. Poor fella. I have never heard so many 'sounds' in my life. Bells and buzzers and chimes and people running in all directions. I was in my glee.
At about 7:05 Dr. W walks in. Needless to say, I was not expecting her to look the way she did. I was expecting a lady in her late 40s - early 50s, with grey hair. Instead, in walks a blonde bombshell in red high-heels and a black dress. Again, just like what you see on TV. All of the doctors here are beautiful. It's kind of sickening.
So, after some brief introductions I went to morning lecture with the residents where the fellow (post-residency training) in critical care went over the basics of ATLS (advanced trauma life support). We talked about things such as airway, breathing, circulation, disability, and exposure and how to go about stabilizing someone who has suffered tremendous blood loss due to blunt force and/or penetrating trauma. I found this very interesting. But, again I'm crazy.
After lecture I followed the 'Green Team' on rounds. We had 7 patients to round on and each resident presented a few cases to the attending for that team. I found this a little strange. Instead of walking around with the patients' paper chart, they wheeled around 3 carts with laptops built into them. From these stations they have access to all patient info and can order diagnostic tests and blood work with a few clicks. We reviewed how they had progressed through the night and any goals of today (mostly to keep them alive!).
While in the middle of rounds, I see Dr. W (who was not rounding with us) frantically exchanging her 4 inch high-heels for flats. She started waving her arms at me as if to tell me "Get your ass up here!" WTF right? I run up to her to see what she needed. Her "code" pager had gone off with a STAT order to a cardiac surgery floor. She was code leader. Why did I not know this? I'm not gonna lie, I got tingly. ANY code blue in the hospital was run by her. I was in love.
We run (and I mean RUN) to the elevators, she uses her special pager powers to summon the elevator, bypassing all other travellers that need one, and we go up to the 17th floor. We get off the elevator and make a mad dash to find a man who could not breath due to severe congestive heart failure. Dr. W gets the first year anaesthesia resident (who is also on the code team) to intubate the patient and I get to watch and hand her stuff! I passed the tube, suction, and even got the remove the stylet! Didn't think I was the shit, I know. The patient did fine and apparently went off to have surgery shortly thereafter. What a rush. She told me not to expect many of those calls - they usually get 1 or 2 during a shift. But, apparently I am the code whisperer.
We returned to the SICU and Dr. W showed me some cool x-rays and CTs that she had collected over the past few years. It was really cool. She went over how to read x-rays and CTs in trauma. Her pager went off again. Music to my ears. Again, we dashed to a floor, this time on the 21st level. This floor was for extremely wealthy people. They paid $650 per night to have a couch and a view of Boston. Nuts. There, we found an obese man who had become acutely bradycardic (from 95 bpm to about 40 bpm). However, once we got there and had the paddles ready to go (I wanted to push the button), his heart rate returned to normal and we left after about 10 minutes of observation. How morbid is it that I was disappointed? Very, I know.
Again, we headed back to SICU where it was almost lunchtime. At about 1130 the magical pager went off again and, once again, we ran to a floor and had to intubate the patient before they crashed. At all of these codes, there were literally like 30 people in each room. How can the hospital afford to pay all of these people!
During lunchtime we attending the monthly M&M (Morbidity and Mortality rounds). We discussed some very interesting cases, but I signed a confidentiality form and can't really say anything about them. I can say though that they were amazing and sad cases. Things got a little heated during the discussion. Again, in my glee.
Right after lunch Dr. W and I, plus the code resident went upstairs to evaluate a patient for extubation (removal of the breathing tube). We were there no longer than 2 minutes when I hear the angelic sound of the code pager once again (last one I promise). But, this time, we were not getting called to a surgical floor. This was the Emergency Department. Apparently when you get a code page from the ED, it is real bad. It means that they can't get the breathing tube into the patient and need our help STAT. I've never seen someone in a dress run so fast in my life. We arrived to find a man who had accidentally swallowed a basic solution with a pH of 13.5. The liquefactive necrosis was setting in and his airway was blowing up like a balloon. After numerous attempts at intubation (using glidescope and fibreoptics), it was decided that this pt needed an emergency airway. I've seen one of these in the HSC before, so I knew what was coming. Normally they wait for the cardiothoracic senior resident to do it, but with a plummeting O2 sat, Dr. W gowned up and sliced the man open. Again, tingly.
So, that was my first day of shadowing. And, I get to do it all again tomorrow. Trauma rounds at 800am with Dr. W. And, she is code leader again tomorrow. Alleluia!
Sweet dreams! Miss you all.
To start, I'm in Boston. Why? Well, good question... I am crazy. That's pretty much the reason. Further to that I am obsessed with everything emergency medicine and was inspired to come here after watching Boston Med on ABC (you should definitely check it out if you haven't watched it yet). So, after just finishing my first year of medical school (holy shat) I decided I would like to go somewhere and see very raw emergency medicine. I mean, I see amazing things in our ERs, but, as you'll see, (I like to use commas, a lot), this is a little different.
I'm spending the majority of my time at Massachusetts General Hospital, one of the top hospitals in the US. I'll also be spending some time at Brigham and Women's Hospital. I will be in the Emergency Departments, Trauma units, and Intensive Care Units while I am here for 2 weeks. But, that's enough introductory stuff... besides thanking everyone who helped get me here! Oh, and to "honest.opinion" and "medstudent" a royal "F you!" :)
So, my first day in Boston was yesterday - 2 days ago for those of you reading this on Wednesday. Nothing much happened on Monday besides I travelled for 12 hours to get here and almost died with the heat here (28 degrees?). I almost sweat as much as Nikita when she thinks about Sugar Momma's... and, that's a lot.
I got on the T (like a mix between a subway and train) and left my apartment at 5:30am to try and find my way to MGH. I was worried I wouldn't make it for my shift at 7 and that I would have a hard time finding the hospital. It's 24 floors. 24. Needless to say, it wasn't hard to find. The hospital is sort of like a huge complex of buildings, all specializing in something fancy.
Today was my first real day of shadowing. I spent it with Dr. W in the Surgical ICU, one of many ICUs in MGH where pre- and post-surgical patients come if they're 'really' sick. I think there was only one patient not on a ventilator and that patient was prescribed "Comfort Measures Only," not something I ever want to be prescribed. The unit consists of about 20 high-tech rooms that really do look like the hospitals on TV. They have glass sliding doors like on House and big screen TVs outside every room displaying their vitals and pt info. Unreal. I guess that's what private health care gets out (more on that later).
So, I was a little early and asked to be buzzed into the unit. I sat awkwardly at a desk in front, only to find out that it was for attending physicians - I was wondering everyone kept asking me if I was there for a consult. Apparently one of the neurosurg guys looks just like me. Weird. Poor fella. I have never heard so many 'sounds' in my life. Bells and buzzers and chimes and people running in all directions. I was in my glee.
At about 7:05 Dr. W walks in. Needless to say, I was not expecting her to look the way she did. I was expecting a lady in her late 40s - early 50s, with grey hair. Instead, in walks a blonde bombshell in red high-heels and a black dress. Again, just like what you see on TV. All of the doctors here are beautiful. It's kind of sickening.
So, after some brief introductions I went to morning lecture with the residents where the fellow (post-residency training) in critical care went over the basics of ATLS (advanced trauma life support). We talked about things such as airway, breathing, circulation, disability, and exposure and how to go about stabilizing someone who has suffered tremendous blood loss due to blunt force and/or penetrating trauma. I found this very interesting. But, again I'm crazy.
After lecture I followed the 'Green Team' on rounds. We had 7 patients to round on and each resident presented a few cases to the attending for that team. I found this a little strange. Instead of walking around with the patients' paper chart, they wheeled around 3 carts with laptops built into them. From these stations they have access to all patient info and can order diagnostic tests and blood work with a few clicks. We reviewed how they had progressed through the night and any goals of today (mostly to keep them alive!).
While in the middle of rounds, I see Dr. W (who was not rounding with us) frantically exchanging her 4 inch high-heels for flats. She started waving her arms at me as if to tell me "Get your ass up here!" WTF right? I run up to her to see what she needed. Her "code" pager had gone off with a STAT order to a cardiac surgery floor. She was code leader. Why did I not know this? I'm not gonna lie, I got tingly. ANY code blue in the hospital was run by her. I was in love.
We run (and I mean RUN) to the elevators, she uses her special pager powers to summon the elevator, bypassing all other travellers that need one, and we go up to the 17th floor. We get off the elevator and make a mad dash to find a man who could not breath due to severe congestive heart failure. Dr. W gets the first year anaesthesia resident (who is also on the code team) to intubate the patient and I get to watch and hand her stuff! I passed the tube, suction, and even got the remove the stylet! Didn't think I was the shit, I know. The patient did fine and apparently went off to have surgery shortly thereafter. What a rush. She told me not to expect many of those calls - they usually get 1 or 2 during a shift. But, apparently I am the code whisperer.
We returned to the SICU and Dr. W showed me some cool x-rays and CTs that she had collected over the past few years. It was really cool. She went over how to read x-rays and CTs in trauma. Her pager went off again. Music to my ears. Again, we dashed to a floor, this time on the 21st level. This floor was for extremely wealthy people. They paid $650 per night to have a couch and a view of Boston. Nuts. There, we found an obese man who had become acutely bradycardic (from 95 bpm to about 40 bpm). However, once we got there and had the paddles ready to go (I wanted to push the button), his heart rate returned to normal and we left after about 10 minutes of observation. How morbid is it that I was disappointed? Very, I know.
Again, we headed back to SICU where it was almost lunchtime. At about 1130 the magical pager went off again and, once again, we ran to a floor and had to intubate the patient before they crashed. At all of these codes, there were literally like 30 people in each room. How can the hospital afford to pay all of these people!
During lunchtime we attending the monthly M&M (Morbidity and Mortality rounds). We discussed some very interesting cases, but I signed a confidentiality form and can't really say anything about them. I can say though that they were amazing and sad cases. Things got a little heated during the discussion. Again, in my glee.
Right after lunch Dr. W and I, plus the code resident went upstairs to evaluate a patient for extubation (removal of the breathing tube). We were there no longer than 2 minutes when I hear the angelic sound of the code pager once again (last one I promise). But, this time, we were not getting called to a surgical floor. This was the Emergency Department. Apparently when you get a code page from the ED, it is real bad. It means that they can't get the breathing tube into the patient and need our help STAT. I've never seen someone in a dress run so fast in my life. We arrived to find a man who had accidentally swallowed a basic solution with a pH of 13.5. The liquefactive necrosis was setting in and his airway was blowing up like a balloon. After numerous attempts at intubation (using glidescope and fibreoptics), it was decided that this pt needed an emergency airway. I've seen one of these in the HSC before, so I knew what was coming. Normally they wait for the cardiothoracic senior resident to do it, but with a plummeting O2 sat, Dr. W gowned up and sliced the man open. Again, tingly.
So, that was my first day of shadowing. And, I get to do it all again tomorrow. Trauma rounds at 800am with Dr. W. And, she is code leader again tomorrow. Alleluia!
Sweet dreams! Miss you all.
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