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.