October 31, 2007
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So last night was my first trauma call.
Again, call began at 5pm where after finishing up notes and paperwork on all my patients, the resident and I attempted to get some “prophylactic sleep”. Twas not to be, however.
The biggest concern of the night was a gentleman who had come in with a minor pneumothorax after being hit by a car. While intially we were not concerned, he continued to desaturate to the point where we wanted to put in a chest tube, to drain the blood in his chest and allow the collapsed lung to expand a bit, letting him breath easier. Now this man, who the rest of his stay with us and consistently been thanking us for all our help and being overall pleasant, was resisting the chest tube like nobody’s business when we said it had to be done to save his life. LITERALLY. No metaphors, if this man did not have a chest tube in, he was going to code and probably die later in the evening.
Of course as soon as we started pushing him to sign the consent for the chest tube, the once friendly man busts out of nowhere with “i want to call my brother-he’s a lawyer”
how quick people are to turn. So the first thing we did is gave him some pain medication and asked if he still wanted to call…he opted to not, and let us perform the procedure…which if you dont recall from my ER stories, is basically cutting a hole in the chest wall, prying it open (not with a finger this time-in surgery, it is a sterile procedure) and inserting a tube hooked up to a suctioning system. Blood got all over our shoes. Nerts. good thing i just wear sneakers to the hospital right now. Not counting the blood that drained out on the bed and our clothing, approximately half a liter (think half of one of those plastic coke bottles) of blood drained out of him. He began breathing easier initially
initially. Then he resumed desatting for some reason, and was eventually moved to the ICU and intubated. He is now in stable condition and off my service. Still..exciting stuff. Here was a man who absolutely would have died if not for our intervention. And for the record when we called his brother to notifiy him of the pts status, he emphatically supported and thanked us
As a brief aside, one of the anesthetics given to numb the patient for chest tube insertion was a benzodiazepine, which has the side effect of amnesia…meaning that you wont remember things that happened shortly before you were given the anesthetic, like threatening to sue, or being scared…convenient how that works out, isnt it? Dont worry he thanked us for saving his life when he woke up
Then I practiced my suturing technique on another gentleman in the SICU, who needed eyebrow lacerations closed. It was my first time ever suturing on the face, which was a little intimidating with the resident standing over my shoulder. I couldnt get my knots to tie correctly and had to redo them a couple times…which would have been a bigger concern if the patient was not in an induced coma
Hey, we all gotta learn somewhere, right?All in all a rather uneventful night-but with the need to constantly get up, its hardly restful.
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Why Not Zoidberg
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Do people actually do this though? I mean, aside from this guy, -on average- do people threaten to have their lawyer come to the hospital or refuse to sign the consent form??? Man. I remember being in the ER after our car accident praying someone would get those nasty glass fragments out of my shirt and bra, not to mention arm. A lady came over, looked down at me, looked sincerely worried, but said, “Legally I’m not supposed to touch you, sorry.” Interesting. Late on, my mother in law had consecutive strokes and I was beyond thankful with the medical staff. I made it my mission to thank anyone who had been involved with her recovery. How does it feel to save a life? You probably get asked this a lot. Saludos.