Observing and Learning

The semester is borderline killing me. I feel like the semester should be over soon because of all the work, but alas, it's not even October yet. Sheesh!

Well, two weeks ago, I was in the PACU. The only thing I need to say about this is about a 3 year old boy who came out of surgery. I was assisting the nurse in putting warm blankets on the kid and checking vitals. I stepped away for a little bit to cuddle another patient, and I hear the nurse yelling at the attending surgeon, "Well do something! You have to start making calls!" The surgeon being yelled at was a new doctor. Like 2 days new, so she was very timid and didn't know what to do first. The nurse was referring to the 3 year old whose pulse was now in the low 30s and not breathing. The nurse started the bag and mask, but soon, people were yelling that there was no pulse at all. The new doctor took over the bag and mask respirations, and the nurse jumped on the bed and started compressions. The OR doors are swinging open as 10 doctors, pharmacists, and anesthesiologists roll in responding to the Code Blue. I'm just staring at the nurse who looks like she's beating the kid. Seriously. I know you have to do strong compressions, but this kid's chest was being compressed into half the width of his body and bouncing back up against the force. It was such a crazy site.
*Edit: FYI, the little boy started breathing again, and I was holding him and playing with him 20 minutes after his heart stopped. Weird.

Yesterday, my focus day was in the Operating Room. If you read this regularly, you will know that I have watched old guys get cut open, no problem. But I felt a little more timid watching little kids be cut open. I walked into the OR to meet the staff I was paired with, Ben Folds cranked up in the background, and I was surprised at how welcoming they were. Want to know why they were so welcoming? Because they are orthopods. As they describe themselves, "We're not really doctors. And everytime we get on a plane we pray that no one has a heart attack or something else wrong with them and asks for a doctor because really, we have no idea what the heart, lungs, GI, etc do anymore. We are glorified handymans who love power tools." I always knew the orthopods were your ultimate guy, but it became quite apparents when everyone on the team was just flirting with each other the whole time. What is this! But I pretty much chuckled the whole time I was with this team, and 2 of the surgeons were freckled red heads, and the nurse I was paired with was named Rebecca, so there were many similarities among us.

The first kid I watched was a 2 year old who was born with a dislocated hip. The surgeons were making fun of this child's pediatrician the whole time at the fact that they hadn't caught this until 2 years old. They joked that they would call the pediatrician and say, "Hey just so you know, your patient is here at Primary Children's having a major surgery where we cut off an inch of her femur, put the femoral head back into the acetabulum, and she'll just be bedridden with a half body spica cast for 3 months while her mother is about to deliver triplets in 2 weeks. No biggie. If you care to correctly assess your patient now, that'd be great." More giggling from me. Apparently, the pediatrician missed the different lengths of legs and the inability to sit symmetrically, but it became evident to the parents that something was wrong when she could hardly walk without drastic limping. After they cut off an inch of her bone and put several screws to hold it in the hip joint, she was casted from her ankles to her chest in a spread eagle position with a small pole between her legs to keep them spread apart. There was a little hole cut out for the girl to urinate and poop, but I can't imagine how messy that is going to get for the mom who will be changing her diapers along with 3 newborns. Yeesh.

The second patient, I actually saw awake and alert before he was put down. This 5 year old boy trots...well limps in in his little hospital suit and is excited at how big his bed is. The nurse starts reading him a pirate book and the anesthesiologist asks if he wants some root beer. "Oh boy yes I do I do!" I feel like the anesthesiologist is a bit of a villain here because he says, "Okie doke but it is invisible root beer so smell this mask really hard...it smells so yummy!" Little boy:"Oooooo sooo yummy!" 5...4...3...2...1....little boy is slumping over pirate book, face smashed into mask. Me: "AWWWWW that is so sad!" Anesthesiologist: "Yes sad...but brilliant!" Okay fine. The resident comes in and asks me if I have any questions and proceeds to tell me about Perthes disease (which I was tested on the previous week on my Pediatric exam-I got an A by the way =) ) and tells me how this kids femoral head is slowly deteriorating and crumbling, which has caused him to limp. The start the incision, and I am reminded of how much I don't like the smell of burning flesh. The surgery team urges me to watch right next to them, only a foot away from the patient! Once they get to the bone, I hear a crack! And I flinch and squeal! All 3 surgeons stop what they are doing and turn towards me, "Yes? Have we made you uncomfortable?" Uh no...I've just broken bones before so it resonates with me. Sorry. Continue. Soon after, it's time for me to go and I bid farewell to the fun crew and their table full of nails, bolts, steel plates, screwdrivers, knives, and other power tools. It's quite comical how much it looks like something you would see in someone's tool shed. Oh man, I love Primary Children's Hospital.