Hello from Moab

Howdy, I know it’s only been a few days, but I couldn’t resist the video game style internet station here. I’m in Moab Utah,going mountain biking tomorrow and maybe thenext. I’ve only got five minutes left and this keyboard has definately seen better times.

The sky is amazing, the scenery indescribable. I’ve been here once before, but I came down Colorado Rte. 90 this time and I have never seen so much incredible mountain, rock and forest before. If you take all the great scenery I’ve seen in all my trips prior to this, including the Ecuadorian Andes, the American Southwest and the Swiss Alps…I’ve seen it all again today!

By the way, what do you think folks who live in Paradox, Colorado do for a living? A web search says there are 24,000 people there, but I only saw one buiding and a church.

Blogging break

Well, I’m off to the mountains and the desert for a well earned vacation. I plan to take lots of photos and will be brainstorming about my bird project. I know you’re dying to know what it is….I can’t tell you yet!. One of you is likely to sneak off and finishe the project without me! BUT…I have found what looks like a good host with PHP and MySQL for $7.95 a month, with a free domain name registration. And I found a better domain name that seems to be available. Don’t worry, I’ll let you in on the little secrets as time goes by…

Oh, and for everyone waiting for the x-ray of the man with a nail in his head, well, I’m going to wait on that one. You see, it’s a worker’s comp case. Even though I can post acopy of the x-ray without any identifying information whatsoever, if the guy decides to sue his employer, that image would be evidence. The statute of limitations is 2 years (I think), so if you’re still dilgently reading then…

I’ll return for better blogging on October 5th!

Life as a traumatologist

Well, my life as a traumatologist is over. My rotation ended today and now I have 9 days of vacation! The lady thrown from the buggy is doing well, she’s needing sedation to stay on the vent. That’s good news, because it means she’s waking up and probably didn’t suffer too much brain damage. The sixteen year old who crashed her car woke up and went home the other day. The little boy who broke his leg woke up the next day speaking only Italian, but by the next day he was back to english and we sent him home.

Mr. Morris ended up having a pulmonary embolism, got a filter, then became septic and had an empyema (pus in his chest cavity) and went to surgery. The past 2 days, he looks like a million bucks! The man who was ejected from his car breaking all extremities while his girlfriend got away with just a broken leg and a seat belt rash is still in the hospital, all four extremities casted, relying entirely on nursing care for eating, bathing, toileting and modesty. The man who’s life I might have saved by putting in an emergent chest tube will probably go home this weekend. He was up and walking around the halls today, wandering into other patient’s rooms.

THe medical students were fun to have around, helpful, and I hope learned some stuff. My intern will be rotating in the ED next month, so we’ll be working together again. And finally, every attending I worked with said I did a great job, and would be happy to take me as a surgeon in our residency program. I think I’ll stick with emergency medicine, though, it will give me more time to play!

Traumish

“Traumish” is the nickname we use for trauma suffered by the Amish population in our area. It sounds horrible, but it actually prepares us for the terrible injuries we see when an amish person is brought in by ambulance or lifeflight. Many of the injuries in the amish community are due to their less than modern lifestyle…I’ve already written about a head trauma case that occured during a community barn raising. (Search the June archives for “raise high the roofbeams carpenters“)

Needless to say, when an Amish buggy is involved in an accident with just about any modern form of transportation, it is the buggy occupants that suffer more than the car (pickup, 18-wheeler) occupants. Yesterday morning around 8AM, our local ambulance crew brought in a woman who had been driving a buggy (alone, thankfully) that was struck by a pickup truck. It was a foggy morning which probably contributed to the accident. Even though the buggy aparently pulled out in front of the pickup, I still have to think that the pickup driver was probably traveling way too fast.

Anyway, the buggy driver was flung about 40 feet from the accident, the buggy was turned into matchsticks and the horse…well, I won’t comment about the horse. The whole accident just makes me angry. When I drive around the area and see the beautiful countryside, amish and mennonite farmers earning their living almost entirely by hand without modern farming aids…I feel like an intruder. I feel guilty that there are paved roads and power plants and white trash living side by side with the amish.

To make a long story short, she was the sickest trauma patient I’ve seen that didn’t die. THe whole ordeal was very chaotic and frustrating…she was so sick, we had to prioritize our studies without having any clue why she was so sick. While the CT scan showed blood in her abdomen, contrast enhancement failed to identify the source! She was transfused massive amounts of blood and blood products, taken to the ICU for stabilization, taken to the angio lab where they failed to identify a source of bleeding in her abdomen. Finally we saw a small bleeding vessel from her mesenteric circulation.

Her belly had grown to the size of a prize winning pumpkin and was just as firm. We took her to the OR and sucked out 6 liters of blood from her abdomen before we could even open the incision to see what was bleeding. Handfuls of clots were pulled out of her belly and finally, we identified tiny pumping arterioles that were ligated one by one. In the midst of all of this, the orthopedic surgeons came in to place a traction pin in her leg…she had an open femoral fracture that she almost bled out of in the CT scanner before I placed a massive pressure bandage on it. Her pelvis was also fairly well crushed.

While repairing the laceration on her face, complete with missing chunks of skin and tissue, I perforated another artery and was sprayed with blood. The OR tech helped me clamp the artery and cauterize it so I could finish my pseudo-plastic surgery I was performing on her forehead. The whole process took about 12 hours, and we transported her back to the ICU.

I was so happy that she survived the operation, not just because we saved her life, but also because the injustice of being hit by a pickup truck while driving her buggy made me so angry. The amish community is very supportive of one another and when we returned from the OR, about 50 amish lined the hallways. They look so out of place, I thought to myself. I was angry that this whole community had to find rides to the hospital to visit her, and I wished that it would have been the pickup truck driver we were operating on instead.

I was post call today, and she was still doing well when I left the hospital at 10:30 this morning, I am anxious to get back to work tomorrow and see how she’s doing.

Fashion update

This just in from Italy…

Colorful rain boots and shirts, pants and jackets with lots of pockets everywhere, are IN.

Bird update:

Much to my chagrin, my idea has already been taken. Even with the same domain name that I wanted to use. But the site is old and dated looking. I am going to press on with my bird project. I did another portion of my PHP book tonight with good success. Next step…colorful boots, pants and jackets with pockets everywhere