He Should Have Been Dead

This gentleman was really, really nice, but he should have been dead before he even got to our hospital.  I wouldn’t be surprised if this was close to a reportable case due to the size of it.

He’d had multiple kidney stones in the past and came in complaining of a “Kidney Stone”.  Classic pain, left flank radiating to his left groin.  You know, his pain may have actually been caused by the kidney stone, but that’s not why he should have been dead.

Whenever i have a patient with a history of kidney stones, I always review previous CT scans to see how recently one was done, how large the stones were and if there were any in waiting in the kidneys.  Despite being seen by one of our urologists, this guy had no previous CT scans at our hospital.

Which means that this thing that almost killed him must have grown fast!

We gave him narcotics, narcotics and more narcotics and he was still having 10/10 pain.  Must be a really big kidney stone I continued to think.  Erroniously.

Finally, 4 hours after arrival, our “routine” CT scan is performed (don’t worry, an ultrasound would not have been any faster).  I listed to the radiologists report in one ear while listening to a nurse in the other ear and writing on a 3rd patient’s chart.

Then I just about dropped everything and asked the radiologist to repeat what he had said…

“The patient has an 8 centimeter leaking aortic aneurism.  Do you have a vascular surgeon there?”

My heart started to race, but I had to keep my cool for the patient’s sake.  Ruptured aortic aneurisms are fatal, plain and simple. This man should have been dead.  50% of ruptured aneurisms don’t make it to the hospital at all.  How long had his been leaking?  How long had his been growing?

I looked at the CT scan. It was probably the biggest aneurism I’ve ever seen.  AND IT WAS LEAKING!

The vascular surgeon came down and personally wheeled the patient up to the OR, where a graft was successfully placed, and he was extubated in the ICU later that night.

Another life saved on Doc Shazam’s watch.  🙂

Nine Minutes in the Afternoon

This guy was real whiny, complaining, “My chest hurts, my chest hurts.”  My very first thought was, “what a wimp”.  He was thirty four years old and appeared relatively healthy.  What could possibly be causing a 34 year old man so much pain that he was squirming in bed?  He wouldn’t look me in the eye and winced everytime I did something to try and examine him.

I felt his calves.  No swelling, no tenderness, probably not a PE.  I asked his medical history and “social” habits.  Pretty low risk for MI.  He was thin, but not real tall.  His hands and fingers looked normal to me…probably not Marfan’s or aortic root dissection.  Hmm.  Pericarditis?  The really bad cases usually LOOK awful, like they are having a heart attack.  This guy was just whiny.  I decided it was probably costochondritis and gave him some toradol while we ran some tests.

Go figure…another pneumothorax!  My second one in 2 weeks.  I later found out that a colleague of mine was waiting for me to finish his chest tube before doing his own chest tube 2 rooms down.  Are these things contageous or what?

I wrote a list of orders…we do so few chest tubes at this hospital, and most of the nurses don’t have trauma center experience.  So I need to be explicit with everything.  You’d think we’d have a nice kit made up, but I needed to call central supply just to get a sterile gown!

Fortunatly, for me and the patient, one of the nurses on orientation had six years of experience in CCU/ICU, but none in the ER. he was very familiar with chest tubes.

I used one of my favorite sedatives again, etomidate, and began the proceedure.  The new nurse was extremely helpful, and the tube went in easily.  The classic rush of air you read about when putting in a chest tube really happens.  And in this case, I watched the patient’s left chest deflate just a bit when I popped through the plural lining of the chest wall.  Apparently he had a little bit of tension developing as well.

As I was sewing in the tube I felt very relaxed and not stressed.  I realized that it was because of the help of the great nurses at this hospital, and the new nurse in particular who knew how to manage chest tubes, set up the pleurevac, tape a chest tube in place, etc, etc.

As I was finishing up, a tech came in to the room and asked, “Are you guys finished with the critical care cart?  Because Dr. Bond needs it 2 rooms down to put another chest tube in.”

I laughed at how smoothly everything went.  As I was signing off on the sedation forms, I checked the time of the proceedure from start to finish.  Nine minutes.  Nifty.

John Ritter’s Doctors cleared of Malpractice Charges

It’s a shame that these doctors had to go through so much grief and stress when in their hearts they (and all of their fellow colleagues) knew that they did what was right and what was best and the patient died anyway.

The treating physicians were cleared of malpractice by the jury in Glendale Superior Court.

Five years of misery for them…I’m sure it adversely affected their physical and mental health, their relationships with their friends and family and their ability to practice medicine with confidence and giving their patients the best medical treatment possible.

I know that John Ritter’s family will never have their husband and father back again…but retaliation and blame is not an appropriate way to deal with greif.

Ironic that after a juried trial the doctors were cleared, and yet the hospital settled out of court for $14 million dollars.

The Inspection

So here’s the house update…

Last week I met with my real estate agent in his office to craft an offer for the house.  I’ve never bought a house before (or made an offer), so this took several hours, and I was very, very tired, having worked the night shift 3 days in a row prior to the meeting.

He presented our offer that night, we negotiated a bit over the phone, and I gave them my bottom line final offer.

They turned it down.

“It’s not over till the fat real estate agent signs,” he said.

And we waited.

I got a call on Sunday afternoon, they had accepted my offer!

Yikes, now the real work starts.

Get an inspection, call the mortgage broker, get a credit check (My FICO is 790!)

more later…