back at it

haven't updated this blog since JUNE 2006. what can i say, i lost some motivation. second year is REALLY tough in my program, and every second i had away from the hospital was one i wanted to cherish and NOT think about work, which meant no blogging.

but now i'm back. I started third year, and I have to say, it's so much better. Two hours less per shift. At 18 shifts per month still, that works out to be 36 hours less per month. That's an entire full-time workweek for most Americans.

Thus, I have more free time. Plus, as a third year, I get to cherry pick the good patients. The PGY1s and 2s have to see just about everyone on their boards, but I get to float and pick off the good patients that are interesting. "Sickies and quickes," we call them -- third years get to take care of the critically ill and those that are very easy to boot out the door with nothing because there's nothing wrong with them. Thus, when i see "vaginal bleeding," "abdominal pain x 2 weeks," or -- my favorite -- "constipation," I grin and think, that has intern written all over it.

So third year is much better, and I'm happier. Still many frustrations, but it's better. The big thing about third year is that we're the resident responsible for the airway during traumas. That can be quite scary. Last month, I went to intubate someone who got shot in the neck. This guy was dying in front of our eyes -- we could see his heartrate, respirations, oxgenation and blood pressure drop precipitously and regularly on the monitor. I put the intubation blade in and it looked like a tomato exploded in his throat. No vocal cords. Couldn't make out any anatomy. Blood everywhere.

This moment is a lot of pressure. Airway is the very first thing that must be established before anything else can take place. Hence, all eyes are on me -- all the other residents, surgeons, EMTs, firemen, cops, etc., who are in the trauma resuscitation room all have eyes boring into me waiting for me to secure an airway before they can move in.

No time to pussyfoot around with this guy. No second chances. No excuses. No maybes. No repeat intubation attemps. Everyone's waiting, and he's dying.

One look into his throat. Blood everywhere. Tissue everywhere. Stop.

"No discernible anatomy secondary to traumatic wound, no cords visualized, everything's completely distorted, you have to cric him right now."

(cric -- pronounced "cryke" -- equals cricothyroidotomy, or just cutting a hole in his throat and putting a breathing tube in that way.)

No time for questions, not even an "are you sure?" The surgery senior swoops in, scalpel in hand, one deep cut into the throat, he holds the hole open, I put in a breathing tube.

Vitals come back.

My scrubs are see-through with sweat. Then mounds of paperwork and interviews with the NYPD and detectives. Sigh.