Tuesday, June 24, 2008
Thursday, June 12, 2008
Emergency
After my April rotation in surgery, I spent the month of May working in the emergency room. The following are short stories of my month in the emergency room. Unfortunately, I don´t have any pictures, but I think the stories will make up for it.
Motorcycle Accident (May 7th)
In my first 10 minutes in the emergency room, I assisted a doctor as he stitched up the forehead of a 18 year old male who had hit a pole while riding his motorcycle. He had a hole in his forehead the size of a half-dollar all the way to the bone and a irregular line ran from his forehead to the back of his head. After numbing him with lidocaine, the doctor began the hour long process of suturing his head back together. Near the end he let me do a stitch. As I pushed the needle through the skin, I guided the needle between the skin and the cranium. It was great to get the experience, but my excitement was muted by this patient´s prospect of living with a nasty scar the rest of his life.
All in One Day (May 13th)
When I arrived in the emergency room this morning a lady was screaming. I thought it was temporary, but she kept screaming for the next hour. It set the tone for the rest of the day.
Around 9 AM, a 55 year-old-man entered the emergency room on a stretcher after arriving in an ambulance. After taking x-rays of his head and chest, we learned that he had a fractured cranium, fractured clavicle, and 3 fractured ribs. When initial observations were done, an intern and I had to insert a urinary catheter. He showed me the process and let me do it. However, after getting the catheter half-way in, we realized that the catheter was too large, due to the man´s enlarged prostate, which had narrowed the urethra. The problem was later fixed with a smaller catheter.
As I was leaving the room of the man, another doctor called me over to hold the head of an 80-year-old woman who was in a car accident with her daughter. The lady was moving her head and was complicating the doctor´s attempt to stitch her right ear. After 3 minutes, she had stopped moving and began drooling. The doctor realized there was a problem when the daughter tried talking to her mom and there was no answer. The woman was quickly moved to the room with life-support and immediately intubated. According to the doctor, the woman had a brain aneurysm and was now in a coma. A day later, I saw the patient´s daughter crying outside of the hospital. I never found out if the patient came out of the coma, but reflecting back on what happened that day, it´s frightening to think that a blood vessel was rupturing inches from my fingers, an event that might have killed her. It reminded me that everything that happens here is permanent and the consequences can be severe.
The Patient and the Finger (May 15th)
Despite seeing several suturing done nearly every day here at the hospital, I had not had the opportunity to serve a patient completely by myself. Today that changed. A 35-year-old man entered with a 8 cm cut along his finger. After filling the syringe with lidocaine, I injected it in the crevices of the cut. For simple cuts like this one, this part is typically the hardest, as the patient usually registers the pain. Also, while the risk is low, injection of lidocaine into an artery can be fatal. In order to avoid this, we pull on the syringe before injecting. If the syringe fills with blood, the point of the needle is an artery and needs to be repositioned. In the end, I made 4 sutures. While the cut of this patient was very innoxius, it was great practice and this level of contact with the patient.
Electrocardiograms (May 21th)
Over the last few weeks I´ve been doing several electrocardiograms per day. While I began accompanying the other doctor´s, they now let me do them by myself. Today, I had my first solo electrocardiogram with a woman. As we need to put 6 electrodes across the chest of the patient, it was very uncomfortable to be serving a patient in an exposed state. However, by the 5th or 6th woman, I had adjusted. It is one of the realities of the job all doctor´s must adjust to eventually.
The Good with the Bad (May 25th)
Near the end of my shift today, an elderly man arrived by ambulance in the emergency room. After finishing with a another patient, I went to his room to observe the doctors. The first thing I noticed was blood all over the floor near his bed, where he had vomited just moments before I arrived. Despite the vomiting, the doctors had gotten him an IV of a glucose/water solution and intubated him, and were working on placing a catheter to his heart. With a yellow tint to his skin, it was clear something had either gone with his liver or kidneys. The doctor told me that he had cirrhosis of his liver; however, since he was talking, it seemed like the doctor´s had things under control. After the catheter was successively placed, I left the room to help with another patient. An hour later, I heard crying from the room and looked over to see the man laying in his room without any of the machines that had been supporting him and his daughter crying by his side. He had died. It was almost surreal. Two hours earlier he was talking and now he was gone. Maybe it was because I did not know the man personally or maybe I´ve become desensitized to death, but I was not bothered by this man´s death. While I felt bad for the family, it´s part of the job when you´re working with the sick. I just hope I don´t become too distant from the patient to see feel for the grieving family.
Scorpion Bite (May 27th)
Probably the most common single reason for emergency room visits here in Morelia are scorpion bites. While they often cause temporary discomfort in the majority of the patients, some can be fatal. During my first few weeks I observed several bites and the treatment process. The doctors taught me symptoms for the 3 levels of severity of scorpion bites. The first begins with weakness and ranges to asphyxiation in the 3rd level, due to the swelling of the throat. The standard treatment is an injection of an anti-venom enzyme that breaks down the poison of the scorpion. Typically, 30 - 60 minutes after the injection, the patient walks out cured. During my last week in the emergency room, the doctor let me give the injection. While it was not hard, it was another opportunity to get first-hand experience with the patient.
Motorcycle Accident (May 7th)
In my first 10 minutes in the emergency room, I assisted a doctor as he stitched up the forehead of a 18 year old male who had hit a pole while riding his motorcycle. He had a hole in his forehead the size of a half-dollar all the way to the bone and a irregular line ran from his forehead to the back of his head. After numbing him with lidocaine, the doctor began the hour long process of suturing his head back together. Near the end he let me do a stitch. As I pushed the needle through the skin, I guided the needle between the skin and the cranium. It was great to get the experience, but my excitement was muted by this patient´s prospect of living with a nasty scar the rest of his life.
All in One Day (May 13th)
When I arrived in the emergency room this morning a lady was screaming. I thought it was temporary, but she kept screaming for the next hour. It set the tone for the rest of the day.
Around 9 AM, a 55 year-old-man entered the emergency room on a stretcher after arriving in an ambulance. After taking x-rays of his head and chest, we learned that he had a fractured cranium, fractured clavicle, and 3 fractured ribs. When initial observations were done, an intern and I had to insert a urinary catheter. He showed me the process and let me do it. However, after getting the catheter half-way in, we realized that the catheter was too large, due to the man´s enlarged prostate, which had narrowed the urethra. The problem was later fixed with a smaller catheter.
As I was leaving the room of the man, another doctor called me over to hold the head of an 80-year-old woman who was in a car accident with her daughter. The lady was moving her head and was complicating the doctor´s attempt to stitch her right ear. After 3 minutes, she had stopped moving and began drooling. The doctor realized there was a problem when the daughter tried talking to her mom and there was no answer. The woman was quickly moved to the room with life-support and immediately intubated. According to the doctor, the woman had a brain aneurysm and was now in a coma. A day later, I saw the patient´s daughter crying outside of the hospital. I never found out if the patient came out of the coma, but reflecting back on what happened that day, it´s frightening to think that a blood vessel was rupturing inches from my fingers, an event that might have killed her. It reminded me that everything that happens here is permanent and the consequences can be severe.
The Patient and the Finger (May 15th)
Despite seeing several suturing done nearly every day here at the hospital, I had not had the opportunity to serve a patient completely by myself. Today that changed. A 35-year-old man entered with a 8 cm cut along his finger. After filling the syringe with lidocaine, I injected it in the crevices of the cut. For simple cuts like this one, this part is typically the hardest, as the patient usually registers the pain. Also, while the risk is low, injection of lidocaine into an artery can be fatal. In order to avoid this, we pull on the syringe before injecting. If the syringe fills with blood, the point of the needle is an artery and needs to be repositioned. In the end, I made 4 sutures. While the cut of this patient was very innoxius, it was great practice and this level of contact with the patient.
Electrocardiograms (May 21th)
Over the last few weeks I´ve been doing several electrocardiograms per day. While I began accompanying the other doctor´s, they now let me do them by myself. Today, I had my first solo electrocardiogram with a woman. As we need to put 6 electrodes across the chest of the patient, it was very uncomfortable to be serving a patient in an exposed state. However, by the 5th or 6th woman, I had adjusted. It is one of the realities of the job all doctor´s must adjust to eventually.
The Good with the Bad (May 25th)
Near the end of my shift today, an elderly man arrived by ambulance in the emergency room. After finishing with a another patient, I went to his room to observe the doctors. The first thing I noticed was blood all over the floor near his bed, where he had vomited just moments before I arrived. Despite the vomiting, the doctors had gotten him an IV of a glucose/water solution and intubated him, and were working on placing a catheter to his heart. With a yellow tint to his skin, it was clear something had either gone with his liver or kidneys. The doctor told me that he had cirrhosis of his liver; however, since he was talking, it seemed like the doctor´s had things under control. After the catheter was successively placed, I left the room to help with another patient. An hour later, I heard crying from the room and looked over to see the man laying in his room without any of the machines that had been supporting him and his daughter crying by his side. He had died. It was almost surreal. Two hours earlier he was talking and now he was gone. Maybe it was because I did not know the man personally or maybe I´ve become desensitized to death, but I was not bothered by this man´s death. While I felt bad for the family, it´s part of the job when you´re working with the sick. I just hope I don´t become too distant from the patient to see feel for the grieving family.
Scorpion Bite (May 27th)
Probably the most common single reason for emergency room visits here in Morelia are scorpion bites. While they often cause temporary discomfort in the majority of the patients, some can be fatal. During my first few weeks I observed several bites and the treatment process. The doctors taught me symptoms for the 3 levels of severity of scorpion bites. The first begins with weakness and ranges to asphyxiation in the 3rd level, due to the swelling of the throat. The standard treatment is an injection of an anti-venom enzyme that breaks down the poison of the scorpion. Typically, 30 - 60 minutes after the injection, the patient walks out cured. During my last week in the emergency room, the doctor let me give the injection. While it was not hard, it was another opportunity to get first-hand experience with the patient.
Tuesday, June 3, 2008
The Volcanoe/Ruins
In 1943, a volcanoe erupted and buried a town at its base. The only building left standing was the town´s church, which is now covered in 20 - 30 feet of lava rock. As we walked from the town to the ruins of the church, we got glimpses of the churches one remaining tower. When we arrived, I was struck the amount of rock that now covered the church. Between the 30 feet of lava rock that now buried the church and missing church steeple, the force of the eruption was very clear. All in all, it was great to get out of Morelia and see some of the diversity of Mexico´s rural scenery and culture.
Video (1 of 2)
http://youtube.com/watch?v=ISj9X-EY8Gc
Video (2 of 2)
http://youtube.com/watch?v=ISj9X-EY8Gc
Monday, June 2, 2008
Uruapan National Park
Last weekend I left Morelia to go to Uruapan National Park. The park is supplied by a natural spring near the entrance. As we travelled through the park there were another beautiful waterfalls draped by beautiful tropical foilage. While we did not see much wildlife, there were these gorgeous white butterflies. Near the end, there was a clavadista diving from a tree. It was very Mexican. All in all, the walk took about an hour.
Despite enjoying the park, I left the park a little unimpressed. I think we are spoiled by beautiful scenery in the Northwest and the park here seemed almost like an imitation of what we have in the Northwest. I´m so used to our parks, being largely untouched by man and left in it´s completely natural state. However, the National Park at Uruapan had man-made waterfalls beside the scenery. It felt like they were trying to compensate for the nature. It was still beautiful, and I enjoyed the time there, it just made me appreciate more the beauty of the Northwest.
Check out two videos of the Park. The first is at the base of a waterfall. The other is of a clavadista diving from a tree. Enjoy!
Video (1 of 2)
http://youtube.com/watch?v=3eMUKXcUVt4Video (2 of 2)
http://youtube.com/watch?v=yZdG97WuHbs
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