I'm not a Dr. but I play one when I'm on call

My first on-call night was pretty uneventful -- I followed the intern around, checked up on a post-op patient (who was feeling marvelous), and then we both slept all night long. Most people I talk to tell me I should cherish this respite, for it does not happen very often. After a few more call nights I would now agree. Here are some stories from my other call nights, one of which had us running from one trauma to the next without any rest from 8 PM to 4 AM. We had 6 traumas that night, which is a lot to fit in 8 hours since normally a trauma takes about 1-1.5 hours to workup.

First let me explain how this works. When people come to the ER, not everyone is treated the same. Heart attacks, asthma exacerbations and the like are medical emergencies, and, as such, are seen by the ER doc, and their care is meted out by the internal medicine or pediatrics house staff after their initial emergent care is managed. MVAs (motor vehicle accidents), GSWs (gunshot wounds), falls with LOC (loss of consciousness), assaults and the like are ruled traumas. Since their problems are not medical in nature, and have the potential to be surgical, these patients are seen by surgeons on the trauma service. At least, this is how it is run at a Level II Trauma Center.

One of my first traumas was an inmate who was dropped off at prison from his outside work program looking like he had been in a fight. He was also in a drunken, combative state with some suprapubic fullness. Apparently inmates with good behavior are allowed to work in the community without supervision -- so long as they have an ankle brace tracking device on. This suprapubic fullness was later found to be an extremely enlarged bladder when, after being sedated by anesthesia, he proceeded to empty said bladder all over my new stethoscope. Turns out he had no major injuries. But his BAC (blood alcohol content) came back at 390! Considering that most people start getting drunk around 100, this guy was pretty wasted.

Another case we had was an MVA, car versus tree. This guy's BAC was near 200. Again, no major injuries. Oh, did I forget to mention that when the police arrested him he admitted to 9 other DUIs? It is hard to be compassionate with one of these idiots -- I'm just glad he hit a tree instead of an innocent pedestrian or driver. But as physicians we are to be impartial in our care of the sick and wounded.

Around 2:15 AM that same night/morning, some guy came in all beat up. Not too much was exciting with him. His chest x-ray and CT scans were negative for any major injuries. But the neat thing was that I got to suture up a laceration above his eyebrow. I had supervision the whole time, but I was glad to actually be doing something to help a trauma patient.

When I was on-call all day Sunday, I saw the most horrific case. Jess referred to it on her blog. This is the patient that did not make it after performing CPR and pumping blood and fluid into her for nearly an hour. Usually we won't work on patients this long, but her heart was still active. We were able to get her rhythm back a few times, but in the end she just lost too much blood. I won't post the details on my blog. This newspaper article gives the whole story.

Some calls are boring, and some you wish you could just save everybody. I've got a whole week of trauma this week. That means that I'll be responding to traumas all throughout the regular 7 AM to 6 PM hours, and I'll be rounding with my team on all the trauma admissions. I'm sure I will have many more stories like this to share, but I think my readers have had enough for now.