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Life as an Attending & Humorous Stories from the ER

It's been nearly two months since I started my new job working at Hunt Regional and Presbyterian Kaufman.  It has been a great couple of months so far with wonderful staff, sick patients and much more time off to spend with family. Melissa and the kids have kept on homeschooling through most of the summer so that we can take some time off in late September/early October to take a three week road trip from Dallas to Maine to explore the East Coast in the fall.  I've enjoyed being able to have a lot more time with the kids since I'm working only about 14 shifts a month although I'm not sure if Melissa knows what to do with me when I'm pacing around the house looking for another project to keep me busy!

We had shared with some of you the difficulty Vivek had been having with his speech especially after he turned two.  He had barely 10 words he could speak around that time and so we had started to meet with a speech therapist to help him with his language acquisition.  Thankfully God had worked amazingly in his life and the switch seems to have flipped - in the past two months he has amassed a several hundred word vocabulary and started to put sentences together.  In fact in early August he graduated out of speech therapy and I think he has been a much happier kid since he can communicate with us.  Thank you to all those of you who had been praying for him!  Luke is so excited about finishing his Pre-K workbooks and  starting his kindergarden school work which includes teaching him how to read - something he has been desperately wanting to do since Karuna learned to read.  Karuna has continued to do well in school and seems to show quite an aptitude for math and reading.  Often times we'll find her reading chapter books in her room if she wakes up before everyone else to pass the time.  We also know for sure we've produced nerds  as her one request when we had our last daddy-daughter date was, "Daddy, can we do some of the X problems? (referring to some basic algebra I was teaching her)."  So we pulled out a napkin and worked on 2x +2 = 10, (solve for x) while we ate dessert and in the end her love bank was full - she is a funny kid!

I've loved my new job so far!  Perhaps the best part of my job when compared to residency is that I now have a scribe who follows me around whenever I work.  For those of you who have never had a scribe, it is usually a student who is finishing undergrad and is interested in medicine who works with us to help us with our documentation.  We use a company called PhysAssist that provides me with a scribe on every shift I work.  The scribe comes along with a laptop as I see patients in the ER.  As I talk with the patient and get the history and exam done they are typing away and completing my chart so that 90% of the time the chart is completely finished by the time I leave the room.  I'll then talk to them about any modifications to the chart as we walk to the next room and I now no longer have to worry about the 10-15 minutes it would take me to document the chart.  Besides the documentation help they provide, they also function as some of the best personal assistants - they can get another physician on the phone for me, keep track of any x-rays/CT scans/labs I've ordered and as soon as those are back they will let me know so that I can act on it.  I've so enjoyed having them around because the part that I've always hated about medicine has been the paperwork and now that they take care of that I feel like I can spend twice the amount of time with my patient to answer questions and really make my patient feel like we are working together as a team to help them understand their disease process.  Also since most of the scribes are planning on medical career they are always interested when you can teach them clinical pearls as we see patients - a great learning experience for the scribes as they work with physicians.

It has been a while since I shared some more humorous stories from the ER.  A couple of these stories have been from the last few months and a couple form when I was at Parkland.  I'll begin with probably the funniest story.  A couple of weeks ago I was working an evening shift and getting quite bored after I had seen my sixth nursing home patient with weakness and urinary incontinence and wishing for a little more excitement.  Just then a nurse came running up to me and said , "There is somebody who was stabbed whose friends brought him in to the ambulance door."  I went out of the physician area to take a look and sure enough there were a group of bikers huddled around a pale and clammy looking man in his 30s who was getting rolled in on a wheelchair from the ambulance bay.  I could feel the adrenaline kicking in and was glad it was not another weak and dizzy patient.  In between the moans in the critical care room I managed to get the story while the nurses put in two large IVs into his arms to pump fluid in while we called for blood and the general surgeon.  This man, a classic biker, had been with his girlfriend about an hour before when they got into a bad fight.  She got angry and pulled out a 7 inch knife and stabbed him in the belly.  She ran off and his friends decided to just bring him in on one of their motorcycles rather than wait for the ambulance.  After several milligrams of hydromorphone I finally got his pain under control and took off his dressing and sure enough there was a big gash in his upper belly with omentum (the fatty covering over the intestines) laid open on his abdomen.  My surgeon was there within 20 minutes and the patient was soon up in the operating room where she did an exploratory laparotomy, stitched up his injuries and he was soon out of the OR.  The next day when I saw the surgeon I asked her how the case went and she replied, "The case was fine but when I got inside his belly I found two holes in his stomach and he had told us that he had only been stabbed once and so I was quite confused.  After I closed up his belly and he woke up I asked him why there were two holes in his stomach when he had told us he had only been stabbed once."  He replied, "Well, when my girlfriend stabbed me, she pulled the knife out and I had always heard that if you ever get stabbed you got to leave the knife in so that you don't bleed to death.  So I took the knife and re-stabbed myself through the hole to make sure I wouldn't bleed to death.  I guess I missed."  When I heard that I was on the floor laughing with the surgeon - I can see keeping the knife in to prevent bleeding but to re-stab yourself so that the knife gets back to the right place and now cause two holes in your stomach was definitely a story I had not heard before!

The second story was of another stabbing victim.  I was working an afternoon shift wishing again for something more interesting than toe pain when I saw on the computer that someone had checked into the waiting room with the chief complaint of "stab wound."  I was quite perplexed as to why a stab victim was in the waiting room and not coming by ambulance and so I asked my nurses to please bring this man back so that I could figure out what was going on.  Looking from  behind the counter I saw a young man in his 20s hobbling across the ER hallway to the trauma room.  He looked like he was hurting quite a bit.  He was soon in the critical care room with a flurry of nurses drawing blood, starting IVs, pain medicines and fluids since he came in with a heart rate in the 120s.  He started to talk - "Well I was at home cutting some potatoes with a 10 inch knife (Who know why you need a 10 inch knife to cut potatoes? - But that is beside the point...) when my kid started yelling and throwing a fit.  I got real angry and so I started running after her to give her a whooping but I also had the knife in my hand.  As I ran after her, I tripped and fell and landed on my knife at which point my fiancé called 911."  The officers arrived and saw this man with a large 4 inch gash across his lower abdomen and took a look at the knife and saw that at least 4 inches of it was covered in blood out of the total 10 inches.  They then called the paramedics to come evaluate him but he was convinced it was just a "flesh wound" and so he would take care of it himself.  He sent the paramedics away but soon started having such bad belly pain that his fiancé was able to finally convince him to come to the ER.  I took a Q tip and probed the wound and the Q tip just kept going in - not a good sign of just a "flesh wound."  I felt his belly and it was hard and tender - peritoneal signs - suggesting that this knife had likely violated the peritoneal barrie and had gone into his abdomen.  We poured in fluids while we called the trauma registry and the helicopter was on its way and within 15 minutes he was in the air to a level 1 trauma center.  Just as an aside, when you work in a rural ED where you are by yourself and you have someone who is very sick there is nothing more comforting than to hear the chopper blades as the helicopter comes in.  I checked up on his blood alcohol level later - it was 303 (almost 4 times the legal limit).  A couple of lessons learned: 1) Don't run with sharp objects in your hand.  2) Don't run with sharp objects especially if you are drunk.  3)  When the paramedics see a knife that is covered in blood, don't just ignore them and call it a flesh wound and stay home - bad things might happen!

I hope you enjoyed those stories as much as I enjoyed being the physician taking care of these patients - regardless of how irrational they might be.  Stay safe and please be careful with sharp objects - they might hurt if they end up in your belly.

Lastly some pictures from my recent residency graduation.

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