weekly woah

What a week, what a week.

As it turns out, this could have been one easy non-hectic week, lots of time to read and exercise and enjoy the outside. There were not may difficult cases this week which would have left for ample time for other various activities. So, after a time-consuming week full of little things to do, complications galore and various tie-ups, I am a bit fatigued to say the least.

Monday was a fun day in the OR. One of the cases that we did was an ischial decubitus ulcer repair using a gluteal cutaneous rotation flap. As it turns out, Dr. Friedman [attending] let the resident [intern Gene] and I do the entire case without scrubbing in. We both thought that was pretty cool and thought that we, in fact, did a pretty good job of it. It seems that patient happens to be in the best shape at this point on the service [or close to it].

Tuesday, Gene and I operated with Dr. Lagrasso doing some STSGs [split-thickness skin grafts] on a couple of patients, in fact, one of them can be seen on a prior blog entry. It was then that I got the chance to do the graft harvest utilizing the almight Zimmer. It is like a really good apple peeler, only the apple peeler is 7 cm wide and cuts at 0.012 inches thick. I am sure that April could appreciate that bit of goodness... mmm April's Apple Pie, yuuuummmmm! [I kind of have a craving right now!]. After that, we had a good little afternoon at the VA clinic before going back to round.... blah blah blah, that was the day

Wednesday was basically time consuming and full of consults. We have not had many consults in the past four weeks that I have been on this rotation, at least not during the day. Well, as luck would have it, we had 4 within 2 hours! It was kind of fun running around to see these patients and what was going on, but between those consults, doing evening rounds and then myself [with Gene supervising] repairing a dehisced wound, we wound up staying until about 8 [I definately don't mind the 14 hour days as long as you stay busy... if there is down time, it sure can drag on!]. The consults were interesting. We had one guy who hit one of those South Carolina trees as he was driving. They just happen to jump out into the middle of the road, much like northern deer. Well, of course he had an EtOH of 0.28 and was + for cocaine. The reason we saw him is that he had a pretty bad nasal fracture. On physical exam, there was not much edema in the area and he had NO pain at all! Crazy... well, not really since it was most likely an old fracture just picked up in this acute setting. Another trauma patient that we got to see had her facial trauma not directly from her car accident [she was trying to mimic the SC trees and jumped out into the road in front of a car and lost] but as a result of blowing her nose. She came into the ED from her trauma scene and after being stabilized she blew her nose and her eye blew up as a result. She probably had a nondisplaced orbital fracture that displaced or something upon the pressure of blowing her nose. Nonetheless, it was not bad enough to do anything about since all sensation [infraorbital, etc] and EOMs were intact, so we left be. But it was ineresting to see nonetheless. Then, there was a consult for another sacral decubitus ulcer that needed debridement... kind of a run of the mill problem for in patient plastics, so it seems. Anywho, this guy's story is intersting... HOD #95 s/p cervical spinal subluxation leading to incomplete quad. C-spine subluxation secondary to seizure d/o with an episode that landed the patient's head into a table. Anyway, after all that time in the hospital, it was finally noticed that he had a stage II/III ulcer. The last patient was seen based on hospital protocol. He got die injected into an external jugular, but IR must have missed or something and extravisated 100 cc of contrast into his neck. Plastics is consulted on such a case in order to make sure that blood and contrast die has not caused any overlying tissue breakdown or damage that can be taken care of. As it turns out, you could not even tell which side it was on, his external jugular appeared intact and there was no skin breakdown from the contrast. End of day... except for going to fix the sacral wound dehiscence... then end of day... Whew! I was also on call, but because I wanted to go to a case Thursday afternoon, I decided to take home call, just in case nothing too exciting happened, I would be able to go to Thursday's case.

I will get to thursday and today later... right now, it is eaty eaty time... that and the fact that I am contemplating the prior thought of the ol' AAP if you will [April's Apple Pie] and feel the need to William Shatnerize sweets into my evening... a mission to seek out new sweets and goodness, to boldy eat junk food like I never have before!!!

WTYL,
G