Thursday, July 13, 2006

Two Tubes and an Idiot

A few days ago my ICU patient had his endotracheal tube removed and replaced with a tracheostomy, aka a "trach". At the same time he had a NG tube (a tube that enters the stomach via the nose) placed to facilitate suctioning secretions from his stomach, but because his NG tube was severely irritating his nose, ENT -- the team who performed these procedures -- recommended that it be removed and replaced with an OG tube (a tube that enters the stomach via the mouth).

I brought this up on morning rounds with my team, and my fellow was confused how an OG tube could be used with a trach in place. I honestly had no idea why he felt there would be an issue, but he really wanted to know if was ok to have both of these tubes at the same time ... so he told me to call the ENT resident and ask. Being an obedient medical student I agreed to call ENT, knowing this would be viewed as an idiotic question. My fellow realized it too and said just to act like a clueless med student to get the answer.

So I called up the ENT resident -- who was no longer at the hospital at this point, but at home -- and asked "Is it ok to have an OG tube in this patient, who also has a trach?" Then, in a slow voice that's usually reserved for talking to a 6-year-old, she said "Um, you realize the trach is in the trachea, and the OG tube is in the esophagus?"

I replied with "I understand", although really I wanted to say "Thanks, but I took gross anatomy too." Her response caught me off guard, and so the rest of the phone call involved me stuttering away trying to ask if it was ok to have these two tubes in place -- without coming across even dumber than before.

I got off the phone as quickly as possible, feeling like an idiot, and relayed the news to my fellow, who thought it was amusing.

Thanks a lot, fellow. There, you got your answer ... and also made me look like an idiot at the same time. I hate hierarchy.

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