Wednesday, July 19, 2006

This is a Spinal Tap

Meningitis patients beware. I am no longer afraid of lumbar punctures, as I performed my first one today.

(Actually I am still afraid of getting one, but at least now I know they don't necessarily have to be painful.)

We had to get an lumbar puncture from a paralyzed patient of ours today in order to help diagnose whatever bizarre illness she contracted that made her become, in a matter of days, "locked-in" -- meaning that she is nearly completely paralyzed, except for her eyes, which she can move up and down. Since I had seen one performed on her earlier in the week, and abiding by the "see one, do one, teach one" principle, my resident let me perform it.

It's amazing how far into the back the needle can be pushed. I plunged in that long needle, expecting it to hit subarachnoid space or bone at any minute, but it kept going. After about 3 inches, I finally felt it pierce through something (I assume dura) and then CSF started dripping out!

A successful LP on my first try ... talk about beginner's luck.

Thursday, July 13, 2006

Latest Grand Rounds

Sorry, I know it's been awhile, but the latest Grand Rounds is up at donorcycle.

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.

Monday, July 03, 2006

New Interns

The new interns arrived at the hospital this week, and they're quite amusing to watch. They are very easy to spot, not only because they walk around with a slightly lost look on their faces as they try to find various wards in the hospital (in their defense, our hospital is huge), but also because their name badges are white, while everyone else's is blue.

It is also nice, for once, to feel like I'm not the least experienced member of the team. While the interns technically do have more medical training than I do -- by just one year -- most of them are from other medical schools and are thus new to our hospital. As a result, they need a little hand-holding on what are typically straightforward tasks, like finding lab results.

For example, the new intern on our team, after admitting his first patient, quietly pulled me aside and asked me to look through his admission orders to make sure he did them properly. I helped him out, flattered that he, someone higher in rank than me, turned to me for guidance. I didn't want to get too cocky, however, knowing fully well that this will be me in one year.

But still, quite amusing.