I don't know how many of you out there watch the show. I attempted to watch it for about all of two episodes, and it just so happens that the first two episodes coicided with my first month of General Surgery, as a 3rd year medical student. For those of you who watch it, you might have an inkling to how a surgery service is run in a academic hospital. At the top of the ladder, you have the Attending surgeons. These are they guys who are finished with their education, and this is now their full time job. Below them are the residents, or the surgeons in training. It's about a 5 year long residency of training, with the chiefs being the 5th years, and the lowly interns at the bottom in their 1st year. But yet, even below them reside us, the always enthusiastic med students who unlike those mentioned above, pay to be there. The 4th and 5th year residents pretty much run the show, with the interns doing all the dirty work, all the attendings really ever do is stick their heads in from time to time. And unlike the television show Grey's Anatomy... no one is sleeping with eachother. In fact, the bantering and ridiculousness of it all made the show pretty much unwatchable after only 2 episodes for me. It's by far the least realistic medical show on TV currently.
Which brings me to the topic of this posting. This was all about a year and a half ago, and although I would have been perfectly happy only having 1 month of General Surgery, I now find myself going through it all over again as a part of my required Sub Internship for graduation. Granted, we did have a choice between Surgery, Medicine, and Pediatrics, however, everything I heard from those that matched into Emergency Medicine said that I should do my Sub-I in surgery. So here I am...again...getting Tmaxs and running around in a hospital at 5am everymorning until about 8 at night.
However, today was an interesting day. A day we probably couldn't have scripted even if we were working for a major television network and had even tried to burn it onto celluloid. You see, in medicine, and in a hospital more specifically, we have a term called a "rock". The general idea is that patients come into the hospital with a problem, we help them with that problem, they move on and go home. This is not true for a "rock". "Rocks" are patients who come into the hospital, wind up on your service, and end up staying there. They stay...and stay... and stay, and they never leave, and there's very little you can do about it. The largest "rocks" can stay on your hospital service for months until what usually happens is they die. Even though there's nothing much you can do for them day by day, they still eat up a considerable amount of your time because it is required that you see each and everyone of your patients everyday. This is the bane and the anguish of the "rocks".
We've had a "rock" on our service for the past 2 months now, one that deserves special mention. You see, he came to us with a very interesting background. From what we were able to gather, he grew very sick suddenly in a hospital in Arizona, where he underwent a "unknown pancreatic surgery." His recovery didn't go very well and he sought out an alternative therapy or something in Mexico. In Mexico he underweant another surgery that ended up giving him a massive raging infection that nearly killed him. Instead he languished in this Mexican hospital with his insides open to the world for about a month. Unable to take it anymore, he actually taped up his stomach by himself, caught a bus to the border and went to the emergency center in a Brownsville hospital. His abdominal wound was so severe that they wouldn't even touch him, they sent him direct to Houston via an ambulance transport.
He pretty walked into our emergency center with his abdominal tape falling off and his insides hanging out of his belly. You can imagine what the interns down there thought when they first saw him. During his two month stay with us, he went to the OR repeatedly to get his abdomen pretty much sprayed out with a water hose the way you power wash two story windows. On one occasion, they put a scope down his esophagus and into his stomach to get an inside view, but once they passed the scope into the intestines, the first thing they saw was not tissue of bowel, it was the ceiling of the OR with the surgeons looking right down into the camera. He had a massive hole (fistula) going from his bowels straight through his abdominal hole and to the outside world.
You can't imagine the pain this guy is in. Our everyday visits with him were always secondary to his pain control. He was always on massive amounts of pain medicine and none of them every really scratched the surface. We had every assurance that this man would unfortunately die on our service. His insides were pretty much mush at this point.
However... we had a plan: Operation Flying Rock was conceived. The patient had often expressed a wish to go back to Arizona, where he still had family, and a hospital that had his records and was familiar with him. The thing though is, you just can't put a person who is one breath away from the SICU on a bus or a plane and ship them to another hospital, or can you? Technically, you're supposed to treat or cure a person before you discharge them from a hospital, sometimes though you just can't follow the rules. The plan was to get this pt. back to looking like a normal human being as much as possible. He was given a good shower, new hair cut and a shave and new clothes that a nurse picked up from Target the day before. The hospital provided for a one way ticket on Southwestern Airlines to Phoenix, AZ. (A plane ticket is much cheaper than one night's stay in a hospital). Up until this point, the patient was getting all of his nutrution through an IV and was getting a constant morphine drip for pain. Overnight, he was loaded up with a IV solution with a very high concentration of sugars. His open abdomen was packed completely full with gauze and four layers of plastic wrap was adhered to his belly to prevent any openings. A taxi was then called this morning with specific instructions (including a big hefty tip) to pick him up at the hospital, take him to the airport, and get him in a wheelchair with a personal escort upon arrival to the terminal. Before the taxi arrived, he got shot up with IM morphine, and was given several tabs of darvocet for him to keep in his pockets. His part was to act as much like a normal healthy person on the airplane just long enough for them to get him to Arizona. Once in AZ, his mom would pick him up and drive him directly to the general hospital there. All this happened at lightning fast speed this morning to make sure above all else he made it there.
Just so you know, this isn't how things usually happen, but stranger things have been scripted, that's for sure.
