28 December 2007

28 DEC 2007 Sinking my teeth in

28 DEC 2007 Sinking my teeth in

I slept hard today. After morning clinical openers, I cleaned up a little business, changed back into DCU's and biked back to the hooch. It was so cold that my fingers hurt in the wind. By the time I got back to the hooch, they were cold and white. Guess it wasn't so silly after all for the military to send me here with big puffy gloves! Rather than cut through the barriers, hop the curb, then pop over the water supply hoses, I opted to take the long way around to the parking lot behind our housing pod. It was too cold to risk ditching my bike like I do some mornings. After being on call for a 24-hour shift, several bodily functions start to get a little finicky. My right eye starts to twitch. It makes me look like a maniac who is just barely holding back an outburst. It makes for great conversations with concerned parents. I actually appreciate those who ask so that I can reassure them that I'm not crazed. After a night on call, my body loses all ability to regulate temperature. I become like a poikilothermic lizard, normalizing temperature with the environment around me. Often post-call you can find me trudging around the hospital in long johns or with a wool blanket draped over my shoulders like Pancho Villa. And lastly, my balance can suffer a bit. This can add some much needed excitement to a boring bike ride out of the hospital compound.

Surprisingly, I know from numerous experiences that after being up all night, I am easily able to operate for another 12 hours straight. That's just what residency drills into you. Tires as you are, you focus on the red patch of flesh bounded by a blue square of sterile towels and do your job. It is a matter of focusing on the need at hand, and ignoring the external distractions as well as the internal distractions. I wouldn't continue to be a surgeon if I wasn't able to turn in the goods after a night awake.

There wasn't much surgery to do last night, but there were some patients to get admitted, herd through tests, and tuck away for the night. And of course midnight chow couldn't be neglected. I did have a chance to sleep for about two hours, but they were not well spent. Rather than sleep out in the open at the PLX, I opted for the surgeons' call room. Sleeping out in the open is convenient. If the ER or ward staff has a question, they just nudge you awake, you answer the question, and you get back to sleep without even moving more than eyelids and mouth. But it does have it's disadvantages. The PLX couch is bound in non-breathable pleather so you usually wake up stuck to it with a layer of sweat. Also it has a few crossmembers that can bite into the spine. The distance between the armrests is slightly smaller than my six-foot height, so I have to curl up a little to fit. The other option is to put my head up on the armrest, but that gaurantees a crick in the neck for later. Lastly, since the PLX is a high traffic open area, there is the risk of a public display of snoring, pants handwarming, or morning wood if I should happen to sleep that deeply. Friend are always happy to record the moment with some candid photography. Fortunately any shame or modesty I used to have atrophied long ago.

Probably for the heat and the dark, I chose the call room last night, and made the best of it. I failed to get restful sleep and woke from my two hour nap with an awful headache. Unfortunately the drains in the call room bathroom were emiting a foul miasma of sewer gas that was slowly asphyxiating me. I'm sure I lost some more of the precious few viable brain cells I have left. Through some feat of plumbing incompetence, our drains cannot maintain adequate water in the stink traps, so whatever waste we send downstream continues to send us vapors to maintain itself in our memories. I'd even rank it a notch worse than the burn pit odor. Worst part is, I'm sure that smell impregnates itself into my clothing and hair the way the formaldehyde would mark me as unclean during my gross anatomy classes back in medical school.

So back in the hooch, I awoke after a comatose nap. I was very thankful for my handy-dandy combination air conditioner and heater unit through the wall of my little half-trailer. It blew away like a hair dryer, blasting my cave with a dry warm breeze. I awoke to find that it was the afternoon. There was the faint aroma of good food wafting in on the heated wind. I showered, donned my PTU's and biked back to the hospital. There I found that a little crew had come from California to brighten our evening with a steak dinner. They were the Cooks from the Valley from Bakersfield California, and they had brought 500 steaks to the hospital for us. they had a long half-barrel barbecue blazing, and the succulent dead cow flesh was sizzling and spitting on the grate. In addition to the hospital patients and staff, we had invited the many troops on base who would give up their off-duty free time to volunteer at the hospital loading and unloading the injured from the dustoff Blackhawks that land on our helipad. It was the best meal I had eaten in months! The fat juicy steak on my plate was kept company by a big baked potato with sour cream and butter, baked beans and a salad. I spoke with the chef who told me that their restaurant had gone to many bases in the US and abroad to feed the troops a special meal. They had even been to Guantanamo, Cuba. They were just fellow citizens who wanted to show the troops that they were remembered and appreciated. Speaking for this one individual well-fed troop here, I can tell you that they succeeded.

We have a friendly little visitor to our hospital that I admitted last night. She is a seven-year-old girl, and a helicopter brought her from another military hospital in the country last night. A friend of mine, Pediatric Pulmonologist A. contacted me last week about her from his base. Three years ago, she had been shot in the neck when she got caught in the cross fire. The bulled lodged near her spine and caused an abnormal connection between the artery and vein in her neck. It creates a constant buzzing vibration in her neck and sometimes aches. Her hands tire easily and there is the chance that this blood vessel could create a blood clot in her neck. For three years, her father has gone from hospital to hospital looking for help. I told my friend that he could send the girl to us and we would try to help. She has a beautiful smiling face, dark eyes, and long curly black hair. She sat calmly and sweetly while we examined her and started an IV catheter in her arm. Her father is a friendly man and speaks near-perfect English. He told me that he had studied in a sports college in Baghdad before the war. He had majored in futbol until he hurt his knee, then he switched to volleyball because he didn't have to cover as much distance. After the war he has worked guarding the border. Whenever he wasn't working, he searched for someone to help his daughter. He has an amazing thick black walrus moustache of which I was very envious!

His daughter had a complicated abnormality of her artery. It is very close to her brain, and I don't know if we are going to be able to do anything for her. I was very fortunate to have the good help of Vascular Surgeon M. Over the past few months I have come to know regard him as one of the most skillful people I know with delicate care of blood vessel illnesses. He is doing everything he can to try and come up with a plan to help this girl. If there is a way to do it, I know he will find it.

It seems that I escaped major punishment even though I tempted the fates by calling the shift last night quiet. It is such good news to see statistics that violence is decreasing in Iraq. I hope that this is a sign that a combination of our policy and efforts on the part of concerned citizens across Iraq refusing to allow troublemakers to maim and kill are starting to make a difference. How good it would be to have our little hospital become obsolete. I can only wish for such a feat.
Be well. Don't worry about us, we'll keep working hard, and at least for the moment we have a good dinner in our bellies!



make mine trauma said...

What a treat. I am not a carnivore by nature but there is little tastier than a perfectly grilled t-bone or rib eye once in a while.
I share a bit of your sleep deprivation maladys. The thermoregulation is a big one. Always freezing. Balance is another. I almost feel intoxicated and sometimes drive as though I were also. My worst one though is my mouth. I say some of the stupidest s*#t when I am tired. It's as if I have forgotten everything about anatomy, pharmacology, physiology, etc. I typically ask intelligent questions during procedures but when I am tired........I often reflect back the following day and realize the obvious that was oblivious to me the night before. I wonder that the surgeon must think I am an idiot!

historyprof0 said...

Yes, sleep dep makes me cold and wobbly, but thankfully, I can still keep doing the academic thing -- makes the all-nighter with sick kid followed by a full day of lecturing possible. Of course, the stakes are somewhat lower in my case. If I slip up and refer to Fredericksburg as a big Union victory, that would make me look like a dumbass and it would be confusing to my students, but nobody dies.

HollyB said...

That's awesome about the Chefs from the Valley! I'm glad you got a nice steak dinner with all the trimmings. Your regular reader "Lainy" has a sis in law who will be with me tomorrow [Saturday] along with her husband, an Army Reserve Col. for the New Year's Holiday. We will be raising a glass or three in your direction.

emergencyem said...
This comment has been removed by the author.
emergencyem said...

"succulent dead cow flesh"

you have such a way with words...hehe

Chris said...

Dear MakeMineTrauma, HistoryProf0, Holly, and Em,

It was good to be able to report the happy news of a good meal! Trauma, I completely forgot to mention the post call loss of internal censoring. I do say the craziest stuff post call, that I would totally keep to myself if well rested! And also with respect to post call mouth, who can forget the dragonbreath! HistoryProf0, I would say that with young minds in your responsibility, mistakes are just as important to avoid! Thanks, Holly, I'll be there with in spirit! It is good to have the connection with you and Lainy. Emm, I'm not afraid to say it, I love the flesh! Why use a euphemism? Tell it as it is!