1st Week

A common sentiment around residencies in teaching hospitals is that you do not want to be injured in July because that is when all of the new docs are on call.  Well, the day after the 4th of July I was on call for the first time.  This was a bit stressful because people do not come into the hospital on the night of a big holiday, they finish partying and then come in the day after.  So I was expecting a big day and honestly I had to say that I was nervous.

In preparation for my first on-call service on the Tuesday the 5th, I came in on Monday the 4th to shadow a more experienced resident.  That morning, I rounded on patients that were on our service.  I cleaned some facial wounds on a patient who had an accident and the face sustained some deep abrasions. The patient also had some deep lacerations.  The lacs was sewn and now the patient was in the hospital trying to recover.  To minimize the scarring the scabs would be scrubbed off with hydrogen peroxide and saline solution.  This causes a lot of pain and so the patient would be given a dose or two of morphine just prior to starting the cleaning.  This patient had to do this 2 times a day.

Another pt came in that day after falling and sustaining a laceration to the head.  Her forehead was lacerated exposing the bone.  The bones surrounding the eye were broken.  The patient suffered an orbital floor blowout.  This is when the muscle and other soft tissue surrounding the eye breaks through the bone and falls into the maxillary sinus instead of being in the eye socket.  So ophthalmology was consulted on this case, as well, in order to assess her vision more closely.  After I showered the gaping wound with saline solution and got rid of the rocks, dirt, pine needles and other debris I sutured together the deeper layers of the scalp and then closed it up.  It was very fun to suture.

This was on the 4th of July.  The 5th of July I was on call but luckily it was not facial trauma call.  It was tooth call only.  So no more facial lacs to sew up, just fascial space infections from rotten teeth.  When teeth are broken down and get infected but do not get fixed with either a root canal treatment or extraction the infection can spread from the tooth and break through the bone and get into the head and neck spaces.  This can be life threatening.  Once the infection spreads to the face and neck, the treatment is to remove the source of infection (the tooth), incise and drain the pus, and then give the patient some strong antibiotics to help fight off the bacterial infection.  Usually the patient has a huge swelling on one side of the face.  Then you look inside their mouth to see if you can narrow down the source of the infection and I usually see multiple teeth that could potentially be the source. For examples see http://www.dental--health.com/bad_teeth_broken.html

I do not know if this is the usual for all people in this area but for the patients that come into the emergency room this is pretty typical.  So brush your teeth and see your dentist.

So far I feel I am a little lost in the hospital as I follow my upper residents.  The patient I am watching over has a gun shot wound to the face.  The bullet entered the cheek broke the mandible and now is lodged in the back of her head.  The OMS team is in charge of correcting the mandible fractures. The patient is also pregnant and OB/GYN is over the fetus, neurosurgery is over the brain damages and the trauma team is the admitting service.  That is how the hospital works: one service admits and is in charge of the patient while they consult other specialists to work on specific areas of the patients' charts.  

Well, it is exhausting waking up around 4 or 5am and then getting home between 10 and 12pm.  I am glad that I made it through the first week of OMS residency and I did no harm.  I was even able to help a few people.