(The photo is daughter Anne after a 28 hr shift as a surgical intern in NYC)

As you may know daughter Anne is Dr. Anne now and a surgical intern at NY Presbyterian hospital in Manhattan.  She has been blogging a bit and I thought you might enjoy part of one of her recent reports.  One of the interesting things about her work is that she has to be good with her hands. She described it to us as “being able to solve problems with your hands.”  I also enjoy solving problems with my hands, though I realize the nature of my work is pretty different from Anne’s.  Anyway, here is Anne’s report filed just after her fall break following 2 weeks of night shift at the hospital:

Yes you read that right they gave me two full weeks away from the hospital. As fun as it was… I’m glad to be back. Tomorrow I start in the SICU (surgical intensive care unit). But first some lights from night shift (not high or low just notable):

Stop bleeding goddamnit!!!!

I got a page that a post-op patient was bleeding. He had a 1cm incision in his groin right over his femoral artery. The blood seeped out of the slit in his skin at roughly the pace of a faucet turned juuuuust past dripping. My first move was to hold pressure for 15 mins and replace the bandage. Paged again, still bleeding. Next I tried a BIGGER bandage. And I put a 1L bag of saline on it for extra pressure. Fail. This is when I called my senior and realized she was scrubbed in the OR… No need to bother her while she’s operating. I got this! I tried a special type of cloth called “quickclot” under my next bandage. And a 5L bag of saline for extra pressure.. Buzz buzz BLEEDING. Where were this guy’s platelets!!!! Skin glue? It’s basically exactly the same stuff as superglue and it’s never let me down before. This worked about like dumping sand on a spring to stop it from flowing. It’s now around 1 am and the patient and his nurse are increasingly (and reasonably) alarmed. It looks scary but it’s really not THAT much blood I keep telling them.. and myself. I’m frustrated! I enter the operating room and quickly run through the four things I tried with my senior. She said those had been good ideas, and that the last thing I could try is placing a stitch across the area and pulling it tight to cinch the leaky vessel closed. I gathered my supplies, told the gentleman to take a deep breath, and quickly slipped my needle in and out, in and out (figure of 8 stitch.) I pulled up on both ends of my suture and… the sweet sweet sight of neatly approximated skin edges sans bloody trickle!! I threw three victorious knots, then one more for good measure. 

Main character in a nightmare:

My phone buzzes with a LEVEL 1 TRAUMA and me and the other two residents hastily make our way down to the trauma bay (Surgery attends every level 1 and 2 trauma activation as these are the most severe categories and there’s a chance these patients will need to be operated on immediately.) We arrive in time to see a frail old woman prostrate on the stretcher. She’s awake and wiggling underneath the gloved hands of ~15 total strangers in masks and yellow gowns. She whips her head back and forth frantically. Her eyes rolled from terrifying figure to terrifying figure. 

It reminded me of when my family went to pick up a baby calf to raise on our farm. I was around 10 years old. We transported it in the trunk of my dad’s beloved ford focus wagon and I sat in the back seat holding its bridle. The calf was frantically searching for its mother’s teat the entire ride, clearly caught in the most terrifying nightmare imaginable.  

We push our way to the bedside and ask for the story. “85 year old woman found down in her house, + loss of consciousness, + head strike, oxygen sat in the low 80s.” A chest x ray showed a punctured lung so we prepared for chest tube placement. I helped by holding the woman’s tiny wrist as we sliced a several cm long incision between her ribs and shoved about 12 inches of large bore plastic tubing into her chest cavity. After her oxygen saturation improved it was time to make sure we weren’t missing other injuries. Again, I helped hold her down as the rest of the team stripped every item of clothing off her body, including her soiled diaper. She laid there in terror. Fully exposed, bloody, tubes and IV’s roughly inserted. But alive. 

Baby’s first appendectomy 🙂

It was around 2am and we had a 30 year old woman who needed her appendix out. It’s the responsibility of the senior resident to do these cases, but my pager had been blessedly quiet the past few hours so I made my way to the OR and asked if I could help. Zac (my senior) said sure, then asked me to tell him the steps of the operation. I’d seen probably 20, so was able to rattle off the major steps. When the attending came in, Zac asked if he could walk me through the case. The attending was sleepy and grouchy and grumbled something about probably not. But after they got into the belly and it was time to find the appendix he motioned me to the prime position and handed over the laparoscopic graspers. For the first time, I took charge. I successfully located the appendix by sweeping the descending colon towards the head. The appendix looks like a finger sticking out from the bowel, it’s hard to miss*. I grasped the tip, and lifted it up towards the abdominal wall exposing its attachment to the ileum. Apparently I did a good job with these steps as the attending let me continue. He told me to switch my grasper for the laparoscopic cautery. This instrument has two hot plates and a blade. You clamp the tissue, burn it, then cut it and release it. I transected the mesoappendix (everything but the very base of the finger.) That went well too. He asked me if I’d ever used a stapler. I said yes (I haven’t but wasn’t about to stop now!!) He handed me the stapler, and talked me through each step. I nestled it down around the appendiceal root and asked if he liked my bite. He said yep fire away. After removing the appendix from the body, he and the senior resident closed the fascia and I closed skin. I left the room literally bouncing for joy. I thanked my senior profusely for asking to involve me. I smiled through 6 am signout. And I hardly slept at all that day. I relived the operation over and over. I dreamt gloriously about staplers and bowel graspers and neatly sewn skin. 

Meanwhile, back in Asheville, we had our first cold weather a couple of weeks ago.  Lonnie the handyman had been fixing a window at one of our apartments and he let me know that the thermostat was physically damaged(one wonders how that could happen?), and therefore no heat in the apartment.  I could tell he was concerned as he went on to say that a woman and a tiny baby were staying there and they would need heat.  The part about the woman and the baby was also news to me.  I texted the actual tenant(who doesn’t have a baby) and she explained that she was out of town and the woman with the baby was staying in the apartment to take care of her cats(all of this is about par for the course for the rental business and left me unruffled).  But I shared Lonnie’s concern about the thermostat, whoever was staying there, as lows would be in the 20’s for a couple of nights.  

Lonnie wanted me to call Tommy our hvac guy, but I didn’t want to because I knew Tommy would be covered up with calls like this on the first heating night of the winter.  If I called Tommy to replace the thermostat there were two possibilities, either he would get to it in a few days which would be too late for the mother and baby, or Tommy would work until 10 pm or later before getting home for his supper.  I’ve known him to do that and I didn’t want to add to his workload.  

I have installed thermostats before.  Some of them just have 2 or 3 wires in back and it is super easy.  I would give it a try myself.  I called the woman with the baby and told her I would be over shortly.  She explained that she actually had a home of her own and was only staying at the apartment occasionally, but that I should be careful not to let the cats out under any circumstances.  I am a cat person, so I would be careful.  And I was relieved to hear that woman with a baby had a home of her own.  

I picked up a thermostat for $25 at Ace.  It would control a heat pump and I was pretty sure it was compatible, if cheap.  Simple can be good.  When I removed the broken thermostat from the wall I was concerned to see at least 7 wires connected, basically one for each color in the rainbow.  This would not be the easiest operation.  But looking at my new thermostat, there were color codes for each wire terminal, and I thought this would be fine, just connect each wire to the appropriate terminal.  I skipped the part of the directions that said to cut power to the system when connecting a new thermostat.  I was pretty sure the voltage in the hot wire was too low to shock me.  Correct.  But while working I did hear the unit try to start when I brushed two wires together.  Not good, because I realized I might damage something by an inadvertent connection.  Anyway, I got all the wires connected.  I turned it on and….Nothing.  Oh and woman with baby had arrived and were watching me and it was getting dark…and cold.

My guess was that in brushing the wires together, I had blown a fuse somewhere.  I checked all breaker boxes but couldn’t find anything.  Dang it.  Dang it.  The woman with baby and all 3 cats were looking at me expectantly.  It was 7 pm and dark and cold.  I called Tommy and told him my situation.  I admitted defeat and asked if he could put me on his list to fix this mess.  He asked me what kind of thermostat I used.  I told him.  I added I thought I had probably blown a fuse or damaged something by brushing the wires together but couldn’t find the problem.  He explained there was a secret fuse, a 5 amp fuse like in a car.  If I took the cover off the hvac unit I would see it, right next to the high voltage wire.  He advised I should definitely cut the power this time.  OK.   So I cut the power and took the cover off the unit and yep, there was the little car fuse.  And it was blown.  Hallelujah!  I would get this woman some heat even if she wasn’t my tenant.  It was a quick trip back to Ace for some fuses.  I inserted it and turned the unit back on with confidence this time.  But.  I heard the fuse blow immediately.  It sounded like a match dropped in a puddle, a tiny frying noise.  How!?  What could possibly be wrong?  It is now 7:30 and I am getting hungry.  

I called Tommy back and he answered right away, perfectly patient and calm.  I visualized him probably in a crawlspace somewhere troubleshooting another furnace taking time to answer my rookie questions.  He asked me about the wires in the thermostat.  I said I was pretty sure I connected them correctly to the correct color terminal.  He hesitated a second, then said, “disconnect the green wire”.  He explained why but I didn’t understand that part.  So I replaced the fuse again, then, without much hope, opened up the thermostat and disconnected the green wire, then put it all back together, and…the unit fired up and worked as designed.  Heat began to flow, and the mother and child and all 3 cats looked happy and peaceful resting there in the little apartment. 

It was late, dark, cold and I felt very happy and beyond thankful to have someone like Tommy to talk me through that silent night.

Merry Christmas.