As fate would have it

So we have been busy trying to clean out the trauma service since Thanksgiving and things were slowly but surely getting back to a good looking census. So when the cheif resident asked if I'd be okay with the intern having the weekend off I thought it might be okay. I figured better for him to get his days off now than over New Years, right? Well, I guess I still think that (because, really, how is New Years weekend going to be anything but complete craziness???) but I would feel better about it if we didn't have to get slammed this weekend. Ugh! Things weren't too bad on Saturday during the day, but then I came in on Sun and see my list 3 times as long. What the heck, people?

So there was good news and bad news in that. The good news was that most of them were "trauma specials." That means they'll get to go home. But also, therein lies the problem. Technically someone staying in the hospital is less work than dc'ing someone. So I had over 15 c-spines to clear, and of course you wait, wait, wait for final CT c-spine reads to come back...and then they all come in at once. And of course everybody wants the collar off since the second it was put on them (now probably 24 hrs later). But obviously I can't see all 15+ people at the same time, so people toward the back of the clearing list are even more cranky than they already were. Anyways, going around to a dozen different floors to get collars off is only half the battle. There's of course the infamous "paperwork" to actually dc them. No small feat there. Plus the pager going off non-stop about other issues, like true medical problems. So as you see, it turned out to be quite the day. But I'm sure I'll be happy when I have an intern to help see people come New Years. Lord knows I'll need it more then than I did this crazy weekend.

Foreign objects

The other day I was discussing with my colleagues the topic of foreign bodies. What have we seen over the years? Probably my most memorable foreign body was finding a koosh ball on a pelvic exam. And let me just say, it'd been there a while. Interesting, but I don't think I took the cake. My colleague had a patient that was "cooking naked" and fell on a can on cooking spray. Don't you hate it when that happens, especially when you relax your sphincters when falling? Fortunately the lid was conveniently duct taped on. Sadly, this is actually not the first time I have heard of a large can being found in lower GI tract. Really, you'd think that would be a unique find, but surprisingly no so unique.

A perfectly round object was seen on AP and lateral views of a pelvic x-ray of another patient. When questioned the patient casually replied, "Oh, my golf ball?" Oh, of course! Now why didn't I think of that? Just where I keep my golf balls. Apparently the patient was annoyed by diarrhea and felt a golf ball was a better choice than, perhaps, Imodium.


I have to say, I learned something in this conversation. I learned a new term "fisting." I'm not sure if I'm better or worse for knowing this information, but maybe somewhat enlightened on an apparently common [sexual] practice. Call me boring, but fists don't sound like a good time. Each to their own I suppose, but clearly even the name could suggest the potential for injury. The "foreign object" was of course not present on admission, but the fist had perforated the bowel.

Well, although some of these stories can be funny and strangely fascinating, they generally aren't so funny in the moment. They actually can be quite serious (like perforated bowel!) and often require surgery for removal or repair. And of course in the category of foreign bodies, often comes impalement. Hum, perhaps I should save impalement for another day.

Acute Care

I just got back from a meeting for Acute Care NPs at the American Nurses Credentialing Center to discuss boards. The meeting reminded me of certain nuances about being a trauma sub-specialty within the umbrella of Acute Care. I'll admit that there were times in grad school when I questioned if Acute Care was the right specialty. Being around a lot of people who love cardiology or neuro or some other system made me feel a little isolated when my thing was injuries. Sure, trauma affects systems, often multi-system, but it is very different then discussing heart failure. But what other specialty would a trauma person be, right?

As I might have mentioned before, I used to work in the ER prior to becoming an NP. For anyone who has worked in the ER before, or really even just in a hospital, you know the ER is a bit of its own entity. It's like being part of the hospital, but not quite. And the Trauma Center I work for now has the Trauma bay separate from the ER. Trauma resus patients come directly to the 2nd floor to the trauma bay, which is next to the OR suites, just in case. So I have nothing to do with even the patients in the ER in my current hospital.

Despite feeling a greatly outnumbered in school, and working in areas of the hospital that can feel a little removed, I do ultimately think Acute Care was the right specialty. It seems perfect now. But being at this recent meeting reminded me that even though we are all ACNPs, we all do very different things and like different areas within our specialty. I do feel like trauma is a somewhat underrepresented, so it was nice to have the opportunity to bring the trauma perspective to the meeting.