Thoughts from the ICU, and why Detroit is a scary place

I've been meaning to type up some stuff about the transition to 2nd year, being at a new program, etc. I'll get to all that stuff in a few days. But today I'm post call, and I had to tell you guys about the amazing volume of trauma I get to see.

Now a lot of people talk about trauma, but they're talking mainly about blunt trauma. Blunt trauma is boring. For a resident, it means chasing labs all night, cajoling radiologists for stat reads on imaging, and waiting for a drunk guy's EtOH to get back to double digits so I can send him home. If blunt trauma goes to the OR it'll be the Ortho or Neurosurgery guys taking them. (You're welcome for the babysitting.) So when people talk about trauma, they usually aren't describing anything cool, but rather just a bunch of tedious (albeit nessecary) work. Nothing for a surgery resident to get excited about.

Penetrating trauma is different, although at most places much more rare. Nothing quite like the rush of going to the OR with an unstable GSW. Don't get me wrong, I'm still a junior resident and don't do much to actually fix the guys. I'm just a small cog in the machine. As an intern, I did the H+P thing, acted as the scribe, did all the erannds and followed up everything. If I did go to the OR, it was as a third set of hands. A few times I did get to break scrub and eyeball a new trauma code while the attending and chief operated. It was a whirlwind of activity, and I was in the middle of it all, even if I was as important as trash blowing in the breeze.

Fastforward to 2nd year. Now I'm in the SICU. I'm barely out of second year, and I'm expected to manage critically ill patients by myself. I usually want to pull a Caywood's dad in my own shorts. But the cool thing is, I'm finding I can handle most stuff. I do have to call the intensivist with big stuff, but 90% of the time I'm running the show. Mananging vents, starting drips, doing procedures, the whole thing.

My first call I had a textbook case of severe hemorrhagic shock, and I was all alone. 18 yo male with GSW to right eye, belly x2, scrotum, and both lower extremities. Systolic out of the OR was in the 70s, refractory to fluids. I admit the patient, start some basic orders and call the attending with the admit, and give him exactly what I've typed here. He says "Sounds good. Get him a subclavian and a CVP at 8 or higher. Good luck."

I was almost constantly at his bedside for 18 hours. He was in shock, sedated, ventilated, the whole deal. But the guy lived. I can honestly say that my post op management saved that guy's life. Not that I'm anything special, any resident could have done it. But I did it. Even though he'll look like a pirate, that kid is alive because I helped him. (Two day later, we were able to extubate him, and amazingly he did really well. He even remembered me from that long night. So I guess he wasn't that sedated. Rarer still, he thanked me!)

This guy was the first of 5 GSWs that I would admit and manage that day. The crazy thing is that this number was not unusual. Being in Detroit provides us with an amazing volume of penetrating trauma (we still get plenty of blunt). The gangs here taunt each other on the streeet by touching their throat and belly simultaneously, as if to say "You're going to need a trach and PEG after we get to you." (We have medically savvy gangs here in Detroit.) We get a lot of patients purposely shot in the neck, and these are celebrated as "wheelchair shots".

I used to think Maryvale was a tough hospital (one time James Matthews and I watched his car get stolen from the 7th floor). But here last night there was a double homicide directly across the street from the hospital. Last week someone attempted to abduct a hospital employee standing outside in broad daylight. Three months ago a guy walked right through security into the ED with a loaded semiautomatic shotgun. He was upset that his grandma died in the ED earlier that week. He raised the gun to fire and it jammed. People started diving out of the way, and security caught up to him and shot him in the ED. A vascular surgeon got carjacked while driving up to the hospital for a case late one night. Crazy, crazy stuff. And it doesn't shock people here at all.

It's definately scary. But I love it. Despite the violence, a lot of the patients are good people. I really like my co-residents. (It's interesting how green we all are, under the same pressures, working together constantly. Sometimes it feels like it's us against the world. You bond with these people in a way that reminds me a lot of being on the mission.)

I am amazed and inspired by the two surgical intensivists I'm working under. Some days I even feel like a doctor, instead of usually feeling like I'm just a poser. I'm absolutely drinking from the firehose and learning tons every day. And then I come home every day to a big party with happy kids and a great wife. Who, despite being pregnant in the humid summertime, still has a pretty great attitude.

(And I'm dang glad I'm not an intern anymore.)