Down in the pit

A bit of background.  The surgical pit consists of examination rooms w a clear space in the middle that holds 3 desks:  leftmost is trauma, center is surgery, right is orthopedics.  Walk-in patients get triaged at the nurses' desk to one of the three desks.  Right next to the pit is resus, which seems to fall solely under trauma's purview, so we're the only ones who receive patients directly from paramedics.  Once we stabilize a patient, we can then refer to surgery or ortho or burns or peds.  We also have two theaters dedicated solely to trauma surgery, which seems to run around the clock.  Obviously, there's the gunshot/stab emergency laparotomies and thoracotomies that we do, but for some reason, we also do wound debridement, skin grafting, and I've seen one bowel obstruction.  

On calls are 24h and run from 7am to 7am.  My first one was last Saturday, which happened to be the perfect storm of ppl doing stupid shit to hospitalize each other.  Not only was it payday, it was also a Darby between the two rival local soccer teams playing in Soweto stadium, and some rowdy political party's first year anniversary, for which they would throw a rowdy party.  Lots of drunkenness, which led to lots of stabbing, RTAs, burns, gunshots.  the stretchers in resus were wall to wall all night long.  You couldn't walk from the foot of a patient to their head without scooting at least 2 beds sideways, like clotheshangers on a discount rack.  More stretchers were placed helter skelter at the feet of the lined-up beds.  It was a war zone.  Things were even worse in the pit (except better bc those patients weren't immediately dying), with people lying, sitting, standing in whatever space they could find.  Patients literally lying on the floor!    We filled the entire pit.  We ran out of blood and X-ray forms at our desk and had to borrow from the fat pads at the other desks  We ran out of lidocaine.  We ran out of small and medium gloves, giving sets for drips, etc etc.  trash and sharps were strewn on the floor and kicked to a corner.   It was the best night I've ever had in a hospital.  And really, it beat most nights out too.  I learned to put in a chest drain, took a few ABGs under pressure, put in a wide bore line under pressure, dressed a burn, sutured and sutured and sutured--all stab wounds.  

That first night, we actually ended up staying till 11am bc josh was stuck assisting in a thoracotomy for an iatrogenic rupture of the internal thoracic artery during a chest drain insertion (not mine, a narrow miss, actually.  I had asked to put that one in, but bc the intern was under time pressure, she said she'd just go ahead and do it.  When she pierced the pleura, a gush of red blood came out.  I actually said "whoa" but she took it as a sign that she was in the right space for the hemothorax.  I'd never seen a hemo before, so I just went w it.  About ten min later, the patient starts getting really sweaty and   We had to resus him.  But bc the bleed was flowing directly into the drain, 1) there was no hydrostatic pressure increase to help staunch the bleeding  2) the bleed didn't show up on the fast scan.  The drain filled up quick though. He lost 1.5 L in no time at all.  He was a young guy, so he managed to compensate quite well initially, so his vitals stayed normal for quite a while.  Kudos to the intern for recognizing the crash just by him sweating.  I would've taken it as a ketamine overdose (we use it to sedate the patients and pretty much keep giving it until they tolerate the drain insertion (it's super painful)).  I also had to stay to sort out some pep stuff (more on that later).  By the time we got to the car, I was exhausted.  And of course, the car wouldn't start bc the battery was dead.  Matt reckons it's bc he left the lights on overnight.  It's a smallish car so we tried to push start it.  Then we tried to jump start it.  Then we tried to push start it again.  No dice.  Finally, the boys called the hire company to change the battery, and I called Chris (a driver I met earlier) to get of me the heck out of there.  Stopped to pick up some food, and Got home around 2pm.  Pulled Up to find the Germans sitting in our driveway.  I didn't realize that they were moving in today and was completely disheartened that my plan to eat an entire pizza in my bedroom while skyping Jon had been scarpered.  Ate in the living room while trying to be sociable.  Didn't get to bed till 3pm, slept till 10pm, skyped Jon for a bit, then slept again till morning, when I began my second 24h on call.  

Second one was just as busy for me--as in, I did the same amount of work, but we actually managed to clear the pit and resus by the time 7am rolled around.  Sutured loads of knees.  Two from car accidents where the driver bashed his knee on the dash and one from a tree falling on him.  Also learned to do a fast scan and cleared a patient w it on my lonesome (sort of, don't worry, the reg was looking over my shoulder at the screen while I did it).  Bc josh and Matt weren't on that night and bc I had had to give the Germans my key, I couldn't leave until they came in and gave me their key.  Of course, it's the one morning that they're late.  So late that the guy who had offered to drive me home leaves, and i have to get josh to drive me back again.  Cannot catch a break w getting home from on calls on time.  Anyways, managed to sleep a bit more, and am about to start my 3rd on call in a row.  Wish me luck.  

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