Elbrecht's Corpuscle

Trauma E

Posted on January 6, 2014 by Elbrecht

Trauma-Team-4

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My final clerkship of medical school was a Trauma Surgery rotation in Columbus, OH. As a “Level 1” Trauma Center, I was certain to see all sorts of medical traumas. From horrific car accidents, penetrating stab wounds and life-ending gun shots, to suicide attempts, both successful and unsuccessful, sporting injuries, and the aftermath of violent beatings.

Rather than leaving Columbus and heading to Worcester, MA for a radiology clerkship where I could stay with some of my dearest friends and put in 4 hour days, I decided to stick around Columbus, have a 4:30A wake-up call, 9P bed-time, and expose myself to an aspect of medicine that I was unlikely to encounter in my future practice as a Family Medicine physician.

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And that is exactly what happened, as the four weeks I was on the Trauma Service was the busiest month in the history of the hospital.

Anyone who knows me well, or has spoken to me about my experiences in medical school, knows that I typically don’t care for the attitudes of surgeons. While it is a profession that requires its practitioners to be exquisitely skilled, the god-like aura that typifies a surgeon, especially towards students, is enraging. (And completely unnecessary.)

—–

But despite this behavior, I wanted to be a part of the care of patients who present to the hospital after a traumatic accident… Or as I was resoundingly corrected by one of the trauma surgeons when speaking of a motor vehicle accident (MVA), “it was a motor vehicle collision, as we don’t really know if it was an accident.” Thanks a**hole.

On the student’s first day of any clerkship, the other students, residents, and physicians will ask about the new student’s future career aspirations. This is done to determine the level of shit the student should be given over the course of the next four weeks.

If the student is interested in becoming a member of that medical profession, they will be held to a higher standard, given more grunt work, asked to work longer hours, and expected to know a ton more than someone who’s professional aspirations are 180 degrees different.

—–

Thus I found myself having the following exchange with the Chief Resident two minutes into the rotation: “So what year are you?”

Me: “I’m a fourth year. And this is my last rotation of medical school.”

CR: “Are you going into Surgery?”

Me: “No. Family Medicine.”

CR: “What the hell are you doing here?”

Despite this inauspicious beginning to our medical relationship, the Chief Resident ended up being a terrific teacher, physician, and all-around good guy.

His “Surgeon’s Aura” was usually absent. In regards to surgeons, this guy was the proverbial medical zebra that you are taught to stop looking for… But in his defense, it’s simply not common place to see a 4th year medical student sign up for a grueling clerkship as their last hurrah of medical school. Typically, it’s something like… Radiology.

—–

Several of the Family Medicine residents with whom I worked previously had suggested the clerkship, so I went into it with a positive attitude. I figured, if anything, that I could bring some humanity into the trauma bay… as by-in-large, the trauma bay is one of the least “human” experiences in medicine.

Upon a patient’s arrival, multiple people are poking, prodding, screaming, shouting, slicing, sticking, cutting, and tearing… at the life and limb of this latest entrant to the trauma bay.

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Depending on their level of consciousness, the patient may or may not be screaming and shouting. If they are unconscious, the distractions are seemingly less, but the situation is quite significantly more dire. I preferred the screaming and shouting patients because it meant they were more likely to survive.

But the surgeons, they prefer the deafening silence of the patient because the stakes are raised, the opportunity to transport them to the surgical theater more likely, and their god-like skills are soon to be exercised.

—–

Over the course of four weeks, I cut off my fair share of pants and underwear, placed innumerable Foley catheters [a tube into the urethra of both men and women], and stuck a gloved and lubed finger into the rectum of more people than I care to admit… but that was all done so that I could say to the patient, “We are going to take care of you”… and to mean it.

In a nutshell, that is the humanity that is absent from the trauma bay. It is a rarity for someone to ask for a patient’s name; no one states a desire to care for you; no one even thinks of doing either of those until the patient is either on the way to the CT scanner, surgical theater, or morgue.

—–

But one of the clinical psychologists I encountered during a previous rotation had mentioned a quick anecdote that stuck with me. His father had recently been in an accident and while laying on his back, with numerous people he didn’t know poking and prodding him, he had some of the terrifying fear, anxiety, and uncertainty removed by someone who immediately stated upon his arrival in the trauma bay, “We are going to take care of you.”

—–

I carried that anecdote with me each time another Trauma was called over the hospital’s intercom system.

I think this kind of humanity becomes absent as a defense mechanism from the care-providers.

Because when someone is wheeled into the trauma bay, their next destination may be the CT scanner to determine the extent of their injury.

Or the surgical theater as a last-ditch effort to save their nearly life-less body.

Perhaps the morgue, because the extent of their injury was too great for even a god to cure.

—–

And when the outcome could be either of the last two, I would imagine it becomes difficult to not simply view each new patient as a body on whom your craft can be practiced… until your craft has provided a life-sustaining result.

Then, after all is said and done, and the patient is alert and speaking to you, their worst day behind them, only then can you entertain the idea of knowing their name; Or offering to care about/for them. Until then, they are simply Trauma [A, B, C, D, etc].

—–

But what if that next day never comes.

And in their final moments no one is calling their name.

No one is telling them that they care about them.

Then what?

—–

When I had a Son

Posted on December 28, 2013 by Elbrecht

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Between the spring of 2012 and summer 2013, I lived in 3 different nYc neighborhoods spanning two of nYc’s five boroughs.

My third and final apartment was actually a room in a woman’s house in Jamaica, Queens. Despite the tightness of the accommodations, I’d only be living there for two months, so I was certain it was survivable. Plus, the room was furnished with a bed, dresser, desk… and the “son-I-never-knew”.

His name is Jacob.

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A 12-year-old with an absentee mother and incarcerated father is quick to bond with anyone who gives him attention, as I quickly discovered.

When I arrived in May, the school year was winding down, so Jacob’s hours of daily supervision was waning in parallel. Jacob was a mildly delinquent kid to begin with and his mother did not allow him to participate in any after-school activities, thus creating the perfect storm for me to become Jacob’s de facto guardian.

—–

Over the course of May and June, Jacob became my shadow… and a constant reminder of why I use condoms. Nearly 33 years old myself, Jacob easily could have been one of my own offspring.

In May, I was completing my Surgery Clerkship, which required me to leave home at 4:30A and found me returning home at 7P on a good day. Jacob would always be waiting for me. On some days, he would hide behind the front door so that when I would slog through it he could pop out and cause my heart to skip a beat. Each time this happened I imagined that skipped beat to be what it must be like to unexpectedly have a woman tell you she’s pregnant.

He would laugh and smile, which despite the soul-crushing daily commute and exposure to hubris-filled surgeons, would cause me to smile in turn.

The part of the house where he and his mother resided was separated from the upstairs rooms, so he would follow me up the stairway and ask what I was up to. Still clad in my scrubs, I would look at him and shake my head. “Give me 5 minutes, then we can hang out.”

He would dart back downstairs only to return 4 minutes later with a rap on my door.

Most nights would revolve around hanging out in my room, where he could watch Netflix on my phone or computer. Not wanting to have my medical career derailed by some scandal, I would allow him to inflate my air mattress on the floor, which propped open the door to my room, and watch some crazy shows.

—–

Typically I would inform him at 9PM that I needed to sleep because of my early morning, but I knew it would take him 30 minutes to finish up whatever he was watching, so I was never upset when he would simply nod his head and keep on chuckling along with whatever he was watching.

On Saturday mornings I would awaken at 7AM to a dull thud on my door. If I hadn’t been regularly awakening at 4AM I might have shot out of bed, swung the door wildly open, and screamed “What the hell, man!” But each time I would calmly put on some clothes, slowly unlock the door, and smile when I opened it to see him standing there, eyes barely open, hair a wild mess, and hear him mutter, “I’m bored.”

I’d reply, “No, I think you are still asleep.”

If Jacob couldn’t find a friend to shoot hoops with, he would beg me to go with him. The first time I obliged, I ended up playing two-on-one basketball with another him and another kid and narrowly avoided having to retire from the game I love by blowing a 11-0 lead only to hang on to win 21-19. I also pulled one of my glutes going for a block.

When he needed a snack, he would ask if he could eat something of mine from the fridge… after he’d already eaten it.

If he felt like scaring the shit out of me, he’d sneak out the second story window in the kitchen, climb on the roof to the window that was outside my room and beside my bed… and bang on it like a wildebeest.

—–

During the first two weeks of June, I was in Boston, but would receive a daily text message from Jacob. It usually said something like, “Poop.” Or to ask if he could eat something of mine, which surely had already been eaten.

A few of the highlights of having a 12-year-old pseudo-son:

1) Being asked what sex is like… while walking to shoot hoops… And quickly realizing this was a lose-lose question.

2) Allowing him to pick a place and time to go see the latest Superman movie… and having the time be wrong and paying $15 for a ticket because he didn’t bring his money.

3) Playing catch with him in Central Park… and then having it abruptly end when he tossed a baseball over my head and it nearly concussed a group of innocent bystanders.

—–

4) Trying to get him to stop kicking a large bouncy ball down the aisles of a CVS.

5) Having him try to jump in the Central Park Pond to catch a turtle.

Despite the innumerable incredible experiences I had in nYc, this unexpected friendship/guardianship ended up being one of the most cherished. Perhaps one day I’ll have a real son of my own. Perhaps I’ll teach him about the birds and the bees while shooting hoops. Perhaps I’ll play catch with him in Central Park. But most certainly, I won’t forget the time I did it all before with Jacob.

I Joined the Army

Posted on December 25, 2013 by Elbrecht

{I was reminded of this day during a text message exchange with an old friend last night… originally posted 12.27.08}

I never thought I would join the army, but on Christmas Day, I decided to enlist. It has always been a passion of mine to serve others through hard work and volunteerism, just like millions of American men before me.

Thankfully though, the army with which I decided to enlist is not currently deployed to Iraq. Instead, I decided to suit up and become a part of The Salvation Army… if only for a day.

Most people don’t realize that The Salvation Army is actually a religious organization with strict doctrine. So strict that you can not marry outside of the Army if you are an officer, even if your spouse dies. Imagine if the US Army didn’t allow you to marry outside of the Army… forget “Don’t ask, don’t tell”… we’re talking full-fledged legalization of gay marriage. But I digress…

My brother, father, and I decided to partake in some volunteerism on Christmas morning/day rather than sitting around my father’s dining room table, eating cereal in our boxer shorts and watching cartoons. We were hoping that our experience at The Salvation Army in Wichita would far exceed that sort of fun. So rather than that sort of excitement, we woke up early on Christmas morning and headed over to The Army’s west Wichita headquarters, suited up in Salvation Army aprons, threw on some disposable latex gloves, and joined the other early morning enlistees.

In any good army, there is a slightly psychotic drill sergeant to whip the enlistees into shape and turn them into model soldiers. Our drill sergeant was “Debbie”, a 40-something woman dressed in jeans that were too tight, a blue Hawaiian shirt, and sporting a set of black sunglasses that were perched on her dirty blond hair. She was whipping soldiers into shape when we arrived at 9:30AM; she was also definitely “on” a cocktail of some psychotropic medication and caffeine, despite the early hour.

When we first arrived, tables still needed to be set, bread put into baskets, cranberry sauce removed from the hermetically sealed containers and sloshed into a giant serving bowl, and individual serving size butters put into bowls on the tables. There were around 30 other volunteers when we arrived. It was seemingly a mix of social outcasts, families torturing their teenage children with volunteer service, old couples whose extended family did not want to spend Christmas with them, and us. We quickly went to work completing the tasks assigned by Debbie as she stormed around the spacious dining room wide-eyed and highly caffeinated. She would occasionally flip her sunglasses down from her hair to her face while responding to a question with “You don’t wanna ask me that… you really don’t!” In the kitchen, there were four guys preparing the feast and I later learned that they had been there since 4AM. Huge tubs of mashed potatoes, green beans, and stuffing were percolating on the executive size stoves. Turkey slices were warming in aluminum cookware while the sweet potatoes were being prepared on a side table. It was only 10AM, but my stomach was craving a monstrous heaping of Christmas dinner.

By 10:15, the dining room preparation had been completed, my father was exhausted from scooping out bowls of cranberry sauce, and Debbie had finished two 20 ounce bottles of Diet Coke. More volunteers had arrived and were making small talk while awaiting the people who would be coming to our locale for a great Christmas dinner. I chatted up one of the kitchen volunteers while he was taking a break and he relayed to me some of the more important and tedious jobs that would need to be completed. While standing in the window between the dining room and kitchen, he told me that he would need a few guys to be at the window at all times to be ready to dispense the clean dishes as they came out of the wash. I decided this would be the perfect job for my dad, brother, and I.

I called them over and we marked our territory by simply ordering around the other volunteers who approached the window with naive curiosity. As described by my new kitchen friend, our job would entail unloading the clean dishes and silverware from the dish rack in lightning quick fashion, transporting them to their appropriate place in the dining room, and walking the dish rack ten feet over to the poor schlubs who were scraping the dirty plates of any remaining food particles. In my mind, it was a job suitable to one person, two at the most, but I figured we had come as a family entity and should just stick together (otherwise, my dad was likely to disappear and leave my brother and I volunteering to our hearts content). I quickly decided to refer to our positions at the kitchen window as a “union job”: one man to do the work, a second man to supervise the first man’s work, and a third man to go on break.

The dinner was scheduled to begin at 11AM, and as the hour neared, Debbie called everyone’s attention to the front of the dining room through the use of a microphone. She introduced a short, balding man with grey-fogged glasses and white hair crazily streaming out of places where it remained on his head. He introduced himself as a member of The Salvation Army and the man in charge of the day’s event. He quickly launched into a quick description of the impending event that went something like this:

“We really appreciate you all coming today. Without you volunteers we wouldn’t be able to serve these people. Remember, these are people too. They are just like you and me, they are people too. They might look a little different, but they are people. Please do not touch them. Many of them do not like that. They might be confused when you touch them. But you can talk to them. And bring them food. Be nice to them, we should show them love, because some of these people have nothing. If we do that, they will appreciate it.”

I quickly glanced over to my brother and asked, “Who the hell are we serving? Convicts?” It wasn’t until that time that I had really considered who would be attending this event, but I had originally assumed that it would be individuals from group homes, potentially homeless individuals, and families who could not afford a nice meal on this blessed day. From the description provided by Salvation Sal, I was half expecting them to wheel in cages that contained half man, half werewolf hybrids who would be frothing at the mouth. Either that or convicts wearing ankle bracelets.

When Salvation Sal completed his stirring speech, Debbie piped in and explained what the ever-increasing multitude of volunteers should be doing from 11AM to 1PM while dinner was being served. Luckily, I had already secured our union job at the kitchen window and I tuned out her crazy-eyed instructions. When she finished instructing the other volunteers, she strolled by our position and stopped to look at the three of us. She asked, “What are you gentlemen doing today? You just gonna stand there and look pretty?” My dad quickly piped in, “Yes ma’am, we found ourselves a union gig, and we’re just gonna stand here.” Apparently, my father had decided to get into the Christmas spirit and feed into Debbie’s now completely evident psychosis. She gave us a crazy smile and flipped her sunglasses down to cover her eyes as she walked away. She returned moments later with a large glass bowl full of ice and four cans of Diet Coke. She looked at the three of us through her sunglasses and said, “Guard these with your life.”

When the guests arrived, it was clear that Salvation Sal must have been scarred by some past Christmas Day fiasco. The individuals were just as I had expected, not the newly released were-beasts that his description had made me envision. Other volunteers took the guests’ orders, brought them food, talked to them and made them feel welcome, and cleaned their place mats when they were finished. This cycle of life continued for the next two hours as even more volunteers arrived, seemingly only to make an appearance after having played a rousing round of Wii tennis on their newly acquired gaming system. These stragglers mostly stayed off to the side and watched the other volunteers do their thing. Our union job provided some action every 5 minutes or so as clean dishes would be brought to the window and we would unload it contents in under 5 seconds and then hand the dish rack to a guy who was dressed like he might be the lead singer of Wichita’s newest 30-something boy band.

During the lull between freshly cleaned cutlery and dishware, the three of us kept ourselves entertained with jokes about union jobs. We were eventually joined by a young boy, approximately 10 years old, whom I nicknamed Huck Finn and who must have determined we were the coolest group in the entire room. He tried to be a fast learner, but repeatedly burned himself with the piping hot silverware because he grabbed them right out of the rack, instead of emptying them into the silverware bin. Of course, in line with our sophomoric humor of the day, we kindly made fun of him for it.

As 1:30 neared, we each took turns grabbing a plate of food and satisfying the hunger pangs that had been emanating from our bellies for the last several hours. Thankfully, it tasted even better than I had imagined. Over the course of the four hours we volunteered that day, my father, brother, and I shared many laughs, performed a serviceable duty to one of our nation’s finest armies, and made fun of a pre-teen who thought we were cool. In the end, it was as fulfilling as I had imagined, but the added bonus of interacting with Salvation Sal, Debbie, and Huck Finn made it a Christmas adventure that I will not soon forget. I might even consider enlisting again next year.

Thank you

Posted on October 25, 2013 by Elbrecht

Today was my last day of medical school. After the completion of 90 weeks of clinical rotations and four semesters of medical science before that, I have completed the requisites to become a licensed physician. More importantly, it means that I am one step closer to being the man I have worked so hard to become. It has not always been easy, as I have struggled to be true to myself and the passion that led me down this path. Yet, it has been a wild adventure full of unbelievable experiences and I feel fortunate to have had this opportunity to be involved in the lives of so many people.

Without the support and care of many people, I would not have been able to weather this journey.

So without further ado, thank you:

– the patients who allowed me to participate in their care and engage in the art of medicine

– the physicians, nurses, and other medical staff who took a minute (or an hour) to teach me how to practice medicine, both the science behind it and its application to patient care

– the faculty and staff at Ross University who helped educate me in the necessary medical knowledge to make a difference in the lives of countless patients

– Will and Emily Bett, my brother and sister, for their incessant support of my journey over the past four and a half years

– Brooke and Jeremiah Redmond, who made me feel comfortable in nYc and whose ever-present encouragement in my pursuit of becoming a physician helped me overcome times of self-doubt

– the clients and staff at The Wellmet Project, who provided the initial spark to my passion

– Brendan Keleher, the Rajon Rondo to my Kevin Garnett, and my best friend throughout this incredible experience

– Matt and Joanna Masterson, who made me a part of their incredible family with whom I could spend my final months as a medical student

– Wacky Matt, Juice, and Rustang, members of the League of Extraordinary Gentlemen and providers of countless hours of pleasure during our monumental group texts, and for being such great friends for the past 15 years; Oxford Circus (Re)Unite!

– My Cincinnati Brothers Gib, Wade, Hoj, and JDawg, for always making me feel like I was doing something important and worthwhile

– The A-team: jRitch, aStolt, and BK, for being my best friends in medical school, during the good times and the bad, and helping me survive a place we called Dominica

– Tara Harrington, my surrogate sister, whose strength and pride always makes me feel purposeful and fortunate

– Samantha Lampert, for being the first person to believe in me, my passion, and my goals

– Ashley Bogosian, for reminding me that the courage to do what is right, in the face of strict opposition, is still always right

– Gabe Griffin and Sona Chikarmane, for inviting me into their home on numerous occasions and being incredible friends

– Marv, Lissa, and Zachary Alexander, my brother from another mother, his incredible wife, and ridiculously handsome son

– Scott Smith, Hallison Putnam, Anirban Sensarma, Chris Miller, Satrajit Bose, Chris “Beeker” Adams, Eva Koutalianos, Lisbet Suarez, Alexis Svokos, and Andrew Weinberg… amazing friends from different stages of my life, who have supported me in their own ways and made me a better person, and I believe, a better physician.

To those of you who might read this and perhaps were not mentioned, you too have played a role in helping me to become someone whom I hope you are proud of.

Thank you.