surgery | Elbrecht's Corpuscle

Black Betty

Posted on April 23, 2016 by Elbrecht

At 2:17AM on a recent Friday morning I couldn’t sleep.

Not in the sense that I was laying awake in bed, thinking about the cosmos, or wondering how “The Walking Dead” Season Finale would play into any future cross-over series that might be developed, or anxiously awaiting the sun to rise again.

I was actually physically not able to sleep.

As my body was beginning to shut down at the cellular level, the efflux of potassium and phosphorus from every cell beginning to overwhelm my blood stream, the pager holstered upon my left hip started chiming again.

The pager transmitted electrical energy, similar to that of a defibrillator, into my body; the potassium and phosphorus blasted back into the cells, preventing a super-saturated metabolic derangement which would have caused my cardiac activity to cease.

Simultaneously, the loudspeaker in the Emergency Department blared, “Septic Shock Alert, ED 47.”

“Septic Shock Alert, ED 47.”

I unholstered the pager from my hip, quicker than Doc Holliday when he penetrated Ringo’s brain with a lead slug, and glanced down at the message awaiting me.

As I swiveled and rose from the stool I had been atop for only a matter of moments, I read the message. Thankfully, it only read “Septic Shock Alert, ED 47”, the electrical companion to the overheard communication, instead of 555-9095.

Or 555-9030.

Or 555-9494.

Those numbers belonged to the Hospitalist medicine service, the Intensive Care Unit, and the ED Nursing desk, respectively.

Responding to any of those calls would have meant either another patient was waiting for me to admit them to the hospital or an already admitted patient was trying to die in the ICU.

If any of those three numbers had been present, I would have needed to take over the care of the actively dying patient in the Septic Shock Alert, while simultaneously trying to:

1) figure out how in god’s name I would possibly get all of the work done I still had to do

2) supervise my junior resident

3) not lose my mind.

I also probably would have taken the pager and rifled it into the closest wall, hoping to have it explode in a wave of energy like the Death Star in Episode IV.

My Junior Resident sat beside me, near catatonic from Night Call’s siren song; I tugged at his scrub top, motioned for him to follow along, and let out a long sigh.

I could not sleep.

I was the Senior Resident on Night Call.

Or as I prefer to call her, Black Betty.

Black Betty is the anthropomorphic representation of Night Call, the overnight shift when physician staffing drops to a skeleton crew and the statistical probability of all hell breaking loose starts creeping up on 100%.

As the sun begins setting on a hard day’s work for most of the physicians, nurses, and ancillary staff in the hospital, Betty begins to rear her ugly head.

Her darkness requires the fortitude of a special type of physician.

Unless you are a Resident like me. Then you are required to show up to spend some time with Black Betty as a part of your training.

You are not a special physician. You are a Resident. And the only thing special about you is your ability to not spontaneously combust from the lack of sleep you have sustained.

Every Resident dates Black Betty. Some for a night here and there, with no specific frequency or expectation. She does not discriminate.

Others join her for a two week stretch; where her smooth skin becomes chapped and dry by the third night, her velvety caressing hands become stiff and arthritic by the seventh, and her formerly gentle kisses become vicious flesh-tearing wounds as the sun rises on the tenth.

Black Betty invites the denizens of the night to start shuffling into the Emergency Department.

And the critically ill whose lives are sustained by technological marvels in the ICU to begin their physiologic derangements.

They are joined by the sickly and elderly who become unpleasantly delirious as a result of her rancor.

—–

To this point in my Residency, I have spent over 20 weeks with Black Betty. A majority of those weeks have come in two week chunks, spread over In-patient Medicine, Surgery, and Obstetrics.

But as a now as a PGY-2, the Senior Resident, I have also had more than my fair share of random Saturday date nights with ‘ol Betty.

She and I have been intimate more times than I would care to admit.

Each date brings about something unique, whether it’s a patient hurtling a chair through a 7th-story window, a near-dead woman’s heart beating in full view of the audience in the trauma bay, or stabbing a needle into a man’s chest to hear the whoosh of air escape and provide his lung the opportunity to re-inflate.

She is fertile with opportunities for us to perform our duties as physicians.

Black Betty had a child, the damn thing gone wild.

dont-scare-your-kids

At 2:43AM on a recent Friday morning I exited ED 47 with my Junior Resident in tow.

Black Betty had provided us an opportunity to exercise our clinical judgement, initiate resuscitative measures, and stabilize an elderly gentleman who had tangoed with the Grim Reaper several times in the past two months.

The Reaper’s grasp had tried to choke off the man’s air supply. But we would have none of that.

Black Betty didn’t care. She shrugged it off.

She knew other opportunities awaited.

And my Junior Resident and I would be there. Waiting.

I would not sleep.

Not when Black Betty has anything to say about it.

Trauma E

Posted on January 6, 2014 by Elbrecht

Trauma-Team-4

—–

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.

—–

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.

—–

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

—–

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.

—–

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.