Sunday, October 4, 2009

I'm currently in my residency program in New Orleans at LSU. As part of my program, we do call rotations. I'm on ER call right now. We also do Operating Room cases every Friday, I've done 3 so far. Two of these particular cases kinda stand out for me. One because it was cute, and other because it really broke my heart. I'll start on the 'down side'.

***To not identify the patient, I'll use fictional names and will refrain from 'specifics' about the patient... not trying to get into any legal troubles while trying to share my experiences***

Patient "Mr. Man" presents to our clinic for clearance for radiation therapy. (I didn't know what this was either until I made it to LSU). Anyway, "Mr. Man" presented with Posterior pharyngeal cancer, and other health issues. Our main concern was to get the bad teeth out so that he could start his radiation treatment. I'm not a physician, but this poor man looked like he was ankle deep in a grave. He had a trach tube also. WELL on the first day he came in, I was a little sick on tummy. I go in to do my little patient interview. I walk in notice this hugggeee mass on his neck and am like 'WELL SHEESH!' (to my self of course). I begin my interview: "Mr. Man, what brings you in today'. "Mr. Man' takes a breath in and HUFFS out a response: my teeth, need radiation'. Instantly I caught a whiff of that bile smelling breath and had to make up and excuse to leave the room so I could gather my thoughts. I say 'Mr. Man, I'll be right back, I need to grab another form'. I walk out calmly until I got around the corner- then broke into a full out jog to the bathroom where I proceded to release my breakfast! I then went to the resident's room and asked for back up! My co-resident goes in to complete the exam. Scheduled Mr. Man for IV sedation in a week.

I was away at an off site rotation and found out later that Mr. Man was unable to under go his IV extractions due to difficulty breathing. Now Mr. Man is scheduled for OR extractions. GREAT- Friday morning, OR day. Patient is to present at 5:30am to check in and get worked up for surgery, surgery scheduled to begin 7am. 6:00am we can't find the patient. His group home personelle says he's at the hospital..but we can't find him. Finally at 7am, a nurse says 'ya'll waiting on Mr. Man? He's sitting outside'. I run downstairs to find Mr. Man and his care giver outside... Mr. Man in obvious pain. I get them to the check in floor, they give him pain meds until surgery time. Needless to say, our 7am time was bumped, and we started surgery at 10am.

Mr. Man is in the OR, we prep for the procedure, before we touch him our faculty memeber is like 'STOP!- dont' touch him, get Oral Surgery down here, this patient has what I believe to be an impending Ludwig's Angina!'. Oral surgery comes in checks things out, agrees to take over the case after we extract. We start procedure (27 teeth..all severly periodontally involved..) teeth pop out like popcorn pop, pop, pop, pop... blah blah blah... We're done! He's in recovery. I get a page.. 'Mr. Man won't stop bleeding'. I go back to recovery to try to handle that situation. Get it fixed, and go home.

Phone rings.. co-resident on the phone: 'they [oral surgery] want you to round with them on tomorrow morning about Mr. Man'. Cool- I'm doing rounds in the morning at 7am with the oral surgeons. I get to the hospital, find Mr. Man, I peek in the window and notice him trying to get up... I open the door and BAM!!! FFFUUUNNKKK flipped me back out the room! I had to gather myself again and ask 'Mr. Man, are you okay?" Because he has a trach tube he can't talk, so he communicated to me by pointing... and he points to his nakedness and a pile of ummm POO he was stewing in in that hot room! (ummm EWWW was all I could say). I remained as professional as possible and reported it to his nurse (at 7:30ish). We make it to his room for rounds at about 8:30am to find the nurses JUST getting to this poor man. It was pretty much determined that this poor fella would probably not make it much further than a treatment or two of radiation, but we had done our part to try to get him ready for his next phase of treatment. NOW- with all of the light hearted stuff aside, on to the part that breaks my heart:
#1- why would someone not try to seek dental help? He was living in an 'insitution' for years, and they never thought to get him any dental care!!!! We (dentists or SOMEBODY) could have POSSIBLY gotten those HORRIBLE teeth out months ago and he could have POSSIBLY started his other therapies MONTHS ago- that could have possibly improved his condition somewhat? WHY people WHY?
#2-WHY did it take an HOUR for somebody to come help this poor fella get cleaned up? He's barely ambulartoy, and he can't exactly call the nurses and TELL them what's wrong. He can't speak! AND when I told the nurses (twice), I get this response the 2nd time 'well miss, look, we have things to do, we can't just stop what we are doing to go clean up one patient. When my aide gets done, then we'll go take care of that, we are aware of the situation'. WTF! Your aide is putting blankets in a closet! What can't she stop about that for a few minutes? YOU are stapling some papers.. .WHAT can't you stop about that for a few minutes to help this poor man?!? Anyway, but this time the Oral Surgeon Chief walks up, and I immediately tell him the situation. He went to the nurses and pretty much lit a fire under em and they got Mr. Man cleaned up. I just don't get it... what ever happened to human kindness? If that was YOUR father, brother, uncle, cousin sitting in there, unable to speak and stewing in POOP, would YOU want a nurse to say 'I gotta get my blankets put up first'? Are you SERIOUS PEOPLE!! Have we lost touch with humanity? SHEESH... anyway, that's the end of that story... I think Imma write the other story in another note because this one is quite lengthy! LOL the next one is a little better though! LOL Peace out HomeFries until next time

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