Thursday, May 22, 2008
Slept 5.5. hours (I just realized today that I have been forgetting to put this on my posts. Not much use to everyone else, but it's helpful to me.)
Last week I saw the most dramatic thing I've ever seen in 6 years of working in emergency departments.
As usual, the department was ramping up to its comfortable level of chaos, and I was in seeing a gentleman who had been waiting 30 minutes or so to see me. (I take pride in seeing patients as quickly as possible.) As I was looking at his open left arm fracture from a dog bite, one of my nurses poked her head around the corner, rolled her eyes, and said, "They're bringin' in a little girl with a tomato cage on her head," implying that I should go to see her right then. Instantly at least a hundred thoughts flew through my brain, and I started to walk to the front of the department. "Hmmph, how did this kid get a damn tomato cage stuck on her head? Are they bringing her in by ambulance? What the F*%$!" About that moment, I rounded the corner and saw a father calmly pushing his 11-year-old daughter through the er as she held in front of her the 3 foot wire conical cage intended to guide tomato plants in their growth. The three large guage (think pencil) wires that formed the point of the cone were embedded in the skin of her forehead and temple. "Damn, that's gonna suck trying to get that sombitch outta there," I thought to myself as I thought about the hundreds of embedded fishhooks I've removed over the years. I just knew those wires were bent between the skin of her forehead and her skull. So I went to talk to her to see how she was doing (no that's not rhetorical) and get a better look at that forehead.
My nurses and I guided the father and daughter pair into a room, and I asked her if she were hurting. "A little," she said, calmly holding the cage and rolling her eyes to watch the flurry of activity around her. To each question, "Are you sick to your stomach? How's your vision? Why is your nose bleeding? How did you get this stuck on your head?" she gave quick, pointed answers in a voice that was astonishingly calm. I was amazed. Even when the wire cutters wouldn't budge the cage, and we had to get a huge, scary pair of bolt-cutters to cut away the biggest portion of the cage, she was unbelievably calm, and not in a way that made me fear she was in shock. As we were cutting the cage away, I realized that the wires were not just floating between the skin and bone. At least two of them were embedded in bone. My brain would just not let me believe that the wires had actually gone through the skull into her brain, but I knew that I had to work with that assumption, so I ordered a CT scan to see inside her head.
While the little girl was in CT, I went to talk to the mother, the other individual most directly involved in the accident, because I was just not understanding the mechanism of injury. Her mother was hysterical. She was wise enough, however, to understand that her hysteria would hinder the process of helping her child, so she stayed in the conference room and out of the way unless she was needed. After some unintelligable sobbing replies, I finally began to understand that she had been cleaning the tomato cages and was slinging them to shake the mud off when she lost her grip on one and it flung through the air, coming to rest in her daughter's head. Think as I might, I still cannot understand how so much force was generated by that single act.
At least able to picture what happened, I went to reexamine the girl on her return from radiology. She was still calm, only minimally in pain, and now a little nauseated. She could still talk to me, could still see, and was overall doing well, so I went to the Xray computer to see the films. All I could think was, "Holy Crap!" One of the wires not only had penetrated her skull but transversed a sinus, her eye socket, and the boney floor of the eye socket and come to rest at the back wall of her head, missing her eyeball, pinning her optic nerve and missing her carotid artery by less than a millimeter. The second wire penetrated the temple, went under the frontal lobe, crossed the skull and came to rest within a centimeter of the brainstem. The third simply skirted the outside of the skull between it and the overlying skin. The 11-year-old lying in my ER had two large wires running directly through her cranial vault.
The next 30-45 minutes were spent arranging for a neurosurgeon to care for her and flying her to where they could do just that. The last 7 days have been spent trying to picture exactly how a tomato cage came to rest not only in her skull but more-or-less through her skull. I don't think I'll ever completely understand that.
Her mother called me yesterday on their way home from the hospital. My patient is not only alive, but she has no lasting effects. Sometimes I love my job.
12kg TGU 10/side-- AS I was doing these, I could tell my workout was not going to be the strongest in the world. I think the degree of difficulty of this workout on my fourth day of working out in a row makes this a little more harder than the workout on Monday. I also firmly believe that I have a mental block with this workout because of the thrusters. They are difficult enough that they play a mind game with me. I'm working on this, though.
5 rounds of the following with Double 12kg bells:
Snatch x 8
Thrusters x 8
High Pulls x 12
alternating rows /side
Swings x 20
Then... 12kg Snatches 25/25, 20/20, 15/15, 10/10, 5/5 separated by 90 seconds of jogging.
Whole thing took me 1hour and 32 minutes.