bursitis, blotchy erythema (reddness), and bleeds

As I stated in the previous post, Wednesday was my first day on the ward.  After biking to and from work 4.5 miles since Sunday in 80 degree heat I was feeling the burn.  Tuesday I broke down and bought a rack and two saddle bags for my road bike.  I was experiencing pain in my left shoulder that I couldn't attribute to working out or sleeping on it.  On the ride back on Tuesday, I just thought of all really important muscles, nerves, and blood vessels in my arm and axilla.  Better safe than sorry.

For work Wednesday I packed the two saddle bags and by messenger bag with stuff.  Boy, I can safely say it was overkill.  I did have a lot of weight but it did not require three bags.  Today I'm going to try and get it down to one saddle bag and my messanger bag.

Walking into the ED for the first time on my own was exciting.  It was 11am, early, so not much was going on yet.  J, a summer medical health tech from Boston University showed me the ropes.  We started with the basic lay of the land, how to clean a room, and how to operate the beds.  Within 10 minutes I was working. In 20 minutes we had moved on to EKGs and IVs.  That's what I call on the job training.

I walked a few patients to get imaging done, ran blood work to the clinical laboratory, chatted with veterans as they waited to be seen, observed and assisted the nurses, physicians assistants and physicians if anything interesting came up.

One spinal cord patient with a brilliant mind came in with what turned out to be a bursitis on his knee.  A bursa is little sack that should have only a small amount of fluid inside to help with joints that experience a lot of friction (shoulder, elbows, hips, and knees) . The attending physician showed me how he ruled out infection or some other inflammatory processes.  We gave him a compress to push the fluid out and sent him on his way.

Another patient was who was a delight had a history of pulmonary emboli and came in because his left leg was swollen and the back of the calf was red like a bruise. It didn't cause him pain but the rapid onset was what concerned him come he make in.  This guy was great we talked about all kinds of things as I took him to get his imaging done.  From where he was born to where he served in the military and what he was up to now a days.  I really like when the conversation flow naturally.  It was pretty easy with a lot of the guys I met on Wednesday.

My last patient for the day was an African American vet who served in Korea.  He was taken to the ED from his dialysis center because he took to long to stop bleeding.  He definitely did not want to be in the hospital which I can appreciate after being on dialysis for hours on end.  It was really interesting getting to talk with him because his experiences seemed so different from the other guys I spoke with that day.  The others seem nostalgic for the good old days in the military.  He didn't complain about having to serve but his story lacked the romanticized tint of the other guys.  It was a good way to end the day.  Partly because his appearance and affect reminded me of my uncle and partly it helped me put the idea of military service at wartime back in perspective.  I'm so glad I was able to say thank you to these vets in person.

I lost track of time after the first hour.  When I looked at the clock again it was nearly 3pm and I was thinking about getting lunch in a bit.

Observation:  Most of the attendings appear to internal medicine docs.  I spoke with one and she said that since we don't usually get trauma patients coming in, the IM docs can handle the emergency room.  It made me think of an urgent care center, which is totally fine with me.  I am not looking forward to seeing trauma, but I'll be there to learn when the time comes!

Highlight: Getting to see an attending to run through the NAVEL pneumonic in actual practice and really use his senses to discover what the surgical resident simply couldn't catch.  He had palpable bruits on his right femoral artery.  The pain he suffered intermittently from was deep to the artery.  When I left at 7:30p, we hadn't figured out what caused him pain so great that he couldn't walk.  I was confident that the docs and nurses would sort it out.

Okay on to another day at the W. Rox VA