MD sees a car wreck. Now what?

I've discussed the hypothetical situation of seeing a car wreck and if I'd stop with my white coat on and see if anyone needed help. He's been a little nervous about the situation for litigation reasons. He thinks I should stop and help and just not mention being a doctor.

I've passed car wrecks since we've talked about this. At first I didn't stop because I was a medical student and heck, I'd read lots of books but didn't trust my clinical exam or ability to think clearly in a possibly scary situation. Since I got the MD letters behind my name I haven't passed one that hasn't had lots of sirens at it; I figure those are under control. There were no sirens today.

I was driving along the highway and saw the slow down up ahead. I was a little miffed and hoped it wouldn't take long to pass because I wanted to get home to see my baby (the last few days I've only gotten to spend 45 minutes at most with her - makes me want to quit - but that's another post). Then I passed the three scrunched up cars with no sirens in sight and decided that baby could wait.

I pulled over and my heart started beating very fast. What if there was lots of blood? Though I'm a doctor, I have to avoid the traumas in the ER because I faint. What if someone doesn't slow down enough as they are going by and I get hit? What if hubby is right and I get sued? I grabbed my pen light and stethescope and put on a good game face and walked calmly over to the first car.

The other two cars were empty and the drivers millling about but in the first car a young girl was sobbing with bruises already forming on her face and arm. The air bag had deployed and she had diffuse bruising rather than a face in the steering wheel; G-d bless airbags. I talked to her for a bit and she was A and O x3 (alert and orientated to person, place, time). No neck pain, but her face and arm hurt. After a quick physical she seemed not to have broken anything and seemed to just be crying mostly from the emotional trauma but I'm sure her face didn't feel good. At this point, the sirens arrived and a police officer came over and asked my assesment. I told him she'd probably be fine but a trip to the ER was in order. She probably needed a head CT and to be watched for awhile. I talked and reassured her a little bit and then left.

Should I have left? When is the right time to leave? I wasn't doing anything more but was the Aura Of The White Coat reassuring her? I was still tachycardic and didn't want to get too involved in things (isn't that what all people use as an excuse?). She was going to be fine. I don't know. I kind of feel like I should have stayed at least until EMS got there. I don't know.

Can we help?

One of my favorite patients on our peds rotation is a 6 yo hispanic girl with PPA (a metabolic disorder) . She's in the hosptial more than out due to almost constant line infections with nasty bugs. We've tried to arrange it so that she could be at home while getting her Vancomycin but Mom doesn't think she could handle that; Mom has other kids at home and The Little One really does take a lot of daily tweaking.

So The Little One stays with us most days. We threw a big birthday party for her last month, the secretaries have learned spanish in order to talk to her and try to teach her words, and the nurses throw little dance parties with her behind the desk in the evenings to keep her entertained. She's of course developmentally close to a six month old but is happy and seems to be having a fairly good quality of life.

Mom just asked me today if I could help her with immigration. Turns out she and Dad are both illegal. Dad left four months ago to go back to Mexico to help with their famlies - their parents are both quite sick. He was supposed to come back three months ago...but hasn't shown up. We don't know the full story - Mom isn't disclosing everything but I suspect he's either been caught or just can't get back across after multiple tries. Now Mom wants to cross back to help him and her parents. She wanted to know if there was anything we could do to help her get back across.

The fairly simple answer is 'no' and I told her that. We discussed the risks - she planned to go at the start of one of The Little One's hospitalizations (usually 14-21 days) and get down and back in a week. Bu what if she couldn't make it back? What if she couldn't ever make it back? What if she got hurt or died? Who would take care of The Little One? And who would take care of her other kids?

I cannot imagine being in that situation. I would be desperate to find and help my husband and my parents but I could never leave my children behind. How awful to be put in that position. I hope she doesn't go but I suspect she might. Who will take care of The Little One?

Medicine is so much more than making sure the Vanc trough is in the right range.

Changing my Colors

I bought a stethoscope today.

I had lost my last one a few weeks ago and have been borrowing one in the hopes that old stethoscope would magically reappear. Magic rarely happens in the hospital in the dead of winter.

Stethoscopes come in very few colors. Black, navy, and maroon are the only colors I see around the hospital and the maroon is a rarity in the sea of black and navy. In medical school, I almost bought a black one but thought it too conservative. So in my wild and crazy ways, I bought a navy blue one; the maroon was just too reckless. For I was going to be a female doctor and I felt a need to fit in with the throngs of black and navy as well as I could.

When I started medical school, I didn’t want to be known as a girl. I’d rather be a solid medical student and in my mind, solid medical students weren’t girly. During medical school, I dated and married quietly. Skirts made an occasional rare appearance in my wardrobe but besides the numerous scrub sets I mostly wore pants with a conservative button up shirt. I didn't gigle, I most certainly didn't lean over in short little tops, and I couldn't be bothered with make up. My little navy stethoscope blended in well with the other serious students.

Then a few things started to change. I got pregnant my third year of medical school. I threw up a few times on rounds, didn’t fit my scrubs very well anymore, and had to change my rotations so as to be within ten minutes of the hospital at all times (placenta previa). After the baby, I’d disappear from the wards now and again to breast pump…something black and navy stethoscope don’t usually do.

This year, my intern year, I thought I could work at becoming a better navy stethoscope. However, the color and I are just not working out. Beautiful Baby Girl gets sick now and then and Hubby and I split the days we take off with her and I’ve missed four days already. The only other intern with a child, a black stethoscope with a stay at home wife, has never stayed home with his sick baby. Skirts and dresses are actually faster to put on in the morning when you only have ten minutes to get out the door because you played with Beautiful Baby Girl for too long. My inpatient exam scores were better than 93% of all residents, not just interns, all residents, but yet I occasionally come to work with a little handprint of oatmeal on my pants. And now I’ll have a new stethoscope, not black, not navy, and not even maroon.

I’m sure I’ll be called ‘nurse’ more often now. I’m sure I’ll get a few funny looks but somehow it felt right.

I bought a stethoscope today. A pink stethoscope.