Experiences of a med student with an incurable travel bug.

Tips for Third Year

As I start my third year rotations in a few days, I thought I’d share some wisdom from Cartoon Doc for surviving the coming year. Here we go!

This incredible account of the Joplin tornado was originally published in The City Wire. It’s a long read, but well worth it. This is why most of us go into medicine — to help in a time of need. It’s not about insurance premiums, or the paycheck. It’s about the people, and helping where help is needed most. Hats off to all the healthcare workers and community members who stepped up during this incredible tragedy.

“My name is Dr. Kevin Kikta, and I was one of two emergency room doctors who were on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday May 22,2011.

You never know that it will be the most important day of your life until the day is over.  The day started like any other day for me: waking up, eating, going to the gym, showering, and going to my 400pm ER shift. As I drove to the hospital I mentally prepared for my shift as I always do, but nothing could ever have prepared me for what was going to happen on this shift.Things were normal for the first hour and half.

At approximately 5:30 pm we received a warning that a tornado had been spotted. . Although I work in Joplin and went to medical school in Oklahoma, I live in New Jersey, and I have never seen or been in a tornado.  I learned that a “code gray” was being called.  We were to start bringing patients to safer spots within the ED and hospital.

At 5: 42pm a security guard yelled to everyone, “Take cover! We are about to get hit by a tornado!”  I ran with a pregnant RN, Shilo Cook, while others scattered to various places, to the only place that I was familiar with in the hospital without windows, a small doctor’s office in the ED. Together, Shilo and I tremored and huddled under a desk.  We heard a loud horrifying sound like a large locomotive ripping through the hospital.  The whole hospital shook and vibrated as we heard glass shattering, light bulbs popping, walls collapsing, people screaming,  the ceiling caving in above us, and water pipes breaking, showering water down on everything.

We suffered this in complete darkness, unaware of anyone else’s status, worried, scared. We could feel a tight pressure in our heads as the tornado annihilated the hospital and the surrounding area.  The whole process took about 45 seconds, but seemed like eternity. The hospital had just taken a direct hit from a category EF-4 tornado.

Then it was over.  Just 45 seconds.   45 long seconds.  We looked at each other, terrified, and thanked God that we were alive.  We didn’t know, but hoped that it was safe enough to go back out to the ED, find the rest of the staff and patients, and assess our loses.

Med flight helicopter at St. John's Regional Medical Center

“Like a bomb went off. ” That’s the only way that I can describe what we saw next.  Patients were coming into the ED in droves.  It was absolute, utter chaos.  They were limping, bleeding, crying, terrified, with debris and glass sticking out of them, just thankful to be alive.  The floor was covered with about 3 inches of water, there was no power, not even backup generators, rendering it completely dark and eerie in the ED.  The frightening aroma of methane gas leaking from the broken gas lines permeated the air; we knew, but did not dare mention aloud, what that meant.  I redoubled my pace.

We had to use flashlights to direct ourselves to the crying and wounded.  Where did all the flashlights come from ?  I’ll never know, but immediately, and thankfully, my years of training in emergency procedures kicked in.  There was no power, but our mental generators, were up and running, and on high test adrenaline. We had no cell phone service in the first hour, so we were not even able to call for help and backup in the ED.

I remember a patient in his early 20’s gasping for breath, telling me that he was going to die. After a quick exam, I removed the large shard of glass from his back, made the clinical diagnosis of a pneumothorax (collapsed lung) and gathered supplies from wherever I could locate them to insert a thoracostomy tube in him.  He was a trooper; I’ll never forget his courage. He allowed me to do this without any local anesthetic since none could be found. With his life threatening injuries I knew he was running out of time, and it had to be done. Quickly. Imagine my relief when I heard a big rush of air, and breath sounds again;  fortunately, I was able to get him transported out.

I immediately moved on to the next patient, an asthmatic in status asthmaticus. We didn’t even have the option of trying a nebulizer treatment or steroids, but I was able to get him intubated using a flashlight that I held in my mouth.

A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine.  The gaping wound revealed his cervical spine and upper thoracic spine bones.  I could actually count his vertebrae with my fingers.  This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him..  We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out.

We felt paralyzed and helpless ourselves. I didn’t even know a lot of the RN’s I was working with. They were from departments scattered all over the hospital. It didn’t matter.  We worked as a team, determined to save lives. There were no specialists available — my orthopedist was trapped in the OR.  We were it, and we knew we had to get patients out of the hospital as quickly as possible.

As we were shuffling them out, the fire department showed up and helped us to evacuate.   Together we worked furiously, motivated by the knowledge and fear that the methane leaks could cause the hospital could blow up at any minute.

Things were no better outside of the ED. I saw a man crushed under a large SUV, still alive, begging for help; another one was dead, impaled by a street sign through his chest.  Wounded people were walking, staggering, all over, dazed and shocked.

All around us was chaos, reminding me of scenes in a war movie, or newsreels from bombings in Bagdad.Except this was right in front of me  and it had happened in just 45 seconds . My own car was blown away. Gone. Seemingly evaporated.  We searched within a half mile radius later that night, but never found the car, only the littered, crumpled  remains of former cars. And a John Deere tractor that had blown in from miles away.

Tragedy has a way of revealing human goodness.  As I worked , surrounded by devastation and suffering,  I realized I was not alone.  The people of the community of Joplin were absolutely incredible.  Within minutes of the horrific event, local residents showed up in pickups and sport utility vehicles, all offering to help transport the wounded to other facilities, including Freeman, the trauma center literally across the street. Ironically, it had sustained only minimal damage and was functioning (although I’m sure overwhelmed). I carried on, grateful for the help of the community.

At one point I had placed a conscious intubated patient in the back of a pickup truck with someone, a layman, for transport. The patient was self-ventilating himself, and I gave instructions to someone with absolutely no medical knowledge on how to bag the patient until they got to Freeman.

Within hours I estimated that over 100 EMS units showed up from various towns, counties and four different states.Considering the circumstances, their response time was miraculous. Roads were blocked with downed utility lines, smashed up cars in piles, and they still made it through.

We continued to carry patients out of the hospital on anything that we could find: sheets, stretchers, broken doors, mattresses,wheelchairs — anything that could be used as a transport mechanism.

As I finished up what I could do at St John’s, I walked with two RN’s, Shilo Cook and Julie Vandorn, to a makeshift MASH center that was being set up miles away at Memorial Hall.

We walked where flourishing neighborhoods once stood,astonished to see only the disastrous remains of flattened homes, body parts, and dead people everywhere.  I saw a small dog just wimpering in circles over his master who was dead, unaware that his master would not ever play with him again. At one point we tended to a young woman who just stood crying over her dead mother who was crushed by her own home.  The young woman covered her mother up with a blanket and then asked all of us, “What should I do?” We had no answer for her, but silence and tears.

By this time news crews and photographers were starting to swarm around, and we were able to get a ride to Memorial Hall from another RN. The chaos was slightly more controlled at Memorial Hall. I was relieved to see many of my colleagues, doctors from every specialty, helping out. It was amazing to be able to see life again.

It was also amazing to see how fast workers mobilized to set up this MASH unit under the circumstances. Supplies, food, drink, generators, exam tables, all were there — except pharmaceutical pain meds. I sutured multiple lacerations, and splinted many fractures, including some open with bone exposed, and then intubated another patient with severe COPD, slightly better controlled conditions this time, but still less than optimal.

But we really needed pain meds. I managed to go back to St John’s with another physician, pharmacist, and a sheriff’s officer. Luckily, security let us in to a highly guarded pharmacy to bring back a garbage bucket sized supply of pain meds.

At about midnight I walked around the parking lot of St. John’s with local law enforcement officers looking for anyone who might be alive or trapped in crushed cars. They spray painted “X”s on the fortunate vehicles that had been searched without finding anyone inside. The unfortunate vehicles wore “X’s” andsprayed-on numerals, indicating the number of dead inside, crushed in their cars, cars which now resembled flattened recycled aluminum cans the tornado had crumpled  in her iron hands, an EF4 tornado, one of the worst in history, whipping through this quiet town with demonic strength.

I continued back to Memorial hall into the early morning hours until my ER colleagues told me it was time for me to go home. I was completely exhausted. I had seen enough of my first tornado.

How can one describe these indescribable scenes of destruction? The next day I saw news coverage of this horrible, deadly tornado. It was excellent coverage, and Mike Bettes from the Weather Channel did a great job, but there is nothing that pictures and video can depict compared to seeing it in person. That video will play forever in my mind.

I would like to express my sincerest gratitude to everyone involved in helping during this nightmarish disaster.  My fellow doctors, RN’s, techs, and all of the staff from St. John’s.  I have worked at St John’s for approximately 2 years, and I have always been proud to say that I was a physician at St John’s in Joplin, MO.  The smart, selfless and immediate response of the professionals and the community during this catastrophe proves to me that St John’s and the surrounding community are special. I am beyond proud.

To the members of this community, the health care workers from states away, and especially Freeman Medical Center, I commend everyone on unselfishly coming together and giving 110% the way that you all did, even in your own time of need.St John ‘s Medical Center is gone, but her spirit and goodness lives on in each of you.
EMS, you should be proud of yourselves. You were all excellent, and did a great job despite incredible difficulties and against all odds.

For all of the injured who I treated, although I do not remember your names (nor would I expect you to remember mine) I will never forget your faces.  I’m glad that I was able to make a difference and help in the best way that I knew how, and hopefully give some of you a chance at rebuilding your lives again.  For those whom   I was not able to get to or treat, I apologize whole heartedly.

Last, but not least, thank you, and God Bless you, Mercy/St John for providing incredible care in good times and even more so, in times  of the unthinkable, and for all the training that enabled us to be a team and treat the people and save lives.

Sincerely,
Kevin J. Kikta, DO
Department of Emergency Medicine
Mercy/St Johns Regional Medical Center, Joplin”

Oh, did that get your attention?

Good.

Now go read this. It’s short, but here’s a quick synopsis: A mother of two experienced a difficult pregnancy but attempted to carry to term despite the risks. At 20 weeks she began hemorrhaging, and was virtually left to die in her hospital room because the physician on call refused to do abortions and failed to contact a doctor who would and could — this despite the fact that the fetus was not viable, that it was already dying. Fortunately, a nurse risked her job and contacted a different doctor who was able to save this woman’s life.

Abortion is a medical procedure necessary for adequate women’s healthcare. This story is just one of the many real reasons women get abortions, reasons that we have no right to judge when it is anyone’s body but our own. This woman would have died without the abortion of her already dying fetus. I fail to see the logic in how it makes more sense to let a woman die, leaving her two children motherless and her husband a widow, than to remove fetus that was going to die anyway. To be clear, I do not think this is the only acceptable situation in which women should have abortion access — it’s just one that highlights exactly why not having abortion access is so extremely problematic.

No, I have not been saved by an abortion. But I could be. Or maybe it will be you. Or your sister. Your significant other, mother, daughter, or friend. God forbid you ever be in that situation, don’t you think you’d want the doctor to save your/her life?

I thought so.

Rapture

Well hey there! I’ve been on a bit of a hiatus thanks to med school being all crazy and stuff. This next month isn’t going to be much better what with boards rapidly approaching, and then we start rotations which I hear keep a person pretty busy, but I’ll try to drop a line when I can — that is, if I’m still alive and/or can access teh interwebz Post-Rapture.

Of course, I’ve been anticipating the end of the world for quite some time now, but I assumed it was going to take place in the form of the boards, aka the United States Medical Licensing Examination Step 1, the first of all kinds of insane exams to make sure we’re not too dumb to practice medicine. Fortunately, some kind souls informed me that the boards won’t actually matter because The Rapture is coming, and after that, nothing matters!

For those of you living under a rock or in a dark corner of a library, like I should be — err, like I am, because I’m totally studying a million hours a day for the boards!…* — let me give you a quick update. The Rapture is officially scheduled for 6pm  today, Saturday May 21. In fact, it’s scheduled at 6pm LOCAL TIME for your convenience!! So nice of them to not make us figure out those pesky time zones. So if you’re really excited, head east now and be the first of your friends to experience the 2011 Rapture! Alternatively, you could head west and avoid the thing all together. Just be sure to leave a note for your friends before you go!

Sorry we missed you!

Of course, there are rules about who gets to go. Ever have a crush on someone? That’s lust. You’re gonna have to sit this one out. Judge others? No rapture for you! Steal? Yep, that candy when you were five totally counts. You’re done. Take the Lord’s name in vain? OMG, guess you’re stuck here! Lie? Cheat? Covet? Eaten pork or shellfish? Think anything bad, ever? Not love everyone you’ve ever met? And perhaps my favorite…

…Predict when The Rapture will happen?! NO HEAVEN FOR YOU!

Yep, the Bible actually says we’re not supposed to predict when the Rapture will happen, so all those who expect it to happen today are ineligible to be taken. Guess you’re stuck here with the rest of us! It’s too bad, really — I was looking forward to some Post-Rapture looting tonight. Would’ve been a great study break, except I don’t take breaks because I’m studying all the time, always.* No one can pass the boards if they take breaks from studying!*

*Lies. No Rapture for me.

“According to the United Network for Organ Sharing, there are more than 110,000 Americans on organ waiting lists. Around 19 of them die each day. There are more than 3,000 prisoners on death row in the United States, and just one inmate could save up to eight lives by donating a healthy heart, lungs, kidneys, liver and other transplantable tissues.”

Interesting piece. The author does a decent job of addressing many of the counter arguments and making his case. Rather than rehashing it all, I’ll just leave you to check out the preceding link to the NY Times article.

Should prisoners be denied the right to decide what happens to their bodies and organs after their death? Are there legitimate reasons for refusing to allow those on death row to be organ donors when they pass screening measures and the lethal injections don’t damage the organs? I am not taking a side in the death sentence debate here, I’m just pointing out an interesting aspect from one prisoner’s point of view. If his organs are viable, why should eight people have to wait any longer for a life-saving transplant? Interesting.

Valentine’s Limericks

I generally have no use for the overly-commercialized card-and-candy holiday of forced affection, but last week I caved to Valentine-writing frenzy. The following limericks/poems are the product of too much fondue and craft supplies; I blame it on the glue. These are mostly my creations, though credit goes out to a few other dirty minds for helping to polish them off. If you’re easily offended/disgusted, I suggest that you stop reading now. If you find humor in lewd, crude nonsense, read on!

I Love Your…Mind

You cheer me up when things are shitty
Because your mind is just so witty.
It’s stuck in the gutter
So I know you won’t shudder
When I say that I just love your titties!

 

S & M

Sometimes our lives can be rough
But soon you will meet someone buff
Now do not fret,
You’ll get very wet
And spend all your time in handcuffs!

 

Breathless

You knocked all the air out my lung
It is to my soul you have sung
My breath it gets caught
And my pants get so taut
It is all because you’re so hung.

 

Neural I Need

Your PNS makes me excited
Your hypoglossal keeps me delighted
I hope that it’s mutual, not just ipsi
Or we’ll have to go out and get tipsy.

 

Spreading the Love

You know I could not love you more
Even though you can be such a whore
Rest assured that the lesions
Will pass with the seasons
And your core will no longer be sore.

Lady Docs get the Shaft

Lest you think that we’re working towards some concept of equality, new research once again proves otherwise.(1) Not only has the gender gap in physician salaries not improved, it’s actually gotten worse over the last 10 years — nearly five times worse. This gap is often explained away by the fact that many women opt for the lower paying specialties and fewer hours because their vaginas need time to pop out some babies, but when factors like specialty and hours are accounted for women STILL earn an average of $16,819 less than their male counterparts.

And that’s just average. Need heart surgery? Your female surgeon will make an average of $27,103 less than a dude. Kid needs ear tubes for all those ear infections? A lady otolaryngologist/ENT (ear, nose & throat) makes $32,207 less than a male. Been a little short of breath from your lung disease lately and need to see a pulmonary disease specialist? The one with the boobs makes $44,320 less than the one with danglies. And remember, that’s AFTER normalizing/accounting for differences in specialty choice, hours worked, and even area cost of living. These women are receiving the exact same training, accumulating the exact same debt, and performing the exact same job, yet they are earning only a fraction of the pay.

This and previous studies have sought an explanation for the gaps and have yet to produce satisfactory explanations and results. One previous argument proposed that female physicians are just a males; these studies tend to merely measure number of patients seen and ignore things like the quality of care, patient outcomes, and patient satisfaction. Maybe it’s just my little lady-brain, but I seem to remember a few lessons from med school and life that seemed to say quantity does not equal quality. The other main historical argument has been that women disproportionately go into the lower-paying primary care fields, but not only has that trend diminished in recent years, women are still earning significantly less than their male colleagues in the same field. Family/marital status has also been shown to have little direct influence on physician salary.

The only explanation that still seems plausible after the data analysis is that there are fundamental differences in the jobs taken by female physicians beyond the specialty field and hours worked. Perhaps women are willing to sacrifice equal pay for a position that allows them more flexibility or is more amenable to their family responsibilities. It has recently been demonstrated that the field of medicine is indeed shifting to a greater focus on quality of life, but here’s the thing — both men and women are placing greater importance on jobs that permit a greater quality of life, NOT just women.

Again – both men AND women increasingly want family-friendly jobs that afford greater flexibility, yet women continue to earn $16,819 less than men. That’s nearly five times worse than the gap of $3,600 in 1999. FIVE TIMES WORSE. Disgusting.

Rants? Theories? Condolences? Distract me with your comments!

 

1. LoSasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 Pay Gap For Newly Trained Physicians: The Unexplained Trent of Men Earning More than Women. Health Affairs. Feb. 2011; 30(2):193-201

The Magic of Chicken Soup

Turns out that chicken noodle soup is more than just comfort food — it not only makes you feel better, it can actually help you get better! It’s intuitive that it can help you with hydration (after all it is mostly water) and the steam can do wonders for your feelings of congestion. However, apparently some anti-histamine is generated from boiling the chicken, which means it’s really an all-natural form of your cold meds! And don’t worry, you get the same benefit* from the canned version as you do from mom’s homemade goodness, so all of you (us) on your own can get in on the action.

…This is what I took from my small group on colds and flu. I’m sure this is what’s going to be on the exam. Really. Totally useful.

*Well, the same anti-histamine benefits, that is. As far as taste goes you might not be quite so lucky.

Bloody Sunday

We’ve been back in class for three weeks here at Lakeside Med (a pseudonym, of course, in keeping with my super-pseudo-anonymity for the occasional awry google search), which means it’s high time for a final exam. This first block was hematology, so I’ve been up to my eyeballs in [information about] blood. It turns out that there the blood can do some pretty crazy things, so I thought I’d share some of the more random ones.

Fun Blood Facts:

-Running is dangerous! For real. Every time your feet slam onto pavement it’s a micro-trauma that can destroy your red blood cells. This fun little hemolytic event is transient and normal, but I’m going to go ahead and use it to justify the days that I skip spin class.

-Kissing can kill you! Actually, it’s hickeys that might do you in: apparently if the bruising is in just the right place – over a major artery – it may induce enough damage to trigger clot formation, which can then dislodge and cause a stroke.

-Pregnancy is dangerous! There are all sorts of reasons behind this one, but a few of the hematologic fun facts: the mother can produce ~50 different antibodies that can attack the fetus, leading to red blood cell lysis and possible fetal death; the mother can develop Diffuse Intravascular Coagulation (DIC) which creates lots of small clots throughout her body while simultaneously causing excessive bleeding…and the list goes on.

The more you know!

Sleep Study Fail

t-18 hours until I’m done with finals…at least I haven’t done this yet!

One hour of sleep is better than two hours of studying, right? Too bad she doesn’t study at our library, which comes equipped with comfy chairs, couches, pillows, blankets, and even teddy bears for your nap time!

Yes. Teddy Bears can be found in our med school’s library. I kid you not.

I can’t decide if that’s more amazing/awesome or weird/creepy…

ok, back to my epic kidney disease chart. No naps for me.

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