Rotation #10 Portland, Oregon

For my last and final rotation I worked on the trauma unit for inpatient medicine at Legacy Emanuel Medical Center, a level one trauma center (the most critical).  I was glad to be back in Portland since I'd been gone for a WHOLE YEAR.  Except, let's be honest, it didn't matter one bit because I had ZERO free time.  For the 6 week rotation, I worked six 12 hour shifts which ended up being about 80 hours per week since my shift would typically run over each day.

The first 3 weeks I worked the night shift, 6 pm - 6 am.  I thought it would be super rough, but I got adjusted pretty well to the schedule pretty quick.  My sole responsibility was responding to incoming traumas.  I was assigned to the foot of the bed.  Responsibilities: cut off clothes, check pelvic stability, all lower extremity pulses, musculoskeletal function, and assess for any cuts, bruises, injuries, etc.  It's amazing how quickly the trauma team works and how fast we get the patient to the CT scanner.  I also was in charge of obtaining the past medical history and writing up the chart note.  I didn't have too many opportunities for procedures since there were also medical residents, but I got to suture lacerations quite a bit and I even got to put in a chest tube.  That was a good day.  It was amazing just how many of the traumas involved alcohol, or some illegal substance.  At least half, I would venture to say.  Man, I'll tell you what, I saw some CRAZY stuff.  The majority of patients were motor vehicle collisions, motorcycle collisions, or bicycle collisions.  But there were also gunshot wounds, stabbings, and even suicide attempts.  Then the random things like kitesurfing accidents, jumping over a freeway interchanges, jumping into shallow bodies of water, getting too close to fireworks, etc.  I worked the night of the 4th of July and saw a few preventable incidents - a hand mutilated beyond recognition and inner thighs burned down the bone.  Fireworks are bad news people!  IF you get too close... Working the night shift, I also had the opportunity to assist on quite a few emergency surgeries.  If you got a message on your pager saying "Direct to OR," it was serious business.  What a fascinating experience -- emergently opening someone's chest wall to repair a hole in someone's atria due to a stabbing, seeing the heart beat so discordantly and then again rhythmically after medication administration.

Can you imagine...
...undergoing a craniotomy because your angry son threw an iron table at your head?
...becoming a paraplegic after diving into water that was too shallow?
...miraculously surviving a bullet that went right between your spinal cord and aorta?
...not being able to speak or minimally move 4 MONTHS after hitting a dog on your motorcycle (unhelmeted)?
...losing your right arm from a car accident because it was hanging out the window?
...not being able to work for months due to shattering both heel bones after falling off your roof?
...riding your motorcycle one minute and waking up alive and well in the hospital the next, having no clue what happened?
...getting the crap beat out of you by some thugs on the street after they yelled at you and you yelled back, and living to tell it?
...surviving stabbings to the abdomen after a man at a bar tried to make the moves on your girl?
...retaining hand function after fireworks blew it apart?
...falling off your toilet (yep, it happened) and then incidentally finding a giant aortic aneurysm that needs urgent repair?
Yep, this was definitely the trauma unit -- the good AND the bad.

I witnessed 3 people die before my very eyes.  The skilled trauma team and trauma surgeons save many lives, but there are those that also cannot be saved, even after everything they can do.  One patient had shot himself through the head and was unable to be revived with 40+ minutes of CPR.  Another had been stabbed in the heart and we couldn't keep up with his blood loss.  And the last and most significant to me since I was so involved in the care, was someone who had been involved in a motor vehicle collision -- had a substantial brain injury and cardiac tamponade.  For the first time ever, I was able to assist with chest compressions on the patient.  I was also second assist during surgery, but after multiple and various attempts we could not get the heart to beat on its own.  I have never had anyone die before me and it was quite the experience, as you can imagine.  So many feelings and emotions coursed through me, of which I still cannot even put into words exactly.  How could the surgeon just stop trying and end it (even though he did ALL he could do)?  Why could we not save the patient?  It was too late... they were basically already gone when they presented to our hospital.  Fortunately, I have knowledge of the plan of salvation and that this is not the end.  Their families will see them again someday.  Sorry for the heaviness of the last paragraph, but I wanted to share some of my experiences.

The last 3 weeks I worked the day shift, 6 am - 6 pm.  The day shift was completely different than nights as I mostly did inpatient medicine with trauma patients who had been admitted previously.  I only responded to new incoming traumas every now and then.  I had anywhere from 2-5 patients each morning that I would go see myself, review labs and imaging that had been done in the last 24 hours and develop a plan for their care in the next 24 hours.  I would then present this information to the attending surgeon on rounds and we visited each patient on the floor.  That took most of the morning.  Then in the afternoons, we went to trauma clinic where we visited with each patient that had been admitted on the TRACU (trauma recovery acute care unit) as follow-up and to assess how they were doing.  Clinic was usually pretty hectic as they scheduled 3-4 patients at the same time and there usually weren't enough trauma PA's to go around.  It was stressful for me as a student, because I was trying to go as fast as I could but also be thorough in my patient assessments.  I decided I do not like scheduled patient visits -- another plus for emergency medicine.

Obviously, working in trauma is a step up from the emergency department, but it only confirmed the fact that I DO want to do emergency medicine.  I want to be the go-to person to ultimately save a person's life.  Although trauma may be a bit much to handle emotionally long term, I really enjoyed my 6 week rotation.

I had the good fortune of living on the east side of Portland (across the river), which is considered more "hippie" (not hip).  But there are some delicious places to eat over there.  My mouth is watering already just thinking about it!  You have to go to Portland for the food!  Honestly, who cares about anything else.  I lived in a quaint little house with another PA and nursing student.  On Saturday, my one day off, wasn't much of a day off as I'd be catching up on what I couldn't do during the week -- exercise, grocery shop, clean, study, pay the bills, etc.  I was actually pretty sad to leave the east side.  Glad I got the opportunity!  I also had more opportunity to explore downtown Portland and spend more time exploring.  It's a beautiful city and I know I am going to miss it!