trauma tries to kill (ok, maim) people, chapter 982374

trauma: a team that combines stupidity with arrogance to the point where it actually frightens me.  i am SO SICK of these people thinking that they have any business managing anything besides bellies and rib fractures.  tonight's comedy of overconfidence?  trauma thinking that they can play urology.

the backstory is as follows.  the patient is young, shot, shackled to the bed because he did something real stupid, screwed his whole life up, and now is being charged with murder.  he has a big (like baseball sized) hematoma in his bladder, and trauma thinks that it's NBD that he's peeing straight blood.  well, that is it wasn't a big deal until yesterday, when they decided to have me jam a garden hose of a foley up him and do intermittent bladder irrigations.  

do you know what that is?  that is 20 frenches of hell.  and the young men folk hate anyone messing around in their special place as it is.  but too bad, in it went and i tried to irrigate.  

tried.  

i could flush in, but not pull back.  and when i flushed the patient would shake and break out in cold sweats.  then his bladder would spasm and bloody drainage would pour out from around the foley.  then he would stand up and fluid would pour into the catheter, as well as all over his gown, sheets, and the floor.  

EVERY. TWO.  HOURS.  

torture.  it was torture.  i told trauma that the first day and begged for urology.  but no, we're going to go with this as a "first step".  and i told the chief resident later in the day that it still wasn't working.  no response.  then i told the NP the next day in rounds.  no response.  then i told the intern after dinner.  no response.

and then, i lost it.  because the situation was RIDICULOUS, their management of the patient was not ok, and i was over playing nice.  

so i called my ladies over on the uro/gyn unit and had a little pow-wow.  then i bladder scanned the patient and found that he had over 600ccs in his bladder.  at this point i could irrigate and nothing would even come out into the foley bag.  so i called the intern on call and told him that we needed a urology consult, NOW.  but he was in the trauma bay, and someone was dying, and he needed to talk to his chief...blah blah blah.  

so i politely ended the conversation and paged the urologist myself.  

and he came in from home with his man-bag chock full of catheters and irrigated 3 liters into the patient and finally managed to suck out 300ccs of clot and 500ccs of urine.  and then he took out my garden hose foley and put in one that was 2 sizes bigger.  he tried to put the patient on continuous bladder irrigation, but the clots were so bad that the tubing kept getting clogged.  so he irrigated some more.  

i stayed in that room with the urologist for over and hour.  there was blood EVERYWHERE.  we soaked towels, all the bedding, the floor...blood was in urinals full of irrigation fluid and graduated cylinders  and 60cc syringes and all over the patient.  the MD would push in a syringe of fluid and pull back nothing but solid clot. (while we're on the subject of bleeding out of ones bladder, do you think that trauma would order an H&H?  nah...)  

but, don't worry guys, trauma can handle this.  pssh.  

and tomorrow, urology will come back and decide what's next.  most likely a clot removal under anesthesia.  

so tonight, trauma, i curse your name.  i curse your arrogance, and your neglect, and the fact that you would not listen to me, and we are NOT FRIENDS.  no we are not.  i am friends with urology, and that doctor is lucky that i did not kiss his face because i almost did, i really almost did.  

and THAT, ladies and gentlemen, is sadly what it takes to get things done on the trauma service...namely, going around the trauma service.  

***and for the record, the next day the patient got a clot evacuation with urology and came back to the floor with a civilized sized foley and perfect clear yellow urine.  the day after that, he was discharged to jail.  you're welcome, trauma.  you're welcome.  ***