Dr. Orthochick: Help

I had a really bad call the other week of the variety where I couldn’t do anything right. And it was busy so I kept on having to double back because I was redoing a lot of stuff. Around 1 in the AM I got consulted for a guy with a finger infection. He had been bit by another person and some genius in the ER had sewed it up so that the infection brewed deep to the sutures and ravaged his pinky. I looked at it and he seemed to have infection diffusely–the whole finger was swollen and he couldn’t move it and he had erythema and lymph nodes tracking past his elbow. So I didn’t really feel like I could handle the situation on my own in the ER, and I say this as the chick who once washed out a septic wrist in the ER. (Disclaimer: Even at the time I knew that was a bad idea)

The problem was, the hand surgeon on call that night was Dr. Ortho. I don’t like Dr. Ortho, he doesn’t like me, I spend a decent amount of time and effort trying to stay out of his way. So I really didn’t want to call him to tell him I needed help, but since the alternative was make a mess out of everything, I gritted my teeth and told myself it was in the patient’s best interest.

What I wanted to say was, the reason why I was scared to do this was because I had a similar patient with Dr. Pregnant at the beginning of the year and I tried washing him out on my own in the ER. I made a small incision in the base of the finger the way you’re supposed to and tried flushing out the sheath, but the infection seemed a little too diffuse for that so I wound up flaying open his finger. I made zigzagging cuts across the palm of the index finger and created flaps. At some point in all that, I must have hit one of the digital artery and nerve bundles (you have 2, one on each side of your finger) and knocked them out. I remember a lot of bleeding and trying to get it under control. Anyway, because he had reduced blood supply to his finger, the antibiotics couldn’t get to his finger and the tip died off from lack of blood and infection. The flaps I had created on his palm turned black and fell off because they didn’t have enough blood. We took him back to the operating room to try and save something, but we saw pus dripping off his other digital nerve and artery. We couldn’t clean them off because we wanted to save at least one in the hopes that his finger wouldn’t die, which meant that we left pus to rot in his finger. He lost his index finger. He was 35 and a laborer.

So I wanted to tell Dr. Ortho that story, but I didn’t want to admit that it was my fault that a healthy young guy lost a finger and even though I have a better idea of what to do now, I was scared. So he came in to do it with me, after berating me over the phone for a good 10 minutes for not knowing how to do a flexor tenosynovitis/septic arthritis washout by this point in my education. He came in to the ER at 2AM, washed out the guy’s finger without talking to me, turned to me at the end of the hour and said “write admission orders and dictate this procedure,” and then walked out without looking back.

I know I should know how to do this by now, and it’s not that I don’t per se, but I really don’t think it’s the worst thing in the world to ask for help.

 

Link to Original Article: http://doccartoon.blogspot.com/2015/06/dr-orthochick-help.html

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Dr. Fizzy

I'm a midwestern physician who has finally finally finally come to the end of my grueling medical training, and at last I have enough time to publish the wealth of cartoons I've created over the years. If you enjoy them, please comment. If you don't enjoy them, then you can just keep your fool mouth shut. Read the rest at Doccartoon.blogspot.com, and make sure to check out his book, A Cartoon Guide To Becoming A Doctor, on Amazon!