A Night at the Grady Red Zone

So, prior to this night I have spent about a year or so at Grady and thought I have seen how dysfunctional this place could. However, I was mistaken. I truly witnessed a combination of extremely crazy patients with severe neglect and inefficiency on the side of the staff and the system.

My patient was a guy with schizophrenia who got hit in the head with a metal pipe and had a 2 inch laceration on his forehead. In addition to that his left hand was shackled to his bed and he also had to urinate every 20-30 minutes. He was in a room with 2 other patients. I cleaned his face and his wound with some saline and
decided to saw up his forehead. I spent about 20 minutes finding the right kind of suture and then another 30 or so finding a mayo tray (if you don't know what a mayo tray is google it) to set up all my equipment.

About 10 minutes after I started to saw him up he started yelling that he has to go to the bathroom, normally I would hold a plastic duckie (angled container into which men can pee if they direct their stream right) while he directs his stream, however at this time I was wearing sterile gloves and was not able to help him. So I thought he was gonna urinate all over my equipment and I would have to start over. Luckily I was able to find a nurse to help him. Right after that was over this patient's neighbour who was drunk decided that he needed to masturbate right then and there (he was about 2 feet away from my patient and myself...hidden from my view by a strategically placed curtain) - I heard the nurses screaming at him to stop and then calling security and that patient screaming back (obviously not stopping what he was doing) that he had "to get it out".

A few minutes later I heard loud screams from the third neighbour in the room (he was admitted for snorting 4 grams of cocaine) yelling at the nurses to take off the shackles from his hand and that he will kill them once the shackles are off. He also then mentioned that he spent the last 15 years in and out of the penitentiary system and that he is "a hard mothafucka whodoesn't let shit slide easy" - especially if he is dealing with snitches or some who is trying to steal his money or his "dope" - "you just got to deal with it right then and there" he said. Then he started discussing how he was able to have sex with women while in prison he then went into more detail into that subject (of note there is noone there actually talking back to him).

His screams woke up my patient who was sleeping while I was suturing his forehead and he started moving his head right and left not letting me do my work. As a result, I had to tell him every 5 second - "don't move your head MR. _____...Don't move your head". He then started talking to his voices and went off on a preaching monologue directed at his screaming neighbour (earlier in our conversation he informed me that he is a reverend..). Finally, after about 30 minutes or so I was able to saw him up somehow managing not to stick myself while putting in his 8 stitches.

Then, I was lucky enough to get a malingering patient who just got released from jail the day before and decided to us the Emergency room as a hotel room - she called paramedics and told them she had pain every where and then later admitted she smoked some crack cocaine and drank a pint of wine a few hours prior - nvertheless she was brought in to the ED. On review of systems (whenever I ask: "have you had diarrhea?...chest pain?..headaches" in a list fashion) she answered positively to every single question - it was quite impressive that her story was changing every 5 minutes or so.

to make long story short (i am tired of writng) - it was night of crazy patients and nothing getting done to make it the most dysfunctional time I had at that hospital to date. I would argue it is most dysfunctional and inefficient hospital in the US.

See the article I posted on this blog on the subject - It was not written by me but it is a great read about how a Western trained local politician is able to create possibly long lasting changes in a developing country. Very impressive results:

"One of Mr. Saakashvili's first steps in office was to overhaul the country's corrupt and hated traffic police. He sacked half of the force's 30,000 officers, then gave the rest a tenfold pay raise and merged them into the regular police force."

Today I attended a ceremony dedicated to Dr. Ken Walker and him being awarded the Outstanding citizen award by USAID. I must say that he is one of the most generous, smartest and inspiring people I have ever met. If you are a in the field of medicine and you reside in the South Eastern US you more than likely heard of him.

On December 17, 2004, President of Georgia Mikheil Saakashvili declared Dr. H. Kenneth Walker to be an Honorary Citizen of Georgia. The award ceremony, which was held at the State Chancellery in Tbilisi, was attended by U.S. Ambassador Richard Miles and Deputy Chief of Mission Patricia Moller as well as by Dr. Walker's Georgian counterparts. In his brief words of appreciation, Dr. Walker, who is a professor at Emory University in Atlanta, Georgia, said, "I’m a small man who stands on the shoulders of very tall people," pointing to his Georgian colleagues.

to find out more about the Atlnta Tbilisi connection check out the following link

The plural form of the word mouse is mice. Hence shouldn't the plural of house be hice instead of houses? confusion ensues.....

Have been listening to Matisyahu recently

Today I became an American Citizen after living for 7 and a half years in the US. The whole process took about 6 hours and included an interview as well as a ceremony with an oath of allegiance and an oath to the flag. Must say that I am proud to be an American and will try to be a good one. I'll finish this by quoting myself (I was more eloquent before medschool) from a college publication in my "younger days":

"The thing I like about the United States is, if you work hard enough, you’ll get what you want. In other places it’s not necessarily like that,"

said Lubarsky. It is still true.

With me there were 56 other people from 32 different countries becoming citizens as well. Was interesting to hear some stories of people living in the US for over 20 years before becoming a citizen. It was kind of exciting I must say.

Taking the American Citizenship Test and getting Interviewed for the Citizenship tomorrow at INS offices in Atlanta.

Do you know the year in which the US constitution was written in (without googling)? Who was the first Commander in Chief of the US? What is the function of the Congress? How many justices are in the supreme court? Who is the head of the supreme court? If both the president and the vice president die who becomes the interim president? What ammendments to the constitution describe the voting rights of the US citizens? How many strips are on the US flag?

and more...

I will let you know how I do.

http://www.nytimes.com/2006/03/14/health/14comm.html?
ex=1143003600&en=dc66ebe2b62439a6&ei=5070&emc=eta1

One of my patient died over the weekend. Must say its a weird experience even though my team was only following her as consultants rather than the primary. Came in the morning, and she wasn't in her room. I checked on the computer and it said she was transferred to the ICU. Went to the ICU saw the cardiology fellow and asked him if she is in the ICU. He told me she was gone.... Made me wonder if I should have come in this weekend, not that it would have changed anything as she was checked on by multiple physicians throughout the day but still... Could I have done something different?  I don't know. It will defintely affect the way I see my patients from now on.