I did get a pretty good sleep yesterday. Slept until 14:30, and when I got up it was raining cats and dogs.
I went on call at 16:30, and I got called at 16:15 with the information that there was a floor patient that needed a head CT tonight, but that there was no hurry on it... I told them that I'd be in around 17:00. When I got there at 17:05, there was not one but three patients that needed doing... one of them an outpatient who was not scheduled. So I got busy getting them done, and one of the techs (my favorite) came over from the x-ray department to help me out. Well, that was kind of snarky, I guess... most of the tech in radiology are my favorites. Anyway, she gave the outpatient his drink, and we had to wait at least an hour before doing the exam, because a pelvic abscess was suspected. In the meantime, I had yet another floor patient come down, this one for a study of her cervical spinal canal. She has cerebral palsey, and they didn't send a nurse down with her medication, so I had to wait for that to get given and to take effect, otherwise it would be like shooting a moving target. Anyway, I got that done, and did another ER patient and then it was time to do the outpatient. I got him dressed and put a needle in a vein and away we went... only it didn't work that way. We use a power injector to deliver the contrast material intravenously... that way, once the injection is started we can get behind the panel to start the scan. Pretty slick, usually. Unfortunately, the needle came out of the vein shortly after I started the injection. I watched it the first coupla seconds, as usual, and it seemed to be going in OK. Anyway, this patient is evidently a pretty stoic fellow, and his arm had to be hurting like hell, but he waited until the injection was done (and the machine told him that he could breathe) before he told me that it was hurting... so most of the contrast was injected subcutaneously. Well, this makes the exam pretty worthless, as well as being extremely painful for the patient. There was no way, of course, that he was gonna let me stick him again. Luckily, we did get enough information to make a diagnosis, and he was admitted to the hospital for surgery today. I've never had that happen to me before, and damn! Do I feel bad about it. I was back on a friendly basis with the patient before he left the department, though. I've been trying to think of what I could have done to prevent that from happening... I should've watched the injection site longer, that would'a done it. Of course, second-guessing myself and beating myself up over it isn't going to do anybody any good. The patient will be OK in a coupla days, the swelling is probably gone down by now and his arm'll just be sore. Since he's having surgery today, that's probably the least of his problems right now. Veins are funny, though. Drawing blood out of a vein is pretty easy, although they do sometimes collapse... but putting something in is a different story altogether. We don't use needles per se, but a sheath that is inserted over a needle, and then the needle is taken out and the sheath stays in place. Pretty slick, when it works. However... sometimes when the contrast is injected, the pressure will eject the sheath if it isn't anchored properly... and then, occasionally, the vein will contract and close off somewhere above the tip of the sheath. When that happens the vein bursts and the stuff goes into the tissue. I think that this is probably what happened in this case, but I'll never know. I just know that I'm gonna be damned careful that it never happens to a patient of mine again. Anyway, after this was all over, I spent about an hour doing the necessary paperwork to report the incident. What a pain... but it has to be done immediately, and it has to be done right. I went to bed with Karen about 22:30, but I couldn't go to sleep, although I'm tired as hell. So I thought that if I wrote it all out I could feel better about it... but I really don't. Today... I'm gonna have to get those brakes worked on. I figger that it'll take me about four hours, and it's not supposed to rain, so I'll be OK. Karen has to go in at 07:00, so I have to get up and take her, because if I need extra parts or something like that I'll need the truck to go get them. And, if I get the Subaru done in good time, I'll do the front brakes on the truck... I have all of these ambitions... I need to follow through on them better. 19:21... So I goofed off until Karen got off at 17:00 and picked her up at work. They had an exciting day... BC/BS of Kansas has been bought by... somebody, can't remember the name. She said that they said it was a merger, but that's not what I heard on the radio. She also said that they said that there would be no changes... like, riiiiiight. But they also said that there would be no buy-outs (early retirements), dammit, and that one is probably right. So I started to work on the Subaru; not much of a problem, really, but I did get all dirty. I need to take the roters in tomorrow and get them turned before I can put stuff back together, though. That means that I have to take Karen to work again in the morning. I got a call from my supervisor tonight, she told me that the patient's arm was doing well today, and that I shouldn't worry about it any more... how did she know that I was worried, I wonder? Today is Andy's 35th birthday, and everyone just left to go to the Outback SteakHouse. I decided to not go, 'cause working on those brakes tuckered me out pretty good and it'll take me an hour to get all of the grease offa me. I'm not used to doing that kind of work, and although it only took about 90 minutes, my whole body is sore from squatting down and getting in the right positions to get the work done. I'm just getting too old for this, I guess. Karla just called, looking for Andy... Drew got bit by a dog. Karla said that it was under his chin and on the side of his face and that it would probably need stitches... I gave her Karen's cell phone number and told her to call back if she didn't get ahold of them and I would go out and get them. I hope that he's OK... I just called Karla back, and she's probably not going to take him to the hospital, so it must not be that bad... On a lighter note, JD should be here tomorrow, I'm looking forward to seeing him.
Yeah, well, I went back to bed after I dropped Karen off at work... slept until 14:30, and I slept really well.