By Christian Stallworth, MD
My name is Christian Stallworth, MD. After a year of General Surgery training, I’m in my third post-graduate year in Otolaryngology – Head and Neck Surgery.
In my first year of medical school, my wife Jenny and I welcomed our firstborn daughter. In my fourth year, we were blessed (and shocked!) to welcome triplets-- two boys and a girl. Jenny stays home with the kids and runs a bakery from our home.
This is a day in my life.
I awaken on December 5, 2006 at 5:45. After a quick shower and shave, I grab a Coke and a PowerBar and I’m out the door, arriving at the VA hospital at 6:15.
This morning is a shirt-and-tie day, with no surgeries scheduled. I’m on trauma call tonight after 5 p.m. I have two post-surgical patients in-house; one who had a left hemithyroidectomy with a parathyroid exploration, and one who had a neck dissection. Arriving on the floor, my chief and I are pleased to see both patients are doing well.
At 7 a.m., we walk to UH for our first conference. The Tumor Board is a multi-disciplinary conference that reviews patients with head and neck cancers.
8 a.m.: Grand Rounds. Occasionally there are refreshments, but not today. The lecture ends at 9; next comes a faculty lecture.
At 10, we meet in the Audiology Department at UH. I’m the resident guinea pig today, having my hearing checked. As a guitarist and loud music lover, I happily learn my hearing is perfectly normal.
At 11 a.m. is the pre-op conference. We third years organize the list of patients and present full medical backgrounds prior to surgery.
Midway through, I got paged by the VA, reporting an inpatient with possible cancer threatening his airway. I rush to the VA by 12:30. At 1:45, the patient with the airway difficulty arrives. He vaguely reports a history of cancer that was treated in Mexico, surgically and with radiation.
I note significant stridor and during
a fiber optic exam I notice a large mass obstructing an inlet to his windpipe.
My chief confirms my findings and we determine he likely needs surgery, but first a CT scan. The radiology technicians say there’s no space available. I track down a radiology resident to get ap-proval. It’s 2:40 p.m.
By 3:02, we view the CT scan results. From the images, we suspect a return of his cancer, but more urgently —increased breathing difficulty. We
recommend to him an immediate
tracheostomy. The patient gives consent for the surgery.
By 3:10, his anxious wife and brother (a priest) arrive. By 3:20, we have an OR and Anesthesia available, and staff ap-proval. I stand with the family as the priest prays over him. By 3:30 we’re ready, but a nurse says the consent form has to be redone. After a brief battle, I redo the form.
At 4:15 we perform an awake-
tracheostomy that goes perfectly. Within 30 minutes his airway is secure. By 5, he’s in the ICU.
By 5:40 I’m back at the VA ENT clinic. I call home. My kids had a great day and Jenny is making dinner. I’m not sure I can make it — I’m on call tonight. Tired, hungry and thirsty, I grab a Coke, sit down and catch up on paperwork.
At 6:15 I’m notified of articles at the medical school I need to review before my cases the following morning. At 6:40, I walk over to collect them. Around 7, I drive home. While driving, I call to check on several critically ill patients in the UH-ICU in case any issues arise that night. I arrive at my home by 7:30.
My family and I are ecstatic to see one another. After dinner, my eldest daughter performs a preview of her upcoming dance recital. My triplets and I play with Thomas the Train, but by 8:30 it’s their bedtime. I help my wife get them ready for bed with my pager on my hip, awaiting any trauma calls. My wife and I have a moment to talk, and then I check e-mail and read the articles for tomorrow. By 10:30, we’re asleep.
My pager awakens me at 11:15. The tracheostomy patient is agitated. He’s pulled out a number of his IV lines and they want to give him calming medication. Many nurses refuse to take phone orders, so they want me to drive to the hospital.
I contact an on-call Medicine resident who agrees to enter orders for me. By 11:35, I’m back to sleep.
At 12:35, I’m paged again. It’s the Pit Boss, and that’s not good. The Pit Boss is the General Surgery resident in charge of Trauma Service and the ER.
I’m told the patient has significant facial fractures. The Pit Boss also mentions a second patient who’s been in a car accident and suffered severe facial lacerations. By 1:10 a.m. I’m at the UH ER evaluating the first man who was playing softball in Eagle Pass when the ball hit him between the eyes and the bridge of his nose. Both eyes are swollen shut and there’s gross nasal complex asymmetry…serious fractures. I call my chief at 1:40 and review his scans with her.
Just after 2 a.m., I see the next patient, who sustained life-threatening injuries and was immediately transported to the OR. Once stabilized, he is taken to the ICU where I go in to evaluate him. He has significant facial lacerations. In the ICU, I find the patient surrounded by Trauma Service. He’s suffering intra-abdominal bleeding and needs to return to the OR immediately. I follow them to the OR so I can perform facial laceration repair at the same time. At 2:10, as the patient is being tended to by General Surgery, I stand at the head of the bed and repair his facial lacerations.
By 3:10, I’m finished. While in the OR, the collective pagers of the Trauma Service go off; obviously a new trauma is on its way. A nurse announces the impending arrival of a patient with a mandible fracture. As the resident on-call for facial trauma, I know he’ll be my next patient.
At 3:35 a.m. the patient arrives. He’s a 20-something assault victim from Medina County. Medina lacked the needed services, so Trauma Service accepted his transfer.
He likely has a jawbone fracture. I wait for the CT scan and films to confirm my findings. He’s officially become an Ear, Nose and Throat patient. It’s now 4:40 and I have 80 minutes before a.m. rounds start. There’s no time to return home and the call-rooms are full, so I grab a nap in my car.
At 5:50 a.m., I meet my chief in the ER. We reevaluate the patient and she confirms my findings. We head to the VA hospital for morning rounds. My call ends at 7 a.m. and luckily, no further calls this morning. All in a day’s work!
