Rape, Cancer and a Chest Tube

Early this morning I got paged to the ER with the junior resident to see an emergent consult for a potential orbital blow out fracture with nerve entrapment. We get to the ER to see the patient and get the story. She was intubated, so she could not tells anything about her condition. This was a 17 year old african american female who was found naked and unconscious in the street (south side) at 2:00 am. She had been raped several times and had blunt force trauma to the face. It looked like she was hit with a bat in the face more than once. She was in bad shape. These kind of cases are always terrible and heart breaking. She was a Jane Doe so no one knew who she was and could not contact any family. We looked at the CT scans and Xrays and sure enough she had an orbital fracture. Fortunately there was not nerve entrapment or that would have been an emergency surgery to prevent blindness. We have her scheduled for Friday to repair the orbit and but the eyeball back where it belongs.

Then we had a 65 year old Polish immigrant who presented to the ER with stage 4 metastatic esophageal cancer. It is unbelievable that the cancer has progressed this far and he has had no treatment yet. He came in because the cancer had become so massive that he could no longer breathe. He did not speak any english. We were consulted to put in a tracheotomy but because his disease was so progressed we had to do the procedure while he was awake because he would not tolerate the procedure under general anesthesia. He was used local anesthesia and he was mildly sedated. However in the middle of the procedure panicked and tried to get off the table, he started to decompensated. We had to hold him down and get the trach placed. In the process of him moving around he pushed one of the clamps into the apex of his lung and caused a collapse of the right lung = pneumothorax. 

It was pretty hectic. In the chaos I got to treat the pneumothorax which is done by placing a chest tube. I made an incision in the intercostal space and inserted a chest tube which immediately relieved the pressure and allowed the lung to re-inflate. It was very cool and bordered on rock star, no wonder surgeons get so full of themselves. I quickly reminded myself of all my weaknesses and was quickly brought back to reality. Placing a chest tube in this environment can be real tricky, you have the timing pressure and everyone is watching you, you are trying to make sure you are doing it correctly all while trying to not injure or kill the patient. Fortunately it all went well and I got to do my first chest tube.