I love my job

I love my job.



I had the pleasure drawing the night shift for Friday and Saturday night on the weekend of the Iowa-Iowa State game. This is arguably Iowa’s biggest rivalry game, ahead of Minnesota and Wisconsin (but soon to be outpaced by the “farmageddon”* that will be Iowa-Nebraska). For the state, this is the most important sporting event of the year. Just as in Los Angeles where every home can be identified as blue or red on the day of the USC-UCLA game, Iowans hang out their black or red this week. Also as in LA, many homes have split allegiances- this game pits brother against brother, daughter against mother, and uncle against cousin. For Iowa State, they pretty have a two game season: Iowa and Nebraska. Considering their usual level of football achievement, they don’t have much else to look forward to (I better be careful- my Program Coordinator is a pooler and a Cyclone and reads this blog).

[* credit: Pat Forde, ESPN]



The Saturday of the Iowa – Iowa State game, when played at home in Kinnick Stadium, is the ER’s busiest day of the year (just ahead of black Friday with all those shoppers trampling each other to get to the $30 blue ray players). And I got the night shift- sweet! I screwed my courage to the sticking place, arranged for some extra medical students to sew up the many lacerations, and poured a double mocha in preparation.



Friday night wasn’t too bad. Just the usual overnight ER crazies. Soon after my shift started at Midnight, the place was completely full, and we sent out the students in teams to tackle the lacerations and broken legs and other delicious trauma. We saw the usual heart attacks, strokes, and brain bleeding. There were college women with bladder infections, young men with toothaches, and nursing home patients with falls. Nothing too wild and it all moved through fairly efficiently. We had the place cleaned up nicely by 6 am.



I returned home and got to work immediately on the Game Day pancakes, which taste even better when you are tired and hungry. I also put bratwurst in the slow cooker to simmer while I slept (recipe below). I went to bed at 8 am, and slept the dreamless, comatose sleep of the mentally and physically exhausted. It felt as good as sleeping off a margarita hangover after a Jimmy Buffett concert, but without the toxic side effects.



I awoke at 2:36pm to the smell of cooked brats and the sounds of Hawkeye football. I piled the brats onto buns and mustard (spicy brown of course, no French’s here) and collapsed onto the couch to watch all the games (the brats are even better with a dark beer, but I had another shift in a few hours). Fortunately for me, the geniuses at the networks had stacked all the great games into the same time slot: Iowa – Iowa State, Ohio State- Miami, Florida State- Oklahoma, and Michigan – Notre Dame. Besides Penn State – Alabama and my beloved yet inept Trojans, those were the only games of the day I had any interest in. Sure, most turned out to be dogs, but how often do you get three national championship rematches in one day! (Ohio St/Miami, Florida St/OK, Penn St/Bama) For bonus points, can you name the years for each?*



I headed back to work early, at 8pm, because I knew there was a bad moon rising. The university has instituted a new policy of limiting tailgating in an effort to reduce binge drinking. We will have the scientific results on its effectiveness later this year, but early anecdotal reports suggest that we have less drunks getting into trouble at the game. As I walked into the ER Saturday night, I wondered if this means we will have less drunks getting into trouble outside the game.



[*2003, 2000 , 1979]



Uh . . . . that would be a no.



The “grease board”, or list of patients in the ER, was covered in complaints related to trauma, assaults, and yes, alcohol. (We haven’t used a grease pencil on the grease board since 2004) I gathered my slightly smaller, slightly less enthusiastic team of students and waded into the fray. After four hours of broken noses, cut feet from broken bottles, and more car accidents than I can count, I thought we had the place under control.



Then the bus unloaded . . . again.



Around 2 am, the waiting room filled completely with more lacerations, more accidents, and a few weird medical cases (what happens in a town full of bars at 2am? Hmmm). There was the worst case of “flesh eating bacteria” that I have seen in a while. We had an old man try to bleed to death from a ruptured kidney (not fun). And we had a couple of really bad, really deep lacerations that the patients just couldn’t explain. One man cut his elbow down to the muscle, alongside the dozens of parallel superficial cuts that are characteristic for a borderline personality . . . er . . . I mean “emotional intensity” disorder. When asked repeatedly what happened, all he would divulge is that he and his friends were “playing with knives.” There you have it kids: don’t play with knives.



Another woman presented with multiple lacerations on her left hand that she says happened when a glass broke in her hand. On a day with so much imbibing, that story is not unusual. But what was weird is that her hands, feet and part of her chest were covered in dried blood. It was quite a bit more than I would expect for a simple cut on the hand. As we went about cleaning her up, there was a palpable sense of conflict in the room between the patient and her husband. We found more cuts on her hand, legs, and one on her buttock (I still can’t explain that one). In the two and half hours it took to clean and close all the wounds, my medical student wisely asked about domestic violence. Just as with the man who played with knives, we never got a clear answer. The man left part-way through the treatment and it was obvious that he was at least partially at fault in the accident that caused the glass to break. But I think there were more than one or two glasses. The woman, although very upset, had the clarity of thought to call her mother into the ER and went home safely to mom’s. There is no mandatory reporting in Iowa for domestic violence, but the woman was encouraged to seek help and protection if needed.



This case, along with the man with the knife to his elbow, made me reconsider my role as a physician. Normally, I take care of whatever injury people incur, protect the children and elders with the force of the law, but let responsible adults go their own way and make their own choices. Here were two consenting adults that were in situations increasing their risk of harm. Should I remain on the sidelines as I always have? Or should I intervene myself in their lives to promote their security? I am still uncertain on the answer, so I have maintained the default and have done nothing. But these two cases made me think about it.



I love my job.



Fight On,

Hans



Bratwurst Recipe:

(this is made for a large crock-pot. For smaller units, use half the quantities)



1 dozen fresh, uncooked bratwurst

1 large onion, chopped

3 tart apples, peeled, cored, chopped

1 jar sauerkraut

1 bottle really good dark beer, like Guinness

3 – 4 cans really cheap ass beer, like Keystone light



Combine all the ingredients in a large slow cooker, cook on low for 6 hours. Remove the brats (they will be starting to fall apart- that’s OK) and reserve the cooked onion/apple/sauerkraut mixture. Serve the brats with buns, mustard, and a few spoonfuls of the cooked sauerkraut. For a more smoky flavor, try finishing the cooked brats for a few minutes on a hot grill. If you don’t have 6 hours to cook the brats, you can brown them in oil first, then cook on high for 4 hours in the slow cooker. The low and slow approach is definitely tastier!