Trach butter

So, today I started a new rotation - Otolaryngology (also known as ears, nose and throat.) It's a two week rotation, and I'm back at the VA. Good old VA. And I am off to a great start. This afternoon in clinic, I had a patient that had a tracheotomy several years ago, and he'd come into today for a follow up visit. He was having some pain around his trach site and for the past week or so had some increased cough and secretions from the trach. I learned that you should never stand in front of someone with a tracheotomy while they're coughing - pieces of phlegm can fly projectile style out of the trach site propelled by the force of a cough. That's what happened to my clinic patient and it landed right on my pants. Sweet. All you can do is grab a Kleenex, wipe it off and tell your patient not to worry about the phlegm he just spit on you. My senior resident informed me that such secretions are called trach butter.

And now, I have to rant. In med school, you have no control over your time. You are constantly being told the when and where of all the minutes of your days, and you never get to go home until your senior resident tells you it's time to leave. It gets really frustrating - especially when your residents have no qualms about wasting your time. Like today - we had clinic in the afternoon. The other med student on the rotation and I saw patients and wrote the residents' notes, and we finished clinic early. I was told that I could leave after we went and saw the two patients on our service in the ICU. My resident then proceeded to spend the next 2 hours working on old notes, checking her email and on the phone making plans to watch The Bachelor later. Finally, we went down to see the two patients, and they really were not doing so well. One patient's neck was disintegrating. The poor guy was in really bad shape. I'm not entirely sure what happened, but a disintegrating neck is never a good sign.

My apologies for the cranky post. Oto blows. Too many ears, noses and throats. I have to go make my lunch for tomorrow and then go to bed - I get to see one of the two ICU patients and have a daily progress note written on him by 6:20am. Good times.