Mr Pincushion

Example of how Internists are different from Surgeons. The hospital I trained at had 2 separate ICUs, Medical and Surgical. The Surgical ICU had mostly post-operative patients, or patients with something surgical related. The MICU had a Smorgasbjord of Respiratory failures of various etiologies, multi organ failures, etc. Occasionally the Internal Medicine residents would ask us to come help them with a Central Line, Arterial Line, Intubation. They never called for IVs because they couldn't start them, only the Nurses did. Anyway, I got called to put in a central line, they'd already tried on both sides of the patients neck and suceeded only in making him look like the subject of a bizarre accupuncture project. Walk down, put in a subclavian line, and as I'm writing my procedure note, the gaggle of Internists,Residents,Med Students, Pharmacy Residents, are just starting their discussion on why Mr. Pincushion is doing so badly. I go back into the room for a second, notice the patients abdomen looks a little funny. Looks, I don't know, sort of hard. Rigid. Its a good thing with your penis, but your abdomen shouldn't ever feel like theres a coffee table underneath the skin. I mention to the resident, that they might want to get an abdominal film in addition to the Chest Xray I ordered to check my line placement. Yeah, Yeah, he says as he turns back to the discussion of why Mr. Pincushion is doing so badly, is it type 4B Mediteranean Renal Failure? Maybe if they change the Antibiotic dose to every 4 hours instead of every 6? Fiddle with the ventilator settings? Don't forget to check a Sed Rate! Nice thing about Chest X rays is they do include the upper part of the abdomen. Check the film, no pneumothorax, and my lines right where it should be, where that big vein joins the Heart thing, well watta ya know, you can see the diaphragm above the liver really well, cause theres a thin black ribbon of air. Free Air, just like you used to be able to fill your tires with when service stations really gave service. Normally you shouldn't have any free air floating around your abdomen, it should only be in your stomach or guts. Of course if you've had your belly cut open, or someones pumped abunch of gas into your belly, all bets are off, but Mr Pincushion didn't have that. I walk over to the gaggle, and show them the X ray. They're all sorta giddy, cause they're thinking somethings fucked up with my line, and maybe theres a collapsed lung or something. The attending looks at me like I'm explaining why a backdoor slider breaks the way it does, he's not impressed, and they'll decide whether to consult my boss when they're good and ready thank you very much. I could have just walked away, secure in the knowledge that I was right, and Mr Haughty Internist would have to explain hisself when the X-ray report came back asking where the post-operative films were. Anyway, Saner heads prevailed, and about 30 minutes later we wheeled Mr. Pincushion to the OR and patched up his perforated Duodenal Ulcer(yeah, Patient was on Ulcer Prophylaxis, Prophylactics don't always work like they're supposed to) Funny thing was, when we left for the OR, the gaggle of Internists was just starting to round on Mr Pincushions next door neighbor, When we returned, just under an hour later, they were Still rounding on the same patient.