Snowed In

We had at least eight inches fall last night. This morning they called it a Level III emergency so non-Healthcare folks could be ticketed for driving on the roads. The schools have been out all week. Some of the drifts this morning were waist high.

Our Chief made it in late, but Jason didn't, so the two of us did rounds at a fairly lazy pace. The morning procedures had been canceled. And while in the ICU visiting my favorite patient at the moment (a repeat ventral hernia repair) we came across a pretty fascinating ID case.

A 41 year old woman came down with Strep throat along with two family members. However, her infection progressed to necrotizing fasciitis. I couldn't see much since her neck was completely covered with dressings and a trach tube, but the nurse said ENT has had to debride her neck twice. She's almost been decapitated by Strep throat!! Obviously she has to have some co-morbidity like Diabetes or an immune-compromised condition. The infection is still spreading down her trunk, so it doesn't look like any antibiotics can save her at this point.

Even if she did survive, they had to remove all her neck muscles, so her trachea and jugulars are exposed. She'd never be able to move head on her own again. The whole thing is morbidly fascinating.

I didn't feel well around lunch, so I let Jason, the third student and our Chief John head over to the hospital where one of our Attnedings did an inguinal hernia, a Lap Chole and a Lap Chole that had to be converted to an open surgery. Attendings have only so much patience for removing big gallstones stuck in ducts with laprascopic tools before cutting the patient open. I missed some good scrub time, but I feel better after a long nap. And Jason just got home so it was a long afternoon in scrubs.

Tomorrow is Thursday, we have our half day a week of didactics starting at 7am. That means fast rounds starting at 6am. Hopefully I can peak in on the woman with no neck to see how she's doing - and maybe answer the question how this unheard of complication could have happened.