I had a really rough day today. My ACE experience this block is shadowing a surgeon who specializes in burns, wounds, and morbid obesity. As soon as I got there we went in to see lady who had had necrotising fasciatis of her lower leg. All the infected tissue was removed and the wounds were grafted over to heal. She had open sores where the graft wasn't completely healed. The second patient had just vomited, which made the entire room smell like vomit. She was a diabetic patient who had one leg amputated at the knee and the other foot in a boot due to a wound which wasn't healing. Then the doctor left me in his office to go have a late lunch and I met a really nice fourth year med student who was doing a diabetes elective and was also spending the afternoon shadowing the doctor. We talked about residency programs and family practice and diabetes. That was probably the highlight of my day. When the doctor came back we went to see a patient with finger wounds. The patient was a mentally retarded man who lived in a nursing home and was in a wheel chair. His finger wounds were caused by him biting his fingers. He had chewed his fingers down to the first knuckle so that none of his fingers bent anymore. As the doctor was cleaning the wounds I started feeling really warm and started seeing spots and feeling dizzy. Then everything started feeling very far away and I knew I was about to faint. The doctor was in the middle of explaining something to the patient and I had to tap him on the shoulder and say 'I'm really sorry, but I need to step out for a minute, I'm afraid I may pass out." I don't remember much after that except the nurse in the room took me back to the office and gave me a glass of water. After that I felt better, but I was so embarassed. Later we went back to this patient and the doctor wrapped his hands and talked to him about ways to prevent this in the future. Apparently they had designed hand guards but he had chewed through the straps and pulled them off, so now they're considering a hockey mask that locks in the back. The doctor told the patient their next option may be to pull out all of his teeth. I couldn't believe it. What little automaticity this man had was being completely taken away from him. The next patient was a young lady who was a senior in high school who was in a car accident and suffered a head injury and massive burns on her neck and shoulder. She was doing great and the skin grafts were healing, but it was emotionally difficult to think of this pretty young girl being scarred for life. What would her prom pictures look like...would she ever regain full mental abilities after the head injury...it was really hard. The next patient was a young man who was a freshman in high school who was playing with gasoline and it exploded in his face and burned his face and arms. His skin graft was taken from his scalp which added to his scarring. He was also healing really well and had full use of his hands and his face was almost completely healed. The next patient was all the way up on the 7th floor and before entering her room we all had to put on long plastic gowns and gloves. The doctor said she had had a bad infection and surgery a while ago and was not in pain and depressed, but I wasn't prepared for what I saw. When we entered the room I realized that she had had her body amputated from the belly button down. It was awful. Some other doctors in the room were working with her to fit her into a new prosthetic device that she sat in which would protect her soft tissues because she didn't have a pelvis. She had a colostomy bag which the nurses hadn't emptied in awhile. I felt like the doctors had stopped treating her like a person. The one good thing about this experience was that it solidified my desire to go into rural family practice. I'm sure I'll face difficult patients and situtations in a rural clinic, but I won't have to deal with gigantic open wounds and drastic surgeries and people who chew their own fingers off. After seeing things like this it really makes me wonder if I have what it takes to make it through the next few years and things like the surgery rotation in the third year. This was psychologically and emotionally exhausting...maybe I'm just too fragile. Today was really the first day of my medical school career that I wondered whether or not I have what it takes... | 
