For Keeps

I am really not ready to start 2007, but it is becoming apparent that I don't have much of a choice. If I keep dating things 2006, people will just look at me funny like the morning last week when I timed and dated one of my notes April 1993. Oops.

Many times people start looking to a new year all goal-oriented and stuff, but I have kind of already set lofty goals for myself, so I am going to ask you a tougher question:

What do you like about yourself that you want to keep this year?

For me, I suppose that would have to be my sense of humor and my compassion for other people. Lately, work seems to be full of war metaphors. In terms of healthcare, sometimes it seems like an "us vs. them" scenario in which the patient is the enemy. (Boy, I sound like our hospital lawyer's worst nightmare.) It is too easy to become cynical. While I agree that when taking care of others, one needs to be able to separate themselves emotionally from their patients, I don't want to get to the point where I have to be reminded about the patient's feelings. And I am guilty of it to an extent, in that I keep a very close eye on the clock. My day is pretty much built up around leaving and getting everything ready to leave on time. Maybe I have been approaching burnout, but I should still be checking and rechecking my patients, rather than their labs and their orders.

So to keep my compassion and sense of humor, I plan on taking better care of myself. Slowing down more in my free time. Less to-do lists, and more time for myself. Letting the voicemail pick up if I don't feel like talking. More saying "no" if I don't want to go out.

Happy New Year!

Typhoid Gary?

Today, I was in the cafeteria dumping salt on my scrambled eggs and about to go hide in the resident lounge when one of the aides from the floor asked if he could join me. He sat down and started talking about his career aspirations and how his dreams of becoming a chef were ruined halfway through culinary school when the heptitis outbreaks started. Then he asked me if I had any kids. That's when I shoved all my remaining bacon down my throat and said I'd better get back up to the floor before they noticed I was missing.

I really need to figure out how to page myself at opportune times.

Half Full Glass

It appears that I have caught a nasty upper respiratory infection over the past week. Yesterday I am pretty sure I was swaying during rounds as I felt feverish and weak. Today I feel better, but I'm kind of raspy and my nose has been running constantly. I think I've lost about 3 lbs in mucus! I definitely cleaned out five or six of those tiny, wimpy hospital boxes of kleenex that were lying around the units. My hands are chapped too, as every time I sneeze or blow my nose, I reach for a pump of alcohol gel.

I feel bad as I am around a lot of really sick people right now. The last thing they need is a nasty cold. At the same time, if I go home, there's no one to come in for me. There are too many notes to write and orders to take care of for one intern to do by herself. No one's said anything to me about it, but I'm pretty sure it's obvious to everyone on the team and they're easing up on me. The attending has been picking only on the other intern... then again, maybe that's because I'm about 6 inches taller than him!

On the plus side, my sinus headache has completely disappeared.

Home for the Holidays

Yesterday after work, I came home and opened the packages that I have been eyeballing for the past week or so. One of them contained cookies baked by my mother. I suppose that Springerle cookies are one of the few reflections of my German heritage. They are a crunchy shortbread-type cookie with a slight anise flavor. I remember opening packages from my grandparents as a child and there was always an old coffee can containing the cookies wrapped in wax paper. Admittedly, they weren't my favorite as they were very hard and the design on the top of them that is made with a special rolling pin always reminded me of bugs. Now, being a coffee drinker, I have a new appreciation for the cookies.

After taking a mid-evening nap, I woke up and drove a few miles out for a candlelight service at one of the local churches. I don't think that I've really mentioned this here, but I haven't found a church community here where I feel like I fit in. There's so much history and tradition in this part of the country. However, that same chronicity also seems to have served as a dividing line. For example, there are over a dozen congregations of the same small sect of Protestantism that I belong to. I don't really even know what the differences are between many of these groups. I have floated around when my work schedule has allowed, and have found most of the churches that I have visited here to be pretty empty. It's not that it needs to be a large social club, but it would be nice to have some friends outside of work with similar beliefs.

Anyhow, the church I visited last night was full. The hymns were reassuring as was hearing the passages. Although I didn't go to the earlier family service, I was reminded of many Christmas programs that I had participated in as a child. Even after all this time, I couldn't help but snicker as we sang the second verse of "What Child is This":

Why lies He in such mean estate,
Where ox and ass are feeding?
Good Christian, fear: for sinners here
The silent Word is pleading.

I can still remember wearing a long-sleeved red velvet dress and having to sing with the other 8 year-olds in front of the church. My buddies Jay and Chad helped to increase the volume on the word "ass" and pointed at each other for the words "sinners here". I think that in the following years that the adult choir took over that song.

The service ended with the traditional lighting of candles from person to person. Just like always, the drip shields weren't quite adequate and I ended up with hot wax on my fingers during the last verse of "Silent Night". There are times when I question what exactly I am doing here as I frequently feel out of place, but last night's service was a reassurance that I am home.

Party Pooper

Last night was our intern holiday get-together. One of our chief residents had a party at her apartment earlier in the week. The department cocktail party was just a little while back. I think I'm officially partied out. For the most part, I'm a social person, but I think I do much better with individual interactions. I just feel so awkward and forced in large groups. I'm not very good at mixing, and I often feel like I have nothing to say or just am kind of observing conversations rather than participating. Then again, when it's the same people over and over, what more is there to say?

After sleeping in this morning, I dragged myself to the gym. I have been reading a book that one of the other interns loaned me about running. I haven't been all that impressed because I think that reading about running is like looking at magazine photos to take a vacation. It just doesn't translate well. The one thing that I have taken from it is that I was overdoing it with working out almost daily. This author recommends running 3 times/week at the most and using walk breaks to increase your mileage and prevent injuries. This has been a little bit unnatural for me as my method before was to pretty much just run until I was exhausted. However, today I ran for just under 4.5 miles! It took me an hour because I'm so slow and I was walking 2 minutes for every 6 minutes of running.

Other than that, it has just been a day of returning phone calls, doing laundry, and watching DVDs. I am working late on Christmas Eve, and partial days (hopefully) on Christmas Day and New Year's Day. I kind of have been anticipating working holidays this year. With my immediate family being so far away, I figured there was no way I would get the 3 days or so off that I'd need for travel. Happy holidays if you are celebrating!

Vacancy

The hospital census has been extremely low this week. Last week we were overflowing with patients, with many checking in for quick tune-ups. Now, with Christmas and New Year's Day approaching, people are impatient and insistent upon leaving. Many more are foregoing their own health and staying at home, ignoring signs and symptoms in order to be with their loved ones. And then there is a small subset of lonely types who want to be hospitalized so that they will have some sort of human contact over the holidays. It's strange-- one would think that heart attacks and pneumonias would come on random days, but then when emotions and human will are factored in, the patterns all get out of whack. I imagine next Tuesday will be crazy.

One of These Things is Not Like the Others...

This afternoon we admitted a patient for elective cardioversion. He has an arrhythmia, and rather than taking medications to control his heart rate and rhythm the rest of his life, he'd rather us just shock him back into a regular rhythm. He had this done successfully back in 2002, and basically just wants a repeat performance.

While I was belaboring over a beautifully eloquent admission note (yeah, right!) it occurred to me how fine the line of the law is. For instance, why can this dude choose and schedule to have voltage sent through his heart when execution via the electric chair raises so much protest? How bad can it be if this guy's doing it again? Granted, his voltage will be considerably less, but similar concept, no? Why can't we just sedate our inmates and then zap 'em? It seems a lot less painful than what poor Gram and Gramps go through when their pacemaker starts malfunctioning and zapping them erratically.

A similar comparison could be made for lethal injection. When someone comes in with an extremely rapid heart rate, we slam them with a medication that stops their heart. The effects last for just a few seconds, but this is sometimes done without any premedication, and I've been told it hurts like Hell. Why is this behavior kosher, while lethal injection is being labeled as inhumane?

I suppose when one analyzes it further, what makes it "good" or "bad" is the intent behind the action and whether or not it's agreeable to the recipient. If Mr. X stands to benefit from the treatment, and our specialists aren't acting outside of their "scope of practice", then it's all aboard for electricity and antiarrhythmics. What if death row inmates got to choose from a variety of options? Would that make it more humane?

I don't believe that the death penalty is a deterrent for crime, but I think it's silly to house anyone for the entirety of their life. It just seems like such a waste of space and resources to me. I've heard arguments that life sentences are a greater punishment, but if we're really looking to punish people as severely as possible, then I think you have to forget about the whole humane argument.

And now that I have probably offended my handful of loyal readers, let the silence begin...

Brilliant

I was on "short call" tonight. That means getting to work at 6:30 am and staying until 8 pm. It's team call, but I don't really feel very involved with this particular team. They kind of overexert themselves and write orders on my patients while I sit back and wait for the staff to call me if there's a problem. I can check labs just fine from the safety of the resident lounge with CNN on in the background and my latte in my left hand. There's no reason to pace back and forth across the floor, asking poor nurses and secretaries why your orders haven't been carried out. That's just crazy. Besides, if the other intern in her desire to become a cardiologist and impress our attending wants to do every admission note and not only manage her patients but invade my space, who am I to stop her? I am quite content to breakfast, caffeinate, lunch, and recaffeinate all while compulsively checking my personal email over and over. I mean, one should pick their battles, right?

I'll always remember shedding many tears after receiving my first "C" ever during my first semester in college. It was in general chemistry. I should seriously thank that professor. Although at the time I was devastated, I think that was the beginning of the end of my perfectionism. The older I get, the more willing I am to let go.

So tonight, instead of leaving at 8, I asked to be excused at 7:15 to attend an interview with resident applicants at one of the pubs downtown. My "teammate" was almost gleeful to run the entire floor by herself for almost an hour. So rather than getting home by 8:30, I got home at almost 10 pm. Brilliant. Rounds tomorrow will come awfully early, and I have no one else to blame for my own tiredness, but I think getting out did improve my mood somewhat.

Trouble

One of my English teachers in junior high used to call me "Trouble". I think that perhaps I should tattoo my forehead to warn off men. BDG keeps calling, despite my "I don't have time to talk to you every day," and the more classic, "Oh, I forgot to call you back," subtleties. I guess I would rather just be by myself than have that kind of drain on my time right now. Maybe if there was some actual chemistry between us, I would feel differently.

Last week, one of the other residents asked me if I was dating one of the other interns. I've been hanging out with him quite a bit, apparently too much. He's got a great sense of humor, but it would be really horrible to date and break up with someone in the program. Too much contact and all that stuff.

On the other hand, I have had a medical student on my team the past week, and he's been really sweet about helping with all of my more mundane tasks like writing prescriptions. He's done with our service after this week, though. I've been showing him little tricks here and there... like what medications are more effective at making people poop. Maybe young and naive is a better route for me than older and wiser?

The Happiest Place on Earth

Lately, I resemble a woman from an Excedrin commercial, touching her temple and wincing with pain. I talk about work entirely too much here, but it just seems like I'm getting pulled in all different angles at once.

It is one thing to get paged and questioned at the same time. It is quite another to get paged and questioned while being bumped into, brushed up against, having your chair stolen repeatedly, and having people pile crap on your stuff and misplace your paperwork... all with a background noise level equivalent to an industrial vaccuum cleaner. Perhaps it is partly the sinus headache I seem to have had for the past THREE weeks, but I just have so little patience lately. One of my patients even looked at me the other day, and said "What's wrong? You usually are much more perky!"

My own personal mascot has become that little pink starfish from "Finding Nemo" who freaks out and wails, "Find a happy place, find a happy place!"

Somewhere Out There

Somewhere a woman in her 30's lies comatose, the victim of a catastrophic heart attack. She was programmed that way, familial heart disease. Her five small children visit every day with their father, hoping and praying. Today her toe twitched. Her husband has renewed hope, but the neurologist says there is none.

Somewhere a woman sits alone in a nursing home. No one has visited her in weeks. She has no idea that she wasn't supposed to make it, that her family had decided on a "terminal wean" from the ventilator. They were actually disappointed when she kept breathing on her own. Who's going to take on care of mother now?

Somewhere a woman sits in a rocker in an empty nursery. The twins should have been born last month. She knew something was wrong when she hadn't felt them move that last day. The ultrasound revealed what she already feared: no heartbeats. What she hadn't expected was the news that her unborn babies were captured on ultrasound holding hands.

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Life is not fair. Many of us are told that as children by our parents, but it's a lifelong struggle to be comfortable with the concept. People get angry, and look for justice when really there is no way to equilibrate their losses. I've heard it said over and over that people don't believe in God because this or that happened, and that a "just God" wouldn't allow such things to occur.

In the end, it all comes down to faith. I don't understand why bad things happen to seemingly good people, or why miscreants seem to get chance after chance. I suppose that in a fair world, there wouldn't be much learning. After all, one can't learn to walk without first falling down a few hundred times. The best I can do is believe that all of this unfairness has a greater purpose.

I don't really have much to write about. Here's something from my past:

I remember standing on the cool metal at the top of the slide of our backyard swingset. It was tall enough that I could look out over the top of our house and see for miles... the few skyscrapers that were downtown, a small levee and overgrown trees to the south.

In the distance, men rode on tractors lighting the fields on fire behind them. Huge billows of black smoke trailed behind them, rising and diluting in the blue sky. The flames burned hot and fast, but extinguished almost immediately, after reducing the dry stalks. Small, black ashes drifted in the currents of the wind and I tried to clasp my hands around them. The burnt remnants curled and flaked in my fingertips and left behind a smoky reminder of their presence.

The smell of a wood fire today still reminds me of the end of sugarcane season.

Agua

Pictures from the other weekend:




The roaring water made me want to build a trans-national pipeline and fill this in:


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I finished with baby delivering on Saturday. It was fun, but at times exhausting. Now I'm back at my hospital again, which is nice because I run into familiar faces here and there.

More Merriment

The workplace Holiday Drinkathon was last night. Open bar, chocolate fountain, assorted fried appetizers, the usual things. I think this one was restricted to residents, attendings, and their families. Afterwards, we went to a bar, and after that to Denny's. I can't remember the last time I stayed out until 2 am. Only a few unpleasant remarks were exchanged here and there, hopefully soothed by alcohol. McNeedy was making unintelligable statements to the higher-ups and my buddy and I tried to steer her away, but perhaps weren't quick enough. Oddly enough, she wasn't drinking at the time.

I'm not really sure what the logic is behind getting a large group of coworkers together and supplying them with alcohol. I know that these parties happen all across America, but unlimited amounts of alcohol with one's coworkers just seems like a recipe for trouble. It seems like a bad formula to me, but the drinks were tasty!

Haiku This

My friend, Ru, is quite the poet. I envy her as I can't manage more than a silly haiku every now and then.

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Holiday Lights

Twinkle, twinkle, lit-
Crap! I slipped off the ladder!
Stupid broken neck.

Cliche

One of my high school English teachers used to circle cliches angrily in red on our papers. If she found one, you were sure to instantly lose points. I often daydreamed of writing in nothing but cliches, hoping to create a product so soaked in red ink that her pen ran out. Ah, teenage rebellion...

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I feel like my writing here has been stagnant of late. Same $%*#, different day. Last night I worked another 24-hour shift. Like a fool, I put all of my eggs in one basket. I went to bed late the night before, thinking I would certainly be able to sneak in a nap somewhere during the day. It was nonstop action from 6:30 am - 1:30 am.

There was no calm before the storm.

I was up a creek without a paddle.

The staff (myself included) was running around like a bunch of chickens with their heads cut off.

There were many women around with buns in the oven.

I felt like a deer, caught in the headlights.

This morning, after being there for 26 hours, someone "accidentally" signaled a cardiac arrest on the Labor & Delivery floor. I was terrified it was someone I had admitted last night and hadn't heard anything about since. I sprinted down the hallway to find that it was actually the scheduled c-section patient I hadn't even met. When I arrived breathless, with my heart racing in the OR, a trail of residents scrambling in my wake, I found that not only had the patient not arrested, but she was awake and lying on the table talking to the anesthesiologist! They had simply wanted another obstetrician present for the section as the baby was starting to look distressed and had paged out a cardiac arrest by mistake... clearly when it comes to that staffer's brains, the wheel was turning, but the hamster was dead.

To talk more of this would be beating a dead horse.

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BDG was here this past weekend. He's a nice guy and we had fun hanging out, but he's clearly not Mr. Right, or even Mr. Right Now. I thought I had eloquently explained this to him on Sunday when we talked about how there could be no "us", and that we both have other things to worry about. I even told him that if he meets someone back home he should go for it. However, he's called several times over the past few days. It was fun having someone to do things with, and we did a bit or wandering around, but I really don't like having someone around all the time. I'm sure the calls will taper off eventually.

I also saw McNeedy today. Fortunately, she was smart enough to not ask about my weekend.

Ahem

So yeah, apparently I'm not exactly a great communicator. About 10 minutes after my last post, "needy co-worker" called me up complaining that she's fat when she's about 3 sizes smaller than me. How rude do I have to be? I guess at least I'm learning how to be more confrontational.

Right now I'm ticking away minutes in the call room. I really just want to go to bed, but I'm stuck waiting on some lab results so that I can send someone home. Labs and pagers, these are the enemies of an intern.

Think Happy Thoughts

I'm ok, but I almost completely lost it with a co-worker tonight who won't stay out of my business. I have told her over and over that I keep my personal life personal, but she just keeps prying and trying to guilt me about not opening up to her. I told her off, but I think I was pretty diplomatic about it. I really just want her to leave me alone. Someone with common sense would, but then I'm not exactly dealing with that here.

The plan is to just relax when I have time off and avoid all contact... perhaps with everyone. Kind of like mini-hibernating. Maybe I'll take a day trip somewhere this weekend and get out of town. No phones, no internet, no pagers. It sounds lovely already.

Eat, Drink, and Be Merry

I think I accomplished all three of the above over this weekend, and even risked four hours of shopping on Friday. I even managed to find a cocktail dress for the upcoming department party! It actually wasn't all that bad, but I still have quite a bit of shopping to do. With having relocated this year, unfortunately most of my gifts will require shipping. Argh. The goal is to be done with it by next week.

My body took advantage of having three days off in a row by completely shutting down yesterday and going into full-on exhaustion mode. I guess I had it coming.

Today I'm back for another 24-hour day at the hospital, which will end with my semi-annual evaluation with my program director tomorrow morning. Yuck. I like the guy well enough, and I actually have some entertaining tales to tell him from "medicine" last month-- let's just hope I'm not completely delirius. Wish me luck!

Seriously?

24-hour call, again.

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My head hurts.

I just got paged by a local pharmacist wanting to know how much Robitussin with codeine to give to my pregnant patient. I wrote "1 bottle". You would think this would translate to whatever standard cough syrup-sized bottle is on the shelf. You would think wrong.

This guy tells me, "We carry this stuff in bulk, I can give her as much as you want."

I'm thinking: that's great dude, give my pregnant patient everything you've got, give her so much cough syrup with a narcotic in it that she can't carry it out the door. Let's see what happens. Perhaps she can score some sweet cash on the street for that stuff. Instead, I say: "How much did I say she could have?"

"You wrote for 1 teaspoon every 4 hours." (1 teaspoon = 5 mL)

"Good, let's give her enough to last her just a few days."

"Um, so how much should I give her? We carry it in bulk. I've got TONS of this stuff."

"Just give her a small supply, she's going to see her real doctor soon."

"Ok, how about 500 mL?"

Seriously? Seriously? Did you really just say that to me? This is a controlled substance, and my DEA number is technically not even real. "Um, let's go with SIXTY."

"Ok, we can do 60. Just so you know, I have this stuff in bulk."

"Great, thanks. You might want to save some of that stuff for someone else." Click.

And yes, I am being a little stingy with the supply on this one. My attending approved the dose, but I still don't like giving it, and the patient said she really didn't want to take it anyway.

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My head hurts.

Just prior to that I got a call from the nurses' station. Apparently, one of them is vacationing in Chicago with her mom, and wanted to know if her mom's antibiotic eye drops could be causing the rash on her face.

1. It's 10 pm. I have been here since 6:30 am.

2. I'm an intern.

3. I'm an intern on the "Obstetrics Service".

4. I don't even know this nurse.

So what do I do? I get out of bed(!), walk down there, punch the drug into my PDA and say, "Nope, don't think so. She probably doesn't need to go to the ER unless she can't breathe or her mouth/throat starts swelling up. Glad her eye looks better. Happy Thanksgiving."

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My head hurts.

I currently have an "induction of labor" cooking. Only instead of putting in a cervical-ripening agent that lasts for 12-hours, my attending went with the one that lasts for 4. This means that I have to check the patient and place another tab at 11 pm, 3 am, and 7 am. Perhaps he hates me? I don't know, I think perhaps he just didn't think about it as he also ordered her a sleeping pill. How is she supposed to sleep for 8 hours if I'm supposed to check her cervix several times overnight? Then, in the morning, after she's had a crappy night's sleep we'll start the pitocin drip, which will make her uterus start contracting and she'll really feel awful. Great technique, eh?

Just a few more minutes, and hopefully we can get her next dose going and I can grab a few hours of sleep.

A Bit of Bell Ringing

One of the nurses this morning said something about how she couldn't believe it was November 21st. Having had my coffee prior to rounding this morning, I quickly shot back, "I can't believe it's 2006!" And yeah, I was being a smartass, but I can't believe how fast this year has gone by. Many days I feel like I just got here. And yet there are signs that I've adapted: most days I am no longer consulting a map, and I have actually given someone else directions to get around town.

Given the time of year, some of you may be looking for a charity to make a contribution to. Or perhaps this is a daily challenge, as you sit around a room filled to the ceiling with Benjamins, thinking "I wish I could get rid of some of this cash."

Anyway, I just want to put in a quick plug for Heifer International. They help battle against hunger and create self-reliance for many impoverished families by providing them with livestock and training. You can contribute as much or as little as you want, and there's something rewarding about ordering something physical like a basket of chicks or tree seedlings to send to a family. I had never heard of this charity until Silk mentioned them in her blog one day, and I'm glad that she did.

I'm off to the grocery store. We're having a potluck on Thursday and I'm going to attempt to make my mother's mashed potatoes of buttery goodness. It will probably end up with me ruining her reputation as an excellent cook as my reproduction will be a mockery of the real thing. I guess I need one of those hand mixer thingy's as well.

Alarming

Since I didn't leave the hospital until after 8 am on Sunday, I wasn't required to be there for 6:30 rounds this morning. Hip-hip-hooray! At least that's what I was thinking when I went to bed last night. And yet, at 5:00 am this morning, I was awakened by alarms. At first I thought I had forgot to set mine back the night before. Then, I realized the noise was coming from outside.

I was thinking that is must have really dumped on us overnight as there were some flurries last night when I went to bed. However, when I peeked out the window, the streets were snow-free. The noise was that of several plowers, however they were scooping up the piles of leaves that have been pushed into the streets. Why there is a need to do this when those leaves have been there for at least 3 weeks, I'll never know.

It was still chilly outside. As I pulled out of my driveway, I noticed that there was a dusting of powdery snow on each roof, although none remained on the ground. The houses were decorated, like they were dusted with sugar... or perhaps cocaine--whichever simile you prefer, you decide. Anyway, it was powdery!

Long Road Ahead

My shift on call wasn't too bad. We had a c-section at 2:30 am. This one wasn't technically a "crash section" as the baby looked good. The woman had gone into active labor, and was scheduled for a section on Monday as she was 2 weeks past her due date, and the baby was estimated to be too large to deliver. At 5 am a "first-timer" came into triage, and to our surprise, she was over halfway dilated and ended up delivering at 7 am. This woman was a champ-- she labored mostly at home and had less than a half-hour of active pushing. All with only one dose of narcotics, and no epidural. I must admit I'm somewhat scared of the idea of giving birth.

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I was looking back at some of my older entries, and I came across this one. It occurred to me that I haven't done any goal setting in a while. Today I was back at the gym. I jogged for almost 37 minutes straight, and was able to do 3.5 miles without any breaks. Not bad, eh?

So here's my new set of 90-day goals:

1. Owe less than I do today. Lately, my credit card debt has been increasing, rather than decreasing.

2. Be at the gym at least 3 times/week. I think it is a little less depressing to set a schedule for myself rather than a goal weight.

3. Make some local friends who don't work at the hospital.

Uh, long-term goals I'm still not so good at coming up with. I do want to travel more, and figure out my career of course, but I have a hard time thinking that far ahead.

Lost and Found

Imagine it: there you are, asleep in your own room. It's completely dark, the temperature is perfect, and there is no place else that you feel more safe. A soothing lub-dub creates a gentle background noise that lets you block everything else out and go back to sleep. Your heart rate begins to slow, as you drift off...

Suddenly, the room shifts, and the pressure in the room itself begins to increase. A white light pierces the room from just behind you. It blinds you with a harsh intensity that you've never seen before. The very wall of your room is splitting open. You want to scream, but you can't. Not yet. There is a sudden burst of air against your skin, and giant rubber tentacles clamp over your head and drag you out of your room... surely, to certain death.

And suddenly, there it is. You can scream, and you do. With all of your might. The noise is overwhelming. You suddenly realize that you are completely soaked. And naked. And it's freezing. The tentacles are moving all about, and before you know it, you've been grasped by your shoulders and feet--not unlike a pig on a spit-- and passed over to a warm, dry bed. The tentacles use warm, white cloths to dry you off, but the noise is still there. It is deafening. You scream and scream and scream, but you're lost. You don't know where your room is. It is gone.

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That's how my morning started on Friday, only my hands were one of the sets of rubber tentacles.

6:30 am- It started when we walked by the OB triage room. Normally, heart tones on external fetal monitors tick away at a staccato pace. This one was about half what it should have been-- it was just above the pace of a second hand. The patient had been scheduled for a cesarean section at 7:30. The slow heart rate was a sign that the baby might not be getting enough oxygen-supplying blood via the placenta. We repositioned the patient and gave her oxygen, but there was no improvement in the baby's heart rate.

6:45 am- I'm scrubbing in at the OR

6:50 am- The first incision was being made.

6:54 am- The baby is out, and "just fine".

Although I've scrubbed more c-sections than I can recall, this was only my second "crash" c-section. My responsibilities are minimal as a resident in the OR, so I can just stand there, hand things back and forth, suction up blood/fluid, cut sutures, and help with the closing. I really like scrubbing in because you get to see a lot, without being the one under pressure.

This surgery was interesting to me because unlike all of the other ones, they did a vertical incision on the skin, but did the regular, low-transverse incision on the uterus. It's always fascinating to me to see the variance in practices of different doctors. This particular obstetrician believes he can get the baby out faster using a vertical incision.

Even more interesting, was that during the case, the scrub tech asked the doctor where a particular pair of forceps was. He had dropped one pair on the floor in all of the rush, and was using a second pair. However, the third forceps was nowhere to be found. Nowhere. Much cursing ensued. It is part of the tech's job to count the equipment before, during, and after each case. As there was no time beforehand, the pre-packaged kit was opened and used without counting. A similar problem had happened last week when the same forceps was missing from the kit.

He couldn't be sure that the forceps had not been included in the kit. All we knew was that we didn't have it. It could have never been included, or it could be lodged somewhere in the bedding, the patient's abdomen, or her newly sewn-up uterus. Bad times. Much more cursing ensued. Threats to file a formal complaint against the packaging service were voiced.

Then, I said very quietly, "I guess we need an x-ray."

"X-ray!" he bellowed. "I want x-ray in here now!"

While we waited for the x-ray to show up on the computer in the OR, he performed the tubal ligation, and we started closing. The x-ray confirmed our suspicion. There were no forceps in the patient; they simply had not been in the kit.

The rest of the day was uneventful. Today I'm back for a 24-hour shift. I'm kind of lounging right now. My work is done. I'm just waiting for the next mess to begin. None of the other residents wanted to scrub the case yesterday. It was the best part of my day. I guess I am an adrenaline junkie. Today, mama and baby are still looking great.

Toxic

On Monday, I participated in three delivieries. I was surprised the doctors let me do as much as they did on my first day since they didn't know me at all. Call overnight was painful. We had started inductions on a couple of ladies, and one didn't tolerate the medication at all. Part of night call responsibilities for this rotation involve returning messages to women calling the answering service with complaints. Surprisingly enough, I was actually able to answer a couple of the callers questions and prevent them from having to come in. I almost felt like a real doctor for a minute or two!

Today I attended an all-day toxicology conference. I had been looking forward to it for over a week as it meant an entire day outside of the hospital. Most of the speakers were well-prepared and had great powerpoint slides, but I just couldn't focus on anything. Normally, I'm interested in toxicology, as it's kind of a mystery to figure out what sort of medication the patient has taken to cause their symptoms. I just felt confused the entire time. I'm not sure that I gained a single thing out of the whole day, other than more calories than I should have consumed.

I had planned on going to the gym tonight (I went for a short run yesterday) and doing some homework, but that got dashed to pieces when my friend called in tears saying she was having a breakdown. Instead, I drove to her house where we watched "Lake Placid" and ordered Chinese food. I really didn't want to go over at all, but she's so unstable emotionally that I just felt like I had to. It's hard to be supportive of someone who internalizes everything and thinks everyone's out to get her. In reality, I'm pretty sure she is not much of a concern to everyone else. I also went over there partly because I felt kind of guilty for asking her if she's been taking her medication.

And then there was the 30 minutes I spent listening and supporting my other co-worker whose pregnant fiance is obviously having gallbladder issues.

Maybe it shouldn't come as any surprise that I often just want to sit on the couch in front of the TV and not answer the phone.

Just Call Me "Grace"

My mother told me once that her and my father picked my middle name because my first and last names were so long that they thought that the middle name should be short. My middle name, Ann, means "grace". This has always been somewhat laughable to me as I am anything but graceful.

Over the past 4 months I have been acclimating to life with hardwood floors. When I looked for a house, I specifically sought out one with hardwood floors. I have allergies, and didn't want to deal with musty carpets. For the most part, they make me happy. I can often be seen taking a few quick steps and sliding for a foot or two in my socks ala Tom Cruise in "Risky Business" only without the tighty-whiteys.

Anyway, on Sunday without even thinking about it, I went running up the stairs in my socks and tripped, striking my left thigh on the edge of a stair. People, I look like I've been hit with a baseball bat, and not just once, but a couple of times. I now have a dark bruise that wraps around the outer left half of my thigh, and it's larger than the area of both of my hands.

One of the things they teach us is that there are three areas of the body that one can bleed out into: the abdomen, the pelvis, and the thighs. One can lose a lot of blood into the chest too, but usually you will have symptoms of difficulty breathing from compressing the heart before all that much of volume has been lost. So there you have it-- a lesson in common sense and a reminder of the workup of a trauma patient all in one moment of clumsiness.

Regrouping

I survived my last call night on medicine! It was miraculous... no pages after 10:30 pm! I slept a whole night without being disturbed. I actually kept waking myself up every few hours to check my pager and make sure it still worked.

Tomorrow I'm on call for another 24 hours to start off my first day of my OB/Gyn rotation. I like delivering babies, though. It's not always convenient, and the hours are even longer, but it's fun. Besides-- 99% of the time, the baby and placenta just come out on their own, with your main function being to ensure that the kid doesn't fall to the floor and split its head open. And it's generally a happy environment, with nurses who really know their stuff and run the show... especially when the attending can't be bothered to make it to the delivery on time.

How to Save a Life

Ok, so the correct title for this entry should probably be something along the lines of "How to Keep a Senior Citizen from Having His Ribs Unneccessarily Broken", but whatever.

Today I was all done with my work, so I was just sitting around when all of a sudden a "Rapid Response" went off over the hospital intercom. A "Rapid Response" requires every available resident, respiratory tech, and critical care nurse to rush over like a mad person to try and help out.

Anyhow, one of the other interns and I took off down the stairs and over to endoscopy, where some dude had stopped breathing after they had given him some sedation medications. I was helping a respiratory tech give him some breaths via a bag-valve-mask when someone goes, "He doesn't have a pulse, start CPR!" Unfortunately, that person was feeling around unresponsive dude's feet when she said that. (Small arteries are not a good place to check for a pulse when in a critical situation.) I reached down and felt a good femoral pulse, and before they could do anything yelled, "NO CPR!" We hooked him up to a monitor which showed that heart was still working just fine-- he just had stopped breathing on his own after being given a benzodiazepine.

By that time, anesthesia arrived with a reversal agent which woke him up. I'm not really sure why the guy was sedated without being hooked up to a cardiac monitor, which would have let everyone know right away that he was still having a good strong pulse and in a regular rhythm. I'm also not sure why whatever surgical specialist stood back while an intern stepped in and assessed his patient, but then there's quite a few things about this hospital that I don't understand. I think the other intern was hovering somewhere in the corner during all of this, but then he's going into ophthomology, so maybe I shouldn't be too critical.

Tomorrow's my last day on inpatient medicine. Unfortunately, it's another 24-hour shift on call. I'm just hoping for more than 20 minutes of rest.

Cuckoo's Nest

With her heart racing, and her feet hammering down the stairs as fast as she could go, she ducked out of the stairwell. She had to get there quickly-- not that it would make any difference, but she was expected to be there. Heads would be counted, and if hers wasn't one of them, there would be consequences.

She flung open the stairwell door so hard that it bounced off the wall. Ahead of her, a metal pair of double doors was just about to shut. She slipped through, careful to avoid their menacing pathway.

She had never been in this hallway before, but she was sure that it was a shortcut. It would save her time; it had to. Where else could it lead but to her destination?

The doors closed with a confirmatory thud.

Ahead of her was a long, narrow hallway. There were no doors. People were scattered randomly along the hallway. All of them were talking, and yet not to each other. Some were in jeans, and some were in wrinkled hospital gowns, with only pasty, spindly legs supporting them.

She spun back around suddenly. The doors were locked.

There was no way out.

She looked frantically along the wall for the button.

Her eyes met his.

He hadn't shaved in about three days and there was a rolled up piece of paper dangling from his lips-- a crude imitation of a cigarette.

"Right here," he leered. "The way out."

He pointed to a intercom button. She jabbed it with her finger.

"Yes?" a cold voice inquired.

"Uh, I think I took a wrong turn," she sputtered. "I really shouldn't be in here," she said while looking up at a sky of insulated tile, her eyes searching for the video camera.

"Honey, neither should I. None of us should!" cackled a voice to her left.

She strode out of the unit and didn't look back, her face flushed. From then on, she would stick to more familiar passages.

Rollin'

As part of the next phase of my "Let's Not Die This Winter" project, I put snow tires on my car today. A couple of my friends were surprised when I mentioned that I was doing this myself, but it's really not that hard. I went to www.tirerack.com and bought a winter package to include tires and wheels. The tires show up at your door in about 4 days. Installing them took little over an hour. Best of all, it didn't include sitting around a greasy lobby trying to be engrossed by a 2002 copy of People magazine while someone else did it. If you are going to change your own tires though, perhaps the most important thing besides knowing where to put the jack is using a cross-shaped tire iron. It makes the job much easier.


Afterwards, I took the car out for a much-needed wash and vacuum. I cleared enough space to be able to park in the garage, too. The next step is an automatic door-opener, but that is not a project I'm going to attempt.

Short Circuit

Sometimes it is the little things that surprise you. Of course I knew that the leaves would fall as it got colder. What I didn't know is that they would fall in order. The leaves on the maple out front are like mini-paratroupers... all crammed in together, each one waiting for its turn to jump. It was surprising to me how orderly they seemed to fall, starting from the very top of the tree and working their way down the branches.


I am sure there is some sort of scientific explanation for it-- such as the nutrient-providing xylem and phloem not being able to reach the distal tips as efficiently. Perhaps if I had paid more attention in botany I would know, but then that kind of destroys the romance of it, doesn't it? Not exactly the sort of thing Walt Whitman would write about, I suppose.


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I worked a 24-hour shift yesterday. We had 9 admissions overnight. That's a whole lot of paperwork. One of the worst things about being an intern is that you aren't independent. Most of the time I end up being micro-managed by a senior resident, whose own responsibilities take precedence over mine. Sometimes they aren't the greatest at time management.

The hardest thing about being on call is that in addition to managing your own stuff you take calls on patients that you've never met. Half the time is spent trying to catch up, while being constantly interrupted by other junk. And then, because a lot more mistakes are made overnight, it's always necessary to check and re-check orders against plans to make sure that the morning team has everything set up. I slept 20 minutes total, and had about a 15-minute lunch and scarfed down a bagel at midnight for dinner while checking labs. Because we were so far behind all night, I didn't get to start my morning notes until we had signed out to the new team. I ended up staying 27 hours, at which point I got sent home.

Last night my PDA died again. This time my pharmaceutical program keeled over due to some inborn error, which just slowed me down more. Medicine is all about being able to access information quickly. And then, after I woke up this afternoon, I realized that I had left my cell phone at work! The electronics, they are out to get me!

Between all the quality of life issues we deal with, sometimes I think it would be better to go back to having only a handful of medications. So many people are on so many medications that it's all too easy to dose things incorrectly or have interactions. There was a pharmacist (not the cute one) that paged me about a dozen times last night. He kept cancelling my orders and switching medications without even speaking to me. In one case he stopped something because he thought that the patient was allergic, but she just develops some nausea and she'd already been given the medication by the ER without any problems. In another case, he switched someone to a cheaper antibiotic, but he wasn't aware of the culture results and didn't know that the bug was resistant to the cheaper med. Micromanagement, I hate it.

And then there was the nurse that paged me at 2 am to ask for the correct spelling of my name. My name is misspelled in charts all over the place, it's not really a big deal. Apparently, she thought I would get ticked off if I saw it misspelled in the chart. Fortunately, I wasn't sleeping, but I think that perhaps that one takes the cake for the most inappropriate page ever.

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Theme song for last night:

You need to know your friends,
You need to know that
I'll be waving my hand,
Watching you drown
Watching you scream--
Quiet or loud.

And maybe you should sleep,
And maybe you just need...
A friend.
As clumsy as you've been,
There's no one laughing.
You will be safe in here...

"Clumsy" -Our Lady Peace

Craptastic... literally

My friend, Ru, once wrote about driving down the road and spotting some roadkill lying there with a fresh coat of white, striping paint running right over its flattened carcass. Her observation was how no one bothered to take responsibility to move the dead beast because "It's not my job."

That was kind of how my day was today. So far November is kicking my butt. I think I had a 15-minute break total during my 10-hour day. The story is too boring and difficult to condense, but it basically ends with me having to do a rectal exam on a patient that should have been done 5 days ago. In the process, I got chewed out by a discharge planner who said I had to "get it done in the next 10 minutes or the patient won't have a bed to go to tomorrow" when said discharge planner did not return my pages for > 2 hours earlier in the day.

From my point of view, today's chain of events are the end result of a big steaming pile of incompetence involving the admitting attending, senior resident and intern; the intern that dumped this patient on me; my senior resident; my attending; and the discharge planner. I have no idea if this lady will get out of the hospital tomorrow or not, but I think the above persons should have to split to $500 cost of another day in a hospital bed between them. I was fuming by the end of this task, as I couldn't simply develop the test card on my own as there is another steaming pile of beaurocracy that prevents one from being able to get anything done without formally having a nurse enter orders in a computer.

If I was a smarter woman, I would have just told the planner that the task was impossible to get done that quickly and not spent another second worrying about it. But I am not a smart woman, and I don't even heed my own advice about not letting people get on your nerves.

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And then I stepped out into the night... It was only 5:15 pm, but the sky was completely black. Snowflakes twirled in the yellow light of a streetlight. The flakes stuck like velcro to my black wool peacoat, and for an instant it was oddly tranquil, the calmness flickering down on me like the little chips of plastic in a snowglobe.

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I went for a run at the gym after all of that. And now, instead of being exhausted and angry, I am simply exhausted.

Sea of Discontent

Tonight I lamented to a dear friend about how lately I just seem to be so dissatisfied. It doesn't even have anything to do with work. Everyone there is nice, my patients are doing well, and I actually haven't been all that busy. Yes, the hours are long, but that's not something that is within my control.

The problem is me.

I don't know what the solution is. When I'm at work, I just want to be at home. When I'm at home, I feel resigned to waste a few hours away until it's time to go to sleep. When I'm out with friends, I just want to get away. I feel like a hollow shell of a person, just moving along a conveyor belt from work to home and back again.

Fortunately, my friend was very tolerant of my complaints. And maybe her therapy of just listening was what I needed. I am sure that at some point I will snap out of this, but right now I am just plodding along-- one foot in front of the other.

Tempests

Right now as I sit in the living room the wind is howling. The leaves outside are blowing by almost horizontally. The air is rushing so quickly through the chimney cap that it sounds like a tea kettle. It has been cloudy and rainy all week and it gets dark very early in the evening. If you look outside, the sky is completely dark, but for a thinner strip of blue in the west. It's not that the sun isn't there-- we are just being completely smothered from daylight by clouds.

This morning I watched "Eternal Sunshine of the Spotless Mind". The movie is about a character who attempts to erase the memories of his ex-girlfriend. The movie got me thinking about memories and how much time we take for granted. When we think about our past, why is it that only certain days are remembered? I can remember certain highs and lows during my lifetime, but what is it about the bulk of my days on this planet that aren't worth remembering?

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Last night I went to a Halloween party with one of the other interns. I dressed as Paris Hilton by wearing very trampish clothing over a skelton costume.

Complete with her dog, Tinkerbell:


The night was uneventful and there were only about 10 people there, half of whom my friend wasn't on good speaking terms with-- which made for an awkward night. I definitely need to work on meeting more people outside of the hospital.

Gluteus Painimus

I HATE Mondays.

There was an error on the call schedule, and at 4 pm this afternoon I found out that instead of going home at 5 pm as planned, I had to stay until 9 pm. Yuck.

When I finally got home, I found that the two cords of seasoned firewood I ordered two weeks ago had arrived. It was blocking my driveway and the rain had been drizzling on it all day. I managed to carry in about 1/3 of it and stack it in the basement. It took me about 20 trips. It is 7 steps down to the basement, and the loads I was carrying were probably between 30 and 40 lbs. The rest of it I'll probably clear some space for in the garage and try to move tomorrow after work. My muscles are going to ache this week!

Turning 90

Pneumonia guy perked up today-- so much that he was transferred back out of the ICU. He was all smiles today, which was great as I needed some relief from my other patients! Hopefully he can go home in a few days. We have to go extra slow with him since he was discharged two weeks ago (before my time on the service) and bounced back with an unresolved infection.

Tomfoolery

Today the patient on my list who was doing the best took a drastic turn. This morning he told me that he just wants to live one more day because tomorrow is his 90th birthday. It seemed like most of my day was spent protecting him from decisions being made by people with more authority than me.

I am not the wisest of interns, but I do know that when you start tinkering around with labs and fluids too much, your patient can easily end up suffering as a consequence. This seems to be particularly true for the elderly. Also, I didn't like the way my senior resident had interpreted my patient's chest x-ray this morning. Luckily, I was able to offer some alternative studies that took so long to come back from the lab that by then the specialists we had consulted had seen him. My stall tactics worked as they agreed with me that he was not in heart failure. My patient narrowly avoided receiving an unnecessary medication that could have pushed him over the edge. Whew. I just hope that he's doing better tomorrow. We are running out of antibiotics to fight his pneumonia.

After work, I participated in an act of gluttony by dining at a restaurant I cannot afford with several of my coworkers. The dinner was hosted by a pharmaceutical company and their guest speaker was speaking about pneumonia of all things. I didn't really come away with much from his lecture, and their medication is not one that we have been using over at my current hospital, but it was fun to chit-chat with my friends on someone else's dime.

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I am always looking for new arrangements of words to use to get my idea across. I figure this quote is good for replacing the saying, "Fool me once, shame on you. Fool me twice, shame on me." Since the last verse I posted was well-received, here's another obscure quote for you:

"As a dog returns to its vomit, so a fool repeats his folly." --Proverbs 27:11

This is not exactly a Bible verse you'll ever find cross-stitched and hanging on someone's wall, but poignant just the same. And yes, I haven't gotten too far in my reading since my last post.

Domestic Goddess Tip #53

If one considers their ironing board to be a piece of furniture and has stuff delicately balanced upon it, ironing one's work clothes on the carpet is not a reasonable substitute.

Using a high heat steam setting over nylon carpet could lead to uh, melting of one's pretty area rug and also a glob of black melted nylon on the side of one's shirt that is rather obvious when one removes their white coat after grand rounds.

Free advice from me to you.

When the Dealin's Done

Poker night was a success. Of course the house wasn't as clean as I would have liked, and we ordered way too much pizza and wings. However, judging by the empty bottles and the number of sticky spots from spilled drinks in the kitchen this morning, I think it is safe to say that "a good time was had by all."

There were nine of us playing all together, tournament-style. The biggest surprise of all? I won the entire thing! Me, who has played poker less times than you can count on one hand. One of the other intern's life revolves around poker: he records poker championships, plays online for money, and is already making friends at one of the area casinos. He wasn't even in the top three last night.

My secret for success? I kept folding because I was busy keeping everyone well-supplied with drinks. Usually I play just about every single hand because I'm an optimist and frankly, I have no concept of odds. Plus, they kept betting really high, so I wasn't comfortable staying in. On one hand, I folded with a straight because everyone kept raising so high that I was sure that they all had straights, too. I got scolded for that one.

No attendings showed up, or any senior residents either. This wasn't much of a surprise though as most of our get togethers tend to be just the interns. And my friend, who I was going to kill for inviting complete strangers redeemed herself. This really hot (and single!) pharmacist showed up. He's a little on the skinny side, but has great eyes and an accent that sounds English to me, but he grew up in NYC. Despite losing early, he stayed for the whole tournament. Although our eyes kept meeting across the table, I didn't get much of a chance to talk to him since my dumbass friend didn't leave enough space at the table for him to sit next to me! I don't know that anything will happen with him, but I will be at his hospital for the next eight weeks, so maybe we'll run into each other.

Confession Tuesday

Okay, so the title sounds a lot juicier than this actual entry is. People, I'm slacking. I am simply not holding it all together.

1. My workouts suck.

2. Today, I got a bill from my cell phone company for the past TWO months of service. Apparently, I neglected to pay last month. I have never forgotten to pay a bill before-- never ever. I guess I should be grateful they didn't turn off my phone.

3. I arrived here on June 23rd. Number of times that I have washed my car since: ZERO. That's disgusting-- seriously.

4. I have been on the easiest rotation ever for the past 10 days, and despite working my butt off on outdoor projects, there are still a ton of things to do before winter (fireplace cleaned, storm window repaired, install automatic garage door opener, driveway resurfaced, snow tires, order firewood, hire snow removal service).

5. I just invited not only all of my fellow residents, but ATTENDINGS as well over for a Poker Night this Friday the 13th (Have I mentioned that Emergency Med people tend to be superstitious by nature?). The place is a mess, and apparently my friend G has also invited over her neighbors as well as Family Practice residents from another hospital!

On the plus side, I got enough procedures in today that I am done early with my rotation and thus have a 4-day weekend ahead. Although I would love to at least take a day trip somewhere, the sad reality is that I need to be more tight with money right now, and should really get my butt in gear.

More Sedona

Ok, this is last of my vacation photos. On my last day, the PU's and I took a dirt road up through the red rocks of Sedona, a different direction from how "The Phoenix" and I had approached it earlier in the week.

The Writing on the Wall

Just off the highway on the way towards Flagstaff, the PU's and I went for a short hike to see some petroglyphs. Is this a tale of an epic battle? An elaborate method of counting a herd of sheep? It's hard to say, but oddly enough it doesn't look all that different from most of the chicken scratch people still carve into trees and benches.

More Canyons

This is the lesser-known Sycamore Canyon, also near Williams.


It is much prettier in person, as many of these shots were taken into the sun, so they're not quite as impressive as they could have been.


I liked the contrast of this dead tree against the green ones.


That evening, my parents and I headed into Flagstaff, where we stopped at Lowell Observatory for some star viewing. It was interesting stuff, and I remembered many a night spent trying to name constellations on summer camping trips. When I was about ten, I was afraid that at any minute the sun would collapse into a white dwarf, and we would all instantly freeze to death. I know that there is a red giant stage in between, but nothing could convince me at the time that the sun wasn't already in its giant stage, and that the scientists just didn't know any better. (Yes, I was a strange one, even back then.)

The VIEW

Ok, so I confess: I was missing my Arizona blue skies. During my vacation week, my parents and I stayed up around Williams and explored the area. It had been too long since I had been to the Grand Canyon.


Remember that 5 mile running goal of mine? Well, the impetus behind that was that "The Phoenix" and I had a major hike in mind last June. Perhaps it was for our own good that we ended up canceling as when I looked over the edge, I realized just how difficult the trail would be. I'm now thinking that I'm going to need to be able to run 10 miles to be in shape for the canyon. A little weight training would be a good idea too, considering the heavy backpack I'll need to tote.


The PU's and I stuck to the rim trail, and despite not venturing down, the views were spectacular. We even caught a glimpse of 3 California Condors circling the canyon. They have a wingspan of 9 feet, and are nearly extinct. My father, despite years of birdwatching, had never glimpsed one before, so I was glad to share that experience with him. Unfortunately, I wasn't skilled enough to capture them on camera.

So, with summertime in mind I returned to the gym yesterday, and was shocked at just how deconditioned I've become. I haven't really gained any weight, but today I went for a run and barely slogged a mile. This is going to be a long, uphill battle, but maybe it is just what I need to avoid the winter doldrums.

Not Sedona

I don't think that I have mentioned this before, but "The Phoenix" lives with her parents. Now it's been a long time, but I do remember getting into spats with my folks when I lived at home. This past weekend, we were specifically told not to go up to Sedona to hike. So we obeyed, and instead went up to Grasshopper Point (conveniently located past Sedona, which they didn't say anything about driving through) to do some rock jumping. The water was freezing, so we only jumped off once and spent the remaining time sunning ourselves on warm rocks.

Seen on the drive up:


Grasshopper Point:



Seen on the drive back:


The small formation second from the left is called the "Snoopy Rock" as it looks like Snoopy's profile laying down on the top of his dog house.

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The majority of my days in Arizona were spent with the PU's, and we did some hiking around that I am allowed to talk about, so more pictures to come.

I go back to work tomorrow morning. I feel like my time off flew by far too fast, but at least I will have easier work hours for the next two weeks. After that, it's full force on the floor until I finally return to the Emergency Department sometime in March.