Jet Lagged

Luckily, I was able to squeeze in a quick visit to my parents' home this past week. Originally, I had planned on leaving after my shift on Sunday night. I raced to get all of my dictations done and sprinted out to the parking lot in the snow. The usual 20-minute drive to the airport took over 45 minutes, and sadly my flight was canceled due to the current storm, which ultimately resulted in 13 more inches to the already established impenetrable wall of white fluffy stuff on my lawn.

ALL of Monday was spent in various airports and my new route included an extra layover and routing through O'Hare, where 200+ flights were canceled. So, I arrived in Phoenix late Monday night, over 22 hours later than planned.

The visit home was brief, but great. It was good to spend time with my quirky brothers and sister-in-law. We helped make gingerbread cookies on Christmas Eve. For reasons unknown, my mother had acquired a lobster-shaped cookie cutter, so many a ginger lobster was born. Being the reclusive group we are, we skipped the hometown Santa parade and gathering of the masses in the town plaza, and headed off to our traditional candlelit church service. The failing octogenarian organist played at 1/3 the correct tempo, and appeared to have a dissociative fugue during the 4th verse of "Joy to the World" as she suddenly began playing a different song with her left hand, while somehow continuing on with her right. It was very strange.

Many a homemade tamale was scarfed down by yours truly. The javelina are again on the rampage, and gobbled up mom's poinsettias by the front door. I hope they get a tummyache.

My parents loved the GPS unit that my brothers and I pitched in on. (It's always more fun to me to watch other people open the gifts I picked out than opening my own.) The MRE's sent by AG were a big laugh, although having arrived later than planned, there wasn't a good time for us to make a meal of them together.

Christmas Day there was prime rib, mashed potatoes, green bean casserole, homemade rolls, Yorkshire pudding, cranberry jelly, and cranberry relish. Sister-in-law outdid herself again with a chocolate cream pie and blackberry/raspberry cheesecake in addition to the assortment of holiday cookies. AG was able to call and is doing well. Apparently, there's a surplus of lobster and steak at the current base he is at, poor guy!

The flight home was uneventful. Half of the snow had melted away in my absence. No sooner had I made it in the door, when I got a call asking if I could work the overnight shift as someone had called out sick. I already had the early shift today, so that wasn't possible, but I got up extra early in the morning and called in to make sure they weren't in overwhelmed mode.

Today was the usual list of suspects: headache, nonspecific abdominal pain, chest pain, acute exacerbation of chronic back pain, neck strain, suicidal ideation, scabies, vaginal bleeding, et al. Guess it's back to the grindstone!

Short Visit

My parents were in town last week for a quick visit. They took a large detour to come here on their way to the annual family reunion. We spent the few days I had off work exploring and driving around. They also met Army Guy for the first time. I hadn't seen them since Christmas, and I'm not sure when the next time I will fly back home will be. It was good to see them, but hectic working my shifts around their stay. Luckily, they are low-maintenance folks that are just as content to explore bookstores in my neighborhood and spend days lounging around my house reading.

Second Wind

Today I took the final part of my medical licensing exam. I was somewhat anxious about it as for Steps 1 and 2, I had blocks of vacation during which to study in 6-8 hour sessions. This time, I didn't want to use one of my precious vacation weeks for board studying, so I've been trying to cram in a hour or so of practice questions or reading here or there. The mantra in med school as to necessary study time is "Two months for Step 1, two weeks for Step 2, and for Step 3-- bring a #2 pencil." That is all fine and dandy, except I have a friend who actually failed Step 3 a few months ago, and at over $600, I don't want to make that mistake.

I think that it went well enough. The exam is actually computerized these days. By the end of it, I was kind of absent-minded, but I think I did alright. I won't find out now for over a month. Some of the cases were ridiculously easy, and other ones left me playing eenie, meenie, miney, mo between options of bizarre syndromes.*

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Yesterday I ran by the lake again. I don't know what the heck people are talking about when they talk about runner's highs and all that garbage. The best feeling I've ever had is getting to that point where I'm not painfully aware of my labored breathing while trying to find a semi-dry area of my hand with which to wipe away the sweat.

The humidity was a killer. The air was so moist, you could feel each oxygen with its two attached hydrogens hurling itself at you. The air was so moist that if you grabbed a handful of it, you could squeeze the water out of it like a sponge.

Mile 1 sucked. Mile 1 always sucks. I took my walk break, and knocked out Mile 2. Second walk break. I hit the hash mark on the path, but I wasn't ready to turn around and start running again, so I walked down to the water's edge. This run sucked-- even the squirrels were lined up along the path, laughing at me.

And then for once, the shuffle option on my iPod saved me. Instead of it's usual trickery of breaking my stride with something like Enya, AC/DC came on. It was a song I hadn't heard in quite some time-- the one I convinced the squad to choose for the halftime performance, much to the dismay of our coach. It was time to stop being a pansy, and run. Miles 3 coasted by, and by the time I hit Mile 4 it was over: bad mood abolished.

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I know I have mentioned this before, but days at work seem to almost have themes. The other day, it was nosebleed day. And, more recently it was "Bad News Day". I can understand that no one likes giving their patient bad news, but when I am at least the fourth or fifth person to speak to a cancer patient that week, I don't think it's fair that I am the one stuck telling them they aren't going to get better.

I had a handoff patient at signout. They had been seen by someone else. I was just supposed to wait for them to get back from radiology, and send them home. Simple. The woman comes back and starts puking all over the place. I get that under control, and then she asks me why she keeps going into renal failure. I tell her that I don't know. I ask her what's going on with her colon cancer. She says she doesn't know what is happening, but her surgeon said he wouldn't operate because the cancer had "exploded all over her abdomen".

Then I ask her what her oncologist said was the next step. She said she didn't know. So there I am, stuck telling her that while I don't know what is going on with her personally, sometimes when cancer starts spreading, different organs start shutting down, and they don't get better. She looked like I had slapped her. I told her that I could treat her urinary tract infection, and give her medicines for pain, but that she needed to talk with her oncologist about her options. They left shortly afterwards, but not before I saw it-- the recognition that she was losing her battle.

It's not fair. I have a hard enough time doing my job-- I don't want to clean up after somebody else. And I don't mean to crush anyone's hope. I do think that attitude is a big part of healing. However, if you are being turned down for surgery because your cancer has metastasized, someone should tell you that this is not only a bad thing, but a VERY bad thing. I went into emergency medicine partly to protect myself from becoming attached to patients. While helping to improve the quality of life of a terminal patient is important, it's also hard to watch them go.

Then there was the very anxious executive who came in after a car accident. He looked absolutely fine, and wouldn't you know it, there was an abnormality on his head CT. Some sort of "spot" that they couldn't determine whether or not it was a benign lesion, a dilated blood vessel, a chronic deformity... or MALIGNANCY. Great. As you can imagine, that little news bit didn't go over so well. "Uh sir, there's something unusual on your head CT..."

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Tomorrow the PU's (parental units) are back in town. It's not exactly the best time, as I am working every day but one of their visit, but I guess that leaves them plenty of time to explore on their own. They have a huge RV now, which somewhat complicates things as it won't fit in my driveway, but I guess it has been working well for them.

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*I know you don't want to actually think of your personal physician just randomly guessing at crap, but if you've been reading this blog for any length of time, you should know that by now, NOTHING IS SACRED.