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.

The Long Walk

Well, I finally did it: last weekend I hiked the Grand Canyon! "The Phoenix" and I stayed in a hotel a few miles from the South Rim and then awoke early the next morning to start our hike. We hiked down South Kaibab Trail, crossed the Colorado River, and hiked out along the Bright Angel Trail. We had been talking about doing this for over a year now, and this hike is the reason I had been pushing myself to run further and further.

We went all the way down and back up in one day, which is highly discouraged by the park service. Despite all of our planning and preparation, we still ended up exhausted and overheated. We hiked from 7:30 am until 9 pm, with the last mile up being in the dark. For the next two days, my legs were so sore that I was hobbling about. Fortunately, neither of us ended up seriously injured, but I don't think that I would attempt a one-day hike again.

This is the start of the South Kaibab Trail:




South Kaibab Trail is very steep and without water, but fortunately a good portion of it was in the shade at the start.




Finally, we reached the river:


This is my proof that I went all the way:


This is near Bright Angel Campground, where we stopped to take advantage of the water supply, working toilet (!), and grab a quick lunch:


Desert squirrels are a little more scruffy looking than the beasts back home:


Taken along the Bright Angel Trail on the way up:



A small group of deer crossed our path. I guess we must not have looked very threatening by that point.


Final shots during sunset:


Although I was concerned about hiking in the heat of the day, there wasn't much we could do about it besides taking frequent short breaks. I couldn't really get heat conditioned either as it was simply too cool outside back home. What I didn't account for was hiking though that big of an elevation change. We were so exhausted by the end that breathing was labored, and we had to stop every hundred yards or so to catch our breaths.

It took us 4.5 hours to get to the bottom, where we rested for 30 minutes before our 8.5 hour hike out. The hike down was about 6 miles, with a mile crossing at the river, and a more gradual 9 mile hike out. We definitely underestimated the hike though, as it was way above our fitness level. Believe it or not, on the way up, there were actually a small group of men running up the canyon!

Best of all, "The Phoenix" and I are still friends and on speaking terms after this adventure.

Sometmes You Feel Like a Nut

I was all set for an uneventful evening. It is 7 degrees outside right now and may hit 20 below with the windchill overnight. I figured it was a good night to just go home after work and stay there. The house has been a little chilly, so I decided that tonight would be a good night to get the fireplace going. I heard a few noises from my fireplace and thought maybe a bird was messing around with the chimney cap as it didn't really seem all that loud.

The fire had been going for about an hour when I noticed a small stick fall into the flames. I didn't really think too much about it. I went on with my cleaning when I hear this loud thud against the fireplace screen.

I looked down, right into a pair of beady black eyes.

THERE WAS A FREAKIN' SQUIRREL IN MY FIREPLACE!

This squirrel was jet black, and huge! He was almost the size of a cat, and surely up to no good!

To be honest, my first instinct was to ram the screen flush against the fireplace and force the thing back up the chimney or to a firey death. I am not very proud that I had that thought, but I didn't know how to easily catch the stupid varmint. Then I started picturing a blazing squirrel screaming its final breaths and decided I had to let the thing out.

It scurried up my bookshelf and then behind the couch.

I tried to herd it towards the door, but it started up the stairs. I chased it back down and then managed to prop open my side door. I tried again to herd the squirrel out, but rather than going down the stairs and out the door, the thing went into my kitchen and started running all over my countertop, climbing the cabinets, and dancing on the kitchen table just long enough to throw all the placemats on the floor! I looked for a broom, but all I could find was a Swiffer Sweeper to swing at the thing. It ran back into the living room and I opened the front door as well. At this point, I think I was yelling obscenities involving the squirrel committing lecherous acts with someone's mother. (Keep in mind that my doors are wide open for the neighbors to hear all of this.)

It suddenly dawned on me that I definitely did not want the thing on the second floor, particularly in my bedroom, so I ran upstairs and closed all the doors. By then the first floor was chilly, and I couldn't find Mr. Squirrel anywhere.

I turned off the stereo so that his claws on my hardwood floors would betray him, but I couldn't get him to come out of his hiding place, no matter how hard I stomped. I shut all of the outside doors and decided to "phone a friend" as apparently squirrel-herding is not my specialty. Luckily one of my buddies was just coming off shift. After much convincing that I wasn't making this crap up, he agreed to come over and help me chase the thing out. Being a typical guy, he kept asking me if I had a shotgun. By the time he had arrived, I had built a wall out of my ottoman and couch cushions to direct the squirrel in the right direction.

When my buddy arrived, he pointed out some tracks by my side door. As I hadn't actually seen the squirrel escape, I made him stay until we had searched under all of the heavy furniture and had given each room a brief once-over. After he got home, he called said something about seeing the trail of tracks lead from my door to the tree out front. I guess that should be somewhat reassuring, but I'm still planning on sleeping with the covers up tight by my neck tonight.

It could have gone much worse. I could have had a squirrel running around catching everything on fire. It is somewhat funny for this to happen this week when I'm just starting my rotation in the burn unit. Early this winter I had the chimney inspected. The guy was supposed to come back out and replace the chimney cap as he said that the kind that I have attracts squirrels. I guess he really knows what he's talking about. I also guess I won't be having any more fires going until that cap is replaced! I am sure it will be months before my buddy lets me live tonight down. Right now, I am anxiously waiting for the fire to finally die down so I can seal that damper up tight!