The Short of It

On Saturday I ran a 5K. This one was for breast cancer and there were about 7000 participants. No medals for me this time! This one was much fancier, with bands playing at a few intervals along the sidelines. And there was a chip for runners to tie to their shoelaces, so that they could get their times. However, the time was when the gun fired at the start to when one crossed the finish line. There were so many people ahead of us and the walkers were mixed in with the runners that it took several minutes to get away from the crowd. I came in 839th if I recall properly, with a time of 33:41 minutes. I think I probably did better and was under a 10:30 mile but the slow start messed me up.

My friends, who are much more seasoned runners, said that usually there is a starting strip and an ending strip when one runs with a chip so that the times are more accurate. The guy that came in first ran a 15:40 time. I thought they were being over ambitious when there was a starting point for people averaging a 5-minute mile, but I guess not!

After that, I took a quick nap and then joined the gang for a barbeque before working the 5pm-2am shift. I pushed it a bit too much, as I just felt feverish and out of it the whole night.

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On Sunday, a group of us met up for a game of Ultimate Frisbee. I thought I would be much better at it than last fall, given all of the running. However, it's more of a sprinting game. There was a med student there that kept smoking me, so I ended up just doggedly running after him the whole game. One of the other residents sprained her knee, but other than that there were no casualties.

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On Monday, a group of movers came and removed the playhouse from my backyard. I have been wanting to get rid of this thing because it sits right in the middle of my grass since I moved in. Fortunately, one of the other interns has a 4 year-old that wanted it desperately, so she was willing to pay a crew to come pick it up. It took 6 men over an hour to maneuver it down my driveway, and they still ended up banging into the roof over the side door!

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Today, I met up with a friend to start studying for boards. I will be taking the last part of my licensing exam in July (hopefully only once), and I am trying to make myself just do a little bit every night. Step 3 is not supposed to be as bad as the first two parts, but I have a friend who failed it, and the stupid thing costs over $600, so I am not at all interested in repeating it!

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Only 8 more days left until my vacation! I haven't had time off since September, so I can't wait! A lot of the impetus behind all of this running is for a big upcoming hike with "The Phoenix". Just the thought of not setting foot in the hospital for 9 days has me excited.

Automatic Electric Chair?

This kind of stuff is why I can't do pediatrics.

No Complaints

Because I do a lot of complaining, here is an entry in which I do not.

Last night was perfect. We had a great combination of residents. Everyone picked up charts as soon as they were in the rack, so the patients didn't have any wait time. The "Big Guy" was on, and he is notorious for flying through patients, so people actually got seen, evaluated, and discharged home in a timely fashion.

I am still working on the pediatric side, and every patient I saw had some combination of fever, vomiting, abdominal pain, and/or diarrhea. It was like directing traffic: go home, go home, go home, and you-- you have to stay.


I was supposed to stay until 2 am, but by then, things were so under control that the attending was letting one of the senior residents leave early. There were a group of residents heading out for a drink from the adult side, and my buddy came over and asked the attending if there was "anyone else he wanted to get rid of." So I got to leave, too.

So I really can't top a night of efficiency, followed by an early release, and social hour with my buddies. I think I was long overdue for a shift without problems after some of the stuff I have been dealing with lately.

Thunderstorms

Outside it is thundering. There are occasional flashes of light here and there, but nothing like the cracking streaks of light that race across the sky like during monsoon season back home.

Work has been somewhat stormy lately. In med school, one of my friends once likened me to a grizzly bear. She said I was normally independent and peaceful, but when backed into a corner, I would be a "force to be reckoned with." I guess I have been doing a lot more growling at work lately.

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A couple of weeks ago I ran a trauma in which a child had been struck by a car. Reportedly, he was unresponsive on scene and bystanders had to do CPR. When he rolled into our department he was talking, but in a lot of pain. His breath sounds were unequal, and his chest x-ray showed several broken ribs and a huge lung contusion. His oxygen sats were dropping, so I ended up intubating him.

Traumas are always somewhat of a mess. There are often too many people in the room and people get focused on starting IVs and whatnot, and it's hard to get through the most important thing, which is thoroughly examining the patient, looking for injuries. I have learned quickly to be VERY assertive, so I can get in and get through my exam without getting distracted. There's still a lot to learn and improve on, but I'm holding my ground.

This case was somewhat frustrating to me as a resident on another service strolled right in and started talking to my patient when she had no business being there. She introduced herself and then had the audacity to tell him she would hold his hand until his mother arrived. I told her she wasn't needed and had to leave because we were about to do some x-rays. She had the nerve to say she was going to stay and get exposed to the radiation as she was not fertile anyway! I glared at her and kicked her out. I don't have any tolerance for bullshit, particularly in stressful situations. Plus, I already had good rapport with the patient, she didn't ask if I needed help, and it was condescending for her to just waltz in and act like she was there to save the day.

Shortly after that, I intubated the kid and he went up to the ICU on a ventilator for a few days. It turned out he had a head bleed. He just got discharged a few days ago.

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Today, I had another kid that was hit by a car. This one was a complete mess. For some reason, his friends dumped him off bleeding in our parking lot, where a paramedic team happened to come across him on the way out of the hospital. We weren't expecting him, so the charge nurse had him taken to a regular room, rather than a more spacious trauma room.

Tonight the problems arose with a consulting service calling another service without our knowledge and canceling our orders and putting in some requested by a person who had never even laid eyes on the patient. This is a big no-no. While in the ER, we are ultimately in charge of the patient. A consult is technically there to make recommendations, and is not running the show.

Basically, this all came to a head when an x-ray tech called me and asked me cancel some of my own orders because another resident told her they weren't necessary. This ended up causing numerous phone calls and conversations about why orders weren't being carried out. I ended up canceling their unnecessary tests and re-ordering everything all over again. I was fuming, and unfortunately the whole mess caused so much delay in getting the testing done, that by sign-out time, everything was still pending for the oncoming resident.

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Like I said, there has been a lot of growling lately.

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On a lighter note, Ruthie has answered my 5 questions.

Bringing Home the Gold

So yesterday was race day. I was not off to the best of starts. Fortunately, my ability to breathe through my nose was back to normal, but there were still phlegmy remnants of my cold. The location ended up being pretty obscure and over an hour's drive away. I only went for a run once this past week and quit after 4 miles, so I wasn't sure what kind of day I was in for.

There were about 130 people registered, but the majority of them did the 5K. My friends and I took off at a snail's pace. There were times when I wanted to walk, but we just kept plodding along. There were several hills along the route, but just when I wanted to stop, we would start to descend and I would be able to build my energy back up. By the halfway point, we had all split off at our own paces.

I didn't bring my iPod, so it was just me and the countryside. Just the sounds of my own rhythmic breathing. Mile 4 was by a cow pasture. That was an incentive to speed it up a bit! That was also the point when I decided I could do this thing, without walking. The only breaks I took were to grab a dixie cup at the water stands and the 15 seconds or so it took of walking for me to gulp the cool liquid down.

The plan was to speed it up for the last quarter mile, but by the time I got there, there wasn't enough reserve left. I ended up running out the last 100 meters or so. My last steps were woozy, but I made it!

I ran my bib number: 1:07, which means I averaged a 10:45 minute mile. That's pretty darn slow!

We stuck around for the door prize drawings at the end and were surprised to find that we all took home medals. The majority of the 10K runners were 40+ and they smoked us! The best time of the day was 47 minutes. I ended up with first place for women 20-29 years. There were only two of us in the bracket, and my friend got the silver. My other friends took gold and silver for the 30-39 year brackets. The guy that won for the 70+ bracket was amazing-- he looked like he was in his 50's! There was this older guy in a yellow shirt that I wanted to catch up to the whole race, but he stayed about a quarter-mile ahead the whole way!

Overall, I am pretty pleased with myself. I have never run even 5 miles continuously. If I keep at it, I am sure I will get faster, but I surprised myself by not having to stop for any breaks!


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The night before the race, I went out with a couple of friends to a new sushi restaurant in town. It was pretty cool because it was remodeled inside to look like a diner. At the counter, there was a long conveyer belt, and the cooks (Are they still called cooks when the fish is raw?) just kept putting out dishes and you picked up whatever looked good as it went by. The plates were color-coded by price. Pretty trendy for not being in the Big City!

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P.S. Call yo' mama today!

This One's for the Children...

Give 'em all a hand folks, those little $&#*@#! have struck again. Halfway through my shift I noticed my throat was on fire, then my ears started popping, and then the sniffles hit in waves every time I tried to dictate a chart.

I guess given all the "viral syndromes" I have diagnosed in the past week I had it coming.

And just so you know, nothing makes me crankier than seeing patients who are obviously less sick than I am. Where's MY Lortab Elixir? Where's MY excuse from work? No one is handing ME popsicles and stroking my hair!

Considering the gastroenteritis and pink eye from my peds month on the wards, I think it is clear who is winning.

Children: 3 Kate: 0

More Spring

Things are starting to look a little bit better around here. I went for a run around the lake yesterday, and actually got a bit of a sunburn! The flower beds in the front yard are looking good, but almost nothing is growing in the backyard.

Five Questions

Chris agreed to be interviewed by another blogger a little while ago and upped the ante by challenging his readers to answer any five questions of his choosing.

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1. Do you feel like you are treated differently by the general public, for good or bad, when people find out that you are a doctor?

Well, no one exactly rolls out the red carpet for me, if that's what you mean. I once got upgraded to first class on an airline, but that was before I graduated from medical school and more due to the low-cut top I was wearing at the time!

I usually don't tell people openly what I do for a living. Occasionally, when people have asked, they act like they don't believe me. At work, I typically get called a nurse by my patients, even after introducing myself as Dr. ______. I don't have a problem with that, but it looks bad when later they tell people that they love our nurses, but were never seen by an actual doctor!

And then, there was the one time this guy walked across Barnes & Noble to chat me up. I was wearing my scrubs as it was just after a shift, and he asked me if I was a nurse. When I told him I was a doctor, he just turned around and walked right off! The resident/intern thing is a confusing thing to try to explain to people, too.

2. What were you like as a teenager?

As a teenager, I remember being frustrated all of the time. I did not ever feel like I fit in with anyone. Most of my friends I had maybe one or two things in common with, but I never really felt close to anyone. During high school, I tended to over-involve myself in all sorts of activities, clubs, and sports. I think that partly stemmed from being bored and trying to find myself. My hometown is kind of bizarre in that it is so small, there weren't really any cliques. I tended to just float from person to person, and never really felt like I fit in. I did a lot of stupid, stupid things to try and please other people that luckily didn't end disastrously. And I didn't date. It was also the kind of environment where everyone knew everyone else's business and I was always too scared to share my feelings.

3. What is the most recent dream that you can remember?

Most recently, I dreamt that a patient was telling me that he had been bitten by a shark. There were bite marks up and down his legs. He denied going to the ocean and said he had been swimming in one of our local lakes. I kept telling him that there was no way that a shark could be in the lake, but he wouldn't believe me. In the dream, I was talking about the patient to an attending and they kept telling me I had to find out the truth. I woke up pretty frustrated from that one.

4. When you run and “get into the zone”, are you a “thinker” or do you just let your mind go blank?

Blank. I like the calm that comes with not being distracted by all of the usual worries and background thoughts that are bouncing around.

5. Tell us something that you have done, that you would not have thought you would have done in a million years.

This is a difficult one for me as most of my recent life has about getting to where I planned to be. To be honest, the move here was difficult for me. It wasn't what I planned on. It certainly wasn't where I expected to be. I am lucky to have supporting friends and family, but I am truly alone here. In many ways, I think that I have grown a lot confidence-wise, and I guess I needed some of that, but it hasn't been easy. I am fortunate to be at a program where I am treated very well, but it is all the other stuff like developing friendships outside of work that has been difficult. If you had asked me 10 years, 5 years, or even 2 years ago, where I would be now, it would never have been here.

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Also copied from Chris:

If you are brave enough to play.... Leave me a comment saying, “Interview me.” I will respond by asking you five questions. I get to pick the questions.You will update your weblog with the answers to the questions.You will include this explanation and an offer to interview someone else in the same post.When others comment asking to be interviewed, you will ask them five questions.

Play Ball!

I just got back from playing softball. We have a team composed of residents, department nurses, and spouses. And we are horrible. The game got called in the fifth inning because the other team was so far ahead. I did manage to bat a run in, and the other time I struck out. I ended up being the catcher, a position that I find scary since we don't have masks or helmets. Our original catcher got clocked in the face by a over-aggressive runner and ended up with a cut below her eye. She probably will have a nasty bruise tomorrow. The good thing about being a catcher is all of the squatting probably is a good butt workout. The bad thing is that you get hit in the shins by bouncing softballs a lot. At least I do.

A few hours before the game I went for a 4-mile run... and rewarded myself with a sundae for dinner. With all of the night shifts lately and weekend activities my running has kind of fallen by the wayside. This is unfortunate as that 10K is rapidly approaching. It most definitely will be a run/walk event for me.

Twenty-Nine

Yesterday I turned 29. It was a good thing, I think. Today was my first day back to work after a 3-day weekend. I probably should have used the time more wisely, but somehow when it comes down to having a day off, I just want to enjoy it.

On Saturday, I went on a Wine and Herb tour with some friends. We got there later than planned, and had to leave early as one of us had to work that evening, but it was fun. We made it to 9 of the 16 wineries. This time I went more with reds rather than whites. At each stop, they gave us a small herb in a container, a snack, and a recipe utilizing their featured herb. I came home with two kinds of tomatoes, basil, chives, pepper plants, and several other things I can't remember. I guess now I can really dress up those Lean Cuisines I nuke every night in the microwave!

On Sunday, I went to see "300" with a friend. It's about a small group of Spartans trying to hold back Xerxes (spelling?) in his quest to conquer Greece. It was very bloody, but the nice thing about the Spartans is that they don't wear pants... and they have incredibly fit bodies! After that, my friends treated me to a fancy dinner and drinks.

On Monday, I went out to lunch with some friends, mowed the lawn for the first time this year, and did some shopping.

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Today I went back to work. The bad thing about long weekends is that it's so annoying to have to go back. I survived, but the day was INCREDIBLY long.

Patient Art

This was given to me by a patient the other night. It looks like it should be a tattoo.

Closing Time

I went out for a quick drink with a couple of people after work last night.

I don't know that it's necessarily a good thing to show up to a bar in scrubs, but whatever. My bartender friend was there and he was just as clever and eccentric as ever.

Being tired + a shot of very fine whiskey = a numb nose for several hours.

Spit It Out

Chris asked the other day what grosses me out, so here goes:

I can't stand spit.

I can't watch people cough up phlegm, and spit it out with a gleaming string of drool hanging from their lips.

Even worse are the drunk, or near passed-out ones that end up with globs of mucus slipping and running down their cheek like raw eggs.

It makes me nauseous and start gagging. Luckily, I've never actually puked from seeing someone hawk up a loogie. And I don't know what's worse, watching them spit it out or swallow it back down.

You can reach for the suction tubing and try to get rid of all of that stuff, but the gurgling sound of the spit getting sucked up grosses me out also.

And I don't like sticking my hands in people's mouths, either. There's nothing worse than peering intently at someone's rotten away molars and having them breathe in your face. I don't know how dentists do it. If I worked in a dental office, I would require patients to gargle with mouthwash before I saw them.

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Feet are not my favorite either. Especially, when you peel off someone's sweaty socks and large flakes of skin go flying into the air. You try and time your breathing, but it's impossible. Somewhere in your nasal passages, some foot flakes get stuck, and the memory of the smell will be stuck in your head all night.

The other day I saw this guy with nasty trenchfoot... as in George Washington's soldiers marching barefoot through snow, trenchfoot. The bottoms of his feet were slimy and yellow, with thick, soggy skin. The tops were swollen, red, and ulcerated. Luckily, there were no maggots. That I actually haven't seen... yet.

Old, twisted, thick with fungus toenails creep me out, too.

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So there you have it: dental hygienists and pedicurists are people who in my mind cannot be paid enough.

Crocus

2nd Chance

The tulips I planted last fall aren't anywhere near blooming, but these ones are keeping me happy in the mean time.

Last night I got another chance at intubating. A woman came in who was unresponsive, jerking her arms and legs all over the place. She was fighting against everyone and randomly coughing and spitting. Her husband was there, but he said that she was very secretive about her medications and he had no idea what she had taken, just that she was acting bizarre all day and kept falling throughout the day. We tried calming her down with some benzodiazepines, but that did nothing, and didn't help her tremors. She seemed to be having a lot of trouble breathing and controlling her secretions, so intubating was an easy decision.

I once again had a full audience as prior to intubating her, it took five people to hold her down. This time I got it! It took two tries because she had a tight airway and the first tube I tried was too large. Things also got a little hairy as she started dropping her heart rate and oxygen saturation after the medication was given, but that all corrected with intubation.

Since we weren't sure if she had overdosed, was going through some sort of withdrawl, or had a brain injury, she got a pretty extensive workup. When everything came back essentially normal, I called the neurology resident who proceeded to yell at me for intubating her and literally hung up on me. Then he snuck in and saw her without talking to anyone. He basically copied my notes off the chart and wrote that he didn't think it was a seizure and that she needed to be seen by a psychiatrist when she got extubated. I am really getting tired of that service. We wanted her to get an EEG, but those unfortunately have to be ordered by the neurology team. I realize that her being sedated kind of messes up his ability to examine her, but I couldn't very well wait until she aspirated on her saliva and stopped breathing. I also didn't have time to wait for him to come down and see her before securing her airway.

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My other "big case" of the night was a 25 year-old with two seizures earlier that day. He had been seen at another hospital, and sent home. I was waiting for the report from that other hospital to decide what all we needed to do for him. My attending said that as he had another seizure since being evaluated there, we needed to do the whole workup. That turned out to be a very wise decision. I was sitting at the computer reviewing all of my patient's results when I pulled up his CT scan. It hadn't been read by the radiologist yet, but clearly there was a huge problem. I saw what looked to me like a tumor, and he had some sort of blockage (obstructive hydrocephalus) that was causing the CSF to accumulate on one side of his head and compress the brain tissue. It wasn't good, and just seeing it made me nauseous.

I pulled my attending away from what he was doing and told him he had to see this scan. I think he thought I was crazy at first. Then I went over the images with the radiologist, talked to neurosurgery, and ophthalmology. Then I had to talk with the patient and his entire family about the findings. I tried to explain it as best I could, but in the end, I ended up showing his mother his head CT. I don't know how to explain the other hospital's decision to send him home, but when I left he was going to get an MRI and he may need surgery right away.

Last night I had a hard time getting to sleep. Two traumas came in at 5 minutes before sign-out and I stayed late doing some dictations, but I was still wide awake at 3 am when I got home. It was snowing hard on my drive home. I just kept thinking about that patient. If it had been up to me, I would have just repeated his labs and not his head scan. This scan was so abnormal that staff from across the room noticed it and kept asking who it was. We never did get the report from that other hospital. Everything else was faxed over, but they said there wouldn't be a typed report until during the week. That's the sort of thing that terrifies me. Forgetting to check one lab or study could be crucial.

Just Another Day in the Department

Last night was a Traumafest. So far, traumas haven't really meant all that much to me because the second-year residents run them. So while they are busy assessing patients and getting to do cool procedures, I'm off in the back of the department talking with Mrs. Smith about just exactly where her belly pain is and getting her to describe her vomitus. Last night my favorite attending was on. This guy just has such a great attitude. Even when he's stressed out, he's still really good-natured and great at supervising.

A trauma came in that the second-year had taken a radio call about. I was free, so I went and helped assess the patient. His breath sounds were good, but when you pressed on the lower left part of his chest there was a crunching sensation and it was quite painful for him. Sure enough, the chest x-rays showed a lot free air was trapped under the skin and several of his ribs were broken. His lungs were both inflated so we ordered a CT scan to get a better view. The CT scan showed a pneumothorax (dropped lung) and the surgery team started talking about putting in a chest tube.

The third-year resident looked at me and said, "You're doing this tube." I was happy about this, but also somewhat concerned about screwing over the second-year resident as it was technically her patient. To get certified in procedures we have to do so many under supervision and get signed off on them. There have been instances in which interns have been given procedures when a second-year still needed them and has less time to get them done because they are closer to graduating. To me, it wasn't worth gaining an angry co-worker for the next year. I gingerly approached the second-year and made sure that she had all of her chest tubes. Luckily she did, so the chest tube was mine!

Now the heart starts beating faster and the anxiety starts kicking in.

For an emergency medicine resident, putting a chest tube in is about the closest that we get to performing surgery. Technically, post-mortem cesarean sections (yikes) and thoracotomies (cutting open the chest to directly get to the aorta to clamp it) are more difficult, but those procedures are so few and far between that I most likely won't do them on real patients during my training.

My attending asked me to get everything set up. I hadn't done a chest tube since September. And, while the patient was stable enough that I had time to get him to sign consent forms, order the medications, and talk to his family first, I didn't have enough time to read over the procedure first. So, I wasn't as prepared as I could have been.

To make things more high stakes, there was a fourth-year medical student, a psychiatry intern, and an internal medicine resident that wanted to watch. The third-year and attending were supervising me, the second-year was going to perform the sedation (which made her happy as she still ended up with a procedure), and the patient's nurse was present, as were a couple of techs.

There were certainly a lot of eyeballs focused on me now, while I tried to run through the procedure in my head. I gowned up with a mask, booties, sterile gloves, and the sweating started. I had to be helped prepping the chest with betadine as I had forgotten to do this before getting sterile. Luckily, the patient was sleeping soundly, so I was free to take my time.

My attending and senior coached me through the procedure. After numbing him up, I cut into the chest with my scalpel and felt for the next higher rib. My hemostat found its way to the parietal pleura (rubbery-like layer of tissue that encases the lungs). By this time, everyone was pressed up against the bed, and air was bubbling up through the blood because of all of the pockets of air that were trapped in the layers of skin. I traced the path of the hemostat with my finger and made sure I was right where I wanted to be.

With a quick plunge, I shoved the hemostat up over the top of the rib and into the thorax.

Air gushed out at me. I widened the hole with my finger and my attending checked my position. This chest tube was different than the other ones I had done because the lungs were mainly still inflated. You could feel their rubbery fullness. I guided the chest tube into place and then closed my incision. An x-ray confirmed it to be in the right place.

I couldn't have asked for a better scenario. The patient was stable, and my supervisors were patient. I was rusty enough on the procedure that my confidence was somewhat shaky. Now I feel much more prepared. If an unstable patient comes in tonight needing a chest tube, I am sure that I can get one in much more quickly.

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Then there was the asthmatic that came in very combative and in respiratory failure. My attending took a radio call saying that they were 2 minutes out, and told me to get the room ready. This time I redeemed myself by having the suction, laryngoscope, and endotracheal tube prepped and ready, with backup tubes and blades if needed. The rapid-sequence intubation (use of a sedating agent and a paralytic) went smoothly with the exception that I couldn't see the vocal cords, so my attending had to help out and reposition. The patient got switched over to the ventilator and sent up to the ICU for management.

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By this time of night, the second-year resident had left. Another car accident came in, and that meant I was running the trauma. It was a young guy, and he was a lot more stable. I was able to take my time and systematically look him over from head to toe. X-rays and labs didn't turn up anything, and I ended up turning him over at sign-out with a nearly-completed negative workup.

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Another cool thing I got to do was trephinate a toenail. This lady had dropped something heavy on her foot and there was blood trapped under the nail. So, we grabbed an electrocautery tool and basically shoved a red, hot poker into her toenail... after numbing her up with a nerve block first. It wasn't very satisfying though, as the injury was old, so there wasn't a whole lot of blood released.

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All in all, I don't think I could have asked for a better shift. I was carrying a crazy amount of patients because the senior basically acts as a supervisor and doesn't see his own. Also, the off-service interns typically don't handle more than a couple of patients at a time. For my other patients, it took a little bit longer for me to get them taken care of, but by the end of the night things were pretty well cleaned up. Now I just have about 90 minutes of dictations to do, and an hour of review reading to keep up with myself.

Seven!

I just ran 7.15 miles! Woohoo! I think I'll go collapse now.

Nightmare

At the end of my shift last night I signed over three patients to the incoming residents. Oddly enough, they all had a complaint of seizure. It's weird how sometimes there is order among the randomness of my job.

This morning at 5:45 I awoke in a cold sweat. My heart was racing. I suddenly remembered there being a fourth patient that I completely forgot to tell anyone about. And worse yet, I had sent her for a head CT and given her a whopping dose of fentanyl (a narcotic) by IV. I could picture her face and remembered a bit of our conversation, but not much. Today was going to be a crappy day, particularly if it was several hours before anyone found out about her overnight. What if she had stopped breathing or had a head bleed that no one discovered for hours? I drifted back to sleep, dreading going in to conference this morning.

Now that several hours have passed and I am awake, I know for certain there was no fourth patient. It was just a dream. The face I'd pictured was one of our nurses. But this morning it seemed so real. I have been a little frazzled lately. I think this is just a manifestation of my worries about forgetting something in all of the rush. It was creepy though, waking up like that.

Oh well, back to work...

Deadlines

I may not have touched on this before, but I am a person who thrives on deadlines. Papers in college got written in massive marathon sittings the night before. Often things were printing as class was starting. Sometimes I didn't have time to spell-check them first. And yet, papers I cranked out generally tended to get scored higher than the ones I edited, and re-edited to the point that the original passion behind my arguments was diluted out.

I have signed up for a 10K next month. I HAD been working out pretty regularly, however I have done nothing for over a week now. Today I tried to do some speed intervals on the treadmill, but I died on the second segment. I think that a good part of that is due to getting up on 5 hours of sleep, and consuming nothing from 6:30 am until after my failed 6 pm run. I just didn't have anything left.

Part of my problem is the last three shifts I have worked have been starting earlier each day, so I have been building a sleep deficit. I start later tomorrow though, so hopefully I can put a stop to it tonight.

Here's to hoping I can step it up a notch.

...and Another Thing

On my flight out, my tube of toothpaste got confiscated! I know there's the whole 4 oz limit on liquids, but the tube was nearly empty, so I figured they would count the amount of substance present. Apparently, they are more concerned with the size of the container? I don't know how having an 8 oz tube with 1 oz of toothpaste is more of a threat than 4 oz in a smaller tube, but whatever. I didn't even know that toothpaste was officially a liquid, but apparently it is quite the dangerous substance! I also got chastized because my clear plastic bag was not the quart size, but the half-gallon size. I only had about 4 items in there, so they didn't give me too hard of a time about it.

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Also, on another street in Manhattan, there were several firetrucks stopped in front of a high rise. As I passed a woman on the street, she asked me for money for food. I was in a hurry, and she was dressed better than I was, so I said "No." Along the way, she said hello to several bystanders as if she knew them personally, and I noticed that she wasn't asking just anyone for money. When I stopped at the next corner to wait for the light, she caught up to me and asked me again for money. I said, "You just asked me for money a minute ago!"

"Well hey, that's good luck!" she replied.

I've never heard of it being good to be hit up by the same panhandler in a few minutes' time, but I sure must look like a sucker. Not only did she select me out as being an easy target once, but twice!

Mini-Break

I went out of town for a few days earlier in the week and met up with some friends from back home who were visiting family in New Jersey. It took a plane, a subway, and a metro train to get there. Their sons are now ages 2 and 4 and have grown so much since I lived with them last year. It was a noisy two-day visit and I was quickly reminded of all of the noise that goes along with living with toddlers. We did not do anything special, just visited for a couple of days.

J and I went to college together, both on pre-med tracks. Somewhere along the way she got married, went into nursing, and started raising a family of her own. I think that there's always a bit of awkwardness between us now. When she looks at me, she wonders what it would be like to still be single and going through residency training. She sees me struggle and I think that she's happy with her decision for the most part.

When I look at her, I think of the people I pushed away to get to this point, always afraid of getting attached to someone. Most of the time I think that I am happy with my decision, but every now and then she makes me question it. Overall, I guess I feel like all of this education and training has kind of put my life on hold. I'm at the point where I can finally start having more say in what I do, and where I'm going as far as this whole career thing goes. I think that the present and the future look good, but much of the time I am not sure whether or I would choose the same path if I had to do it all over again. I suppose that doesn't really matter, and I should just quit looking back.

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On the way home, I hit Manhattan at rush hour. As I walked up the stairway to the street at Penn Station, commuters were streaming down the stairs in the opposite direction. There was a nonstop flow of people, like ants swarming out of a nest once it has been stepped on. They were lined up, tightly shoulder to shoulder, like the Greeks with their war formations, but instead of working together for the greater good, it was every man for himself.

On 34th street, crowds were gathered on either side of the street. There was the sharp sounds of a police officer's whistle and lots of honking. From within the crowd I heard someone say there had been an accident and a person had been hit by a taxi. I strained to get a better look. I couldn't see anything. I didn't know if I could be of any help, but I knew if I just kept walking away I would feel guilty about it for the rest of the night.

It must have taken me a few minutes to work my way across the street and through the crowd. Finally, I got close enough to see what appeared to be a teenager laying on her back, with her arms folded across her chest. She was talking to woman crouched by her side and seemed fairly calm. There didn't look like there was any bleeding or gross deformity. By this time, the sirens had become louder. An ambulance turned the corner. My plan had been just to ask if they needed any help, but she looked pretty stable, and other than keeping her still until she could be checked out further, there was nothing to do. Then, I left.

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I took a long subway ride to the airport after first stopping at a pricey soap/cosmetic store that one of my friends has raved about. If you have a smelly subway ride in your near future, I highly recommend traveling with a bagful of bath products. There's nothing quite like a mixed bag of "bath bombs" to wipe out that gross sweaty smell of the train car.

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Since I had given myself generous amounts of time to not only get back to the city, but get to the airport, I arrived at JFK 3 hours before my flight. This, of course, ensured that my flight was delayed yet another hour. On the plus side, I had plenty of time to get all of my journal articles read for conference the next day! This was my first trip flying on Jet Blue. While it's true that there is more leg room, and free personal cable TV for each seat, I would have gladly traded these amenities had I been able to avoid the turbulence and near-death experience I had just prior to landing!

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I think it is quite possible that I need a vacation from my vacation!

First Bloom!

I guess it is true that crocus blooms first. I was pleased to see this in my backyard today. I planted a large assortment of bulbs and perennials this past fall and am curious to see just what actually grows. There's a good variety of stems poking through the bark in the flower bed up front, too. No starts of leaves on the trees just yet.

It is blindingly sunny today. The last couple of days of rain have finally melted away the last stubborn piles of ice. I think I'll go for a walk and get my fill of vitamin D, and then do a little bit of housework drudgery before I head off to work.

Making Mountains Out of Mole Hills

Yes, it is really almost 2 am.

I just got home... from work.

How is it that pimples can just show up out of nowhere? There you are, minding your own beeswax, when you glance in the mirror and there appears to be a huge appendage struggling to grow out of your face? No warning, just out of nowhere. It is just like those crazy mushrooms that magically show up in your yard in the the morning.

How is it fair that I can have pimples and little crinkles around my eyes at the same time? It seems like I should have at least been granted a decade or so of perfect skin before the wrinkles started in.

Pretty, Pretty Princess

On Thursday night I played poker (Texas Hold 'Em, tournament-style) with some of the co-workers. I came in second.

On Friday and Saturday, I spent several hours sticking scalpels into various pockets of pus on multiple patients and sewing up assorted lacerations. (The butt abscess patient actually thanked us with a gift basket of snacks!)

Yesterday, my attempt at running was ruined by a sinus headache. With every step, it felt like the Keebler elves were inside my head pounding at my frontal sinus with their mini-hammers.

Tonight I am working. Before I do, I am going to go blow my poker winnings on a pedicure.

Whew!

Work went ok last night. One of my attendings was talking to me about how she had a similar setup during her intern year, and spent almost the entire year out of the department before she finally came back. She said that she used to get sick before every shift. That made me feel a lot better, as much of the time I make myself sick with worry.

My shift ended at midnight, but I didn't get home until after 3 am. One of my patients had a posterior shoulder dislocation, which is kind of unusual, so I decided to stay late and help try to get it back in. We were unsuccessful even after sedating him, but apparently the orthopedics team got it on the second try because when I checked his file before I dictated his chart today, there were new x-rays showing it back in place.

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Today I just had to go in to the simulation lab for a few hours. I suppose that the sim lab is the only objective way of comparing resident knowledge as all of our interactions are recorded and then we get debriefed afterwards. We're participating in a study to see how the lab simulates real stressors, so when we do our scenarios we have to wear these backpacks with several leads attached that monitor our respiratory rates, heart rates, armpit temperatures (!), and then we have to spit into test tubes before and after each scenario to see if our stress hormone levels are changing. Mine today was pretty challenging. The mannequins are fairly realistic... they can be hooked up to monitors, have heart and lung sounds, etc. There's a couple people behind a mirror that can change the programming in response to the medications we give. My patient was programmed to die regardless of what I did, but I did manage to respond to the scenario correctly. I think I may have even redeemed myself a little in the eyes of the attending that runs the cases.

I would say that I am normally a pretty independent person, but every now and then it is nice to be told that you are doing a good job. There are so many variables in residency that it is hard to know if you are actually at the level you are supposed to be at. And, while it is almost all on-the-job training, a lot of times there is no feedback until you do something different than the way your supervisor would have done it. I haven't really gotten chewed out by anyone, but it sometimes seems like the pats on the back are few and far between.

I read somewhere recently that for every negative comment a person receives, it can take about twenty positive comments to repair those hurt feelings. I don't think that I tend to criticize others a whole lot, but I definitely don't compliment them as much as I should either.

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This afternoon, I put on my iPod, listened to Norah Jones, and walked along a frozen lake for about an hour. It was cold, but I was fine as long as I didn't dawdle. There were almost perfectly round mirrors of silver water in areas that were melting along the lake's surface. It just seemed kind of random how certain patches were melting ahead of others. The circles were almost all about the same size, too. The trees are still just skeletons standing around in awkward nakedness, but along the water's edge Canadian geese were happily rooting around in the half-covered grass, finding some sort of new life to munch on.

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Oh, and I almost forgot: "The Phoenix" matched at her first-choice program! She's going to be an awesome pediatrician!

Performance Anxiety

Tonight I go back to the department. I am extremely anxious about it. I have finally finished all of my off-service rotations and now will be in either the Adult or Pediatric Emergency Department for the rest of the year. I really like our attendings and our residents, so it will be good to be around some familiar faces. However, at the same time, now I will be around long enough for them to figure out just how dumb I am. What if I hate it? So far this year, I have been flying under the radar. I have had good evaluations and no incidents with administration. In many ways, I kind of feel like the invisible intern. While my colleagues have been having confrontations with the staff, most of them don't even know who I am! I guess I will just have to step it up a notch. Maybe the desire to not look like a complete idiot will be a better motivator to keep up with my reading.

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In other news, my younger brother was in a car accident over the weekend. He has about 6 months left in Kenya as part of his Peace Corps mission. Apparently two jeeps were passing each other on a mountain curve and his got knocked hard enough to roll it over twice. Luckily he was on the inside part, so they didn't roll down the side of the mountain. He ended up needing some x-rays and stitches and now has to take HIV prophylaxis meds for the next month as they weren't sure that all of the blood on his face was his. Between this and losing 40 pounds that he didn't have to spare from bacterial dysentery, he has had quite an adventure over there. He's done some good things too, like constructing a subterranean dam, solar-powered water heaters, and is trying to get a windmill project off the ground before he leaves. I am sure it is an environmental engineer's paradise, but I can't wait to see him. At least now he probably won't be such a picky eater.

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As for running, I did 6 miles on Saturday, and rewarded myself with ice cream on Sunday.

Alone in the Crowd

Last night I went out again with the coworkers. We started out late, so I figured there couldn't possibly be too much trouble as there wasn't enough time for people to get too intoxicated. Boy, was I wrong: they just drank faster! To make a long story short, the same girl ended up needing to sleep over at someone's house, but this time I made sure that it wasn't at my place.

There seems to be some sort of lack of distinction with them between the terms single and desperate. They seemed like they were bound and determined to shove me off on any nearby guy. First, there was a creepy flight attendant that didn't get my sense of humor. Then there was a guy that was extremely good-looking, but totally plastered. He was literally using the barstool and myself as crutches to keep from falling on the floor.

The other unfortunate thing about my coworkers is that they get really LOUD when they're drinking. They kept suggesting that I leave with this guy as he was, "like, totally hot." Unfortunately, drunk guy picked up on this and asked if he could come over. I said "no", and then as the bar was closing he kept just standing there like I was going to change my mind. Finally, he left and I got chastized for being too picky and was told that I was never going to meet anyone if I didn't "hook-up" with them, and that I could get to know him later! They all kept looking at me like I was crazy when I said that I don't believe in taking random strangers home.

Besides, I figure that if he wanted to get to know me at all, then he would have asked for my phone number or given me his. Clearly, he was just looking for someone to spend the night with.

I talked this over with my friend today and fortunately she agreed that sleeping with people is not a good way to get to know them. I thought that this was somewhat backwards, but last night I was clearly in the minority. Maybe I am just more conservative, but I don't get why these girls have such low standards. I don't know why there is such a disparity between myself and them as to what is appropriate behavior, but it is not something I am going to compromise on. Maybe I should just stop going out to bars with them, and only join them for activities that have an actual purpose, like dinner, poker, or bowling.

New Mileage

Yesterday, during my long run I did 5.25 miles! I am still going with the run-walk method, but I haven't been at it regularly enough to see if I am making better progress. Otherwise, the weekend was pretty uneventful. I watched a movie at a friend's house, and did catch-up housework here. It turned out that I didn't get a single page on Friday night! Today I was supposed to attempt cross-country skiing or snowshoeing with some friends, but the weather did not cooperative. There is still quite a bit of snow lying around, but water is running steadily down the streets.

And Now for Something a Bit More Whiny

He leaned over the counter this morning, making small talk while writing a quick progress note. Around his wrist was a white rubber bracelet, of the type popularized by Lance Armstrong and his Livestrong cancer awareness effort. The last three letters read -T-H-Y. He was clever enough, so I asked him what it said. He hesitated a little and then turned it around a bit so that I could read: A-P-A-T-H-Y. He told me that he has another one at home that says DESPAIR. I know this was just a sarcastic, and somewhat thoughtless response to all of the trend following bracelet-wearers.

However, the bracelet kind of stuck in the back of my head all day. It didn't really help matters that the reason that he was checking up on our patient this morning was that he had accidently overdosed one of her meds yesterday. If I were in his position, I don't think I would want to be seen with that around my wrist.

Then I started thinking about what my bracelet would say if I was to describe how I felt in one word.

TIRED?

WORRIED?

FRUSTRATED?

LONELY?

USELESS?

Schedule-wise this has been a more relaxed week for me. I have been working out more regularly, and even reading a little every night. And yet I just feel like a mess. I don't know what I am accomplishing here. I kind of feel like I am in a pit with steep, muddy walls that I can't climb out of.

If I had my pick, I would want my bracelet to say CONTENT or more simply LOVED, but those seem to be feelings well out of my grasp right now.

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I am on home call right now. It's hard not to just sit there and stare at my pager, willing it not to go off. It is annoying that the key to sleeping tonight is directly related to a 1" x 2" x 0.5" electronic device. I HATE THAT THING. A person with a good attitude would be grateful for being able to spend a call night at home, but unfortunately I am not in that state of mind... yet.

This evening, I watched "An Inconvenient Truth". It was pretty good, and I think that I may have learned a thing or two. I did not realize that Al Gore was such an idealist. I used to be like that. I guess maybe I just need a little refill on my supply of hope.

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P.S. "Match Day" for medical students entering residency programs this July is coming up next week on the 15th. Please keep "The Phoenix" in your thoughts and prayers.

The Face of Evil

Photo by Rick Leche, who has some amazing wildlife shots on www.flickr.com

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!

A Few Steps Forward

All truly great thoughts are conceived by walking.
- Friedrich Nietzsche

I wanted to clear my head today, so I went for a walk. Just around the neighborhood, nowhere special. The clouds taunted me-- first with big, fluffly "lake effect" snow, and then with stinging sleet. I don't know that any "great thoughts" came to mind, but afterwards I did feel a little better.

During medical school, I somehow befriended a gruff, older classmate. She had been forced to retire from her career by an injury, and made the unlikely choice to relocate from Maui to the dusty, polluted desert to attend medical school. She was quite a character, and I think I learned a lot from her during our few years together.

One of the things that she liked to do was walk early in the morning before class. A few times she actually convinced me to meet her at 6 am and accompany her on a two-mile walk from our apartment complex. It wasn't much, just a short trail along the edge of a wash behind the same stucco houses that pop up in crops all over that city.

She was a big believer in taking care of one's self emotionally as well as physically. I believe she'll make one wickedly-awesome psychiatrist. One of the things that she shared with me was that she used to walk along the beach of the North Shore every morning, and that walking Skunk Creek (I am not making that name up!) by our school was the best she could do to replicate that. Getting outside and away from everything else helped her to calm down enough so that she was better prepared to deal with the rest of the day. I'm hoping to transition to running outside when the weather's better because while I can blow off steam at the gym, it is not exactly a relaxing escape. And, while I try to relax when I am home, often I can't seem to get my mind off all of the things that I should be doing. Maybe adding a few evening walks a week will help.

Last Call

The weather has been crazy lately. On Friday morning I nearly fell in my own driveway as the snow had melted on Thursday and re-frozen overnight. I was on call on Friday, and today the temperature was almost 40, so again, there was much melting. I went to the gym for a quick run, and less than an hour after I returned home, it started snowing again!

Last night was somewhat of a milestone as it was my last 24-hour shift of the year. Apparently, I have one weekend of home call coming up, in which they can page me at any time and I have to go in if they need me. Many of the other interns have had weekends free of interruption with this arrangement, so I'm hoping for the best.

I will be meeting up with one of my friends and her kids in a few weeks, but otherwise no vacation until June. Hopefully, my motivation will return again once I get back in the department. I just have no desire to do anything right now. I don't feel like I learned very much during my time on the pediatrics floor. With the quick turnaround, constantly flipping patients, and constantly revolving community pediatricians there just wasn't any continuity of care. Towards the end, I did end up with some more normal cases, but the amount of social work issues that came up was just staggering. I don't know how pediatricians do it. Between the neglect, physical abuse, and poor decision-making skills of many of my patients' parents, I think I would end up on anti-depressants if I did this full-time.

Otherwise it was a day of napping, TV watching, and wallpaper attacking. And just a tip: if you're scoring wallpaper and using a chemical spray to help remove it, it also helps to sponge it down with hot water before scraping.

Multiple Guesses

Sorry the posting has been so scant as of late. I just don't feel like there's much of anything to write about.

Today was our annual in-service exam. Every year during my residency I will be subjected to the American Board of Emergency Medicine's guantlet of questions. After residency, graduates are supposed to take a board exam to be licensed in their particular specialty. Taking this test is supposed to be helpful with preparation. I didn't really do much to prepare for it this time. I have been trying to keep up with my weekly assigned reading, but I don't always get everything done. I should be reading more about the patients that I've seen during the day, but somehow I just don't want to deal with it when I get home. The test was 225 questions long, and I probably finished the exam among the first third of the group. That doesn't really mean anything. Usually, I will quickly scan through my answers after I take a multiple choice exam, but I just wanted to get out of there.

My understanding is that as long as I show improvement every year, that is all that matters. I think I may have set the bar pretty low today. Some of the questions I knew right away what they were looking for, but there were many that I just had no clue about. Many times I have felt like I am just plugging along this year, not really learning much. However, as I was working my way through the test, I kept remembering particular patient encounters and tried to remember how we handled each particular situation. I guess I am learning, it just doesn't seem like it when there is such a vast expanse of things to be knowledgeable about. Part of my frustration comes from my continual inability to retain information. Many times I feel like I am forgetting old information faster than I am learning new stuff.

No Sex In the City

On the now-canceled show "Sex In the City" four career women parade about from bar to bar, always dressed to the nines, leaving a trail of men in their wake. Somehow, when I go out on the town, there's never any intelligent conversation or men worth keeping.

Last night we went out again. I thought it would be a more fun experience as I had put McNeedy on a plane outta here earlier in the week, and there were some guys going in the group, so I didn't think I would have to be the one carrying my coworkers home. The night was boring, but going well enough when I turned around and Coworker #2 was bawling again. She ended up crashing at my house overnight. I didn't really want her to, but I was kind of stuck as she was in no condition to drive home, and the single guys in our group didn't really want to cart her around, either.

I was supposed to go skiing again today, but I was awakened by sounds of an asthmatic drunkard coughing all night long, so I didn't really sleep well. She was still passed out this morning, so I couldn't very well kick her out and dump her back at her car. By the time she woke up, the whole morning was gone. I wasted the afternoon by napping to make up for the poor sleep. What a waste of a day off. Maybe I'm better off only going out with couples, so I don't end up having to babysit drunken single chicks.

Not Exactly a Snow Bunny

I went downhill skiing with some friends today. I don't know how to ski. Apparently, it's not something that you can just slide off a lift chair and take to naturally. At least I can't. I attempted skiing once two years ago. This time I thought I would be better prepared as my friend said that he used to work as a ski instructor. He forgot to mention that he doesn't believe in bunny hills. We went straight to the trails. He and his wife coasted downhill with ease. And then there was me...

I don't mind falling. It is the getting back up part that stinks. I have improved greatly in my turning techniques, however I still get really scared any time I start to pick up some speed. Snow plowing down a slope takes a lot of muscle work. Scissoring back and forth across the mountain rather than down is a LOT slower.

And my friend? While his wife and I enjoyed a quick lunch at the lodge, he checked out all of the other trails and decided that they weren't anywhere near as tough as the standards he was used to. Next, he took us on a blue square trail... and then a black diamond trail. The falling didn't really seem to let up any.

After three runs, I was toast. My legs were quivering and my left knee is sore from the time I veered off the course into the powder and buried myself. It is really, really hard to stand back up again. I think that people who are good at downhill skiing probably don't get much of a workout. As for me, I will definitely be taking the elevator tomorrow as the stairs just might kill me. Apparently, there were perfect conditions today: lots of fresh snow, no ice.

The good thing about finishing up before your friends is you can sit in the lounge and sip something lovely called a SoCo Cocoa... which involves hot chocolate and quite a bit of Southern Comfort. They want to go again next weekend, but I have a feeling I will still be limping around then.

Roses, Bagpipes, and Sloppy Kisses

Last night was really bizarre. McNeedy recently broke up with her boyfriend as did another random coworker. They both descended on me, wanting to go out to drown their sorrows. I threw on a bulky sweatshirt, offered to be their designated driver, and geared myself up for a night of adult-sitting.

I am not a regular bar-goer, so I drove us to the one bar in town that I am familiar with. We secured ourselves seats at the bar, and McNeedy began talking up the bartender/manager. She was rewarded with a free beer. A stranger sidled up to us, and began chatting us up. I sat between my two bitter companions. The bartender decided that I was "the Boss" of the group and started to get friendly with me. He helped us dispose of the creepy stranger, and tracked down drunken Coworker #2 when she wandered off to dance at a nearby club.

The bartender, who had also been drinking the entire night, came out from behind the bar. He bought me a rose from a flower vender and we were serenaded by a random friend of his who came in with a set of bagpipes. McNeedy and Coworker #2 continued to get sloppy. The bartender kept checking up on us throughout the night, and he stealth-kissed me a couple of times. Then he said something about me being to much of a worrier, and how he was going to give me something to take home and smoke later to relax! I declined.

Finally, Coworker #2 stumbled back in and we closed our tab. McNeedy settled up, and bragged about how her flirting had gotten us a much lower bill. Meanwhile, the bartender slipped me he phone numbers and tried to arrange to meet me in the ally to "give me something for the road." By this point, McNeedy was puking and Coworker #2 was in tears. I tried to find the guy on the street to decline his stash yet again, but couldn't find him. Everyone got home safe, but I don't think I'll be going out with the girls anytime soon... not to mention returning to that bar! The guy was witty enough when he was sober, but I'm not going to call him. The bad thing is that people in our department sometimes head there with attendings after a busy shift to hang out. Hopefully my name doesn't come up.

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Despite getting home close to 2 am, I was up by 8 this morning. I immediately paged my one normal friend in town and demanded that he take me to breakfast, so I could yell at him for not being available to go out with us last night.

We went to an indoor driving range and hit golf balls for a while. I'm not very good, and actually had not touched a club in years. It was fun, especially as it was in an tent-like dome. If you hit the ceiling hard enough, large chunks of ice would loosen and slide down the opaque parachute material with a crash. Afterwards, the day was killed with watching movies and eating too much at dinner. I guess I'm not a very exciting girl. I would much rather have a calm day like today than the mess of last night.

Tiny Hearts

Yesterday there was a Harlem Globetrotter on the floor. I think he was there to cheer up the kids, but I didn't see him do any tricks. We have quite a few malnourished infants in the nursery, so the nurses took a bunch of pictures of him holding some of our littlest ones. One of my kids is only about 5 lbs even though she's 3 months old, so she was smaller than the basketball!

It snowed about 10 inches overnight and another 4 since I cleared the driveway this morning. Conference was canceled today, so I unexpectedly got a day off. Mainly I've just been lounging around. I tried removing some of the wallpaper from the guest room, but it's a much bigger project than I had figured on. I tried scoring it first and then applying a chemical spray, but it just doesn't come off in large pieces. This may be because the previous owner painted over the wallpaper, so it's kind of thick and unyielding. I tried also steaming it with an iron, but my iron only steams when it is horizontal, so that doesn't work. The plan is to get all of the wallpaper off this winter so I am all ready to paint when the weather's warmer.

It's nice that I ended up with the day off because I have another 24-hour day tomorrow. Hopefully, the weather will discourage too many people from coming or going.

I don't really know what to do with the entry labels. I can't imagine that my entries would be anything that anyone would be looking for by topic.

I'm Rubber, You're Glue...

I sat there this morning and kept my mouth shut. Around me there was smirking. I took a long swig of my coffee. It was too hot, and the liquid burned as it went down my throat, through my esophagus, and right into my stomach. Tonight my tongue still has the angry, sensitive sensation from the scalding. However, sipping at my coffee was the only way I could keep quiet.

I hate morning report. Morning report involves sitting around a large conference table and discussing a case that was admitted overnight. Typically much bashing of the Emergency Department ensues. Today's case was a four-day old infant with bloody vomit who also had a fever. A full septic workup was started looking for a source of the fever by checking the blood, urine, and CSF. The baby was started on antibiotics and admitted to the floor.

The head pediatrician started in on how the cause for blood streaks in the vomit wasn't worked up very thoroughly, and how he thought that the antibiotics weren't really necessary as the infant was being monitored in the hospital. Then he made some snide comment about the ER starting antibiotics as we just wanted to avoid lawsuits in the event of a bad outcome.

Does he consider the unnecessary death of an infant a "bad outcome"? Why is it ok to take chances with someone's child? Our job in the emergency department is to look for life-threatening conditions. Yes, most of the time we see people who don't have a doctor or can't get an appointment. However, in the event that we do find or suspect something serious, we act on it. Otherwise, it would be called the Let's-Just-Order-A-Shitload-Of-Tests-And-See-What-Your-Dumbass-
Doctor-Wants-To-Do-In-The-Morning Department.

Granted, there could have been a little bit more of a workup done for the vomiting. However, the kid was already being admitted to the hospital, and the mother gave a history that her nipples were chapped and sore from breastfeeding. The blood could have been swallowed or it could have been coming from the baby. There's a test that can distinguish maternal blood from the baby's blood that could have helped with this, but it takes awhile to get those results. Is it asking too much for their department to do something more than just sitting back, observing the patient, and waiting for our results to come back? Does it pain them to have to do some work?

This is a problem that I will continue to face. When patients are passed between departments, either side often has issues with the other. However, I think it's rude for them to be so critical when they know that I'm sitting right there. It also didn't help to improve my mood when it turned out that many of their residents were clueless as to when to start the workup, or how to even do it.

Sometimes it's hard to keep a poker face when you really just want to tear someone apart.

Lights and Sirens, part 2

Maybe I had this coming for previously mentioning that I have never been pulled over by a police officer. However, I think it had nothing to do with my speeding last night, but rather my friend's bad luck. This guy has the worst luck of anyone I've ever met. He is very smart and conscientious about caring for his patients. However, a while back he got in some BIG trouble with administration about a confidentiality issue. The next month he had the mishap with a procedure, in spite of being supervised by multiple attendings. I am sure all of us will eventually run into the sorts of things that he is, but he just seems to be hitting them all at once. Maybe I'll ban him from riding in my car.

One of our friends is in the middle of a breakup, so we were at her house for moral support. I was very tired and was almost at his house to drop him off when I saw the lights in my rearview mirror. The officer informed me that I was going 41 in a 30 mph zone, but that he mainly pulled me over because I have tinted windows on my car. Huh? Then he said something about how they were just stopping a lot of people at that time of night to make sure nobody was drinking. So I had to do a bunch of counting backwards and dexterity tests with my hands... which I passed, in case you were wondering. Fun stuff.

So now I'm confused. Is it ok to speed as long as you don't have tinted windows? And my windshield is not even tinted. The rest of the windows have a light tint which was ok back home, but apparently is not a good thing here.

Running Late

Usually, I get to work about 15 minutes before I'm supposed to start so I can kind of get a grip on my surroundings or spend a few minutes chatting with someone in the locker room without being frantic about getting somewhere.

On Monday, the first patient that I met was a 13 year-old boy. He was unresponsive. He had been in the car with his dad when their tire blew out and they flipped upside-down into the frozen waters of a nearby creek. His father died that night. The boy was taken to our hospital, and several tests had shown that there was no brain activity. His mother, who had not been in the car that night, made the tough decision to stop all medical interventions, including fluids and nutrition. As he was seizing uncontrollably, there was little hope of him regaining any function. Over the weekend, one of the nurses had an issue with fluids being withdrawn, and decided to restart his IV without having an order to do so. I don't know how that issue was handled, but this is what I walked into. I briefly met the mother, examined the patient, and continued on with my list of patients. Fluids were again withdrawn. Tuesday I had off, and Wednesday was a conference day so I was excused.

Today, as I walked in, I was told that the patient had just died. I think that I have never been so thankful to be running late in my life. By the time I got there, he had already been pronounced, and the poor overnight resident had to stay late finishing up the paperwork. I don't know exactly what I'm learning about medicine this month, but I am certainly getting a crash course in ethics.

My next patient was the opposite end of the spectrum. The resident from last night had been taking care of her so I hadn't really known much about her case. She was doing well enough after her surgery to be transferred to the rehab floor, so getting that accomplished was my goal for the morning. As I sat down to read her chart, I was surprised by what I found: this girl was from Iraq. She had been a very sickly child, who was having fainting spells that were getting worse. It turned out that she had a large defect in the wall of her heart that separates the two ventricles. Her oxygenated blood was mixing with her deoxygenated blood to the point that her body wasn't getting the oxygen that it needed. She had seen doctors in Baghdad for this, but after keeping her on medication for a year, they had stopped all treatment and told her family that the condition was inoperable.

And that's when the miracle took place. Somehow her path was crossed by a U.S. soldier who brought her here. To sum the story up, last month she got a patch placed over the defect in heart. She developed a fatal arrhythmia in the operating room, and a pacemaker was immediately inserted. Her left side is weak, and the head CT I ordered this morning explains the weakness as there is evidence of an old stroke. However, today she has a chance. Her life will never be that of a normal 9 year-old, but with therapy and some medications, she should do well. I tend to not make political comments because in general I have nothing nice to say, but today I was proud of my country.

It kind of reminded me of that tale about the starfish, where the old man is on the beach throwing the starfish he finds back into the ocean. A young man points out how they will keep washing ashore and there's no way to save them all. The old man keeps at his work, and says something like "well, it makes a difference to this one."