A Sick Sense of Humor is Mandatory

So, "the other day" I saw this guy that had amputated his right ring finger. He had somehow crushed it at work and literally pulled the end off when he pulled it out from where it was smashed. He showed up accompanied by a leather glove in a Ziplock bag full of ice.

After I checked out his stumpy finger and saw the bone sticking out of the end of it, I wanted to look and see how the detached part looked. So, I took the glove over to the sink and proceeded to examine it... but not before plugging the drain as I have a bumbling co-worker who had the misfortune of dropping someone's tooth down the sink last year! Sure enough, I could feel something squishy at the fingertip end of the glove. I tried shaking the glove out, but the severed finger would not come out.

Here comes the punchline: At that point, I told the patient I wanted to cut off the end of the glove to get his finger out, but not before asking him if he cared, or was "attached to the glove!" Sometimes, I crack myself up!

Unfortunately, the detached skin was too soggy and devitalized to salvage (don't put things directly on ice) so I think we just threw it out. And, if you have seen Michael Moore's new flick, "Sicko" then you already know where unsalvaged fingers go...

Audited!

Do you know what makes for a fun day? How about checking your mailbox and getting a letter from the Department of Health? How about that letter being from that Narcotics Department?

Still not having fun?

I'm not in trouble. It was just a letter alerting me that one of my charming patients has been bouncing from hospital to hospital, and I was one of FIVE people who sent him home with a prescription for narcotics in a period of a few weeks. However, I do not appreciate having made the Narcotics Division's list.

Being in Emergency Medicine, there is no continuity of care. We have computerized records, so I am able to look up a particular patient's recent visits and hopefully someone documented what scripts they sent them home with. Unfortunately, there's no city-wide list, so other than reviewing our own records I don't have any way to prevent this from happening again. The best I can do is stick to supplying only a few days of meds at a time and referring people back to their regular doctor. Argh.

And You Thought You Were Having a Crappy Day

In that wild and crazy idealistic mind of mine, I would like to think that my job is about helping others. Sometimes though, it seems to take a drastic turn towards meeting someone's demands, rather than practicing any actual medicine.

Here's a story one of my co-workers told me about a horrific experience in which one of her patients workups suddenly went "crappy" the other night:

A male in his mid-forties presented to the ER with chest pain. He had several risk factors for heart disease, so he got the workup: chest x-ray, EKG, bloodwork, aspirin, nitroglycerin, oxygen, and maybe even some morphine for his pain. Midway through his workup, the patient decided that he wanted to leave, that there were better things that he could be doing with his time.

Unfortunately, the man had an IV site in his arm, so he had to be stopped before he hit the door as sending someone out with an IV site in place can lead to all sorts of headaches from providing them with easy access with which to deliver their "unprescribed meds" to infection, bleeding, or damage to the actual blood vessel. Not a good idea.

So the gentleman was stopped and escorted back to his room. In the meantime, another well-intending, but often clueless coworker of mine decided to have a heart-to-heart talk with the guy and convince him to stay. Getting him to stay consisted of fetching him a turkey sandwich . Fine. Whatever.

So the guy stays and waits for his labs to come back, all the while glaring at the nursing staff and demanding them to wait on him repeatedly. Finally, in spite of all the catering to his wants, he gets up and walks out the door... but not before defecating on the floor.

There's nothing that frustrates me more than dealing with rude people like that. Most people are fairly rational, and I think understanding when it takes time for their workup to get done or even when they get pushed back in the line a little bit when something more serious comes in. However, there's always those few demanding individuals that want everything done for their own convenience that cause the most problems.

Sometimes I think that the line between us and animals is very fine, if it exists at all. It's too bad he didn't make it out the door the first time, as a lot less time and effort would have been wasted.

Today's Headlines

Sorry I haven't posted in a while, thanks to those of you who have stuck around.

Lately I have been doing the overnight shift. The bad thing about the overnight shift is that you walk into a messy department. The good thing is that by sunrise, everything has pretty much calmed down.

I have been involved in no small amount of trouble over the past week. There have been shootings, stabbings, and the usual strokes and heart attacks. For the size of this city, we do pretty good. One of my attendings says that working on the pediatric side is pretty much like practicing veterinary medicine, because the infants can't tell you what is wrong with them. I think the same is pretty much true of trauma patients.

I generally don't get much of a story from them. It's usually something along the lines of, "I don't know what happened, I heard gunshots and then I realized I had been shot." Or the more classic, "I was walking to church when this guy just walked up and stabbed me in the chest."

It is generally the next afternoon when I wake up that I get the full story. There's nothing like hearing that the guy you spent 3 hours resuscitating was part of a string of retaliation while you sip your coffee. Or that the guy that died got stabbed because he called his girlfriend a "fatty". Hell hath no fury like a woman scorned, I guess. But then I guess it's better that we don't know what happened... easier not to develop a bias and all that.

Waterfalls

The walk was short, but what a great view:

Yawn

The PU's just left. Today was the one day during their visit during which I didn't have to work. I seem to be run down more now than usual. One would think that it would be no big deal to spend a few hours eating and squeezing in a quick activity or visit and then going off to work, but it's exhausting. I think I am very lucky in that I have low-maintenance parents. They are generally happy enough to just see me for a bit here and there, and entertain themselves the rest of the time.

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.

All Work and No Play

Here's a few pictures from my recent "work" conference. This was the main part of the hotel. They were smart and put us in the back building.

We learned a new dice game. This was hours before security got called that first night.


Views from the kayak.




I think I would like to try sailing some day.

Oh, and I Forgot to Mention....

Some days at work are easy. The asthmatic comes in for a tune-up and goes home. The heart failure patient was a little too indulgent over the holiday and now needs to be admitted, diuresed, and discharged after an observation period. The sprained wrist that may actually have a hidden fracture that needs a splint.

"The other day" (From here on I will now be referring to encounters as having occurred "the other day" to further obscure identities.) my shift was filled with "Oh yeah, and another thing" cases.

#1- First there was the cop that came in with what he was sure was a kidney stone as he had one in the past and it felt similar. So, after getting his pain under control, we checked his urine and ran him through the CT. Sure enough, he had a kidney stone. However, he also had a BULLET fragment in his back. It was very superficial, there were no scars on his skin and it didn't need to be removed. However, it seems to me like having been shot would be something you could kindly remember to mention in your medical history.

#2- Then there was the prisoner that I think just didn't want to go back to jail. Everything was wrong with this guy. He'd had seizures, and although he admitted to not taking his seizure-prevention medication, his case wasn't that simple. He also claimed he was attacked and blacked out when he was arrested the day before (head CT), was vomiting blood, had blood in his stools, a fever, and difficulty urinating.

Our whole workup process is based on the idea of a chief complaint and ruling out life-threatening issues. When you give me a bunch of unrelated crap, it just slows everything down. This guy was young, so he learned first-hand that if you complain of blood in your stools, you're getting a rectal exam. If you complain of bloody vomiting too, and your rectal exam is unfortunately positive, you are definitely getting a tube down your nose.

Getting a tube down one's nose also involves flooding your stomach with saline, and sucking said saline back out into the vacuutainer to make sure that there isn't any active bleeding going on. Meanwhile this involves hawking up all sorts of mucus, and nose lubricant-- which is, by the way, the one thing that makes ME sick to witness. And, this is all very entertaining for the officers accompanying you to the emergency department. Here's a hint: next time, stick with the seizures.

#3- Then there was my uncooperative patient. He had a history of some baseline mental retardation and lived by himself. He called his sister up, and told her he just "didn't feel right" and she had him transported to the hospital. He was stubborn and extremely frustrating to examine as he refused to follow directions and wouldn't give me any description other than just "feeling blah". He did seem to have some more distractability than he should have though, so into the CT scanner he went, with having a plethora of labs pending. This was at the end of my shift. I was dictating his chart the next day, and guess what? The guy had evidence of a recent stroke on his scan. We had no idea when the onset was, and there wasn't much to do acutely, but 30 year-olds who just feel "blah" shouldn't be going around having strokes. Now I am a little paranoid about sending anyone home.

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Posting around here has been scant this past week for two reasons:

1. My laptop's power cord wasn't connecting well enough to charge the battery. It had gotten to the point where no amount of jiggling would do. $135 and four days later it is better, but I think this machine may be nearing hospice-time as the power button is now sticking and it doesn't like to shut down.

2. We had a state chapter conference thing that was four days long. I survived rooming with McNeedy and even went out kayaking for the first time ever. It was a fun time, but between all the lectures and hanging out, I ended up exhausted.

July 4th Memories

Somewhere in the linen closet at my parents' home, there is an old green and black flannel blanket. It has several holes in it, and I am sure the thing is quite musty. It is scratchy to the touch and I am sure there are still several burrs still clinging to its worn fibers. It is the last blanket on Earth that you would ever want to offer to a guest.

However, to me that blanket is special. I remember many a July 4th when our family would park along the street of a residential neighborhood and walk what must have been close to a quarter of a mile to find an empty spot on the grass of a local park. All of our arms would be full. Some of us would be carrying lawn chairs. Some of us would carry jackets for when the heat of the hot Texas sun finally dissipated and it got chilly. Someone would be dragging the old orange and white cooler along. Inside the cooler, there would be ice-cold lemonade, and cold fried chicken. My mother would always have brought along some salted popcorn (made on the stove, not the microwave back then), fruit, and some cookies.

That was our tradition. We'd lie on blankets, my brothers and I, straining our eyes against the dusky sky-- looking for the firemen setting up the fireworks. People around us would be waving sparklers.

Finally, you would hear it, the slight whistle of a rocket shooting up in the sky. You would try to guesstimate just how far up it would go, and then-- all of a sudden, bright lights filled the sky.

The green and black blanket was used to duck and cover when the loud cannon booms that rattled our young eardrums would go off. There were many holes poked through it by little fingers as we wanted to be under cover, but still able to see the night sky.

At the end of it all, the sky would be filled with smoke. There were several years when fireworks fell on a dried up cluster of trees and created quite an impressive blaze. After it all ended, we'd stagger back to the car, as suddenly the sleepiness and full-belly combo hit.

After we moved to Arizona, there still were firework shows, but it wasn't the same. By then, my older brother and I were well on our way to becoming miserable teens, and it just wasn't as magical.

Clearing My Head

I don't know what it is about being near water, but it is always very soothing for me. Yesterday I ran by the lake again... granted it is a polluted lake and when the wind blows just so, there it this odd, almost metallic smell to it.

Just the same though, I like running under an old signal bridge, and along the water. The slow, gentle ripples are the one thing moving slower than me as I doggedly jog along, being passed by roller bladers in their fluorescent shorts and bicyclists with their aerodynamic helmets and spandex.

Speedboats cruise back and forth, painting white lines in the glassy water.

The geese are gone today, but along the water are ducks lined up in a row, and every now and again I spot a robin in the grass.

As I plod along, a wee girl with pigtails paces me on her purple tricycle. For a minute, it is her and I-- neck and neck, until her mother calls her back.

Black-Eyed Pleas

I have nothing much to comment on.

The eye is much better, but is still distinct enough that I have now become a "familiar face" to even the surgeons.

I gave in and turned the air conditioner on because I was tired of waking up in a sweat from the stagnant summer air.

I turned it off again today after a cold front came through.

I am hardly running, but sweating like I have gone three times as far.

Even the grass thinks it is too hot to grow this week.

Death caught up with one of my patients this week, and there was nothing anyone could do about it.

Anniversary

Ok, so this entry is a little off. I arrived here with my friend, Ru, June 22nd last year. So much has happened here since that long, frantic drive. I remember closing on the house on the 23rd. On the 26th, I started orientation at the hospital.

Today the new interns are starting orientation, and they will be in the department next week. We are having a welcome party for them this evening. It has gone by in such a blur. If it weren't for this blog, I wouldn't be able to tell you what I was doing most of this past year. Names and faces of patients have long been forgotten. I am glad to be able to look back on bits and pieces of what I was experiencing here.

This coming year brings new responsibilities. Most of the time I will actually be in the Emergency Department, with helpful nurses and clerks that I already know. So much of last year was learning how each service did things, and I won't have to deal with that any more. Now it's time to buckle down and start carrying more patients. In our department, the second years see the bulk of the patients as the third years are busy precepting medical students and interns. While it will definitely be busy, at least I will be doing things that are relevant to my career.

The Shiner

My eye, sans makeup, in all of its glory:


Initially, there was a lot more swelling, but it does not hurt at all. It is really just an eyesore (ha ha).

Keep Your Eye on the Ball, NOT the Ball on Your Eye

Um, yeah... so we lost the softball game last night 13-20. I started off catching and managed to get injured before the end of the top half of the 1st inning.

It was all very stupid.

In our little intramural league, we don't have a lot of equipment, specifically masks for the catchers. The first time I played catcher I was intimidated by having some stranger swinging a bat with all their might just a few feet from my head. The second time I was a little bit more comfortable, and last night I hardly gave it a second thought.

And, while I stay nice and pretty far back from the plate, that doesn't give you any protection if a foul ball suddenly ricochet's off the bat and heads straight for your eye in a split second.

I didn't have time to move.

I didn't have time to think.

The softball clunked directly against the ridge of bone just above my left eye. I stood up from my crouched position, as the first thought that entered my mind was, If I fall down they're going to think I passed out and make me go into the emergency department.

The rest of the game was spent on the bench with an ice pack slapped over my eye. My vision was fine, and my head didn't really even hurt.

Today when I woke up the eye had swollen up even more and I could only open it with great effort. Dark purple and hot pink pooled blood had collected above and below my eye.

When I walked into the department this morning, everyone stared. Several of the nurses lectured me for not seeking treatment. One of my attendings was initially concerned about my vision, but once he saw that my actual eye looked fine, he switched to giggling every time he saw me the rest of the morning.

And wouldn't you know it, one of my first few patients this morning had a black eye... only hers wasn't even a quarter the size of mine, and she'd gotten it from being punched out last weekend! My attending asked me if I had any sympathy for her, and I just laughed as I had joked about immediately sending home anyone that looked better than me at the beginning of the shift.

The eye actually doesn't hurt at all. I took a good dose of ibuprofen during my shift, even though it wasn't bothering me, and by the end of the shift I was actually walking around with an open left eye as much of the swelling had gone down.

It certainly got me a lot of attention today, although none of my patients actually asked what happened. I got all sorts of nicknames today from "Lefty" to "Slugger". Not exactly how the girl who doesn't like to draw attention to herself wants her day to go. Part of me would have liked to have found an eye patch and a stuffed parrot to wear on my shoulder.

The funny thing is that tomorrow night is the big graduation dinner, and I have to get all dressed up. Too bad I don't have anything fuschia to match my eye.

I think part of my next paycheck will go to donating a catcher's mask to the team.

Wiped Out

The last two night shifts have left me wiped out. Emotionally-difficult patients, and always the less sick ones demanding more time than the really sick ones. Last night we seemed to be having a special on drunken lacerations that required a lot of time to repair. And for it being a week night, there just have been way too many patients coming in lately.

Right now, we're transitioning through the end of the year. The senior residents are done, so rather than running stuff by them, every one of us have to present to the attending directly. This wouldn't be so bad but we have been so busy lately that the attendings have been having to see patients on their own, so there ends up being a waiting line to talk to the attendings. So basically, my fastest, most-efficient coworkers are gone, so I'm feeling a little frustrated with all of the delays.

And on top of the working, there are numerous other activities going on this week, and morning meetings and simulation labs that have been keeping me busy. Fortunately, someone asked me to trade my shift tonight with them, so I can go to bed at a decent hour tonight after this evening's softball game.

Finally, the results of our national exam came back today. I am disappointed with my performance, but our program doesn't really place a whole lot of importance on the test. I didn't prepare for it at all, and that is pretty much obvious by my score. Basically, I just need to show improvement next year, and I managed to score low enough that I can pretty much guarantee that. Maybe this is the kick in the butt that I've been needing though to motivate me start seriously studying for my upcoming licensing exam next month.

In the Summer Time...

Much of this weekend was spent catching up on much-procrastinated on housework. Bleh.

On Saturday, I went down to the local farmer's market for the first time. I feasted on fresh strawberries, tomatoes, and peppers. There were plants everywhere, but I held back and only bought a rose bush to replace the one that died during the winter.

I thought I was showing pretty good restraint, and then I walked by the table of Amish baked goods, where I bought both a homemade pecan pie and a tray of coffee rolls. I have been living off the coffee rolls for the past two days. They were slathered in just enough cream cheese frosting and resting in the perfect proportion of cinnamon and sugar goo. Can you imagine more perfect food? I can't.

One of my friends dislikes the Amish. She says that they don't pay taxes, and feels it is hypocritical for them to come into the hospital as patients, particularly in the intensive care unit, given their shunning of current technology. Personally, I don't really see what the problem is. Just like any other community, I imagine that they have a hard time letting their loved ones go. And, while I don't exactly know what kind of financial resources they have, I just kind of lump them in with all of our other uninsured patients. At least they only show up for care when they absolutely need it, rather than coming in with imaginary aches and pains in order to get certain medications or a night's stay. One of our senior residents did a research project looking at return visits and costs of care for that special group of patients we call "frequent fliers". He found that 1% of the county healthcare budget went to covering costs for one of these patients alone. Now that's ridiculous!

I also went for a run along the lake, and saw several of this spring's goslings tagging along with their parents. Their feathers were still fuzzy. Although they were fairly large in size and learning to feed themselves, they still deferred to "mother goose". That's kind of what I feel like at work. Sometimes it does feel like I am just blindly following the leader, but slowly I am starting to think for myself. I had my second semi-annual evaluation this past week. Those things seem to turn out much briefer than I expect. I don't know what they are like for anyone else, but mine are just kind of "keep doing what you're doing" talks. I guess that's a good thing.

I called my father yesterday (Happy Father's Day if you celebrated!) and found out the PU's are in Montana currently. They're enjoying their RV and slowly meandering across the country to meet up with the family in July for a reunion and me at some later point.

Vegas, Baby

The rest of my vacation was pretty much spent recovering from our hike. I met up with an old college roommate and we flew to Las Vegas to see "Mamma Mia". It was a fun show, and after losing a few bucks quickly at the tables, we decided to spend the rest of our time there lounging by the pool and at the spa, which was good for my sore muscles.

I was in Phoenix long enough to witness a car accident in which someone plowed through a red light right smack into another vehicle. My friend and I left our names and numbers with the officer on scene, but as there were 2 other witnesses, I don't expect to be contacted to provide more details. Luckily, no one appeared seriously hurt.

I won't say that getting away fixed everything, but I do think that I have at least had a better attitude at work this past week. And, while the annoying people are still annoying, there's just nothing much that I can do about them, so there's not much point in worrying about stuff.

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.

Dentist for a Day

My vacation started with "The Phoenix's" graduation. When you graduate from medical school, you get hooded at graduation. It's not really so much of a hood as it is a velvet sash that goes around the neck. The person doing the hooding has to have a doctorate degree. There are instructors available to hood graduates, or at our school you can be hooded by a family member. "The Phoenix" and I side-stepped this little requirement by telling our school that we were cousins.

As I was flying in the night before, "The Phoenix" picked up my gown and hood. She told me the hood was purple, which I thought was a little odd as it was green last year, but then I thought maybe it had to do with my specialty or something.

All was going well enough, until an elderly gentlemen came up from behind me and started straightening my hood. "All of us dentists have to look good," he said. So that's how I found out that purple is for dentists, whereas green is for medicine. Between me not being her cousin, and not being a dentist it was quite the misrepresentation.

Her ceremony was just as long and drawn out as mine was. Our CEO (Yes, I said CEO, not president) was there, wearing her blindingly large, gold University medallion, ala Flava Flav style.

Finally, we double-checked that the name on her diploma was correct, and booked it out of there! I remember the feeling of relief that came with having that piece of paper in my hand.

VACATION!

I am on vacation starting NOW! No updates for a bit.

Back in the Habit

I am back on the adult side. Today there was suturing, splinting, and another CHEST TUBE! Woohoo! Goodbye fever and diarrhea-land!

Screw Job

I worked late on Friday night, but now I have until Monday evening off. This is the first time I've had two days off in a row all month.

My weekend didn't exactly start off the way I wanted it to. Saturday, I rolled out of bed and went to open the blinds on one of the windows in my bedroom. I was surprised to see that some of the siding of the house was hanging off in the breeze! There had been a pretty rough storm the day before. Several trees lost some limbs on my street, but I didn't think it would tear part of the house off!

Luckily, I could reach the section by hanging out the window without having to climb out onto the roof. I could just picture myself falling off the roof and having to go into the ER-- definitely not how I wanted to spend my day off. I hammered the section back in, adding a few extra nails. However, it wasn't flush with the wall.

I decided to find the longest screws I had and drill through the siding into the old wooden stuff beneath. Unfortunately, this meant a trip to the hardware store for pilot point drill bits as the "all-purpose" set I had wasn't meeting my purpose. The new bits went through the aluminum like butter, and I bought some all-purpose caulking as there was still a gap between the siding and the window ledge.

This is where my project went downhill.

I squeezed and squeezed on the caulking tube and got nothing. So finally, I used both hands, only to have the back end pop off and the stuff started to ooze out the back of the tube! Then I tried spackling the stuff onto the side of the house (mind you, I was upside-down hanging out the window doing this), but it wasn't working. Finally, I just started sticking my bare fingers in the tube and slathering it on like frosting. It sort of worked, and luckily, since it is clear and high up, I don't think it is too noticeable. I wouldn't recommend this "technique" though, as I'm not exactly sure that caulking is non-toxic.

The gap definitely needed to be fixed though, as I have old plaster walls in my 82 year-old house. Just under that window the wall kind of bows out and I put my knee through it when I was cleaning the window a few months ago. Maybe with the siding water-proofed there it will stay dry and when I get around to patching the wall it will stay nice and smooth. Finally, because I'm a girl and care about such things, I put some clear nail polish over the screw heads so that they won't start rusting later. Pretty resourceful, eh? Or I guess I could have just used better screws.

Last night I was over at my buddy's for a movie and a few beers. He was impressed, right up until the finger-painting part. He said, "Why didn't you just use a caulk gun?" This is the part where my head spun around and I said, "WHAT?" Apparently, the back end of those tubes is designed to slide forward, which is why the stupid thing popped open when I squeezed it. I thought it was just supposed to work like a large tube of toothpaste! I have another tube to redo the mildewy part around my bathtub, but luckily I hadn't gotten into that yet.

I guess part of the problem is that I have all of these home improvement books, but I don't technically look up things before I do them. I just do them and am then later shocked to discover that there's a better way to go about it. Apparently, J isn't as clueless as he likes to pretend to be. I may have to start enlisting his help around here.

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Today's mishap was in the kitchen. I am trying to do more cooking around here, as I basically use my stove to heat up frozen pizzas. I am smart enough to not attempt new dishes for other people, and am first trying things out on myself. Tonight's attempt was at stuffed peppers. One of the peppers split open down the side. I briefly thought about suturing it back together. It turned out that it didn't even matter, as the stuffing only filled four of the COLLOSSAL bell peppers I had rather than the six the recipe called for.

Other than trashing my kitchen , I thought that things were going well until I saw this:


Here's a closer look in case you missed it:


That would be a tupperware lid, melted on one of my burners. Luckily, the thing peeled off in one piece once it cooled down.


The peppers actually didn't turn out too bad:


I was too full to eat more than half of it though, as I also made some Beer-Cheese soup which was quite tasty... and it didn't involve harming any innocent tupperware!

Glad I Am Not an Early Bird...

I think that working in the medical field, I may have some phobias that are different than the average person. As an EMT, I was horrified to learn about rectal prolapse. We were talking about this very subject with a neighbor during a hockey game the other week, and he said something along the lines of, "What do you mean my ass can fall out of my butt?" Comedic gold, let me tell you!

I am not afraid of having a heart attack. It's all the little weird things like anal fistulas and necrotizing fasciitis that freak me out. I know that I am not alone in this. I had an instructor in medical school who said that he was always afraid of the produce section at the supermarket. Whenever the automatic misters would come on to spray the fruit and vegetables, he said he would take off running. There is a somewhat rare bacteria that can inhabit irrigation systems and he didn't want to get Legionnaire's disease. It's kind of funny when you think about a grown man racing out of the grocery store, but I guess we all have our little quirks.

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Anyway, back to my point: the other night a child came in with a complaint of worms. It turned out that she had pinworms. Not a big deal-- easy to treat, but kind of gross! I never really expected to encounter them as in med school they tell you that the worms typically only come out at night. If you suspect a patient has them, you place scotch tape over the patient's anus and by morning, there will be worms stuck to the tape. These worms weren't even bashful... they were easy to see! Fortunately, the child was young enough that she wasn't even aware that they were there.

Seeing them reminded me of this song that one of my little friends taught me in grade school:

Did you ever think, as a hearse goes by,
That you might be the next to die?
They wrap you up in a big white sheet,
And bury you down about six feet deep

They put you in a big black box,
And cover you up with dirt and rocks,
And all goes well, for about a week,
And then the coffin begins to leak!

The worms crawl in, the worms crawl out,
The worms play pinochle on your snout.
They eat your eyes, they eat your nose,
They eat the jelly between your toes.

A great big worm with rolling eyes,
Crawls in your stomach and out your eyes,
Your stomach turns a slimy green,
And pus pours out like whipping cream.

You spread it on a slice of bread,
And that's what worms eat when you're dead.

So I discovered that pinworms are just like scabies and lice. Once you see them, you are doomed to a shift of compulsive hand washing and just can't shake that itchy feeling until after a good night's sleep.

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.