100 Things

I have been home for about a week now, and it's taken me a little time to get back into old routines. I spent five weeks in Alaska (four of it working, and 1 of it playing). A few days since I have been back were spent catching up on sleep and mail, and then diving back into busy night shifts.

There are a ton of pictures to sort through, and stories to tell, but I am glad to be home. I'm going to follow a lead from Chris, and list 100 things I'm grateful for (in no particular order).

1. Family

2. Army Guy

3. Friends who will let you drag them around at crazy hours for a week and still speak to you.

4. Friends who will wake up their new spouse before the sun is up to meet you for coffee at the airport during a layover.

5. That it gets dark here before 1 am

6. Alarm clock-free mornings

7. Surprise dinners waiting for me in the fridge when I get home from work

8. Anchorage bus drivers that will mail a forgotten cell phone back to you across the country

9. Antibiotic eye drops (don't ask)

10. Microwaves that don't explode when you nuke a fork... uh, twice

11. Air conditioning

12. Summer breezes when the A/C stops working

13. High-speed Internet

14. A stable job

15. Online banking accessible anywhere

16. Coffee!!!

17. DVR

18. ... and cable

19. Worn-in sneakers

20. Scrubs so I don't have to bother with getting dressed

21. Supportive co-workers

22. Knowledgeable and efficient nurses

23. Shady trees

24. Having a roof over my head

25. Alarm system

26. Perennial flowers

27. Smooth intubations

28. Unexpected happy outcomes

29. Cruise control

30. Non-exorbitant dairy/produce prices ($7/gallon of milk, $5/avocado!)

31. iTunes/iPod

33. No cavities at the dentist!

34. Quiet time to read a book

35. Picking fresh blueberries from the Alaskan tundra

36. Digital cameras

37. Nights on-call when the pager didn't go off for a few hours

38. Lightning bugs

39. Reliable transportation

40. Deadlines to push myself harder

41. Finished races

42. Friendly faces at work

43. Vacation time

44. Mint-chocolate chip ice cream

45. Female predecessors who paved the way for me in the workplace

46. Soldiers

47. Freedom of speech

49. Hand-written letters

50. Laughter

51. A finished book chapter revision

52. Freedom of religion

53. A warm hand to hold

54. Afternoon naps

55. That I live in a society that wants to take care of its elderly, disabled, and women with children

56. Opportunity

57. Rediscovering old friends

58. Free time

59. Benefiting from the creativity of others... art, music, theater, movies, comedy shows

60. Ability to travel

61. Good health

62. Optimism

63. Ability to vote and participate in government

64. Ability to have input in my work schedule

65. Ability to work overtime

66. Room to improve in my cooking skills

67. Rainy days

68. Parents that valued education

69. Tree-lined neighborhood

70. Long walks around the lake

71. Tiny details in snowflakes


72. Teachers that challenged me

73. Patients that trust me

74. Mexican hot chocolate (it's cinnamon-y!)

75. Long soaks in bubble baths

76. Foot massages

77. Post-shift bar trips

78. Long highway drives with the radio blaring

79. Running into someone I've helped in the community

80. The comics section in the newspaper

81. Learning more about other people's life experiences through blogs/comments

82. Covered parking

83. Waterproof hiking boots

84. Hours-long phone calls to de-stress with my buddy

85. That first "welcome-back" hug with a loved one

86. First-time "I Love You" and I guess the ones since then, too!

87. Starry nights and trying to find constellations

88. Campfires and s'mores

89. The way time seems to help me forget bad memories

90. My work ethic

91. My stall tactics

92. The way sumac turns impossibly-red in Fall

93. Twinkly Christmas lights

94. Memories of my grandparents

95. Daydreams

96. A future to look forward to

97. The smell of fresh-cut grass

98. My sense of humor

99. There are significantly less mosquitoes here than in Alaska

100. TO BE HOME!!!

Northern Exposure

I am off to catch a flight today and start a new adventure. The plan was to get a lot of entries done before I left and take advantage of Blogger's scheduled posting options, but of course that didn't happen. I don't know what my internet capabilities will be, so there probably won't be any updates for a while. Let's just say the next five weeks will include working without a CT scanner, Air medical transport flights, and meeting up with "The Phoenix" for bear viewing, hiking and kayaking!

Striking Out

Thankfully, with July has come the end of the workplace softball season. I think we actually ended up forfeiting the last two games due to lack of interest. Unlike the record number of injuries last year (my eye, a broken nose, and a broken HAND) for slow-pitch softball, this year's injuries were pretty tame. One of my co-workers dislocated his knee, and another one strained an already bad shoulder, but that was pretty much it.

I was somehow elected team catcher again, despite any actual talent. I did wear a mask at all games as Army Guy declared there would be no dating in public if I managed to bang up my face again. Unfortunately, due to scheduling difficulties, I was available to play almost every single game.

Most of the games were mercy-ruled. We did actually win one game, but it was because the other team had to forfeit when one of their teammates had a seizure as she was standing at first base. At the time of the forfeit, they were already creaming us 6-0 in spite of already taking an automatic out in the lineup for not having enough female players.

A few of us have suggested that next year, we just meet weekly for beer, and forget about this whole softball mess beforehand. Maybe we'll have a bowling team, or better yet, darts-- that would at least make for more interesting injuries!

Rockband

Every now and then, unique opportunities present themselves at work. This past weekend I helped staff an all-day rock concert. We worked for free (I'm sure someone got paid somewhere, but it wasn't me!), keeping the air-conditioned first-aid building a revolving door of heavily-tattooed drunk punks walking in and out. It was a rock/alternative concert, so naturally there was an all-day mosh pit that kept us busy. Paramedics on ATVs regularly brought in the vomiting and wounded.

For the most part, the patients were all drunk. There's nothing more annoying than telling a drunken fool to hold still while you stitch up their ungrateful face with a portable spotlight in a garage for lighting.

ME: "You need stitches."

DRUNK DUDE/CHICK: "I don't want stitches."

ME: "Well then, you can walk out and tomorrow wonder why your face is such a mess."

DD/C: "Fine, put them in. Ow! OW!!!! OWWWW!!!!!! I F***'N HATE GETTING STITCHES!!!"

ME: "Shut up, that was just the betadine."

There were a few serious injuries-- someone got run over by a car and another landed on his head and may have had a neck fracture. Most of the stuff was pretty simple. Our only capabilities were starting IVs and suturing. We were supposed to have been supplied with some Tylenol and Motrin, but ended up not having anything other than nebulizers for asthmatics and antiemetics. Oh well. Anyone with a loss of consciousness, possible fractures, or vague complaints that couldn't be evaluated got shipped out. A full-term pregnant woman came in actively contracting, but she wasn't actively delivering, so we shipped her out, too.

There were 12,000 concert attendants and I think we treated 78 patients. There's a formula for figuring out how many medical providers are needed to cover large-scale events. It's a pretty rough guideline though, because there's no way to really plan for large-scale pandemonium, like when a stage collapses on people or there's a fire/chemical exposure. Our coverage was exellent, and the day was relaxed enough that we took turns walking around the grounds and enjoying the bands. A mid-concert rain shower made for a lot of mud, but kept the temperature cool enough that despite all-day beer guzzling at an outdoor venue, we didn't see too much dehydration.

I stuck close to my attending on breaks because he was well-known to all of the security guys. They let us up right in front of the stage. We were behind the security guard barrier, so it was hilarious watching them catch crowd surfers all night long, and release them back to the masses. I can't imagine the workout from grabbing drunk adults and setting them down safely on the ground hour after hour.

I took these pictures with my cellphone, so they're pretty crappy, but you get the idea.

The music was great, so it made dealing with all of the drunk people worth it. The headliners were Shinedown, Seether, and Three Days Grace. We people-watched from in front of the stage for some of Shinedown and most of Three Days Grace's performance. I could hear most of Seether's songs from standing outside the medical station. Luckily, even drunk people wait through good music to seek medical treatment.

Three Days Grace:

More Three Days Grace:

I think I saw more than enough tattoos and belly flab to get me through the next year. There were a few young women who needed assistance from security getting their shirts and bikini tops back on. I gave my single guy buddy a hard time for missing out on the concert! It was entertaining just watching random shoes and water bottles flying though the air of the crowd.

Short Visit

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

Sympathy for the Devil

The other day, an EMS crew dumped a guy on one of our trauma stretchers. He was on a backboard, so we did the usual stuff as far as stripping him down, looking for injuries and asking him a whole bunch of questions. I can always get a bit of a hint from EMS about the patient. If the patient's been difficult, they pretty much transfer them over and take off before you can get any questions in. If the patient's injuries are interesting, or if they like the patient, they tend to stick around through our initial assessment and x-rays. This was clearly a case of dump-and-run.

This guy was a motorcyclist that rear-ended a stopped vehicle and went flying over the handlebars. He was wearing a helmet, and supposedly stood up and was walking around on scene, but now was complaining of some rib pain and difficulty breathing. As we were checking him out, his main concern was that we didn't cut up his black leather vest. Fine.

So, I continued looking for injuries. There wasn't a mark on him, but he had an interesting collection of tattoos. On one arm was an Irish flag with swastikas, on the other side big letters (in Old English script) that said, "Death to the Queen!" I felt the need to ask him which queen was out of his favor... apparently it's the one in England. He countered with a series of questions about my heritage, and I would have loved to tell him I was English, but my last name kind of gives away my background.

We continue on with the questioning, and there's not any telling marks on his body for injury. His chest x-ray in the trauma bay is negative, but he's complaining of a lot of pain, so we get him ready for a catscan. At this point, he tells me that he doesn't want to be given any blood because "It's against my religion." His vitals are stable, so I tell him that I don't think that's going to be an issue.

One of the nurses asks him if he's a Jehovah's Witness, and he says, "No, I'm a devil worshipper." This causes one of our nurses to cock an eyebrow and reflexively make the sign of the cross across his chest. "And I don't want any salt, either," snarls the patient.

Drip.... drip... drip..

"I don't plan on giving you any salt." I tell him.

Drip.... drip... drip..

"Saline, I mean, I don't want anything with salt in it," he adds.

Drip.... drip... drip..

"What's wrong with a little salt? The only reason it's in the saline is to make it more balanced with the electrolytes in your blood. If I put water into your veins, it would leach out all of your electrolytes and make you very sick," I try to rationalize.

Drip.... drip... drip..

"I don't care. Salt is used in Christian ceremonies like baptisms and weddings, and I can't have any of it in my body. I don't ever eat it, and I don't want any saline!" he protests.

Drip.... drip... drip..

"Ok sir, if you don't want the saline, I can stop it, but I should probably let you know that it's been running since the medic put that IV in your arm, and you've gotten almost a full liter of the stuff."

"WAAAAAAAHHHHHH!!!! TURN! IT! OFF!!!! WAAAAAAAAAAAAHHHHHHH!!!!!!!!!!!" he screamed, and started thrashing around.

So the fluids got turned off. The rest of his time was pretty uneventful. CT scans were negative for any fractures or pnemothoraces and he went home. His blood pressure and heart rate stayed within normal range, so he didn't need any more fluid or blood products and he went home. One of his matching vest-wearing buddies showed up for moral support, and before he went home, a Hispanic woman showed up with his 6 year-old son. With all the swastikas, I was kind of surprised that the guy spoke a little Spanish and would have a minority taking care of his child. I always find it odd that people that are obviously born and raised in this country still carry around predjudices from generations ago (Ireland vs England). Then again, since I don't have any tattoos, I always have the expectation that if you are willing to have something permanently scored onto your flesh, that it has some meaning for you, and I suppose that is not necessarily true, either.

Two Years in the Making

Every fall I have added new bulbs to the existing ones slumbering in the flowerbeds around my house. I often forget where and what I have buried. For the past year, there have been prominent green leaves next to the front steps. I could not remember what kind of flower they were, but given the size of the leaves, I had great expectations.

A few weeks ago, giant iris blooms appeared out of nowhere that were so heavy that the stalks tipped over to the ground. I guess it takes two years to make an iris, but I think that they are worth the wait.

Humble Pie

It has been a rough week for me procedure-wise. The other day I saw a septic patient. He had a fever, diarrhea, a heart-rate twice normal, and a soft blood pressure. So, we did all of the usual things, and then I got called to his room because there was a problem getting IV access. No problem-- time to put in a central line (an IV placed into one of the larger veins in the body- internal jugular, subclavian, or femoral veins). I didn't want to access his neck because he'd been shot there recently and there was a lot of scar tissue, a retained bullet and bone fragments. I didn't want to access his groin because of the diarrhea issue and with him being paraplegic it seemed like it would be easily contaminated. So, I settled on the chest. The needle connected with the vein and I had no problems floating the catheter in over the wire. However, when I went to check the ports, I drew back air instead of blood. Uh-oh.


At this point, the patient's father came in the room and said that central lines wouldn't work on his son (which doesn't make sense) and that he would have to have a PICC line (large catheter placed into one of the arm veins). So, we abandoned the procedure, and called for the PICC team.


And that's when the patient decompensated. He went from a heart rate of 120 to 160 to 200. The monitors get very angry when one's heart rate is 200... that's a whole lot of beeping! I had already had a sinking feeling about my failed procedure, but this just confirmed it. A quick portable x-ray showed it all: the patient now had a pneumothorax.


There was no time to wait for a PICC line. This guy needed fluids, antibiotics and was heading towards needing a pressor. Quickly, I put in a femoral line while the ICU was called. The ICU resident automatically called the cardiothoracic surgeon and that's how I ended up creating business for my least-favorite surgeon. The treatment for a pneumothorax is to put in a chest tube to decompress the air and reinflate the dropped lung. I'm capable of doing a chest tube on my own, but by that point surgery was involved and it was too late to uninvolve them.

I talked to the patient and his father and let them know what had happened. Apparently, the exact same situation had happened when a subclavian was attempted when the patient was shot several months ago. My attending was pretty cool about the whole thing, shrugging it off with "Well, they say you haven't done enough subclavians if you haven't dropped a lung." However, I think I am going to be more than a little gun shy about doing them in the future. As for the patient, he did well and went home a few days later.

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And then there was the patient that walked out of an ICU against medical advice a few days ago. The nurse called me immediately into her room and there I found a heavy older woman only able to speak 2-words at a time. She said the other hospital called her at home and told her to come in immediately or else they would send the police to her home to escort her to the hospital. (This story doesn't quite make sense because the patient appeared to be completely capable of decision-making to me, but that was her story.)

Anyway, the woman was in respiratory failure and had asthma and COPD. Not a good combo. She refused any IVs, and said she had a DNR (Do Not Resuscitate order) "somewhere" and did not want to be intubated. So now I have a patient in respiratory failure that's tying my hands behind my back as far as letting me help her.

We started breathing treatments. She had already taken oral steroids at home.

She got worse.

She agreed to let me give her one shot of something, so we drew up some terbutaline.

She got worse.

She agreed to an IV finally, and medication-wise I threw everything I could think of at her.

She got worse.

We tried non-invasive ventilation.

She got worse.

Finally, she said she wanted to be put to sleep. I confirmed that she meant she wanted a breathing tube, and to be put on the ventilator. I then called her neighbor and made sure there was someone to take care of her dog. Apparently, that was why she left the other hospital in the first place and didn't want to come in today.

We set up for intubation. She was difficult, but the tube passed easily, good color change, breath sounds. Fine. Before we could confirm it with a chest x-ray she desats and turns purple. I pulled the tube, but now I can't get it back again. I can see just a hint of where I need to put the tube but it's not going in. I try to use a different tool, but it doesn't work either. Finally, a colleague steps in and is able to get it. The patient went off to the ICU. She got extubated two days later, and is still in-house, but at least she's been moved out of the unit.

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So it hasn't been the greatest of weeks. Two big blows to my confidence. Everyone has bad days, but it is kind of poor timing as I am about to start working part-time at another hospital without an attending to be my safety net.

13.1

Thirteen miles is a long way to run. I ran a half marathon last Sunday (Yes, I also called my father!). I ended up finishing much better than I thought, at 2:30. For some reason, I had it in my head that it would take me 3 hours to finish. I did walk about a quarter of a mile of the race because I got a bit overheated, but overall I'm pretty happy with how I did.

This particular race has only been around for about 4 years, so while there was also a full marathon and a four-person relay marathon going on, it didn't attract athletes as competitive as in the 10-mile race I did earlier this year. The fastest marathoner came in at 2:50.

I ran with another couple from work. AG was there, but he didn't get to run because of a knee injury (healing well, but too soon to test it). Our race packets got mixed up, so I ended up accidentally running with his number and chip timer. When I crossed the finish line, they read off his name, took one look at me, and then tried pronouncing his first name a different way to make it sound more feminine! He was a great asset-- doing all the driving, calming my nerves, and just being great moral support.

While running the race, I decided that I would have to be crazy to attempt a full marathon at this point in my life. The running schedule for just a half marathon pretty much sucked up the majority of my free time these past couple of months. And to be honest, I didn't even run as much as I should have. So now with multi-hour runs off my schedule, I am once again a free woman... or at least free to focus on my academic projects, and doing stuff around the house. I would like to not completely blow off running entirely and do a couple 10-mile runs a month, but we'll see how well I maintain it.

Washington DC Day 2

Day 2 was another full day of walking, museums, and monuments.

International Spy Museum, which featured all sorts of mini cameras, a dog poo radio transmitter, a lipstick gun, and an emergency rectal tool kit (Unfortunately, I am not making that last one up!):

Recently built (2004) World War II Memorial:

The Washington Monument:

The Lincoln Memorial:

Korean War Memorial:

Statue next to Vietnam Memorial:

Statue honoring medics/nurses during wartime:

The Jefferson Memorial:

An inscription inside read:

I am not an advocate for frequent changes in laws and constitutions, but laws and institutions must go hand in hand with the progress of the human mind, as that becomes more developed, more enlightened. As new discoveries are made, new truths discovered, and manners and opinions change with the change of circumstances, institutions must advance also to keep pace with the times. We might as well require a man to wear still the coat which fitted him when a boy as civilized society to remain under the regimen of their barbarous ancestors.

We also squeezed in the Smithsonian Air and Space Museum, and attempted the Holocaust Museum, but they were closing up for the day. There are so many things to see and do there, that I would like to go back again sometime. It was fun having a weekend with AG to explore and ignore phone calls and email.

Washington DC Day 1

Some traditional and not-so-traditional sights found walking around Washington D.C.

I am still not sure what they meant by "Kiss & Ride" at the Metro Station:


No clue what building this is:

The Capital:

J. Edgar Hoover FBI Building:

The White House:

This was at the Smithsonian Museum of Natural History. The title of the display was something along the lines of "Man Taming a Goat". It cracked me up, because if I worked in a museum, I'm sure I would get bored with setting up traditional displays.

Roman tile mosaic:

Door detail from the Department of Justice building:

Arlington National Cemetary:

Changing of the guard at the Tomb of the Unknown Soldier:

That night, we had tickets to a murder mystery dinner. There were some strangely dressed people in the audience that we had originally thought were part of the cast, but it turned out that they were just bizarre people in the audience.

All the Pretty Horses

Last weekend AG and I went to Washington DC. I had never been there before. He did a summer internship during college at the FBI, so he was a great tour guide and helpful at navigating the Metro and figuring out where to stay inexpensively. We spent two full days cramming in every museum and memorial we could find. I quickly noticed that Washington DC seems to be a city in love with horses. AG was laughing at me as I went on a quest to capture every horse statue that I could find.

We found these while walking around town:

This one was at Arlington National Cemetary:


Behind the Lincoln Memorial:

Gremlins

AG came back last week. It is nice to be able to talk to him regularly on the phone, not to mention being able to put my arms around him! For once, we both had a three-day weekend off in common, so we seized the opportunity to jump in the car and make a break for it. Our trip was almost ruined before we even got to our destination. After stopping for dinner about 2 hours into the drive, we went back out to my car and it wouldn't start.

In fact, the key wouldn't even turn in the ignition.

I couldn't imagine what the problem could be as I had never had any problem with the key sticking before. We were in a small highway town in the middle of nowhere. There was no Saturn dealership for miles, and it was after-hours on a Friday night. Even if we could get into a dealer early on Saturday morning, our weekend would be wasted.

I was just about to throw up my hands in disgust and call a tow truck. However, tucked inside my wallet I had a roadside emergency key that came with the car in addition to the two sets of keys and remotes. My memory was that it was just a key to be used in the event that I locked my keys in the car, and it would only work in the doors, but not the ignition.

AG suggested we try it anyway, and wouldn't you know it: it worked! It was kind of clumsy to slip the key far enough out of its plastic sleeve to turn in the ignition, but it served us well the whole weekend.

When I got home on Monday, I tried my spare key, but it wouldn't turn in the ignition either. Tired and frustrated, I went in to work my evening shift-- which turned out to be crazy-- 3 GSW's and a bizarre ICU case.

On Tuesday, I got up early to take the car into the dealership. They checked the lock cylinder and said it was ok, that both keys had just gotten too worn down to work any more. The "spare" key was the one that I used almost exclusively for the first few years I had my car, until the remote battery died and I switched over to the second set. However, it worked perfectly fine the last time I used it.

It seems pretty odd to me that both keys would be worn down to an inoperable condition! However, I'll just blame it on Car Gremlins and be thankful that it wasn't a more expensive problem and that our weekend wasn't ruined (pictures later). Just the other day, I had considered removing the roadside key from my wallet because in the 6+ years I'd been carrying it around, I had never needed it. I guess now I will always keep a backup key around.

Sleep to Dream

Last weekend was spent visiting Aunt Ruth. I had wondered why the flight to Indianapolis was so pricey. As it turned out, it was the same weekend as the Indy 500. I perplexed more than a few race fans on the plane when I said I was planning on spending a nice, quiet weekend in a retirement home rather than watching the race.

Last fall, Aunt Ruth suffered a hip fracture from a nasty fall. She made it through surgery, and finally rehab, but she's definitely slowed down quite a bit from my visit two years ago. Since the fracture, she's had three more falls, but luckily hasn't broken any more bones. For me, the weekend was an opportunity to see her at her baseline. With my grandparents, there was always that expectation of an upcoming visit that was canceled abruptly by death. At least for me, visiting Aunt Ruth is somewhat awkward as in my head, I am always expecting it to be our last meeting. Happily, so far she's proved me wrong.

As it turned out, she had full-blown hip replacement last fall, which is kind of shocking given the high mortality rate (up to 35% in the first year following surgery) and her age (105 this past February!). I am sure that she made the decision as she would have hated to be bed-ridden, but it seems like most orthopedic surgeons wouldn't touch someone her age. Now she is clearly having balance issues and the long walk to the dining room now has to be interrupted by rest breaks.

Her remote memory is now being affected. She introduced me to a lot of other residents. Sometimes I was a doctor, sometimes I was a nurse. Sometimes I was from Washington, sometimes I was from Arizona, or Louisiana... it's a good thing we sat with different people at each meal, so nobody caught on!

Our days were full-- with meals at 8 am, 11 am, and 4 pm. In between there were 3 or 4 naps a day. It was a good visit and she reminisced often, sticking to the same memories that she felt comfortable talking about. We talked of Appersons and life on the farm.

Like my grandparents before her, Aunt Ruth is withdrawing from the world around her. The woman who used to read three newspapers a day still has a picture of Ronald Reagan at Camp David from 1984 on her desk.

Luckily, although she never had any children, one of my uncles checks on her several times a week. The staff at the assisted living center also seem to be pretty good about checking up on her several times a day. The day is soon coming when she will have to move to the nursing home wing, and she seems to be all too aware of that, but is putting it off for now.

I prefer to think that her mind works better when she drifts off to sleep, returning to a time of antiquated behaviors and expectations, a world where she makes decisions rather than having them be made more and more for her.

An Update, but Not Really

I have been neglectful about updating this thing as of late. Lately, I just seem to be content at doing nothing. Free time abounds, and instead I am content to waste it all. The running has continued, in spite of the "unseasonably" cold weather lately. My motivation has off and left once again. Tomorrow I am heading out to visit my Aunt Ruth, if I can get myself packed and on the plane! Let's hope I gain some inspiration from talks with a centenarian.

Puddle Jumping

Yesterday, I ran in a 5K race. I had participated in the same race last year, but this year I did much better, coming in over 3 minutes faster than last year's time. The first mile I ran in 8:34, which is flying for me (I am typically a 10 min+ distance runner)! For me, the highlight of the race was passing by this guy doing Beatles karaoke by himself dressed in a Sgt. Pepper-style costume, complete with mustache!


Today, I went for a 12-mile run. It was raining most of the time that I was out there. Unfortunately, I stepped in a puddle right around mile 6, so that changed my stride to step-splat-step-splat with rain dripping off the right side of the bill of my hat. The sprinkling finally stopped for the last 3 miles, and that was when the wind picked up. A rain/sweat-soaked fleece shirt does not make for good insulation. On the drive home, I was still sweating and shivering at the same time.

My legs are already telling me that tomorrow is going to be a day of rest. The good thing about getting the run done today is that was the longest run according to the training plan. The rest of the weeks before the half marathon taper off. It does make me nervous to be running 13 miles on race day when I haven't run that far in practice runs, but there seem to be two theories in training: either build up to 90% of the race distance and back off, or run 110% of the distance and back off. I guess the main thing is to not fall into my usual pattern of taking weeks off entirely and avoid injury.


I did finally pick out some new shoes, but I haven't worn them yet because I figured today was not the time to break them in.


Here's the old stand-by's:

They will probably be reserved for nasty weather until the end of softball season, when they'll make their debut in the ED. (Hospital shoes stay in the hospital, given the nasty things that can be found on our floors.)


And the new pair:

The fancy running store I went to measured me, analyzed my stride on a treadmill, and pored over the soles of my old shoes. I received a look of disapproval when I said I had been wearing my old shoes for over a year. Then an engineer-type dude sat down next to me with his 9 year-old Nikes! These ones have a lot more arch support, so we'll see if I still end up with sore feet. (Either way, I don't imagine I will stop taking advantage of Army Guy's foot massage skills.)

Into the Wild

One of the things that I have discovered that I like most about running is the ability to clear my head. After a certain point, it is just one foot in front of the other, with breaths rising and falling as part of the pattern. I think that I must be somewhat unbalanced, as after I get going, I inevitably develop an ache in one shin, which melts away as an ache in the opposite knee develops, which recedes in kind as a groin or butt muscle begins to whine. (How is it even possible for only one side of your butt to be sore?)

The other thing that I like is being outside. Now that Spring has finally arrived, there are all sorts of distractions... dandelion seedlings taking flight.

• The other day, my friend and I had to slow down to pass a group of geese and their downy goslings. As we approached, the mother started hissing, just like a cat, in our direction! Luckily, we were able to make a wide enough arc from her path that no sprints were necessary. I have a feeling I can't outrun an angered goose in flight!

• Earlier this week, as I rounded a corner, a beaver quickly scuttled into some reeds.

• Today, during my run, I was pretty much a blank slate, when suddenly a hawk swooped in for a quick attack on an unsuspecting small animal, soaring just feet from my face!

Currently, I am on an elective block, which lately has meant fluttering about from room to room in the ED looking for pathology on ultrasound. Basically, I pop in, introduce myself, and slop some cold gel on a stomach, leg or chest, and then disappear, leaving a slimy snail trail in my wake. It's been interesting to kind of be on observer status in our department. No dictations to do, only minimal paperwork. Sometimes there is an attending around to provide on-the-spot teaching, but often I am left to my own resources... which typically involves getting coffee and chatting with coworkers. Not bad at all.

April Showers Bring...

I was more than a little surprised when I opened the curtains today to look outside and found this guy staring back in at me! The storm window on that window is broken, so he had flown up and gotten caught in between the layers of glass.

Slow and Steady

On Sunday, I lined up behind the starting line with a bunch of serious runners. For 10 miles we ran up and down the streets of this city... through downtown, bad neighborhoods, exclusive neighborhoods, the university campus, and past "Hospital Row". I surprised myself, and was able to do the whole thing without walking! Granted I have been building up to this run for months, but up until now, my longest run had been 8 miles continuously on a treadmill, and just shy of 7 miles on the flat trails by the lake.

One of my friends decided the run sounded like fun, and signed up at the last minute. She hadn't trained at all, so I tried to discourage her from it, but she attempted anyway. For the first 5 miles, I plodded along with her at a 12-minute pace, but ultimately ended up parting ways when she needed to stop. I think she was a bit upset at me for not stopping to walk with her. I am glad I didn't though, because the race organizers were pretty serious about only keeping the streets in town shut down for as little as possible. I finished at 1:57. As I stood at the finish line waiting for my friend, they started re-opening the streets and rolling up the finish line at 2 hours and 15 minutes. As it turned out, my friend had her husband pick her up at mile 7. I'm pretty sure if I had gone at my own pace, I would have completed the race at least 10 minutes faster.

The race was a lot of fun though, and I saw several parts of the city that I had never seen before. One of the highlights was a small park with lots of small hills and twisting paths around a pond. Best of all, I beat my own distance record! There's a half-marathon (13.1 miles) that Army Guy and I are planning on running with another couple in about a month, so I think I am well on my way to being prepared for that. As for the new running shoes, I'm planning on going to a running store in a couple of days to get custom-fitted.

After the race, I felt pretty good, and worked a full shift that night. Yesterday, I just felt kind of tired, so I limited myself to walking the hills around my neighborhood. Today, my shins are kind of angry, but I am nowhere near as sore as I had expected to be. Perhaps that slow start was a good thing after all!

Mama's New Shoes

The other night, a couple of my friends and I went for a nice dinner at the local casino. Afterwards, we decided to hit the gambling floor. It made for some interesting people-watching. Despite being in the middle-of-nowhere, there were a few women who were dressed up in mini-skirts and heels. However, there were no well-dressed men to be found-- mostly biker-types, seniors, and scruffy-looking young adults with questionable hygeine. I don't know who or what these young women were expecting to find, but clearly there weren't many options.

Anyway, my friend and her husband proceeded to argue about exactly how much money he should be allowed to "throw away down the toilet." I had brought a set amount to mess around with, but as the situation was somewhat tense between the two of them, I settled for putting down $20 at the roulette table. After nearly losing it, I was up to $40. My friends were still bickering, so we walked around a bit. I was about ready to get out of there, but my friend's husband decided he was going to play some poker, no matter how much she scrunched up her face at him. (Isn't going out with married couples fun?)

I shrugged it off, and sat down next to him. I ended up getting dealt two jacks, and as I had paid for a "bonus", I was already sure to win something just off the deal. My friend's husband unfortuately didn't get much of anything, but I ended up with a full house and up $100. I decided there wasn't any way I could beat that, so after one hand of poker, I called it quits, having just won enough to buy a new pair of running shoes I had been trying to justify. It made for a short night, but I figured it was best to quit while I was ahead.

Amateur Transplants - YouTube Fun

One of my friends was sharing this clip the other day at work. (Beware of office-inappropriate language!)

My friends give me a hard time about not liking Billy Joel, but here's a more tolerable version of one of his songs:



And finally, I think this one's the funniest:

Treinta

Yesterday I turned the big 3-0. I think it is safe to say that a sure sign that one is getting on in years is the feeling of being younger than your actual age.

Sigh.

The morning I spent sleeping in (there were snow flurries!). Although I had the day off, I went in to work in the afternoon because we were having pig lab. Pig lab, like cadaver lab, involves performing as many surgical procedures as possible in order to help residents gain hands-on experience on rare procedures, so that in the event we do have to perform them on patients, we will at least have some exposure to the procedure rather than learning on a live patient.

The pigs are heavily anesthetized and then euthanized towards the end of the lab. We only do the lab a couple of times a year, and there are only a few animals available for the resident class to work on together, so it was too important of an opportunity to miss.

I am certain that some people would be horrified by this type of learning. However, doing a thoracotomy on a living animal is completely different than on a cadaver. There's no substitute for working with real blood vessels and beating hearts. At our program, we utilize mannequins and simulate different scenarios, but again, it's nothing like the visceral experience of a real patient.

Yesterday was our second session at the pig lab. As luck would have it, just a few days prior, a cricothyrotomy was performed in the department on a difficult airway patient. While I am sure that the situation was very stressful, I can't imagine the resident having had to perform it without having had the lab training first. And I am certain that the patient and their family are glad that they weren't on-the-job training! Although animal labs can certainly make you squeamish, I think that our program does a good job about being as humane as possible and maximizing the learning opportunities from each lab animal, while minimizing the number of deaths.

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After lab, I met Army Guy for a nice dinner. Throughout the day, I caught up with friends and family via email/phone. It was maybe not the most traditional of birthdays, but still a good one.

April Showers

Heavy spring rain showers pummeled the flowers outside. I love all of the color, but the sickeningly soapy-sweet smell of hibiscus is a little overwhelming when I open the door.

Checks and Balances

"So this was part of a check-off thing tonight, right?" he said, with the last word said with a hopeful lilt.

"Yeah, they've been wanting to meet you for several months now, and I had been blowing them off. But now it's done," I answered.

"Good."

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Army Guy and I were leaving from a dinner with some co-workers and friends. I am still really impressed with AG. He's willing to try new things, and puts up with meeting my friends and co-workers... even the annoying ones. And he shows a lot more restraint in annoying situations than I would if I had training in hand-to-hand combat!

I have told him that he doesn't have to hang out with my friends or even like them, but so far he's been really good in social situations. Even better, is that everyone seems to like him! Maybe I have just dated socially-inept people in the past, but typically I either couldn't even get ex-boyfriends to go out socially with my friends or the few encounters we had were always awkward.

While I pride myself on being pretty independent, it is nice having someone to do things with, talk to at the end of the day, and who pretty much instantly makes you happy just to be around them.

Bright, Sunshiney Days

Spring is definitely here...

-The daffodils Ru helped me plant last fall are blooming, with tulips on the way.

-Red-breasted robins chirp and flutter from one green branch to the next.

Bright-colored petals are competing for pollination, animals are competing for attention from the opposite sex, and local teens/young adults loiter outside-- ending stupid arguments with violence and gunfire.

Rooty Tooty Fresh N' Fruity

What does the name Emergency Department mean to you? A place to go for help when you are sick or injured? How about a place to go for breakfast? As it turns out, that's really all one of my recent patients was looking for.

She was a hand-off patient, meaning that another person initially saw her, and transfered her to me at shift change. The story was that she had just been discharged from the hospital the day before and was back with more pain. It was her typical sickle cell pain. No chest pain, no difficulty breathing, no fever. So the other resident treated her pain, gave her some IV fluids, etc. Sick sicklers we work up with labs and imaging, those with pain crises we treat and if we're unsuccessful at controlling their pain, they get admitted to the pain service for PCA pumps, and other meds we're not willing to administer willy-nilly in the ED.

So, I was a good little resident and immediately re-assessed the patient after signout. Her pain was a little better, but she said that she usually gets better pain relief when the morphine is pushed, rather than run in with fluids in a drip. Fine, second dose: IV push, followed by another liter of fluid.

In the meantime, the breakfast cart arrived in the department. Breakfast trays had been ordered for all of the overnight psych patients and nursing home guests that for whatever reason couldn't be moved out of the department overnight due to placement issues. Typically, we don't feed our patients as oftentimes they are not around for more than a few hours, are potential surgical candidates, or are in acute distress and can't actually swallow anything safely.

It is not "three hots and a cot", people.

So the sickler requests breakfast. Fine. Since the cafeteria was actually up and running by this point, a nice, hot breakfast arrived at her stretcher in less than 30 minutes. That's pretty damn good. During that 30 minutes, she pressed her call button no less than three times to demand fruit punch, more fruit punch WITH ICE, etc. from her poor nurse who was also managing an overdose-patient, a cardiac patient, and I think an asthmatic, all with multiple orders and monitoring tasks to keep up with.

Finally, the tray arrives. The call bell for Room 19 immediately starts beeping. Soon afterwards, the charge nurse comes up to me, and said that the patient was upset that there wasn't any meat on her breakfast tray.

She said, "This ain't no breakfast-- there's no meat in here! I've gotta have bacon or sausage, or I'm just going to go home."

That was the best news I had heard yet.

So, I go back to the room and tell the patient that I hear she's feeling better and ready to go home. She says "Yeah, my pain's all better, I just want to finish my breakfast." So we discuss follow-up plans with her hematologist to discuss chronic pain management.

The unsatisfactory breakfast? Steaming-hot cheese omlet, 2 pancakes with maple syrup, and hot coffee with cream and sugar. (I think I'd crammed a pre-smashed protein bar into my pie-hole that morning on the drive in, so I was seriously eyeballing her breakfast.)

Patients like this always frustrate me. I think her nurse should have set out a tip jar. They stroll in and out of the department frequently, and have been in so many times that they come with all sorts of crazy demands and expectations. Occasionally, they present really sick, but like the boy who cried, "Wolf", when you see someone multiple times every month it's hard to take their complaints seriously.

Often, it seems to be the patients who aren't paying for our services with co-pays or insurance premiums that try to glean as much out of the hospital as they can. I wonder how this works with countries with socialized medicine. Surely they still have the frequent-fliers, mainly drug-seekers, but do they have patients that are just as demanding, or do people abuse socialized medicine less?

The Stuff of Genius...

I never said I was smart. I was supposed to go for a long run after work today. However, things got crazy midway through the afternoon, and I never got a chance to eat anything for lunch. So, instead of just sticking it out, I decided to head home, wolf down some oatmeal cookies and gatorade and then go for a run. Apparently, nothing spells bricks in your tummy like oatmeal cookies. And that's how my 9-mile run went to 1 mile with 2 miles of walking. Argh.

Spring, Sprang, Sprung

On my way off to work on Sunday, I noticed the crocus were blooming in the front yard. I guess Spring this year isn't so far behind last year, it just has seemed like such a looonnng winter. It's been in the 60's for the past three days, a drastic change from the snowflakes that were still falling last week.

Yesterday, I went for a run out by the lake. The ice had finally all melted away, there weren't any boats out, but there were a few ducks testing the water. The bare trees looked funny in the bright light... naked and exposed, huddling next to each other.

Today I finally turned the heat off, and have several windows cracked open. It feels good to air out the house.

I had a few days off last week, and when I went back to work the other day, I was shocked to find out that a teenager I had admitted a few nights before had died suddenly on the floor. She'd had heart and lung problems her entire life and had been leading a relatively normal life when she started coughing up blood. When I saw her, she was completely stable, and she got admitted for more formal testing. Everything was done correctly-- specialists were called in early and responded quickly, and I don't think that there was anything that we could have done differently.

While death and bad outcomes aren't all that uncommon, I guess I just have high expectations for stable patients that get admitted. Emergency medicine is high-pressure, but generally you can lump patients into just a few categories: those that go home, those that get admitted and then go home, and those that you just can't fix. I think that I have been brooding about this case because we all thought that this child would do so well. I had to really push the parents to allow her to even stay to get evaluated.

I Wanna Be Sedated

I haven't updated for a while, although it has not been for lack of material. Things have been busy in the Peds ED. It seems like every shift is clogged up with sedations. Like I have said before, I like kids-- I just don't particularly like dealing with their parents.

The other day, I got called over the intercom to go into Room 7 for uncontrolled bleeding. I wasn't quite sure what to expect. When I walked into the room, I saw a relatively calm toddler seated on the bed with blood oozing through the dressing on his head. His mother was pacing back and forth uttering all sorts of obscenities while her "friend" sat in a rocking chair by the child's stretcher, shoveling Doritos into her mouth.

The situation? Rottweiler vs. Toddler

As I unwrapped his head, I couldn't get a good view of the oozing wound. He had a second laceration on the top of his head that went down to the skull, and there was an odd flat spot on his head. I notice an orange crumb fall on the sheet and and look up to realize Mom's friend is eating her chips over my patient's bleeding head. I am already annoyed.

I tightly wrap up my patient's head injury, fill out consent forms and personally take him to the CT scanner. He's only 4, and there's a good chance he won't hold still for the scan. Mom is still doing nothing to comfort her child (unless swearing is the equivalent of a lullaby at home), so I hold him in my arms, and place his turbaned head in the headrest of the CT scanner. One of our nurses gave him a stuffed dinosaur, and as we wrap him up burrito-style for the scan, I place the dino on his little chest so he has something to look at while the machine buzzes around his head.

Luckily, the scan's clean... no skull fractures. I pick boy and dino back up and back to room we go, where he gets hooked up to the monitor, and we start pushing the sedatives (midazolam, atropine, and ketamine in the Peds ED). His eyes spin and "Mom" laughs at the drunken expression on his face. She doesn't want to stay for the repair, and I kick Dorito-muncher out of the room.

His cuts are deep, extending through the galea down to the skull. The bleeding has finally stopped with the pressure dressing. My attending and I are deep into repairing the wounds when random Ortho resident walks in, and goes, "Wow, what layer are you guys at?"

"That would be skull," I answer, tapping the hard surface with my suture needle.

"Shouldn't ENT be doing this?" he asks. (Ear, Nose, and Throat Surgery is the substitute for plastics at my hospital.)

"Why would two strong, independent women need ENT?" I answer, gesturing at my attending. Who let this guy in here? He's about as helpful as Dorito-woman!

He says something about another patient to my attending and ducks out.

Several absorbable sutures and staples later, the wounds are all closed. Luckily for the kid, his injuries were all in the scalp area. Although he will have some huge scars, there's not a mark on his face. "Mom" finally returns a bit more calm. They don't exactly seem to be the most reliable at follow-up, so I go over wound care and antibiotic coverage three times with them. We also gave him IV antibiotics. "Mom" still has done nothing to comfort her son, and Dorito-woman interjects some helpful anecdote about something she saw on TV.

I was ready for my own chemical-induced nap by the time they left, and had to exchange white coats as mine now had blood all over the shoulder. I think that The Ramones said it best.