Friday, December 14, 2018

Gentle Into That Good Night


Emergency Departments have their share of regulars.  The patients that come back time and time again. Some you don't mind. Some you inwardly cringe and say, "Oh, God, them again." Seriously, George, this is the second time this shift.

They come and they go until one day you notice that you haven't seen someone in a while. You don't say their name because there's an unspoken superstition that like saying "Beetlejuice" three times they'll reappear. We have staff members who's sole purpose is to work with community physicians and mental health agencies with a goal to keep these "frequent fliers" or "super utilizers" out of the ED, so sometimes you don't think too much about not seeing someone for a while.

Then one morning there's a code alert on the radio: patient found unresponsive lying in front of a business, Fire and EMS responding.

Is it a drug overdose? Narcan and a sternal rub and by the time they come to the ED they're awake and cursing you for taking away their high.

Is it one of our regular drunks? Brought in overly intoxicated wearing the same clothes they've been in since the last time you gave them some new ones, covered in their own bodily fluids and sometimes some accompanying unwanted guests that have to also be washed off.

Is it someone who had a coronary event? This early in the morning, someone on their way to work who's having the "Big One" and collapsed.

You sit and wait for the radio to sound again wondering. I look over the rack of patients waiting to be seen and the patient board and begin to mentally prepare for whatever comes... is this going to be a prolonged Code Blue or is it going to be a quick evaluation with a "metabolize to freedom" disposition.  It all depends on that next radio transmission.

The radio crackles again with "Patient update." That usually means they're coming in Code 3 with lights and sirens and CPR in progress... or it means 1144 - deceased on scene.  Today it's an 1144.  Someone didn't make it through the night. 

I relax a little, and I and the staff move on through the day not really giving a second thought about that life; we have other lives to save today.  Then the next day you hear it was one of the regulars;  someone who you'd seen come into the ED just a few days earlier with their regular complaint.  One of the "Oh, God" ones.  And, you start to wonder...

You begin to think about the movie "Groundhog Day" where Phil goes back each day working to keep the homeless man alive by doing something to change his final course... and every day he fails.  "Sometimes, people just die."  And, this reminds you of the quote in "M*A*S*H" where Col. Blake tells Hawkeye "...rule number one is young men die. And rule number two is, doctors can't change rule number one."  Was there anything you could have done? Sometimes the answer is, "no."

On the way home, I think about that person and my interactions with them. The debilitating addiction to drugs and alcohol that put them on this path. The multiple resources to try to help them. Their steadfast resolve to not change a thing about their life because it was their life, and that's all they had to call their own;  no family (those bridges having been burned a long time ago), no possessions (it's easier to be homeless when you don't have to worry about someone stealing what little you have, or keeping track of it when you've been on a three day bender), nothing except the few dollars in your pocket with which to buy that next bag of meth and the pint of vodka to keep away the demons in your mind.

I think about them laying down for the night, that coldest night of the year so far.  Did they dream?  Did they remember their dreams of being a child and all of their wishes for their life? Of being a young adult and experimenting and experiencing all that life had to offer?  Of being in their 30's, addicted, being separated from family and friends, raging against the world? Of their life now and anything beyond that next score or that next drink? Did they dream as their body failed for the last time to make it to morning, where someone would find them and EMS would be called to transport them to the ED again..? Where we'd recognize them and say "Oh, God, not them again..."

That's what haunts my dreams.


Wednesday, December 5, 2018

#43 is in the Books...


Today I visited National Park #43/60.

Even though it was a cold and rainy day, I wasn't dissuaded.
I have one free day while I'm in 29 Palms to do this,
and I took advantage of my free time this afternoon.


Some people really love the desert.
I'm more of an ocean and forest girl, but I can appreciate the beauty
in the stark vastness of the desert.



But if you look closely enough,
you start to see life in unexpected places.



Although, I wouldn't want to get to close to this...



Or these...



These are actually called "jumping" cholla cactus because 
if you inadvertently brushed against one of these
one of the branches might stay stuck to your clothing...
or in you... 


Ouch!


A few more shots...




Got the stamp...


Only 17 more to go...!


Friday, November 30, 2018

NaBloPoMo2018 - Day 30

I thought I would leave this as the final thought as this month wraps up.

Emergency medicine comes down to this... the lesser of two evils, or as I like to always say, there needs to be balance and symmetry in all things.

About 75% of everything I see in the emergency department comes down to poor choices, poor habits, or poor coping skills. I see the devastating toll that substance abuse takes on bodies, on families, on the community.  I've seen every possible complication that meth can produce on the human body; from simple delirium to full blown psychosis, from a simple lesion to a person literally digging the skin off their neck because they are convinced there are "worms crawling in there," from skin infections to full blown sepsis requiring ICU admissions... people have had heart attacks, strokes, miscarriages, and temperatures so high they've essentially "fried" their brains and died... meth mouth is a real thing... tweakers are real... and zombies do roam our streets wearing tattered clothing with vacant stares mumbling incomprehensible words... I've seen teens on meth as well as 70 year olds on meth... and I've told my students time and time again, "Meth be bad, m'kay..."

So the next time you're tempted to "meth around" drive to your local donut shop and have a chocolate glazed instead.... I'll help you with your diabetes later...

#NaBloPoMo18

Thursday, November 29, 2018

NaBloPoMo2018 - Day 29


Today is my beautiful girl's 7th birthday...

I can't believe it's already been that long...

Here's the blog post I wrote on her first night home:
You can read all about her first two years on this blog...

And you can see her first birthday video here:


I love my Dixie... 


She's traveled with me all over the Western United States...

And when I travel without her,
even if it's just going to work,
she's always waiting for me when I get home...


Here's one of my favorite photos of her
she's about 6 months old:


Happy Birthday my Dixie Girl...!


#NaBloPoMo18

Wednesday, November 28, 2018

NaBloPoMo2018 - Day 28


I think the worst part of having diabetes is it really limits the foods you can eat... well, that's not to say you can't eat what you want, except, you can't eat what you want... well you could but then you go blind, lose feeling in your legs and have parts of your body amputated... you have an increased risk of heart disease and are at risk for infections going very badly and not healing properly...

Kinda sucks...

To say I have a very strong family history would be an understatement... I knew that I would become a diabetic, it was just a matter of when... like a ticking time bomb, except there was no big clock on the side giving you a countdown... well, it was good while it lasted... I ate what I wanted and never thought about calories or glycemic indices or carbs or well, anything...

And, now?  It's just not the same.  Every food item is analyzed down to it's molecular makeup... how many carbs? How many sugars? How much fiber? Subtract fiber from sugar equals total sugar? And, that's for every food item, so imagine trying to eat a meal... Like the one above I shared with friends recently while in San Diego... meat good... everything else... bad... and, don't even get me started on alcohol! All alcohol is bad, mostly because of the sugars... and the fact that the medication I now have to take doesn't react well with it...

Did I mention this sucks..?

It's changed my life in some good ways though... my weight is down because I don't eat like I used to... or drink like I used to... also, I tend to exercise more, because my weight is down and I have more energy, but moreso because the more I exercise the more I can cheat a little bit and I don't have to take as much medication. My last two doctor's visits showed great HbA1c numbers, and my doc told me I could cut down on my medication... win!

I still love food, I just sample more than eat... everything in moderation... 

#NaBloPoMo18

Tuesday, November 27, 2018

NaBloPoMo2018 - Day 27


I've collected the small pieces of paper from the insides of fortune cookies for many years.  I'll occasionally find them stuffed into wallets or purse pockets when I go to change from one to another. Sometimes I'll laugh at the small paper message.  Sometimes I'll contemplate on the message for the day.  Most of the time, I'll stuff it into another wallet or purse to find on another day.

I actually have a small wooden box packed somewhere that's got lot of these tiny strips of paper.  I couldn't find it in time for this blog post, but I may have to look for it just to see what treasures are hidden inside.  And, don't even get me started on the whole ".. in bed" game.  We might save that for a whole other kind of post.

Since I couldn't find my most recent fortune cookie message, I went to horoscope.com and hit their fortune cookie feature to see what would turn up... 
from horoscope.com
"Stop letting other people stand in your way."

I'm trying to find a reference point for this, because in general I've never let anyone stand in my way of doing what I wanted to do.  Oh sure, as a kid had to follow the rules and do what the parents wanted, but as an adult, if I wanted something I went after it and usually got it.

The one thing it did make me think of was some advice I recently gave to a mentee from my alma mater.  My university started a mentor program, and I actually got to meet my mentee while I was in San Diego last month.  She asked me how I would handle this situation: she went to a meeting of a new student group that was forming and felt a little uncomfortable being the only Hispanic woman going into the meeting.  

I couldn't help but hold back a chuckle.  I quickly explained that there were two things I've never thought of myself as being when I've gone into a new situation: a Hispanic or a woman.  I explained that I would have walked into the meeting as a student first with some experience or knowledge to share or add to the group. When applying for medical school, or interviewing for a surgery program, my race or gender were never carried into the room with me... I was an intelligent student with a strong background and great letters of recommendation. In the emergency department I'm not the Hispanic female doctor leading the code, I'm the doctor leading the code... with a kick-ass smile and a fiery attitude... ok, so maybe I carry a little of my race and gender with me... but it's not how I define myself.

I told her to stop seeing herself as an identity and focus on what she is... an intelligent pre-med student with a voice and something to share in the new student group. She deserves to be there as much as any other person in the room no matter their background or chromosomal identity... she wants to be a doctor, and I'm trying to share a little bit of my attitude with her... we'll see how she does because sometimes the person standing in your way is yourself....


#NaBloPoMo18

Monday, November 26, 2018

NaBloPoMo 2018 - Day 26


My AOL group prompt for today asked about what I might talk to someone about over a glass of wine. It's kind of hard to say. When meeting new people, I generally keep the conversation light; try to find things in common. Talk about the weather, or a sports team, or about a recent movie or book.

Friends and I catch up over a glass of wine.  Who's dating whom. Who changed jobs. Where are our lives going and are we happy with our current choices. Do we still love our spouses and can we put thoughts of long ago relationships away.

Really good friends and I just sit.  We sip our wine and relish in the time we're spending together. A lot of times we speak very little. Just a look or a nod. A question is answered with a facial expression; we know each other so well. We savor being in each other's presence the way you savor a fine chardonnay.

And, the wine will matter. 
Casual acquaintance: something cheap and easy... a house wine. A red blend. Something you'll sling back and not even take a second thought about.

Friend: a wine you're familiar with. Nothing adventurous. Almost like comfort food. A Coppola Merlot. A Trefethen Reisling. a Cakebread Cabernet.

Really good friend: you'll splurge a bit on this one. The wine has to have body, bouquet, with a spectacular finish. You might experiment on this one. Possibly a boutique wine from Chile. A giggle with an unexplored wine from the MidWest. A serious white from Germany.  Something fun and challenging that you might take a photo of the label so that you can remember it later.

Talking over a glass of wine with me is no insignificant thing. And, don't even get me started on if there might be a second glass... or the paired morsels... that's a blog post all on its own...

#NaBloPoMo18