From #596 to #520, Z is for Zaftig

Definition of ZAFTIG

of a woman

: having a full rounded figure : pleasingly plump

Yeah, that's about right...

I have a thing for roads...

I like photographing them...

they hold such promise.

You have to continue down them to know where they will lead.

Some roads you can't escape...

some roads you choose...

I thank the 10 or so new readers who have opted to come along on my journey.

It may not always be pretty, but I am glad for the company

to share the time.

I hope you all have grown,

and we will continue to pass this way together

growing by the experiences of others

that they have chosen to share

in this little corner of the cyberspace world...

Thank you...!

#520 - Y is for Yes, I Can...!

I hate having my photo taken... I don't find myself to be at all photogenic.  I think that's one of the reasons I liked photography so much.  It gave me an excuse to always be behind the camera rather than in front of it.

Our vacation in the Caribbean forced me to be in front of the camera a little more than I would like to be as my husband kept insisting that there needed to be more pictures of me and of us during this wonderous trip.  Coming home and looking through all of them, I realized that I NEVER want to look like this again.

So, today I took the first step in changing my future.  My friend and I hired a personal trainer, and we had our first session today.  I'm not saying it's going to be easy.  I'm not saying I'm going to come out looking like her (skinny wench that she is already, my friend, not the trainer.)  But, I am saying I'm making a public commitment to get improve myself physically.  So that the next time I'm forced in front of a camera I won't look like a potato stuffed unsuccessfully into a spandex suit...

And, my goal is a pair of jeans from college... Levi 501s, stone-washed, button fly... you know the ones... date night with the black boots and white t-shirt... oh yeah...!

#520 - X is for eXasperation

I think most doctors I know are social misfits.

We don't know how to have normal conversation.

We really don't like being around people.

Yet we choose a profession where we are forced to interact with people

much to our own chagrin.

I think that frustration is compounded when 

you choose a specialty like Emergency Medicine.

You deal with some people on their worst day.

Those, surprisingly, are the cases we like best.

You deal with some people on what is a 

perfectly ordinary day for them 

which they've made just slightly more interesting 

with a trip to the ED.

We don't like those cases so much...

Really...?

You came in for that...?

You know you can buy over the counter medication for that...?

Really...?

You didn't know that...?

I guess when you input your symptoms into WebMD, 

you forgot to read the most common ailments and

skipped beyond to all the 

in-no-way-connected-to-your-disease-process-at-all problems...

which you don't have...

and, no, you don't need an antibiotic for that...

And, stop smoking...

#522 -W is for Weary Traveler

I have been away from home for two weeks. We left for SoCal(12 hours). Went from there to Willliams, AZ (7 hours). Took the train to the Grand Canyon (3 hours). Spent the night at the Grand Canyon, then returned to Wiliams. Left the next morning for Sedona (1.5 hours) then off to Laughlin, NV(5 hours).

Spent three days in Laughlin before returning back to SoCal(4.5 hours). Drove up to Oakland where my DH stayed to go hang gliding before heading home, while I drove to Sacramento(2 hours) and worked 4 shifts. I drove back to Oakland yesterday to present at a conference today, and have now been sitting at SFO waiting for my plane (which, naturally is delayed) for the last 4 hours with about another two to go.

A short hours' drive after I get to the airport will finally get me back home....

Did I mention I love to travel...?

#522 - V is for Veronica

any of a genus (Veronica) of annual or perennial herbs of the snapdragon family that have small pink, white, blue or purple flowers with a 4- or 5-lobed calyx, a rotate corolla, two stamens, and the fruit a compressed capsule

I don't know that I've ever shared this on my blog,

but my parents didn't name me.

According to my mother, they were really expecting that I would be a boy.

Mind you, this was in the days before finding out the sex

of a baby via ultrasound was commonplace.

So when I was born, and

disappointingly a girl,

they didn't have a name ready.

My mother stated that she was at a loss.

She asked her OB,

an old Jewish doctor,

what did he think.

He said, "She looks like a Veronica."

And, so I was named.

And, no middle name because 

"my name was too long to begin with."

Yeah... it was like that...

#522 - U is for Unbelievable

Just thought I would share a few reasons why patients came to the ED.

Understand, these were a few of the more unbelievable cases...

Multiply this by the several dozen other random reasons

we see on a daily basis...

As my colleagues says,

job security...

#528 - T is for Time

I once asked my DH if he thought the dogs knew

when we were going to be going somewhere different.

Did they recognize that suitcases and bowls meant

they were not just going to the store or to the beach?

He answered, "No."

All they know is "we're getting in the truck,

and we'll see where we are when we get there.

And wherever THAT is, we'll have fun!"

They say that dogs "live in the moment."

A topic I wrote about when we got our second dog, Dillon.

Working strings of shifts like I do

with only a few precious days off in between

it's hard to live in the moment;

only thinking about what I am doing

in the here and now

instead of worrying about what has to be done

in the next few minutes

hours

days

weeks...

Having been on vacation this last week with my mom,

I really tried to just think about and enjoy the time with her.

But, it seemed to go so fast, and 

before I knew it,

we were back on the road heading home

and work

and life

started interrupting even those last few

precious hours...

But, still, I can say, we had a LOT of fun...

#532 - S is for Slammed

Can you see the panda with tongue sticking out?

Some days in the ED can be horrific.  Yesterday was one of those days.  Having come back from a glorious 9 days of vacation, I was ill-prepared for a full night shift as waves of patients descended upon the ED.

I hadn't even started my shift and decided to pick up a patient who had just rolled in the door by ambulance so that the prior MD could start in triage and we could let the triage MD go home early since the ED wasn't that busy.  Little did we know that the second that doc walked out the door, all chaos would break loose.

At one point or other I had:
4 dialysis patients all with various complaints
a chest pain patient that went straight to the cath lab
chest pain that got ruled out
cancer patient with a fever
low blood sugar
teen overdose on aspirin (235 pills wow!)
migraine headache

headache and dizzy

pregnant with gallbladder issues

drunk and faking seizures

colitis

terminal ileitis

2 ear pains

2 short of breaths

pneumonia

enlarged thyroid

head bleed with an aneurysm

"I want pain meds"

arm infection

leg infection

and probably several more that I can't remember in the dizzying

deluge that was last night.

Back to the fun tonight...

and, it's a Monday...

ugh...

A New Place to Begin Anew

I don't have to post a blog today for the challenge, but since I promised one last week and I didn't deliver, I thought I would write one today.

When I first started blogging, it was on a platform run by AOL called Journals at AOL or something like that.  Suddenly AOL pulled its platform, and we (my fellow J-landers and I) were left floundering as we tried out other platforms.  I ended up on Blogger.

Since I had long answered the question that "yes, there are squirrels in Buffalo," I thought I would name my new blog "Buffalo Squirrels Won't You Come Out Tonight?"  Partially, this was to pay homage to my new temporary home, and partially, it was a tongue-in-cheek reference to the clientele I was meeting in the emergency department.

As I transitioned from a first to second year, I could see changes in my attitude toward dealing with patients.  I think I also became more reflective of some of the patients and cases I witnessed.  I gained a lot of experience dealing with emergency situations, some medical and some traumatic.   I also wrote a lot more about my patient experiences than I had before.

We had a plane crash that year with 52 souls lost.

I celebrated my one year anniversary with my DH.

I learned a little about a LOT of orthopedic surgery, mostly during call when the "Black Cloud" of the ortho service was my resident.

I ate my body weight in New Orleans while on a conference.

I spent a month with the county medical examiner and had a great rotation... hard to believe when you're dealing with death, but some of it is so fascinating.

I started off my senior residency year and had the worst case of my residency which still haunts me to this day.

I continued my love for all things fire truck related, and became assistant medical director of the Buffalo Niagara International Airport Airport Rescue Fire Fighters.

Hubby and I traveled the Interview Trail to find our new home in the Pacific Northwest.

I was sued.  The upside was returning to Boston and really enjoying the city and colleagues.

I crewed on a racing sailboat during that last summer in Buffalo and thoroughly enjoyed it!  Which led to my first posting on You Tube as I filled a video full of the hundres of pics I took that summer....




And, finally, graduation came, and I planned the cross-country move along with the end of that blog and the beginning of this one.

Thank you for joining me on this journey through memory lane... enjoy the rest of the challenge!  And, please, I hope you continue to enjoy this little blog of mine...!

#533 - R is for Relaxing

You need vacations;

some time to get away and forget about life,

such as it is.

I need vacations.

Given the day to day drama of 

working in the Emergency Room,

if I didn't take the time to decompress

every once in a while,

I know my patient satisfaction scores

would really start to suffer.

But, the trick is in knowing how to vacation well.

We go to new places.

Explore new parts of the country, 

or own glorious state of California. 

We Google anything we have a question about,

or hound the locals,

or hound the other visitors.

It kinda helps that we have a bit of wanderlust.

Now that I am mostly settled in one place,

it's harder to get out exploring.

We really need to make the time to go away.

And, as we added on the responsibilities of a 

house,

dogs,

goats,

etc.

it gets even harder to get away.

But still we must...

#533 - Q is for Quilting

At one point I decided I was going to learn how to quilt.

I set up a sewing machine.

I bought a LOT of fabric.

And, true writer that I am,

I set up a blog site.

This is one of the first quilts I made.

It was for my husband's birthday.

He doesn't care that the points don't line up.

He doesn't care that I didn't do 

a perfect 1/4 inch seam in all places.

He doesn't even seem to mind that I

"quilted" this somewhat haphazardly on my

small Singer sewing machine.

He just appreciates that it's made with love.

Which is shown by the two bears in a heart

right at the center of the quilt...

#53? - P is for Post

I am managing to get a daily post in

despite the fact we are currently traveling

and the only internet access I have is my phone...

but I am getting my posts in...!

#536 - O is for Oh, Momma, That'sa What I Like!

Happy 75th Birthday to my Momma...!

#538 - N is for National Parks

Momma always said the most important thing you could do for yourself in life was to travel.  

And, so we have... and still do... 

as much as she can handle...

Look familiar...?

Yes, it's the Grand Canyon...!

And, here's Momma at almost 75 enjoying the view...

She doesn't care that she looks like an eskimo...

For her it's all about warmth and comfort,

and her new Patagonia jacket...

And traveling in style...

I alway like to read local books

whenever I go somewhere...

But, this book has me freaked out...

It's a very macabre book about all the deaths

that have occurred in the canyon and

how they occurred.

Suffice it to say, I am getting nowhere near

the edge of a cliff,

going off any marked trail,

nor going down into the canyon

without an experienced guide,

a satellite phone,

GPS unit,

and about a week's worth of water for a day hike...

For now, Momma and I will hunker down 

and enjoy to view from way over here...!

#538 - M is for Mass Casualty Incident

My training is in Emergency Medicine.

My subspecialty is EMS (Emergency Medical Services.)

My interests are in Mass Casualty Incidents

and Disaster Medicine.

Days like today are what we train for.

One of my colleagues from residency was at the race today.

She also was in my subspecialty group,

and her interest is in mass gathering medical services.

I don't know if you realize that when you have a sporting event

you have to have x amount of emergency medical services per x amount of people.

The more people, the more extensive the list of 

emergency medical personnel you have to have on hand.

She was working the medical tent at the race.

Usually she deals with sports-related injuries.

Today turned out to be a little different.

When you watch the video of the explosion,

and you start to see people running away,

pay close attention to those who run toward the danger,

those who started pulling down the barriers even as the second bomb exploded,

who immediately went into Mass Casualty Mode 

and started helping.

That's EMS.

That's my friend,

who ran back to help start up triage

to help the injured.

This is what we train for,

and she did what I would have done/would do

in the same situation.

I loved Boston the year I lived there training at BWH.

We watched the marathon from the Common as the first racers came into view

the year I lived there on one of my random days off.

I pray for those affected by this incident.

#562 - L is for Lazy

a : disinclined to activity or exertion : not energetic or vigorous

b : encouraging inactivity or indolence <a lazy summer day>

That's about right after working six shifts in a row after having worked 4 out of 5 previous days..

The fun resumes on Monday with the A to Z challenge, but I will post about my second blog as an added feature tomorrow... unless I am still feeling lazy...

btw, my most favorite squirrel picture ever:

#563 - K is for Kum Ba Yah

There's a big push in the ED recently to get our patient satisfaction scores higher.  When asked, I said the only thing to add to what we're already doing is to serve drinks and offer a moist towelette.  A little tongue in cheek, I know, but now with the government trying to get into the business of managing healthcare, they are trying to cut costs by all means possible.  And, that includes not paying ED's that fail to meet a certain standard of patient satisfaction.  Imagine that, you provide a service that you are legally required to perform and you don't get paid even when you do everything right because someone decides to give you three stars instead of five.

What they fail to realize is that when someone gets something for nothing, and has no responsibility at all for the privilege of taking someone else's money and using it as their own, everything from their EBT card to medical care becomes an expectation.  I work in an area where something like 65% of our patients are on some sort of government assistance.  They come to the ED for their coughs and colds and pregnancy tests because they can, and they're not expected to give so much as a $5 co-pay.  They come in demanding their CT scans, MRI's, antibiotics with a twist of lime and a pillow because they don't have to pay for it.... ever... if a bill comes, it doesn't matter.  They HAVE to see me in the ER.  I can't go to the doctor's office because I owe money, but not the ER.  They HAVE to see everyone.

They get upset because they're made to wait 30 minutes, an hour, maybe two.  I know of ED's that have 5 hour waits on a regular basis.  They get upset because I didn't give them the antibiotic WebMD told them they have to have for a condition they read about.  They expect to come in and have a full physical, lab work, and imaging done because their primary is "taking too long," "has it ordered for a month from now," "thinks I should have this other test first and I think I need to have it done now for this chronic problem I've had for the last 6 months."

So we get poor patient satisfaction scores and comments when we say no.  When we remind them it's not an emergency.  When we tell them that we're not a pharmacy, radiology suite, lunch counter or hotel.  When we ask them to be patient because someone else's family member is dying, and they can't be seen right this minute for the viral illness that's been going on for the last week and for which they haven't taken even a Tylenol because "I don't get my check for another week, and I don't have any money right now, but hey watch my kid play on my new iPad mini while I go out and have smoke."

So while I face the prospect of getting paid even less per patient while still trying to maintain the same level of service and face the real possibility of losing even more staff because the hospital can't afford that extra nurse because it's not getting paid or collecting as much per patient, we're all expected to come together and hold hands and keep the cheery smiles going.  If you think about it, the ED really is a "come by here" kinda place.

Sorry about the rant coming at the end of working the last 6/6, but sometimes you just gotta vent.

And, as always, the views expressed here are my own and in no way reflect the views of the physician's group, hospitals or professional organizations with which I am affiliated.

#563 - J is for Jeep

Those of you new to my blog may not realize

the love affair I have with my Jeep...

This little vehicle has taken me everywhere.

I bought it with my graduation money

in Chicago at the start of my 

surgical intern year...

It traveled cross-country to Boston,

then back westward to Minneapolis.

From there to Buffalo,

and then on the long road to California.

I've carried everything from chickens,

to guineas, to dogs and goats in it.

I've explored mountains and beaches.

Taken it in the snow and surf.

I can't imagine being here without it...

#567 - I is for Inspiration

Where do you go to for inspiration when you're writing?

I turn on music.

I try to shut everything off so that the voices in my head can take over.

I've written before, that writing for me is simply

allowing the stream of consciousness to flow from the brain to the fingers.

I can't be interrupted because I lose the rhythm of the writing.

And, sometimes I have to wait for inspiration to hit...

Some days it's just a few minutes,

others it's scrolling through email, Facebook, YouTube,

watching a movie, etc.

Today at work I didn't get much inspiration,

which was ok...

a nice, peaceful day at work is needed 

from time to time...

#568 - H is for Hungry

I don't get a lunch break...

There's no 30 minute leave work and take time for a break.

I'm lucky if I get 5 minutes to run to the bathroom

without someone calling me on the phone.

I usually get breakfast.

The ED doesn't start getting busy until about 10 in the morning.

So I always make sure I get a good breakfast.

Some days, I do get a lunch,

but some days I don't...

We work twelves, so even if I get a lunch around 1:30,

it's still a looong time until 8 p.m. when I get off shift.

So around 6:30, I start to daydream,

and I start to think about what I'd like to be eating....

smoked turkey drumstick

Rubio's fish tacos especial...

for those of you that recognize this, 

yep, it's the Pesky Combo...

yum..!

and hot dogs...

why do I crave hot dogs...??

The nurses try to keep me fed...

Because they say I get like this:

#568 - G is for Guinness

I always said I liked a "beer I could chew."

I also always said that "life was too short to drink domestic beer."

Guinness fits the bill.

I had a day off today, which was much needed.

As, I thought about today's post, I started thinking about

what I like to do on those infrequent days when I have nothing to do,

and I like to do nothing...

Sit back, and have a cold one.

But not always a Guinness...

I save those for special occasions...

No Rest for the Wicked

If you can imagine, today was crazier than yesterday even though we  saw less patients.  But let's not dwell on that too much...

So, even though I don't have to have a post today for the A to Z Challenge, I thought it would be fun to share some of my favorite posts for those of you new to my blog site.

I have been blogging since 08/06/2007 when I was heading east from Minnesota to Buffalo.  My first blog was entitled "Do They Have Squirrels in Buffalo?" because I had developed quite the squirrel army on the property of our rental near White Bear Lake, and I was going to miss the daily goings-on of my little furry extended family.

That blog chronicled the first year of my Emergency Medicine residency and the adjustments I had to go through switching from a surgically-trained mind to an emergency medicine trained mind.  I finally got married to the man of my dreams in that year, and we went on a belated honeymoon.  I wrote about the different rotations I was having to do, and how some could be more painful than others.  Having a chance to cut... in surgery the theme was: a chance to cut is a chance to heal, and I do enjoy doing things more than talking about doing things.

The year went by, and I started gaining more responsibility as I started my second year.  Also, I started getting more snarky in my commentary, especially while working the children's hospital.  I started doing shifts with the Mercy Flight crew and wrote about my first helicopter ride.

I ended with a final post on 10/26/2008.

Next week, I'll post my favorites from my second blog: Buffalo Squirrels Won't You Come Out Tonight?

#575 - F is for Frenetic

Momma told me there'd be days like this...

Here's an example of the kind of day I DON'T like to have in the E.D...

My shift started at 0800, there were already 5 patients on the board,

4 of which my colleague signed out to me waiting for lab or xray results.

The patients I saw today:

 - patient who swallowed an entire bottle of herbal supplement after confusing it with a bottle of 5 Hour Energy Drink

 - leg pain for a week, worse today

 - I Didn't Know I was Pregnant show candidate who came in about 7 months pregnant and using meth

- patient with facial lac after a fall out of their wheelchair

- psych patient off their meds who ran out the door twice, and brought back by police once

- patient who passed out while getting out of their trailer

 - strep throat

- skin infection

- patient who passed out while doing chair exercises with their senior group

 - asthma attack

 - migraine headache

- hair coloring on beard gone awry

- dental infection

- alcohol intoxication, passed out in front of the local market

- cough for several months

- chronic headache who could only be treated with demerol which we haven't had in the ED for years

- tick bite brought in because "we didn't get it all out"

- end of life hospice patient

- patient who was second in line to be seen, but left because after waiting 30 minutes they couldn't wait any longer for the CT they knew "they just had to have" for the belly pain that had been going on for several weeks

- appendicitis

- eye irritation

- panic attack

- alcohol intoxication hit in head by spouse with head laceration that then cussed us out and ran out the door

- skin infection

- febrile illness in transplant patient

I left out identifiers like sex... the pregnant person you can figure out.

I left out much of some of the back story because this is a small town

after all, and everyone knows everyone's business as it is...

These all came in within a 12 hours period and kept my ED busy

the entire time...

Let's now even talk about how many charts I have yet to do...

#584 - E is for Emergency

Let me give you an example of what constitutes an emergency...

There's a patient that comes into the ED often,

usually after trying to act like a tough guy

and coming out on the losing end of a pair of fists.

Alcohol is also usually involved.

Mr. Tough Guy messed with the wrong

pair of fists and received several stab wounds

as a reminder that there's some people

you shouldn't mess with no matter how drunk you are.

He got the "homey drop-off" at the entrance

to the lobby of the ED.

As he staggered across the room leaving a trail of red

that quickly caught the attention of the triage nurse,

she rushed out and met him 

escorting him straight back to the trauma room.

Her first impulse was to call out to the passel of people

waiting to be seen for their coughs, sore throats, or

knee pains that had been going on for the last 4 years

and say, "Now, THIS, is an emergency...!"

And the kind of patient that makes up for all the others that show
up on any given day....

#588 - D is for Delta

In science, the Greek symbol of delta mean "change."

And, sometimes, we need change in our lives

to take us out of a rut...

I started working extra shifts in Sacramento at the beginning of this year,

 so I have been making many trips 

over the hills to work in the "big city."

I did it as a challenge to myself intellectually.

It's good to get out of your comfort zone every once in a while, 

and working in the fast-paced environment of a metropolitan

hospital definitely does that to you.

Whereas I generally see about 20 patients a day in my small rural ED,

we see about 20 patient an hour in the city.

It really tests what you are made of as an ED doc

as you quickly make decisions about diagnoses and tests.

I think it's made me a better doc at my small main hospital.

Like Shania Twain sings, "A change would do you good..."

#593 - C is for Cats

I write about my dogs so often, that most people don't know I have cats...

Three of them...

Winston, Sofie and Lacey.

This month, Winston and Sofie turn 10 years old.

They're only a week apart in age, but I raised them both together.

*Sofie is my BabyDoll.

I love this cat so much, it's like I can't remember a time when she wasn't with me.

She almost died, and spent a few days in the kitty ICU just after I got her.

She never grew too big, and is my petite chatte...

*Winston is the big bruiser...

There was a warning sign on his cage at the rescue that said,

"Extremely Playful."

I didn't notice it until I had already signed the paperwork...

Haven't regretted my decision one bit.

The cats have been with me since the start of my residency,

in my first apartment in Chicago right after medical school.

They have been my comfort and joy on those days when I didn't think 

I could possibly make it back to the hospital for another day. 

Patiently waiting for me to come home and play with them.

They've made every single move from Chicago to Boston,

Boston to Minneapolis,

Minneapolis to Mahtomedi,

Mahtomedi to Buffalo,

and Buffalo to rental house in California,

And now finally Home where the redwoods meet the Pacific...

Cheers to another 10 years...!

*Links lead to scrapbook pages I made when they turned 5 years old...