Circle of Life

It's amazing when you think about what can happen in a day.  Dare I say it's amazing when you think about what can happen in just a few short hours;  or, even what can happen within just an hour.  Is it too cliche to say that life can change in the blink of an eye?  In the E.D., events like these are commonplace.

I had a shift recently where at one moment I am running down the hallway to help a new life come in to the world (didn't make it on time, baby was already out) and the next moment I'm coding a cardiac arrest that I pronounced about 10 minutes later.  A life begins as a life ends.  Both rooms full of family in tears.

I've had patients come in with a minor complaint that I later have to walk into the room and have a frank discussion with regarding their disease... their life-changing disease... their "you better start making final arrangements" disease... their "is there anyone you want me to call" disease...

I've sutured patients after a motor vehicle crash who lost family members within the same car.  I've seen them cry and scream, sit with tears streaming down their face, or sit eerily quiet as if by not acknowledging their surroundings they can convince themselves that it's all just a bad dream.  They certainly didn't expect to be there when they awoke this morning.  They didn't know that taking that side road was going to make that much of a difference.  They didn't know that 15 seconds was going to  be the distinguishing factor between life and death.

At the other end, I've counseled women (because when you're 12 and pregnant that makes you officially a woman in my book) who I've let know that yes, the rabbit died (who even knows that reference nowadays?)  I've reassured a lot of women that their pregnancy is going well.  I've seen birth, death and everything in between.

Some days you wonder how any of us survive... Maybe I'm feeling existential today, but it's all a part of life after all...

Life Moves Pretty Fast

 I can't believe how much time has passed since the last time I posted... Let's get you caught up on "life on the farm" shall we...?

Why, yes, this is a baby goat... Her name is Boot Scootin' Boogie aka Bootsie. She is a bit of a surprise. When we got our goats about a month ago, the breeder said that Josie was sterile. That she'd been with a male goat for a while and hadn't gotten pregnant. So, last week Monday after the goats were put in for the night, I told my DH that something was wrong with Josie. She kept calling out from the barn and seemed very restless. He argued that she was just being annoying as always, and we went to bed. The next morning while I was in the shower, DH went out to let out the goats and chickens for the day. He came back in and said, "Something's wrong with Josie." I asked what, and he said he didn't know but that "something's falling out of her behind." I quickly got dressed and ran outside. And, that's how Bootsie came into the world. It's been an amazing week of watching this tiny little shaky blob slowly find her legs.  She now scampers around the yard with her Momma.

I did medical control for the Tour of the Unknown Coast bike ride again. It's a fabulous 100 mile bike ride along the coastline here going from redwood forests to the coast and then up an impossibly steep series of hills before the scary downhill run home. No major traumas, just some dog bites that had to be attended to.

Dixie is a week away from being 6 months' old. It's been awesome seeing her grow up and develop. She went through an impertinent teenage stage which she is slowly getting over, and she's really turning into a wonderful dog.

As for our "mutant chickens" that I wrote about in the last post... well, 3 have disappeared. One for sure died, as we found it near the barn. The other two, we're not sure, but I hope there isn't another wild cat around. We have seen foxes around, so maybe they got eaten by one of those. Nonetheless, DH thinks we should stick with bigger breed chickens. They seem to do better.  In fact, tomorrow I'm supposed to get 2 more large hens and a new rooster.

Work continues about the same, and I know we're starting to head into the trauma season, so it's going to get even more busy. I was chosen as an instructor for a new program on patient safety so that has kept me busy with training and meetings. I also am the new pre-hospital care medical director, so that is going to take up a little more of my time.

With new babies, a new puppy coming soon, and living in this wonderful place, I know I am going to have to get a better handle on my time... I don't want to miss anything...

There But For the Grace of God

The Mutant Flock

While I was visiting my mother, a bobcat decided to visit our property and made off with two of our chickens.  I was kind of sad because I'd grown attached to Mr. Waddles the rooster and our little hens, of which now I just had one left.  My husband and I discussed getting new chickens, and I called the original breeder where I'd gotten the chickens from last September.

He said he didn't have any chickens, but he knew of someone who might be selling theirs.  He had told me about this "someone" almost around the same time I originally got my chickens, but at that time I didn't want two roosters around.  This time, though, we said "sure" to a small flock of 6 chickens.  They were collected up and brought to our house about a week ago.  We're not quite sure yet what to make of them.

I call them the "mutant" chickens.  They belonged to an elderly gentleman who was no longer able to care for them, and they look like they haven't been taken care of for a while.  Some are missing feathers, one is missing an eye, and the rooster sounds like he's got a bad case of emphysema.  Our one sole bantam hen from the original group won't go near them.  Five hens and they haven't laid one egg.

For some reason this got me to thinking about life and the different paths that we all follow.  Both sets of chickens came from the same breeder.  Our chickens got to come to our home, the Beverly Hills of chicken life;  acreage, plenty of food, a large coop, etc.  The other chickens went to, well, let's be honest, a trailer park.  They had small living quarters, a small yard, and I am not sure how often they were given chicken feed since they don't seem to know what to do with it when we throw it to them here.

My own life could have gone in so many different directions.  Any small change of circumstances and I would be in a completely different place than where I am now.  I thought about that today when I had a patient come into the emergency department crying hysterically and hyperventilating.  She's now homeless as a result of finally getting out of her abusive relationship.  She was trying to make something of herself;  getting a medical assistant's certification.  She's had problems with alcohol abuse in the past, but kept herself clean enough to make it through her program.

Tonight she'd had enough of the emotional abuse from her significant other and had packed all her belongings and was trying to leave.  A verbal then physical altercation led to her ending up in the E.D.  She cried as she wondered where she was going to go next.  No family, no money, seemingly without any support at all, and she's my age.

I tried to reassure her that things would get better.  We called the sheriff who documented her wounds, took her statement, gave her information on local resources.  We gave her a phone, she called her son, arranged for a ride, and we discharged her to home... well, to wherever she was going next.  Hopefully not back to her significant other.  Hopefully, her circumstances will change for the better, too.

North to South

Dodger  Stadium & LA Skyline

There's always something kind of surreal about going home.  My mother lives in Southern California in the home where I was raised.  I lived there until 1997 when I left for medical school.  I go back about 4 times a year.  It's both familiar and different every time I return.

Mom and I celebrated her birthday in Laughlin, Nevada.  We know the places we like to stop for meals;  how far apart the rest stops are.  We know the casino layouts as if we were in our own homes.  I know, scary.

We spend the first part of the trip on banal things:  like gossip.... or shopping.  We spend the second half of the trip on serious things:  money, health... living wills.  I know I've written about the importance of knowing your loved one's wishes ahead of time.  So many people come to the Emergency Room with a loved one that can no longer speak for themselves.

Mom and I have very morbid, albeit humorous, conversations on the subject.  Mostly about how she doesn't want to give me Power of Attorney for Health Care because she's afraid I'll "pull the plug" just to get the inheritance.  I told her since she didn't want a fancy coffin, I was just going to get a refrigerator box from the electronics store;  things like that.

But, seriously, it's important to know what your loved one would want;  from the clothes they want to be buried in to who gets the ugly turkey platter that gets pulled out every Thanksgiving.  In the E.D., I just want to know if they would want to be resuscitated (chest compressions, shocks, etc.) or to have a breathing tube put in and be placed in a ventilator.  Mom's already said she doesn't want "an artificial life."  I just want to be kept alive if there's a possibility of being an organ donor... 

Anyway, it was a successful trip by all accounts.  Mom got to gamble and show that's she's the Slot Machine Queen.  I got to come home and spend some time in the heat and traffic.  We discussed some future plans, some estate plans, some dinner plans.  And, now I leave back to my little house on the edge of the wilderness... wild cats, porcupines and bears, oh my!

Sweet Spring...

I love the poems by e.e. cummings...  They are so simple in presentation, yet so complex in depth and meaning.  


This is one of my favorite poems by him.  I've written about it before, but I thought I would share it again as I share some pictures from around my garden over the last couple of days.  


I'm so proud of this little bright spot in our new home.  Tulips and daffodils bring so much hope and promise for the season ahead...!

"sweet spring is your
time is my time is our
time for springtime is lovetime
and viva sweet love"

(all the merry little birds are
flying in the floating in the
very spirits singing in
are winging in the blossoming)

lovers go and lovers come
awandering awondering
but any two are perfectly
alone there's nobody else alive

(such a sky and such a sun
i never knew and neither did you
and everybody never breathed
quite so many kinds of yes)

not a tree can count his leaves
each herself by opening
but shining who by thousands mean
only one amazing thing

 (secretly adoring shyly

tiny winging darting floating
merry in the blossoming
always joyful selves are singing)

"sweet spring is your
time is my time is our
time for springtime is lovetime
and viva sweet love"

My back yard as seen in 180 degrees panoramic view... 

Like Moths to the Flame...

Some days the E.D. is just like this...


I was signed out a patient that was waiting for a simple blood test.  The blood test came back slightly abnormal so I called the patient's private physician, and we made some medication adjustments and the patient was discharged back to their senior living facility.


I spent 20 minutes wrestling with a 4 year old who was bitten in the face by the family dog and needed just one stitch to hold his lip together.  And then, I got several more patients that were "verticals" meaning patients that had simple clinical problems: uti's, colds, etc.  Quick see, write a script, discharge.  Then I got my next patient.


He was convinced that a sexual encounter he had over 30 years ago is still causing multiple medical symptoms that have to be checked out a couple of times a year.  He couldn't answer any of my questions with anything more than a grunt or a yes or no.  For every question about his condition he kept telling me, "It's in your computer somewhere."  Very frustrating.  I ordered some simple things and got him some medications for his symptoms and then discharged him.


No sooner had we cleared out the room, then there was a banging on the triage window.  A patient was having chest pain after an assault.  His face was beaten, he had a cut lip.  He said he felt pressure in his chest after the assault but managed to go to the police station to file a report, and then to the optometrist to get his glasses fixed.  The optometrist told him he didn't look so good and maybe he should go to the E.R.  By the time he got to us, his chest pain was pretty severe, and his EKG confirmed a STEMI.


We went into overdrive to meet our goal of sending this patient to our sister hospital to the get to the cath lab.  At some point in the middle of this flurry of activity, there was a large BOOM!  It was thunder.  Then suddenly, hail the size of ping pong balls started falling.  Within a few minutes, the ground was white.  We all looked at each other thinking, "Oh, &*^%$!"


Sure enough, the tone out signaled an ambulance call to a multi-vehicle accident.  Then a second ambulance was called out to the same accident.  Then another tone out for a another accident.  About this time, my husband texted that one of our new goats had jumped the fence that he had put up in the barn.  And another tone out sounded for the patient we had sent out earlier in the morning.  And another tone out for a frequent flyer who was "lethargic."


While we waited for ambulances to start arriving, I saw another couple of "verticals."  Another patient showed up with a possible ectopic pregnancy, but she signed out AMA because she had to "go pick up my other kid from school."  I explained the risks of everything from worsened pain to bleeding to death, and the patient left.


We got the "lethargic" patient in.  The STEMI got shipped out (did I mention he had his service dog with him? A large German shepherd that went with him in the ambulance).  And then three patients all came in at the same time from the car accident.  While I got them all seen and orders written, we got another couple of "verticals" through the triage window.  I quickly saw them, and we seemed to be on a roll.


Then a mother brought her son in for an evaluation.  He'd fallen on his back and hit his head while playing basketball out in the rain.  She wanted to make sure he was ok since he had "hit his head on the side where his brain was."  I kept a straight face while she said this.  The patient in the other bed on the other side of the curtain giggled somewhat loudly.  I politely explained that the brain filled the whole skull and didn't just sit on one side.  I could still hear giggling as I walked out of the room.


My car crash victims were all discharged and a new round of ambulance patients filled the rooms.  My "lethargic" was transferred to the sister hospital since her cardiologist was there.  I admitted a very sick patient with heart failure.  I sent home an elderly gentleman who kept falling, most likely because he was over-sedated by all the medications his physician had him on.  I signed out an elderly lady with broken ribs from her recent fall and came home.


My hubby reported that the wayward goat jumped every barrier my husband set up, so our barn now looks like Fort Knox.  One of my cats caught a mole and decided to play with it in the kitchen while my husband was having lunch.  At one point, the cat tossed the mole up in the air and it landed in my husband's boot.  So that's how his day went. 


Seriously, you can't make this stuff up.

Here a Goat, There a Goat...

Welcome to my world...

And, welcome to the newest members of the family:

Josie (aka Leah) and Betty.

If you've been following my blog for any length of time, you know that the house that we bought almost a year ago wasn't kept up.  We've been doing a LOT of work with the weed-eater, however upkeep is now becoming a full time job.  So, we got goats.


We'll have to see how this furry duo earn their keep... however, they are so cute to look at, I am sure they'll have no problem finding their place in the growing menagerie.