Tuesday, November 30, 2010

NaBloPoMo Day 30... Huzzah!!

All righty then.... I made it through 30 days of blogging... OK, 29... but still.  It's been a long month.  I thought that I would never run out of things to blog about.  Granted I can always write about work, but seriously... how often do you want to read about the same patients and their complaints?  And, I'm not at the Drama Trauma center any more, so no more interesting stories from them.

Looking forward:  At church this Sunday the pastor mentioned something that I have always felt - Christ is the reason for the season.  Yes, ok, Hanukkah is around the same time of year, but it's considered a minor holiday.  Kind of like how Cinco de Mayo (a small battle fought in Puebla, Mexico) is a minor remembrance as compared to the 16 de Septiembre which is the Mexican Independence Day.  But, I digress.

For years, I've always said, "Merry Christmas" in response to someone's holiday greeting.  My Christmas cards say, "Merry Christmas" when I can find them with a bear or cow or fancy Christmas tree on them.  And, I say, let city halls in communities with a preponderance of Christians be allowed to decorate their grounds with a Nativity scene.

Christmas in Wisconsin
I love Christmas.  It's my favorite time of year.  I love decorating.  Getting a tree.  Putting up lights outside which I will be able to do this year!  They won't be covered with snow, though, for the first time in 13 years.  Wow... it will be a wet Merry Christmas this year...!  Looking forward to hearing (and reading) how you celebrate yours...!

Monday, November 29, 2010

NaBloPoMo Day 29

Ok, seriously, let's go through this one more time...

The emergency department is where you go when you have a, wait for it, emergency.

When you go to the emergency department, you will have your emergency evaluated in a process called triage.  Triage doesn't mean that because you think you are really sick with your 5 month history of back pain that you will be seen before the patient with the 5 minute history of not breathing.

Now, if you are sitting in the waiting room, people will be brought in before you even if you got there before them.  If you make it to one of the exam room, you still may sit for a while because ambulances never stop coming and sometimes sicker patients need a little more attention.

Once you are seen, all the tests you think you need are still going to take some time.  If you need labwork, count on at least 90 minutes.  Fifteen to have the labwork drawn.  An hour or so to process the lab.  And then fifteen minutes or so for me to notice that the results have come back.

Think about the same for x-rays.  All bets are off when it comes to CT scans.  I can't control when the tech decides to take you.  If you need contrast by mouth, you need at least 2 hours.  If you need IV contrast you need to have a lab first.  Unless you're an emergency.  Then it's straight to the CT scanner and the kidneys be damned.  Of course, I still have to wait for the radiologist to read the CT.

Ok, got it so far?  We're not even going to talk about what happens if you need to be admitted.

Sunday, November 28, 2010

NaBloPoMo Day 28

Today was my Day of Rest.
I am exhausted after doing nothing all day long.
Not thinking.
Not planning.
Tomorrow back to work.
Like Scarlet O'Hara.... I'll worry about that tomorrow...

Saturday, November 27, 2010

NaBloPoMo Day 27

Although I enjoy writing on this blog every day, I think I am about ready for the NaBloPoMo to be over.  I worked too late tonight, mostly because I had about 25 charts to dictate from the last two days, and Lord knows I hate to dictate (this flashback is for you, Betty!).  But I have tomorrow off so I sucked it up and got them all done.

Since I really couldn't drudge up any inspiration from work today, I thought I would share one of the NaBloPoMo prompts from this week:  what's on your walls?

Since we are sort of between places (currently renting), I don't have anything up on the walls.  When we do FINALLY get a home, I plan to put up photographs... lots and lots of photographs.  And photo art.  This tree is courtesy of the Warholizer website.  You just upload your photo, and it randomly assigns a color and creates a Warhol-style image.

I Warhol'd a car...

I Warhol'd a cat...

I even Warhol'd myself...

What fun will you create?

Friday, November 26, 2010

NaBloPoMo Day 26

I don't like taking away hope.
I don't like sizing patients for cane poles.
I don't like telling a patient it's time to stop fighting the good fight.
But, sometimes, it's the right thing to do.

End stage cancer.  You didn't tell your family.  You didn't want anyone to know how sick you really were.  Now you won't stop throwing up.  You can barely breath.  I have to ask how much help you want.

If I put you on a ventilator, you will never come off again.
If I do chest compressions, electrical shocks, give drugs and get your heart back what kind of life would I be giving back to you?  

Sometimes I have to have that discussion for the first time with a patient because they didn't want to have that discussion before.  Family doesn't know what the patient would want because they thought they still had time.  Had counted on the six months, the year, the two years they were told.

What happens after?  I don' t know that I've ever been asked that before.  Did you talk about burial plans?  Cremation?  Services?  You have to let us know what the patient would have wanted.

There's a short window now to get it figured out because I've already written for the morphine.    Soon they won't be having any pain at all...

Child of Morpheus

Take me to your sweet euphoria
Child of Morpheus
Hold me in my dreams
Tranquil angel
Falling with no fear of landing
Child of Morpheus
Close my eyes for me.
- Inkubus Sukkubus

Thursday, November 25, 2010

NaBloPoMo Day 25

Giving Thanks

Dear Lord,
I thank You for the gift of my family.  For being surrounded by love and understanding.
I thank You for my friends.  For knowing that I have people I can turn to in times of need.
I thank You for my kitties.  For having joy and unconditional love.
I thank You for my new life.  For being filled with awe and wonder at my new surroundings.
I thank You for the talents You have given me.  For allowing me to share them with others in Your service.
For these and all Your blessings on my family and friends, I thank You.

Wednesday, November 24, 2010

NaBloPoMo Day 24

Sometimes you just have to take a leap of faith.... or a walk around a corner....

For the last several weeks, my DH has been walking the local beach.  I've joined him, as I've written, on several occasions.  At the south end of the beach is an outcropping.  My DH would tell me how the tide is never down enough to allow walking around it, and how he almost got washed off of it while standing on it.

Today we went for our usual walk and the tide was down.  He told me not to go around it.  He warned me not to go around it, but as the photos show I really didn't listen to him.  The beach and cliffs were even more beautiful than I imagined would be just around that corner.  You could almost imagine you were alone on the edge of the world.

Of course, a set of waves rolled up higher than I imagined, and I got wet from the knees down... but as I ran around the out-cropping back to my DH who was just shaking his head at my capriciousness, all I could think was that it was so worth it....

Tuesday, November 23, 2010

NaBloPoMo Day 23

Ok, I have 20 minutes to get this post in for today.  So I thought I would quickly write about something I love.... cows.... which I am now happy to be surrounded by in the are in which we are living.
These are just some of my new neighbors.  

Every day on my way to work I pass several dairies.  They rotate the cows around from field to field so it's interesting to see where any group of cows will be on any given day.  It can also vary depending on the time of day I am driving through the main road.

Some fields will be full of soft brown guernseys.  Other fields will have the familiar black and white holsteins.  Some will be full of young calves;  others full of udder-ful heifers.  And, I do notice that the saying "party till the cows come home" probably has some truth to it as I have seen some herds of cows running to the barn at certain times of the day.  No one is rounding them up, they just seem to get in line and start heading for home.

What do I like most about cows?  Cheese... it goes good on everything.  And my DH can't understand how I will cut off a wedge "finger" of cheese and munch on it as a snack.  It's just that good.  Pizza - always with extra cheese.  Offer me any type of cheese on whatever I am eating, and I will say, "yes, please to cheese."

And something I've often wondered..... Gary Larson showed it best....

Monday, November 22, 2010

NaBloPoMo Day 22

Instead of sharing the banalities of today's E.D. shift (back to the medicine tomorrow) I will share this meme that a friend sent out today.  Warning, sarcasm may or may not be used here:

Getting to Know Each Other!

1. What time did you get up this morning?  Rolled out of bed around 0615 PST

2. How do you like your steak? Knocked over the head and served at room temperature.  That's what I always said.

3. What was the last film you saw at the cinema? Amadeus in 1985 at the Prince Albert Royal Cinema in London.

4. What is your favorite TV show?  Toss up between House and Grey's Anatomy... just can't get away from the medicine. 

 5. If you could live anywhere in the world where would it be?  Someplace green, near the ocean, surrounded by trees... oh, wait, I think I might already be here...!

 6. What did you have for breakfast? Coffee, a scone, and a scoop of "hospital egg surprise."

 7. What is your favorite cuisine? Whatever's being served at the restaurant I walked into.

 8. What foods do you dislike?  I can't handle liver... yuck!

9. Favorite Place to Eat?  Sitting at the table in my mother's home.

10. Favorite dressing? Toss up between blue cheese and thousand island.

11.What kind of vehicle do you drive?  Jeep Liberty Limited in Patriot Blue

12. What are your favorite clothes? scrubs, I always wanted to wear pajamas to work

13. Where would you visit if you had the chance?  The clinic located near base camp at Everest.  I've heard it's got a great view.

14. Cup 1/2 empty or 1/2 full?  1/2 full, so top 'er off!

15. Where would you want to retire?  Someplace green, near the ocean, surrounded by trees, wait, didn't I already answer this?

16. Favorite time of day?  Morning, sunrise.

17. Where were you born? La Mirada Community Hospital

18. What is your favorite sport to watch?  Hockey

19. Who do you think will not tag you back? Someone who never reads my blog, or facebook, or who I didn't tag in the first place

20. Person you expect to tag you back first? Who's closest?

21. Who are you most curious about their responses to this?  I'm not a cat, so really not curious

22. Bird watcher?  yes

23. Are you a morning person or a night person? Morning, sunrise, I think I've answered this one before, too.

24. Do you have any pets?  Three cats

25. Any new and exciting news you'd like to share? My life is written out online at my blog, pretty much nothing is new, or exciting.

26. What did you want to be when you were little?  Older

27. What is your best childhood memory?  Can't remember, but I'm sure it had to do with travel or food... or travel and food... or traveling to get some food

28. Are you a cat or dog person?  I'd say wannabe Cat Lady

29. Are you married?  yes

30. Always wear your seat belt?  Never been without it...

31. Been in a car accident?  several

32. Any pet peeves?  Don't tell me you're going to surprise me with something because I will annoy you endlessly until you tell me what the surprise is.

33. Favorite Pizza Toppings?  something, something, and extra cheese

34. Favorite Flower? blue dutch iris... and orchids

35. Favorite ice cream?  Ben and Jerry's Chubby Hubby... or anything involving chocolate and peanut butter

36. Favorite fast food restaurant?  Rubio's, I could eat there every day

37. How many times did you fail your drivers license test? never

38. From whom did you get your last email? my bff from med school

39. Which store would you choose to max out your credit card? since it's only got a limit of $500, pretty much I can buy groceries and max it out... 

40. Do anything spontaneous lately?  um, I work 13 hour days, 16 days a month, my life is pretty much planned out for me

41. Like your job?  well, it's like a box of chocolates... refer to that blogpost if you need further explanation

42. Broccoli?  with cheese

43. What was your favorite vacation?  any time I left the country, or the county, or walked out the front door and ended up on a plane somewhere

44. Last person you went out to dinner with? my DH

45. What are you listening to right now? hockey, I watch it too

 46. What is your favorite color? Ceylon blue

47. How many tattoos do you have?  none, I worried what it would look like at age 90, and couldn't decide on what would still look good where

48. How many are you tagging for this quiz? none, I'm an equal opportunity sharer

49. What time did you finish this quiz? 2322 PST

50. Coffee Drinker?  Only if I need the caffeine... and it's made at Starbuck's

Sunday, November 21, 2010

NaBloPoMo Day 21

A baby died today;  a very small infant.  One minute I'm excited by the end of my overnight shift quickly approaching, and the next I am hearing the words you never want to hear come over the radio, "En route to home for infant not breathing."  I think the whole ED staff stopped for a minute waiting for the next report.

Then we begin to organize.  Prepare a room, grab the pediatric resuscitation cart, where's the Broselow tape, get respiratory alerted.  The on-coming attending arrives, and I tell him what is going on.

The next report comes over the radio, "Attempted intubation, bagging via BVM, chest compressions ongoing, no IV access.  Five minutes out."  Ok.  Grab the ultrasound, do we have the right sized needle for the EZ IO, call an overhead infant code.

The infant arrives.  One, two, three, gently over to the gurney.  Let's take a look.  Intubation attempted.  Ultrasound shows no cardiac activity.  Temperature is 31 rectally.  The parents are hovering expectantly, holding onto each other tightly, watching our every move.  The other attending and I look at each other.  We know there is no hope.  We try to make our attempted resuscitation last as long as possible for the sake of the parents.  But soon the staff understands our motions.   We take one last look with the ultrasound.  Silent snow.

We turn to the parents.  They have a sense of what they're going to be told before a word is even said.  They look around at us and our staff and see our eyes looking down, looking sad, tearing up and looking at them wordlessly.  Cries of anguish fill the ED.  The infant is gently wrapped and the parents are brought to the bedside.  We file silently out to give them their last moments with their child.

I go to dictate my last patient's chart, stopping to hug the nurse who stepped into my work area to "get it together" before heading back out to the other waiting patient in the E.D.  She apologizes, and I tell her it's ok to show her emotion.  She starts to shake as tears run down both of our cheeks.  She quickly recovers and steps out.  I take a deep breath, dial the familiar number, and begin my dictation.

Saturday, November 20, 2010

NaBloPoMo Day 20

There's a quote, which I may or may not be wrongly attributing to Osler, about how being a great doctor means that you, amoung other things, have to be a great scientist.  And, what do scientists do...?  They observe.

That's what I did mostly last night.  I observed.

I had two patients come in... one young, one old.  Both had potentially life-threatening conditions.  The young one had croup.  The old one had angioedema.

Croup can go bad real quick.  One minute you have a reasonably healthy 18 month old, and the next thing you know you're putting in a breathing tube and doing everything you can to help them keep breathing.

Angioedema can go even worse.  The tissues in the face swell up in reaction to an allergen.  Most often a medication called Captopril, but sometimes it's due to a simple food allergy.  The lips swell, the cheeks swell, and then Heaven forbid, the tongue swells.  You can do everything right, and the patient may still die.  The best case scenario can be a cricothyroidotomy which is basically cutting a hole in your neck to place a breathing tube into.  This is the blog post from my first ED Cric.

Unfortunately, the patient later died in the MICU.  But, in a strange twist of fate, their child was awaiting a kidney transplant, and the patient was a match.  Maybe some things are just meant to happen... although, that experience has continued to affect the way I practice medicine.  So, like last night, I gave my medications, and sat back and observed.  However, a little prayer now and then doesn't hurt.

Friday, November 19, 2010

NaBloPoMo Day 19

 So today I got to indulge in something I hadn't had for a while... free time.

Hubby and I took a walk along the beach and looked for rocks.  If you remember a prior posting, we have been carrying a backpack on our walks and collecting rocks that caught our fancy..

Today, there were rocks galore, and a bit of sunshine!
So many rocks, but we were looking for very special ones...

The beach is ever-changing.... and it's really interesting to see how things can change from one day to the other.  The last time I came the rocks were just along the shoreline.  Today they were scattered way above the wave line.

Did I mention how much I love the beach?

Thursday, November 18, 2010

NaBloPoMo Day 18

"Oh, I don't drive. I keep taking the test over and over again, but, I'm all, this is hard."

That's kind of how I felt after taking my board exam today... "but, I'm all, this is hard." That line kept me laughing for a while. Hopefully, I will find out in 90 days that I don't have to take this test over and over again... once was enough...!

For fun, I will share with you my test taking anthem... A good friend and I were working our way through med school prerequisites. We were both "non-traditional students" a good many years older than most of our classmates, so we supported each others' decision to go through it all over again. One of our most challenging classes was Organic Chemistry. We sat across from each other in class, and our ritual before every test was to tell each other, "Hakuna Matata." No worries.

We both made it through premed. We both made it through medical school. Now years later I still think of those times... struggling with every exam... working three jobs to pay for school... sweating out the MCATs.... wow... wonder where my friend is now...?


Wednesday, November 17, 2010

NaBloPoMo Day 17

There's a scene in the movie "Memphis Belle" where one of the characters is talking about his dream of opening a chain of restaurants where the food is the same in all of the restaurants.  His colleagues laugh at him and ask who would want to eat the same food everywhere.  He answers that they would because it's "comforting."

This is not that scene, but still one of my favorites from the movie...

I was thinking about the "comfort food" comment as my husband and I left home to drive the 4 hours east toward Redding where the testing center is for my board exam. He has a theory that the better the restaurant, the more cars will be parked in front of it. As we pass restaurant after restaurant with an empty parking lot, we settle for a familiar chain restaurant.

It's based on my theory of "when you don't know where to go, you go to where you know..." Again, the notion that going somewhere where things are familiar is comforting. Hence the reason why McDonald's are popular around the globe. We were in Australia, surrounded by yummy and awesome foods. We saw a McDonald's and had to go in. It was like a little taste of home in a foreign land....

Tuesday, November 16, 2010

NaBloPoMo Day 16

So, I have my Emergency Medicine board exam on Thursday, and for the last month I have been doing review questions and reading study guides.  This in addition to working and getting used to my new surroundings.

Now, like the Larson cartoon to the left... my brain is full.  I think I've hit the wall.  Tomorrow should be a semi-relaxing day of driving over to Redding to spend the night before the exam.  I'll take my camera and perhaps capture some of the sights we pass.

For now, it's time to sleep.... perhaps to dream... although, most of my dreams lately have been about being back in medical school and residency training.... eek.. it's hard being a life-long student!

Monday, November 15, 2010

NaBloPoMo Day 15

Well, are you sick of my daily blogging yet?  It's actually kind of hard to come up with something to write every day, but it has given me something to do as a creative outlet...  Since I am halfway done with the NaBloPoMo challenge, I started thinking about halves:  halfway, half full, half-baked, half the calories, etc, and I really liked the idea of writing about optimism and seeing the world as a glass that is half-full.

I have a test to take on Thursday that will clear me to take another test in 5 - 8 months.  Then I will be done with tests... for about 10 years.  Do I think I'm ready...? Heck no.  Do I think I'll pass...?  Maybe.  Am I worried about it...?  Just a little.  I felt less prepared for my USMLE Part III exam and did well.  I was freaking out about my USMLE Part II exam and obviously passed.  So, I'm the eternal optimist.

So as not to take up too much time... I need to sleep to get up and keep studying tomorrow... I thought I would share a poem by Emily Dickinson entitled "Hope."

Hope is the thing with feathers
That perches in the soul,
And sings the tune--without the words,
And never stops at all,

And sweetest in the gale is heard;
And sore must be the storm
That could abash the little bird
That kept so many warm.

I've heard it in the chillest land,
And on the strangest sea;
Yet, never, in extremity,
It asked a crumb of me.

Sunday, November 14, 2010

NaBloPoMo Day 14

I worked the local Urgent Care today, which medically is very uninteresting.  I wrote in a prior blog post how you see, pretty much, the same seven people in urgent care... and the same can be said for today.

So, I decided to take a peek at some of the prior prompts given by the NaBloPoMo website for things to write about and found this question interesting:  

Thursday, June 10, 2010

If you could go back in time and meet your 16-year-old self, what three things would you tell yourself?

1.  Follow your heart and don't be swayed by other people's perceptions.  It took me a while to learn for myself that some people had their own agendas, and that I really needed to learn to think for myself and trust in my own instincts about things.

2.  I'd like to tell you not to fall in love with a fantasy because you're going to get your heart majorly broken in a year or so.  The results of this will lead to another relationship which will eventually lead to a loss of two of your closest friends.  Friends are forever;  true love will come when you're older.

3.  Your small sedan is not the appropriate vehicle in which to transport 10 track team members (two in the trunk)... so don't do it... even though it will be a lot of fun...

Saturday, November 13, 2010

NaBloPoMo Day 13

"Bows and flows of angel hair and ice cream castles in the air
And feather canyons everywhere, I've looked at clouds that way.
But now they only block the sun, they rain and snow on everyone.
So many things i would have done but clouds got in my way.

I've looked at clouds from both sides now,
From up and down, and still somehow
It's cloud illusions i recall.
I really don't know clouds at all."
 - Joni Mitchell

I don't know that I've ever taken the time to explain about clouds in medicine.  Specifically white clouds versus black clouds.

I was the proverbial white cloud.  A big fat fluffy white cloud.  Nothing ever happened when I was on call.  I had the "Night of Traumas" when I was a surgical resident, but for the most part, I had relatively easy shifts.  As an ED resident, there'd be a trauma here and there... Maybe a code, but not all at the same time.

My good friend in EM residency was the ultimate black cloud.  I would have a reasonable shift and then she would show up.  Traumas would roll in.  Cardiac arrests would roll in.  She laughed and said it was toughening her up.  We didn't want to be scheduled after her... or, Lord, no, with her.

Since becoming an attending, the RN's tease me and tell me I'm a black cloud.  They say the ED has become more busy since I've been working there.  They say not only are there more patients, but the patients are sicker... traumas, codes, people needing to be intubated or sent to the ICU.  I have to admit I have had some busy shifts.  Hmm... wonder if that silver lining is tarnishing just a bit...?

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