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... 


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...


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...!


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... 


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 and hit their fortune cookie feature to see what would turn up... 
"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....


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...


Sunday, November 25, 2018

NaBloPoMo 2018 - Day 25

I had this commission done by a local artist.
It pretty much captures everything I love about my life right now:
we live in a beautiful environment
where you can literally walk on the beach
and may not see another person for hours,
I have 2 great dogs that we've raised and trained
who've brought us such joy,
and I have my wonderful DH with whom
I've shared the last 20 years of my life with.
This painting hangs in our bedroom and reminds me every
night of how blessed I am to have this life right now.
I hope and pray it always does.


Saturday, November 24, 2018

NaBloPoMo 2018 - Day 24

I hate working the holidays.  Not because I have to take time away from my family, which is not the worst part, it's that every time I work the holidays there's always a tragic story.

I haven't worked a Thanksgiving in over 4 years. This year I've worked the whole weekend: Wednesday thru today. All the cases I saw were pretty benign... But, today was the day...

I had a patient come in not breathing or responsive. Seems they had gotten up at their usual time and were going through their usual routine. Then they complained to their spouse that their arm felt weird. Soon they were having a full blown seizure. EMS was called and they gave the patient some medication to stop the seizure, but it also slowed their breathing so I had to put in a breathing tube.

I talked to their spouse and, like I've asked multiple times, I asked if they had a plan in case their heart stopped.  They did! The spouse even carried a card with their wishes on it.  We rushed the patient to the CT scanner where I wanted to make sure that they didn't have a brain bleed.  They didn't, but what they did have surprised everyone: they had a brain tumor.

I now had to go and tell their spouse that their loved one had a brain tumor. Most often, the tumor is not a primary and it's a metastases; so that meant there might be a cancer somewhere else that caused this one. I could see the pain in their eyes. I could see the sudden weight of an unknown diagnosis. I could see the love they had for their spouse.  And, I hated that I had to be the one to cause them such grief... during a holiday... one they will probably never forget...

I hate working the holidays...


Friday, November 23, 2018

NaBloPoMo 2018 - Day 23

Source: FanPop

Darn it, Disney, you did it to me again...

I've loved animation since like forever.
It started with Kimba the White Lion,
continued on with Speed Racer,
and Mickey Mouse pre-1940's is my favorite by far.

As Disney developed more techniques,
the limits of imagination for animation expanded.
And, now they've given me another character to love.

Yes, I know, Big Hero 6 was released about 4 years ago,
but I am just getting around to seeing it.
And, I'm in love with Baymax...

I think it's because he's a "medical companion."
He's someone built for the sole purpose of helping others.
And he's big and fluffy...
What's not to love?


Thursday, November 22, 2018

NaBloPoMo 2018 - Day 22

Hope that you had the most blessed of Thanksgiving days
and that you were able to spend time surrounded by friends and loved ones...

I couldn't prepare my usual feast as I had to work today for the
first time in about 5 years.
The hospital provided us with a traditional turkey meal
so it wasn't so bad.
And, the patients didn't come in the hoards I expected...

Of course, tomorrow will be the real test.
We'll see who overindulged today
or who gets caught in the hoards heading
out shopping tomorrow...

Not me, I'll be back at work...


Wednesday, November 21, 2018

NaBloPoMo 2018 - Day 21

During this time of year when we stop and think about families and being with families, I stop and think about the strange Son of the South that I married and how my life has changed... remember, I'm a born and bred SoCal city girl...

This is now my team. Weekends during the fall are spent cheering them on... #RollTide

Suddenly I'm going to Monster Truck rallies...

This is Talladega... What? I'm at a racetrack watching cars going around and around?  Have I actually been to Daytona Beach and Las Vegas Raceways as well..?  Yes, but Talladega is like home...

I've learned how to tend to chickens, and cows, and now sheep... 
I've learned how to work a tractor, and a bulldozer...

And grits... I've had to learn to cook grits...
And, we have "dressing" for Thanksgiving, not stuffing...
And, I learned how to make my mother in law's yummy Sweet Potato Casserole, but according to my Southern Hubby, I still can't make biscuits as good as his mother's, nor can I make "fried pie" like his aunt... I'd never even heard of fried pie...

Still this is now my family.  And, 20 years later, I still have to pull out the English-Southern dictionary because every once in a while that dog just won't hunt... 


Tuesday, November 20, 2018

NaBloPoMo 2018 - Day 20

I'll be working on Thanksgiving Day...
Sadly, a lot of what you think might come into the ED on that day
is not what comes into the ED on that day...

I'll see depression.
I'll see alcohol and other substance overdoses.
I'll probably see a car crash or two.
I might see some nausea/vomiting from overindulging
in turkey and pumpkin pie.
I'll see homeless who just want a warm bed and a meal.
I know there will be the Holiday Heartbreak story.
I dread working the holidays for that.
There is always a tragic, unexpected death or
near death case that will just ruin me
for several days due to the sheer emotions
associated with it...

But after several years of not working the holidays,
it's finally my turn...
I hope Hubby will have a wine bottle open for when I get home...
based on previous experience, I'm going to need it.


Monday, November 19, 2018

NaBloPoMo 2018 - Day 19

I've been trying to avoid being political on this blog,
but today I have to take a minute to talk about gun control.
My thought: the only way to stop a bad guy with a gun
is to be a good guy with a gun.

I never liked guns much even though I grew up around hunters
and there were always rifles and small arms in the house.
I wasn't interested in them; to be honest they scared me a bit,
but I didn't mind them, and I never thought about using them for
anything other than what they were intended for... hunting.

At some point, I learned my mother actually had carried a small gun
around with her since there was some concern that that my natural father
might try to abduct me.  It never came to pass, and when I found out about it,
it made my mother seem kinda badass.

I've treated lots of gunshot victims.
Most were secondary to drug deals gone wrong.
A few were on the losing end of a gunfight with LEO's.

Then over the last couple of years, people started to die
because guns just seemed like a quick and easy way to 
deal with thoughts and feelings that couldn't be
dealt with in some other way.

First, a surgeon I had worked with and was familiar with
shot and killed his girlfriend then shot and killed himself.

Then a very good nurse friend was murdered by her father-in-law in a
murder-suicide most likely driven by her and her mother-in-law's
chronic illnesses. The mother-in-law was killed too.

Then a former senior fellow from my time in cardiothoracic surgery
at the Brigham in Boston was murdered by the family member
of a patient he had operated on.

And, just when doctors are being told to #StayInYourLane
and fighting back by saying #ThisIsOurLane
an Emergency Medicine doctor, not known to me, 
is murdered today in Chicago.

And, so here we go again with the debate...

After one hospital shooting a couple of years ago,
I had a discussion with the nurses about what we would do
if an active shooter situation arose.

One of the nurses told me that she would "shove me under the desk"
and they would go confront the shooter.
She said I needed to "stay alive" so that I could help them later...
That stayed with me as I thought about huddling under a desk
while others defended me and their patients.

This year, I decided to take matters into my own hands, so to speak...
I joined the NRA.
I bought a Glock 26.
I learned to shoot.
And I got my CCW.

For some reason, instead of dealing with feelings in other ways,
people are using guns.
Is it the pervasiveness of reality video games?
Is it the influence of television and movies that glamorizes guns?
Is it the lack of authority figures in their lives?

Why are so many people resorting to killing?
A jilted lover...
An angry family member...
A desperate husband and father-in-law with failing memory...
An angry ex-fiance...

Colleagues are ranting about
public health issues
mental health issues
patient safety issues
  and, I agree with them in some respects.
There aren't enough mental health providers,
there aren't enough systems in place to help people
to learn to deal with their problems.
We need more secure hospitals and public spaces.
Heck, our hospital just got security guards within the last year,
and I've been here for almost 8 years!

But let's focus on the the deeper issues of mental health
and why people can't cope or deal with their problems.
Texas, 1966 - a marine in a bell tower
San Ysidro, 1984 - a security guard in a McDonald's
Texas, 1991 - former merchant marine in a restaurant
Virginia Tech, 2007 - student with mental problems
Let's focus on role models lacking for young men
and the disintegration of the family.
Columbine, 1999 - Trenchcoat Mafia
Let's focus on the entertainment models of video games
and movies influencing our actions.
 And, on and on and on...
But, not the guns,
the guns were simply the tool used to perpetrate the action.
Just like planes and box cutters killed over 3,000 people on 9/11
Just like those that "drank the Kool-aid" and were killed by cyanide in '78
Just like the sarin used to kill 12 in a Japanese subway

You can't blame the means, you have to blame
the perpetrator and uncover the most important question:
the why...?
Followed by
What can we do...?

Yes, those are bullets in my handbag.
I have a CCW now.
For that moment I've been shoved under my desk,
and it's still up to me to help my staff...


Sunday, November 18, 2018

NaBloPoMo 2018 - Day 18

I'm taking a cue from the dogs
and resting on this Sunday...

Tomorrow I'll start a run of 6 shifts in a row...
a few thoughts for the week:
please drive safely
please chew your food completely
please don't overindulge in alcoholic beverages
please take a breath before dealing with unruly family members
& if you don't have family, volunteer at your local shelter
and help serve food to others who don't have family...
or food...
or shelter...
or hope...
much as I'd love to see you,
I'd rather it be social,
than in the ED...


Saturday, November 17, 2018

NaBloPoMo 2018 - Day 17

So my blog title:
I'm a fan of a lot of animals.  I never thought much about squirrels until I moved from California to the Midwest for medical school.  I think Canada geese dominated those med school years because during the fall they were everywhere! And, there were a few squirrels, but you didn't really see them until winter when you would see their nests in the trees.

Then I moved to Chicago... not many squirrels in the city.

Then I moved to Minneapolis, and a little house I shared with my then fiancé along one of the lakes. And we had a great yard. With a lot of squirrels. On my days off, I would stare out of the window and watch their antics while I worked on lectures for a class I was teaching.  Soon I was feeding them, bought one of those squirrel corn spinner things, a squirrel bungie corn thing, and my love of squirrels developed.

Then, when I was accepted to residency in Buffalo, 
I started to keep a blog and hence the first blog title:

And they did!  This one lived just above my car park.
He'd chatter at me when I'd come out of the house.

Then after the first year of residency, I started my second blog:

The blog followed the next two years of 
my Emergency Medicine Residency.

When I graduated from residency, I started this blog:
"California Dreamin' Squirrel"
Which details the last 8 years since I graduated
with all of it's new adventures
and a few tragedies...

But now I collect squirrels...
In photos and in real life.
Friends send me videos and memes.
It's become my thing...

In a couple of years, maybe I'll start a new blog...
Wonder what that title will be..?


Friday, November 16, 2018

NaBloPoMo 2018 - Day 16

"If you want to find me I'll be
Playing with the boys..."

I was having a bout of writer's block this evening,
and the prompt from my online group just wasn't 
inspiring words to come forth,
so after a couple of hours of doodling and needing to
put words to blog, I decided to play the iTunes Shuffle...

Whatever the next song was, no matter what,
I was going to write a blog about something it reminded me of...

"So say "Geronimo" say "Geronimo!""

And suddenly I was thinking of my uncle Ruben;
the one I've written about before who raised me like a father,
who taught me how not to be a girl,
and whom I think of whenever I'm about to do something
definitely not girl like...

Like flying a glider...

Hubby thought it would be a great experience to feel what
he feels when he is hang gliding, but in a more
controlled environment...
if you can call flying powerlessly through the air controlled, 
but whatever...

After about an hour of ground instruction,
here's me sitting in the cockpit about to be towed up...

The tow plane pulls you to altitude and then lets you glide..

"Now I'm feeling so high, like a G6..."

And that's what you do... you ride the thermals and try to get some lift
so that you can keep going.

I was so fascinated by the view I almost forgot I was supposed to be
flying the plane.

"If you've got troubles let 'em go, 
let 'em soar so high, high into the sky 
just like a red balloon..."

And I did... the flight instructor said I had good instincts,
or maybe he says that to all the newbies to give them confidence
and keep them coming back...

Still, I actually did fly and control the glide plane all the way back
to the runway approach, and the instructor brought us in for the final landing...

I thought about my Uncle who would be so proud
that he raised me to be fearless,
to accept challenges,
to continue to take him wherever I roam
in my heart...

Bucket list: fly a (glide) plane

"I had the time of my life and I never felt this way before..."


Featured Post...

The Mid 40's are in the Books

For some reason I never got around to writing about traveling to National Parks numbers 44, 45 and now 46...! Back at the end of June...