#277 - L is for St. Lucia

We took a Southern Caribbean cruise in 2013,

and my favorite island was St. Lucia.

We landed at the port in Castries City and jumped

on a small boat for a tour of the island.

There are small fishing villages all along the shores,

and they sell their wares on the streets in town.

We were able to enjoy the local catch of the day...

We went around the western side to Soufriere Bay

and landed in Soufriere.

Along the way, we saw the famous Pitons.

The color and clarity of the water was amazing..!

And, I took lots of pictures of boats.

We traveled to the "drive thru volcano" and 

did a short waterfall/jungle hike.

This is my favorite photo in St. Lucia so I am showing it again.

Cheers, to our next trip to St. Lucia!!

Pass the bottle..!

#278 - K is for King Salmon

There's a small town located just north of where we live

in Northern California called King Salmon.

We occasionally go to a restaurant out there

called "Gill's by the Bay."

It's a great little mom & pop place,

and the owner is usually on site.

I like to take the dogs there after breakfast

because it's a nice short walk past a pet cemetery

down to a shallow, protected cove where they can

run and swim.

On some Sundays, there's a pack walk where

the dogs can interact with others of their kind.

On warm days with good winds, it's also fun for humans

such as my DH.

I like strolling on the beach

collecting shells...

It's a great little place so close to home...

#278 - J is for Jacksonville... Oregon

Most people don't know about the small town of

Jacksonville, OR which is located to the west

of Medford and just south of Grant's Pass.

The only reason I know about it is because

my DH hang glides, and it's one of the major

spots in our area.

The peak shown above is Woodrat...

This is the cliff where they throw themselves off from...

I mean, launch their hang gliders from...

Paragliders also launch from here as well,

and during the summer months, the sky is full

of bright colors...

Here's my DH coming in for a landing...

Given that Jacksonville is one of the gateways

to the Applegate Valley wineries,

I can enjoy the trips as well... 

plus a little vino helps keep the 

spousal nerves in check...

#278 - I is for Inspiration

Funny, I couldn't find anywhere I have traveled that started with the letter I.  Ixtapa?  no...  Irapuato, Mexico?  Yes, when I was young, and I think I have two pictures somewhere of a street scene.  Inverness?  no... Ireland?  No...

So I found myself looking for inspiration which led to this photo:

It's me, my mom, and my grandmother.

I'm currently on a road trip with my mother, and as

we retrace roads we traveled long ago, I 

found myself thinking about my grandmother,

who died in 1987, but who also traveled these roads.

And my mother; wondering how much time I have left

with her... and how many more roads we will be able

to travel in that time we have left.

She is my inspiration to travel,

to explore,

to do everything in life that I want,

and to do it all well...

#278 - H is for Humboldt County

I thought I would share some of my favorite

photos from where I am currently living:

Humboldt County...

From Centerville Beach

To Ferndale

Past Bull Creek

And the Honeydew Bridge

From Point Mendocino

To Table Bluff near Loleta

I love the Eel River

And the Pacific Ocean

I love seeing Roosevelt Elk!!

And sea-faring boats in the harbor at Eureka

This is where I call HOME...

A place where Scottish Highlander cows

can walk casually down the road...

Come visit us some time...!

G is for Grrr

On a trip and I can't connect to wifi and my personal hotspot on my phone won't work either.  Going to be in a hotel tomorrow so I should have a real post then...

Until then, enjoy this oldie from today's date in 2008 while I was still in residency:
And technically I talk about Guillain-Barre so there's a G involved...

My Guillain Barre patient took a breath today. Just a small one. Well, maybe half of one, but it's a big thing! Even she was surprised. So excited she tried another breath and was able to do it. It all started this morning when I noted that she was able to flex her fingers, ever so slightly.

We decided to do a "nif" (negative inspiratory flow) test. It tests how much pressure a patient can create when inhaling. You and I, normal lungs, we can generate a high pressure, greater than 40 or 50. My patient inhaled to an 8 or 9. But this is HUGE considering that she has been on a ventilator for over a week, not able to move anything below her neck during this time.

She finished her last session of plasmapheresis and was being transferred back to Children's Hospital as I was leaving this afternoon. Of note, her primary caretakers since her admission have been my fellow Emergency Medicine residents. One of my colleagues evaluated her in the Emergency Department. He then sent her to the Pediatric Intensive Care Unit (PICU) where a 2nd year EM resident intubated her and took care of her. When she was transferred to BGH, another of my colleagues admitted her to the ICU and then transferred her care to me when I started. We're hoping the 2nd year EM resident on service in the PICU tomorrow will be able to take care of her... kinda like keeping it in the family.

Other than that, the most I can comment on is other patients in the unit. My fluffy white cloud is following me around, and as I left this afternoon my second patient was being transferred out. I picked up no patients during the day, and tomorrow I will round on one of the other intern's patients as she will be taking the day off. We'll see if I get any patients after rounds tomorrow from the overnight service.

So, these are some of the other patients in the unit:

- a schizophrenic patient intubated with pneumonia. They are literally "crazy" and won't be easy to extubate. We'll have to see how they do.

- a patient with severe aortic stenosis (heart valve that is blocked) who is not eligible for surgery and who needs to remain on the ventilator to keep their lungs from filling with fluid. The attending is trying to talk to the family about placing a tracheostomy versus extubating the patient and "letting nature take its course."

- a patient that pulled their own endotrachial tube out and actually seems to be doing ok despite the fact that they were near death about 3 days ago. Still touch and go, but holding their own right now.

- a patient with lung cancer who has multiple complications and abscesses. They are end-stage, so for the most part we're doing palliative care. They were too sick to be in the cancer institute so we are trying to get them stable enough to be transferred back.

- a patient who developed severe sepsis, almost died and needed to be intubated within a few minutes of arriving in the ICU, who is unable to clot their blood and who had the misfortune of having a venous line placed into a non-compressible artery. They were headed for a procedure to try to safely remove the line when I was leaving.

- a patient who ate something bad (not sure if at a restaurant or some old hamburger meat) and was infected with e.coli 0157:h7 which causes a severe bloody diarrhea. Unfortunately, this patient developed sepsis and is now in multi-organ system failure. I will have to see if they are still alive when I go back in the morning.

finally, the GI bleeder with a "spurting" artery at the base of a massive stomach ulcer. I placed an NG (nasogastric - nose to stomach) into him when he came back from the endoscopy suite, and he was being wheeled to interventional radiology/surgery when I was leaving.

Funny, I keep saying, "as I was leaving" but that's how my day went. Everything happened in the afternoon, as I was leaving. That's what's been interesting about this rotation, not knowing what I am going to find when I step in the door in the morning...

#278 - F is for Fleener Creek

We travel to a lot of places,

but sometimes it's just as much fun to 

explore your own back yard.

Fleener Creek sits about 10 miles down the road from us.

It's a short, downhill half-mile walk...

And you come to this... a beautiful secluded beach

at the end of Fleener Creek

Some days it's like you're the only person on the planet...

Mysterious

Amazing

Beautiful

You have to carry a tide chart, though,

because they come very quickly and

the cliffs are very steep

I love capturing my DH unaware...

Then comes the 1/2 mile back UP hill...

But definitely worth the trouble for all this beauty...!