Wrapping Up 2014

So I write after my month-long self-imposed hiatus.

November just took the life out of me.

As did working about three weeks of 6-8 straight days in the ED

then driving to pick up Momma in SoCal, 

then driving back 12 hours home to work over Christmas

then.. then.. then...

Now, December, and 2014 for that matter, is winding down, and I am posting.

Christmas is by far my favorite holiday, and with working so much this year

I really didn't feel like I got to enjoy it.

Usually, I have all my decorations out the weekend after Thanksgiving,

get the lights put up by the first, and the entire house decorated.

This year, I had one day around December 13th to go out and pick a tree with my hubby

so that he could cut it down, drag it into the house, and then

half-ass decorate it so that I could have that done before going to work the next day.

Even my reindeer just got lined up on the mantle with no small trees and candles

around them like I usually do.

No trimmings on the front gate and fencing.

Not even lights on the house...

Then today I took it all down.

Day after tomorrow I drive back to Sacramento for another 

9 shifts in 10 days.  So I have to have everything ready in the house

before I leave.

I got to enjoy Christmas for all of about 16 days.

I wonder if I will be able to arrange my work schedule next year so that I can

take most of December off..

We'll have to see what the new year brings

as the door closes on this one....

Wishing you and yours a very Merry Christmas

and a blessed and joyous New Year...!!

Day 30 - At Last

There's always a little bit of a letdown at the end of the NaBloPoMo (national blog posting month) even though it's a bit of a blessing as well, because writing on a daily basis is hard.  I'm a bit of a perfectionist so I always overthink my blog posts... will they like it...?  will they get it...?  will they like me...?  will anyone even read what I've written...?

I try.  I think we all do.  Bloggers feel as though they have something important to share with the world, and it's tough putting ourselves out there on a daily basis for a month.  Given that I'm a bi-monthly poster at best, it seriously takes a little out of me whenever I post.  Of course, I've written before that in some ways this is just a means to expressing the creative side of me given the high stress environment I find myself in most days.  But, still, who doesn't want to think that they're the greatest writer since Douglas Adams?

Anyway, tonight I bid you adieu for this year.... it's been quite the road as we've covered cases in the ED, the current state of affairs in healthcare, current events, my uncle's birthday, my dog's birthday, suicide, dancing it out, and of course Mexican telenovelas.  Thank you for joining me again this year for this little adventure.  I hope you'll stay throughout the course of the year for my random musings as this next year promises to be an exciting one with almost monthly trips planned along with several long journeys in the works...

Thank you!!

Day 29 - Dixie's Third Birthday

Today is our Australian Shepherd Dixie's third birthday, and here is her video:


If you'd like to see how she's grown, here are her other videos:

Dixie's 1st birthday video

Dixie's 2nd birthday video

Don't judge me, I just have fur children...

Day 28 - Semi-Live Feed

I thought I would try an experiment today and put in events as they happen during my shift in the ED.  I don't have Twitter so I can't "live feed," but we'll see how this works out, so keep checking back as I will update this post as the day goes along and time permits.

0500 - Came on shift to get sign-out of 14 patient waiting for admission, discharge or consultants to see them.  This didn't include the 3 people who were on psych hold awaiting placement at local psych facilities.

0503 - The first ambulance of my day arrives bringing in someone with a "numb arm" because they fell asleep on it.  I send them to the lobby to await fast track.

0510 - Ambulance (AMB) - "my shoulder and hip hurt"

0530 - reviewed a chest x-ray (CXR) and diagnosed pneumonia in a toddler

0545 - picked up a patient that was triaged earlier with abdominal pain

0550 - AMB - spouse called because patient "didn't want to wake up."  Patient admits to "drinking a lot of alcohol last night."

0555 - AMB - elderly patient with shortness of breath

0630 - patient with shortness of breath has a large fluid collection on their lung, call for drainage; another patient from sign-out has a dislocated shoulder and the orthopedist asks for me to do procedural sedation so that it can be reduced - after a lot of propofol (aka milk of amnesia) the joint is put back in place and discharge orders are written; another psych patient has forms to be signed so that they can be transferred

0700 - getting busy; two car crash victims come in for evaluation; taking care of more of the sign-outs and getting them admitted/discharged/sent to psych, etc

0800 - AMB - "I'm dizzy and haven't been taking any of my medication"
         - AMB - "My heart is skipping beats, and I think my potassium is low"
         - AMB - "My finger is infected, I've had diarrhea and stomach cramps, I haven't picked up any of the medications I was prescribed for infection 2 days ago."
         - AMB - Assault
         - AMB - Psych nursing home patient with abnormal labs.

0830 - I got coffee on the way in... yeah, Dutch Brothers!... I just finally got breakfast... what I really needed was a Snickers bar since I was turning into quite the Diva
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0900 - all Hell's broken loose... about 5 ambulances in a row and the psych patients are starting to get restless...

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1000 - trying to clean up from the pile of EKG's and CT scan results that are inundating my work space... did I mention about 4 more ambulances arrived?

1015 - baby bell went off... another life comes into the world

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1100 - AMB - "My chest hurts and my esphophagus is in spasm."
         - AMB - "My back hurts because I was sitting at dinner and then coughed."
         - a "drunken bitch" that was a signout from overnight has finally sobered up enough to state that she doesn't remember what happened last night and wants to know why her ankle hurts so bad.  What she doesn't remember is stripping off all of her clothes and running naked down the middle of the street.  Happy Thanksgiving...!
        - AMB - "I've had the flu and my back hurts.  Oh, and I had neck pain with a fever..."
        - AMB - "I got a flu shot and now I think I have pneumonia"
        - AMB - Patient sent from nursing home with concern for weakness and they "need a feeding tube."
        - "My ear hurts"  I diagnosed a ruptured eardrum, and the patient wanted to know what I was going to do to "fix it."  I attempted to explain that they usually fix on their own, but she said that she couldn't hear and needed something done sooner.... yeah, um...

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1200 - Help arrived, I don't have to pick up any new patients, however I had a pile waiting to be seen still
         - Concern for stroke, from Wisconsin, fellow cheesehead...
         - SVT and COPD admitted for both
         - HA with concern for head bleed because of prior history of head bleed
         - AMB - Concern for stroke with dementia, makes for a difficult physical exam
         - Pediatric asthma... parents, STOP SMOKING..!!
    
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1300 - Trying to clean up from the day.  Labs to be reviewed.  Radiological studies to be followed up on.  They say on average an ED physician gets interrupted multiple times a minute.  I'm wrestling with managing over a dozen patients at once including the lingering sign-outs from the morning, especially one that is cursing at staff and telling everyone around them to F-off.  They're over 70 years old by the way...

1330 - Lunch while I chart!

1345 - Underage patient who smokes pot they "find around the house" here with concern that their "tongue is going to fall off."  They sit on the ambulance gurney holding onto their tongue so it doesn't.  I ask them to put their tongue back in their mouth.  They instantly realize they can and try to jump off the gurney saying "I'm all better I can go now!"  But, they can't because some of the other medications they "farmed" around the house are kicking in and they start to vomit.  I'll be signing this one out for sure.

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1400 - I'm under the gun.  My scribe has left and I need to finish discharging/admitting/transitioning patients while I continue to be interrrupted and the other MD is getting overwhelmed by the waves of humanity.  Funny how fast things can change.  Yesterday at this time there were 10 patients on the board, no one in the lobby, and I was leaving my shift early... now there's a full board of 25+ patients along with 22 in the lobby, the longest of which has been waiting almost 3 hours...

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1430 - I've got almost everyone admitted who's going to stay including the back pain because it just "hurts too much to walk" despite dosages of narcotics that would have me (and most people) unconscious for the next 36 hours.  Still waiting on call backs from admitting physicians.

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1530 - The last of the admitting physicians have called back.  Everyone is signed out.  I am headed home... whew!

Day 27 - Giving Thanks

Remember those who work to keep your family safe.

Remember those who work to keep your loved one healthy.

Remember those who work so that your

emergency doesn't turn into a tragedy.

Thankful for my colleagues, law enforcement officers

and first responders who shared this holiday

with me, doing what they do best.

Day 26 - Warning Labels

Most people know that they shouldn't drink and drive...

but they do.

Most people should know that they shouldn't use 

certain prescribed medications and drive...

but they do.

And we see the aftermath all the time in the

Emergency Department.

Or, I should say, all that remains from the aftermath;

because those that die immediately in that

rollover,

head on collision,

auto versus pedestrian,

or other accident

never make it to the ED.

We hear about them later in the news,

from family that come to the ED looking for their loved ones,

from the police officer, sheriff's officer, CHP officer, paramedic

or worse when they survive the accident, 

but then are pronounced in the ED because they are

too broken to be fixed.

But the DUI offender...?

They're rarely injured seriously.

There's a saying that there's a god that protects

drunks and small children, 

and never is that more truly realized than in the ED.

Sorry your ankle hurts "really bad,"

but that combination of methamphetamines and norcos

which caused you to cross the center line

should hold you over while you're being processed in jail

for the deaths of those grandparents who were just

traveling to see family.

I know your head hurts.

Bummer that the alcohol you used to wash down

the benzos you have for anxiety can't help that.

I'm sure the family of the child I'm flying out to a trauma center

understand that you needed to "just run out for some cigarettes."

I'm sure they're thinking of several ways to help you

stop smoking... permanently.

The nurses and I realize you think you need your

next dose of pain medications early for your broken wrist

by the endless pushing of the call button with your

good wrist which is, by the way, handcuffed to the bed,

but we're a little busy over here trying

to keep the teen you hit on their bicycle alive

because they've now got more tubes in them than a

1950's television, and the bleeding isn't stopping.

Would you like to make a donation?

Oh, no, sorry, the blood alcohol level is a little

too high, and the cocaine surge probably would be a bad thing.

Yes, back/tooth/arm/leg/stomach/neck pain can be very bad.

Here's your prescriptions for ibuprofen and norco.

Make sure you read the warning label, don't use alcohol

and don't drive or use heavy machinery...

any questions?

Day 25 - Text You Later...

Part of my evening wind-down routine is to get onto the computer and do what I call "link leaps of faith."  You know when you click a link that takes you to another link and so on, and so on...?  I was trying to think about what to write about and came across a link to an article posted by a woman who was sharing texts she and her hubby have sent to each other.  I liked the idea, so I went through my phone to find some of my own.

Now, you have to understand a couple of things.  One - my husband can't type or spell, so sometimes it's a challenge figuring out what he is trying to say, but I will translate for you.  Two - hubby and I have had a long distance relationship since we've met and even after we married.  I still continue to travel for weeks at a time, and sometimes he goes for get-aways with his friends, so lots of texts get sent while we're on the road, or he gives me updates on the goings-on at home.  I think some of the texts are self-explanatory, but I will help out on the others...

Conversation regarding another doctor's hobby...

We live in a very small town, so even a DQ is a big deal,

and DH has a sweet tooth...

I let my DH know how my day at work is going...

He celebrates when it's good...

or when I get really frustrated...

When I'm traveling, he let's me know

what's going on around the house...

Everything...

And the aftermath...

For some reason he was obsessed with a spoon

that he thought might have gotten "stolen by the caterer" or

accidentally thrown away.  When I found it in my travel lunch bag,

I taunted him with it...

After some early conflicts, he and my mother now

have a better relationship...

We travel often with her, and as I've said before,

she's the Slot Machine Queen...

Traveling with Momma...

She was coming to visit for Christmas last year, and

since we're Hispanic, she asked for some tamales ("Molly's")

which I asked my DH to pick up on the day she was going to arrive...

My DH, always thinking about food...

But the best texts show the attention to details...

Even when we're apart...

We always say good-night, ILY...