Hockey Heaven

Ok, so my fiance knows that if I ever left him for anyone it would be Paul Kariya of the St. Louis Blues.  That's hockey, folks.  Hockey came to Southern California in the early 90's in a big way with the Mighty Ducks of Anaheim, now known as the Anaheim Ducks - Stanley Cup Champions.  One of my mother's vendors at the time had season tickets, center ice.  We went multiple times over the course of 2 years.  Sure, there were the LA Kings, but now we had a hockey team in the OC... several years before it became known as the OC, but whatever.

When I left for med school, I didn't just follow the Ducks, I followed my favorite player, and I still do.  Every time his team comes to play near the town where I am, you can bet I'll have tickets.  Don't laugh, you have your favorite _____ (fill in the blank with your favorite band, actor, actress, performer, singer, baseball/basketball/football player, etc.), and I have my one little vice.  Oh yeah.  BTW, I do also have 2 hockey sweaters with his name on them.  Goal in life, to get them signed.  Sigh, one day.

Anyway, Flat Adrian will be shipped off tomorrow with a stack of photos from his visit, including tonight's little jaunt to the HSBC arena where Kariya scored a goal and had 2 assists as the Blues beat the Sabres and broke their 5 game winning streak.  What makes me sad is the Blues won't be back again until January, and they will be playing in Toronto... hmmm... wonder if I can manage tickets to that game..?? :D

I am not writing daily because ultrasound continues to be boring;  for you and for me.  In about a week I'll start working in the BGH Cardiac Care Unit, so things should pick up, Blog-wise.  Until then... some pics from tonight.  I wanna ride the zamboni!!  

flat Adrian with mom eating a pretzel

Tags: hockey, Paul Kariya, Flat Stanley, St. Louis Blues

I'm Still Scanning

I haven't really written in the last several days since ultrasound is actually kind of boring.  No one wants to hear about the 25th abdominal ultrasound I've done.  And, I have been too busy trying to get mom settled and ultrasounds done that Flat Adrian hasn't had much to do either.  Today he sat at the clerk's desk at ECMC and helped Yvonne work and greet people as they come into the Emergency Department.  and then he met Trauma Dog 

He also helped the trauma team get ready for an incoming Mercy Air Flight
  That's about it for him for now.  But, we'll get some more adventures in during his last days in Buffalo.

Tags: Flat Stanley

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Giving Thanks...

   What I am thankful for this year:

 - a warm apartment and warm kitties to come home to
 - a fiance who keeps me safe and loved
 - a mother who is still able to love and support me despite the long distance between us
 - a new beginning in Buffalo and the ability to be of service to others
 - a group of friends that continue to travel with me on this life's journey
 - and, the prospect of an exciting and wonderful year to come....

Tags: Thanksgiving

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My Flu Shot Worked... I got the flu

I am all about prevention.  I get a flu shot every year since I am surrounded by sick people at work.  I was feeling especially vulnerable over the last 2 weeks at BGH because it seemed like every other person was coming in with "shortness of breath," "cough and cold symptoms," "muscle aches and fever," etc.  I started work at ECMC on US/telemedicine and made it my mission to get a flu shot which I did on Tuesday.

And it worked... I got the Flu on Thursday.  My tonsils swelled to the size of walnuts, and for about 30 minutes I considered going into the E.D. as it began to feel as though my throat was slowing swelling shut.  I hung in there.  Friday morning I slept in and woke up with two hours to spare before having to leave for the airport.  After taking 3 and a half hours to make a 60 mile drive... all because it took an hour to cross the border and another hour in traffic... I had 30 minutes to make it to my flight... oh yeah, I had to clear U.S. customs before being allowed to leave Canada, I almost literally walked onto my plane.

Just about the time my cold tablets fizzled out, we were in turbulence over the Colorado Rockies.  For about 20 minutes we were like a martini:  shaken not stirred.  That's when the GI portion of the flu decided to hit, and I had to make a mad dash to the bathroom.  Luckily, the line of people who had waited out all the bouncing before being able to get up were nice enough to let me through.  The universal "hand over the mouth" distress sign probably went a long way as well.

I was able to sleep when I got to my mother's.  Then we ran around all day shopping for important things you can only find in Southern California... like a decent pair of shoes at Nordstrom's.  I slept again and prepared for the long ride back to Buffalo;  mom in tow.  That trip went a whole lot better.  My sinuses held during the flight, and my cough didn't hit until we were nearing the U.S./Canada border.  But, I was on home turf again and felt I could handle anything.  This morning I slept in and have been resting, drinking O.J. and tons of anti-oxidants.  Tomorrow I will see how long I last at work.  I have lots of scans to rack in.

For those that don't know my background:  I have been on and off planes since the age of 5.  When I was a contractor in the Wash. D.C. area during my brief period of  having a "real life" between college and pre-med, I flew back and forth across country 8 times in the span of 3 months.  After this, I was flying from where I lived in Mexico City to the U.S. every 2 - 3 months for a year, mostly to renew my tourist visa which is only good for 90 days in Mexico.  I know how to travel.  I can work my way through just about any airport.  Even before 9/11, I had been through some of the toughest security systems:  Frankfurt, Athens, Dallas-Fort Worth (I think they thought I was some kind of drug runner because I had a bunch of entry/exit stamps from Mexico City to various U.S. border cities... I still think I was about 3 seconds away from being taken into a back room for a "closer inspection.)

So, just some thoughts for the "occasional tourist:"
 - think minimalism.  Yes, you may look awesome in your 3 inch heels with the multichain belt, baubles and bangles, hoops and rings, but all that "bling" is gonna ring when you go through security.  When you take 5 minutes to take off all of your accessories to get down to the t-shirt and painted on jeans you're wearing, you're delaying the rest of us.  Especially when you keep insisting some piece of jewelry isn't going to ring and you make several passes across the metal detector before finally agreeing you need to remove it.  Then you're insulted that they want to take you out of line for a "pat down" and wand scan because you're still ringing.  Which also leads to...
- wear a camisole or non-underwire bra.  My mother and I learned this on our trip to Vancouver.  Unless you're planning on joining the Mile High Club mid-flight, no one's going to notice your Plain Jane cotton best, so leave the metal-braced fancy ones at home or be prepared to be wand scanned.
- if you live in that super secret part of the world with no television, newspapers, or other people who have traveled before, I still think it's a good idea to read the 100 or so warning signs at the airport about bringing liquids past security.  If you somehow manage to not do so, and completely ignore the security officials at the little table with examples of what you can and cannot bring with you, don't decide to start sucking on your bottled water right before you go through the scanner and then spend 2 minutes arguing with the security people about how you didn't know you couldn't bring it you.  They're going to make you throw it away/leave it behind.  If you want to save money, bring an empty clear hiking bottle and fill it up at the drinking fountain once you get past security.
- when you get on the plane, it's rude to leave your bags at the front of the plane when your seat is at the back of the plane.  Yeah, it is.  That means that those of us sitting in the front have no place to put our bags so we have to put our bags toward the back of the plane and then "swim against the wave" when people are trying to get out of the plane... and, I will glare at you during the flight each time you come to get something out of your bag, oh yes I will.
- oh, and as much as I like Queen and, occasionally, Outkast, I am sure the 80 year old grandmother sitting next to me would rather listen to something a little less jarring to her nerves and delicate sensibilities.
- I think they should make a rule that cell phones aren't allowed to be on when in the plane at all.  It's bad enough I am hearing about your problems with your co-worker while waiting in the terminal, then I have to hear about it during the long walk down the jetway, while sitting waiting for everyone to board and then again the minute the plane touches down when you call to check your messages which includes any updates regarding this co-worker which occurred during the duration of the flight.  I think second to that is the "I just landed so I have to reconnect and make plans with every person I know between the time that I land and the time we arrive at the gate."

I think that's enough of my travel diatribe for now... Flat Adrian didn't make the trip because during a flu-induced mental lapse, I forgot him at home.  No worries.  Mom is here for 3 weeks, and I promised to show her, and him, around town.  

Tags: Flu shots, air travel, cell phones, tourists

Tele-whatacine?

I talked yesterday about ultrasounds, and I thought I would talk a little about telemedicine today since it's the other half of my rotation.  I think I might have mentioned before that we're connected to the entire New York prison system.  We have an office with a computer, video monitor and speaker phone, and there's a similar set-up on the opposite end.  For the most part we "see" patients, and the local jail infirmary R.N. does a physical exam as we deem necessary.

Sometimes, the patients/inmates need something simple done.  Sometimes they need to be referred to a local community E.D. for a more formal work-up.  Sometimes they come to us.  We had another pica patient today from one of the local facilities.  Pica, as you may remember, is a condition when you eat "non-food" items.  In this case, he ate his plastic wristband name tag.  And, I found out, it wasn't his first time doing so.  He'll get scanned, scoped, the item will be removed, and he'll be returned to prison until the next time he finds something new to eat.

Nothing much else.  Here's a few of my scans from the last couple of days:

a side view of the heart


a view of the liver and right kidney (center blob with 2 white blobs inside)


if you look closely you can see this 5 month old baby.  it's head is the light gray circle on the right and if you got up leftwards, that's actually it's spine curving toward its butt

Flat Adrian and I visited the Anchor Bar today.  I wrote about it on an earlier post. It's historically, the original home of the "Buffalo Wing" and there's a great article about it in the New Yorker http://www.newyorker.com/archive/1980/08/25/1980_08_25_082_TNY_CARDS_000331411

We had some tasty wings, and several of my colleagues lifted a pint or two in celebration.

Tags: Flat Stanley, Anchor Bar, Buffalo Wings, telemedicine, ultrasound

A lighter shade of grey...

O.k. So I changed rotations and now I am back at ECMC doing a month of ultrasound and telemedicine.  I spent a few hours yesterday with the ultrasound tech getting oriented to the machine and learning what my responsibilities are going to be for the next 3 weeks.  It's a month's rotation, but I have vacation for the last week, so it's just 3 weeks in length.

Today I came in and started doing ultrasounds on patients.  I think it will get a lot easier once I figure out what I am seeing on the screen.  Chest x-rays, no problem.  I remember when I first started, I could never find the carina (that's where your trachea or windpipe divides into a right and a left branch).  Then one day it was like those magic 3D puzzles.  My eyes focused and boom, there it was.

CT scans were the same thing.  Something that looks like a liver, there's the kidneys and then loops and squiggles of bowel.  An inflamed appendix you say?  Sure.. uh huh.  Again, one day, pow, there it was.  Now I am facing the challenge of reading the different shades of grey with wavy lines and snow in between.  Luckily, the patients have been very nice and VERY patient as I try to get in my multiple views.

Since, for the most part, doing an ultrasound on someone when they come into the E.D. for, say, a urinary tract infection, isn't usually warranted, we develop a pitch to explain why we would appreciate scanning their heart, belly and pelvis.  I sometimes feel like a late night info-mercial announcer.  "Today, and today only we're offering free ultrasounds to screen for such things as kidney, gallbladder and bladder stones."

I don't really mind.  I'm working banker's hours and not having to think too much.  Which lets me focus on other things like getting my apartment "mom ready" since she will be coming out to stay with me for 3 weeks, and taking "Flat Adrian" around town.

Here's an update on his adventures:  Today the Mercy Flight crew was nice enough to allow Flat Adrian to visit the helicopter and even sit inside.  Pilot Matt let him sit in the captain's seat and even took a picture with him.  If the video works, you can even see Flat Adrian waving goodbye as the crew takes off on another run.

Tags: Mercy Flight, ultrasound, telemedicine, Flat Stanley

The Final Weekend

It's over and done.  I survived the month at BGH.  From what I've been told, it's a very challenging month in many respects.  The patients are more complicated, the attendings are more demanding, the system is annoying.  At ECMC, you make one phone call, maybe two to get a patient admitted to the hospital.  Today, one patient took 5 phone calls to finally secure a bed.

I've worked the last three days, and I chose not to write until the end.  No real specific patients to comment about, but just some general observations.  What I really missed about ECMC were the stories.  Patients were just more animated and colorful.  They had very interesting back stories.

At BGH, I felt like one of my favorite TV doctors:  House.  Just when my faith in humanity would start to return, I would get scammed by a drug-seeking LOL NAD who looked like they should be sitting on someone's porch knitting a sweater with a pitcher and glass of lemonade at her side.  "Everybody lies." 

There's also a certain dissatisfaction in not getting an answer to a patient's medical condition.  At ECMC, most patients had a problem/issue that could be resolved; i.e. I got hit by a car and now I need surgery.  Here at BGH, there's not always an end-point.  We admit patients for further work-up.  Many times I looked up a patient's admission to find out what happened to them or what the real diagnosis was.

But, overall it's been a good experience.  I feel a lot stronger in certain areas, and I know the areas I need to develop and work on.  For now, I will relish in the next month and playing with the ultrasound machine.  Also, in getting up later and coming home earlier...

Flat Adrian Update:

given the more free time I will be having, we'll have some time for more adventures...

Tags: BGH, ECMC, House M.D., emergency medicine

Good-night, my Love...

Beer meter: 0, another good night

I am getting married in about 3 months.  Amidst the chaos that comes with trying to plan a wedding long distance and in a short amount of time, you lose touch just a little bit on the real reason for the event.  The fact that you found someone to share your life with.  Last night brought that sentiment home and gave me pause in many ways.  Suddenly, "Until death do us part" took on a very real meaning.

We weren't very busy, and by about 11:30 p.m. we had pretty much cleared out most of the day's patients and only had about 4 patients on the board at any one time for the rest of the night.  I had an ambulance come in and bring a gentleman who was having problems breathing.  His wife came along with him. 

As I did my interview, I began to get a sense of the dynamics of their relationship.  He would talk and she would finish his sentences.  She would talk and he would interrupt.  Then they would talk at the same time.  She called him stubborn and told me how she had tried to get him to come to the E.D. sooner.  He just rolled his eyes as if to say, "There she goes again telling me I told you so."

But, you could definitely see the love and affection each had for the other.  The gruff but gentle teasing.  The way she fussed over this and that.  The way he told me proudly that they had been married for 55 years.  I could tell.  There's a lot of love there, and hopefully we managed to give them a couple of more years together.  He was in heart failure and anemic.  I made sure he got a transfusion and got him admitted to the hospital. 

My second gentleman wasn't doing as well.  He came in having trouble breathing and his wife had followed behind.  She knew he was very sick, and when I asked about his wishes as to whether to have a breathing tube put in should he continue to have problems breathing she deferred to him.  He looked at her questioningly and she said, "It's your decision.  I can't make it for you."  They looked at each other again for just a heartbeat more, and he told me that he did not want to be intubated.

They continued to look at each other as I explained that I would do everything I could to make sure that he was comfortable.  She held his hand accepting his decision, and he put his head back and closed his eyes.  I kept checking on him over the next couple of hours, and he started having more irregular heart beats and difficulty breathing. 

I made the decision to put him on a Bipap machine which would help support his breathing without putting a breathing tube in.  In essence, it makes it easier to breath, and at this point, I could tell he was getting tired.  As I worked to keep him stable, I called and arranged for him to be admitted.  All of this happened just at the end of my shift, and I had to sign him out to the incoming doctor.  My attending and I agreed that we were basically admitting this gentleman to die.

The last image I had as I left the E.D. on the way to my weekly meeting was of his wife, still holding his hand, resting her head against his bed as he continued to struggle to breath on the Bipap machine.  He was fighting so hard to not let go and just fall asleep that he was actually working against the machine.  But, I know that he will eventually get tired enough fall asleep.  To just let go.

****
Flat Adrian spent another night with me in the E.D.  I will actually have a couple of days off, so we'll see where else I can take him:

   

Tags: Flat Stanley, end of life, Bipap machines, till death do us part

Monday Diversion

Beer meter: 0 again!

Last night when I got to the E.D. the entire place was packed.  I've come to learn that we actually have about 33 beds in the E.D. plus about 6 more in the Fast Track area.  Last night, every single one was full and there were about 10 people waiting in the Waiting Area.  We were officially on diversion.

Diversion means that walk-in patients can still come in and wait their turn as they are triaged.  All ambulance traffic gets "diverted" to another facility.  Also, since we are one of the larger hospitals in the area, we get admissions from surrounding smaller hospitals when they encounter a patient that needs a higher level of care.  So, we "divert" those patients as well.  Actually, they were all getting sent to E.C.M.C, so their E.D. was packed as well, but I digress.

I jumped right in and started seeing patients.  I can't believe the volume of chest and abdominal pains I see.  Also, SOB's. (Again, shortness of breath not a comment on the patients themselves.)  So everything is becoming garden variety in this the start of my fourth week here.

Some standouts from last night:

I have no problems giving lots of narcotic medications to people with legitimate medical conditions.  Cancer patients get all they want.  Pancreatitis people who aren't raging alcoholics get a good amount.  Drug seekers who try to scam me out of oxycodones by telling me that they're allergic to everything else and are in sooo much pain they can't do anything because of the pain get none. 

If you followed the link I wrote about previously, you will understand when I say that no one can have 10/10 pain.  One of my colleagues said 10/10 pain is being hit with your own amputated leg.  Seriously.  I think almost all of my patients tonight described 10/10 pain.  If you have that much pain you should be screaming at the top of your lungs, writhing in bed, and nothing short of being knocked unconscious should relieve it.

We had things under control by about 2 in the morning.  At that point we only had about 4 patients on the board and no new patients coming in.  We opened to ambulance traffic again and had a few come in over the next couple of hours.  We left 5 people on the board at sign-out.  I don't mind, I have one night of nights left then it's back to the day shift to finish out the weekend and my rotation.

For the next 2 weeks, I have "Flat Adrian" visiting as part of a school project.  So I will be showing what he's up to here.  If you are not familiar with the story of "Flat Stanley" google it for an excerpt and links to the Flat Stanley Official Website.

   

 

Tags: Flat Stanley, pancreatitis, drug-seeking behavior

Pregnant and 40

Beer Meter:  0 it was actually a tolerable night

This is a quickie:

Last night amoungst the heart failures and asthma exacerbations, I had a patient who will be turning 40 tomorrow.  She's homeless, her kids have stolen her glucose meter, she has no money for her medications, and she doesn't have a regular physician.  From time to time she goes to the walk-in clinic to take care of whatever ails her at the moment... oh, yeah, did I mention I diagnosed her pregnancy last night?

This got me thinking of a poem I wrote in my Literature class while in college.  Our subject was to make a political comment on society.  Mine was called "A Matter of Timing.  I think I remember my first line as being:

For or against abortion?  For or against the death penalty?  What I guess you're really saying is it's just a matter of timing.
I then went on to describe a person not allowed to have an abortion who then goes and has a child they don't want.  So the child is raised in a loveless poor environment where they go on to do drugs, steal, end up killing someone and then get the death penalty.

Now, I am not advocating abortion or the death penalty, but this situation made me think of that poem again and made me wonder what this child's life is going to be like.  When you wonder why doctors sometimes seem cold and distant, I think it's because of situations like this.  You have to block yourself off sometimes from certain aspects of your patient's lives or else you would probably end up doing more harm than good.

Now, off to the trenches again.

Tags: abortion, death penalty, poetry, physician distancing

An added hour of fun... not!

Beer rating: 1

Daylight saving time is over (trust me there's no 's') and last night, the lucky 4 of us who worked the extra hour as we "fall back" in time really felt it.  In a past life, I actually have been in a bar once or twice during the time change.  Then it's not so painful... last call, no, oops, an extra hour to get that next drink or two in... ahh.

Some thoughts on last night, the first of 4 before I switch back to days to complete this rotation....

crack cocaine habit: $40 a day, ok, so that's about $1200 a month x the last 7 months = $8400.  Wow.  On Disability, you say?  Once, again, your tax dollars at work.  Admit with chest pain.

500 pounds is the maximum that our CT scanners can accommodate.  Again, it's very difficult to get the proper treatment when you don't fit on the machinery.  In this case, I will argue any statements regarding making accommodations for everyone.  The lively discussion we had in our E.D. regarding how to go about treating this patient lead to some thoughts which included "vaccinating" patients with tapeworms;  in case you didn't know, "diet pills" sold in the early 1900's actually contained tapeworm eggs.  You ate what you wanted, the worm consumed all the calories, you lost weight.  However, there's a rather nasty bit about worms not always sticking to the stomach and traveling to other parts of the body.  Also, you have to one day "lose the worm."  Snopes.com is my website of choice when it comes to matters of urban legend.  They file this one under "undetermined" but I think there's enough evidence to support the story:  http://www.snopes.com/horrors/vanities/tapeworm.asp  Regardless, weighing 500 # does not make for ease of patient care.

One of my patients started "hearing voices" about a month ago.  Most of the voices sounded like family members, but one voice was actually given a name:  Michael Mahooly.  They convinced her that her entire apartment was filled with video cameras to watch her every move.  Unfortunately, the tumor in her brain that we found when we CT'd her head has nothing to do with the voices.  She was transferred to psych.

Crack, alcohol and a big wad of cash do not always make for a fun Saturday night.  They just might lead to your getting your head smashed and cut to bits by a broken off bottle as someone decides to lighten your wallet.  It's going to take 2 teams of surgeons to repair the eyelid laceration and the mincemeat that once was your ear.  Better for you to get sent to ECMC where they can handle traumas.  Yep.

Ok... off to bed... tonight will come much too soon.

Tags: cat water fountain, crack cocaine, obesity, brain tumors