Monday, December 31, 2007

Happy New Year 2008!!!

Saying good-bye to 2007:

Started the New Year dancing at the Withrow Ballroom just north of St. Paul, MN during the middle of a major snow storm that dumped almost a foot of new snow overnight.  I checked in my boots at the door and carried my dress shoes in my hands.

Working as a House physician at Fairview Southdale and UMMC.

Driving my Jeep on frozen White Bear Lake! 
Riding the Valentine's Day Minnesota Zephyr dinner train out of Stillwater, MN and Jerry asking me to marry him at the end of the trip.  I don't know if I was more excited about the proposal or the little blue box.

Snowboarding several times at Afton Alps.

Jerry was gone over Spring Break and I worked back to back 36 hour shifts with a 12 hour break in between.  NOT fun, but brought in a lot of "cha-ching!"

The week with Mom and Jerry in Manzanillo, Mexico with side trips to Colima, Guadalajara, Puerto Vallarta, a whole lot of seafood and snorkling Los Arcos.
Interviewing in San Diego(I didn't get the job), and showing Jerry some of my favorite beaches.

Interviewing in Mankato(I didn't get the job), and wondering what I would be doing come July 1.

The phone call from Buffalo, the phone interview, and then the offer.  A rush trip to Buffalo to look for an apartment on the day the bridge collapsed in Minneapolis.  (Several weeks earlier during rush hour traffic where I passed workmen using jack-hammers on the highway as I drove over the bridge, I wondered how safe it was and if there was a chance it could collapse.)

The three weeks I had to pack up my life, my cats and a moving van, yet again, and make the "half" cross country trip to Buffalo, NY.

Setting the date for the wedding once my job was secured.  Eeek!

Being thrown into the E.D.'s at ECMC and Buffalo General and keeping track of my adventures on this blog.

Spending three weeks with my mother and Flat Stanley who came to visit including a very memorable Blues vs. Sabres game.

Ultrasound and this CCU rotation which is, Thank God, almost over.

A new year approaches... who knows what new adventures it will bring, the biggest being a wedding and a trip to Riviera Maya, plans for a cruise, and the start of my second year of Emergency Medicine residency.



Here's to wishing you the very best the new year has to bring!  I can't wait to find out...

Saturday, December 29, 2007

Kissing Cousins

I'm going to get back on the soapbox, yet again, to talk about the importance of having advance directives, living wills, etc.  I have a patient this week who suffered a massive stroke.  So massive that they will never have a "meaningful recovery."  Essentially, my patient is brain dead.

Somehow, they managed to tell their children that they didn't want a tracheostomy (breathing tube in the neck) but not much else.  Now, I have had many discussions with families about their loved ones' health and final wishes.  I am, as some of you know, a strong proponent of "letting nature take its course."  Sometimes in medicine I think we forget that just because we can doesn't mean we should.  And, this is moreso in the critical care setting where letting go is sometimes the best medicine we can practice for our patients.

Anyway, unfortunately, this patient's family is, shall we say, mentally challenged.  Rumors abound regarding in-breeding and first cousin marriage, but regardless, my patient's children don't understand the meaning of brain death.  They still think their parent has a chance of recovery.  I spent 2 hours, and a priest and social worker spent another 2 hours trying to explain to them that their parent is dead.  They may be on a ventilator, but that doesn't mean that their parent is going to wake up.  I knew they didn't quite get it when one son kept asking if a blood transfusion or feeding the patient would help.  I don't know that I have ever been so coarse or so graphic with a patient's family, but they just didn't understand.

I plan to talk to them again on Monday and see if anything we talked about sank in.  I told them they could be at the bedside when they were ready to say good-bye to their parent, but even then, I think they thought if they didn't do anything their parent would recover.  It's a difficult situation, and very frustrating.  Again, all of this would be a moot point if my patient had a living will, advanced directive, tattoo across the chest (as I've heard rumored someone actually does) which states "Do Not Resuscitate."




So, as we go into the next year, maybe a New Year's resolution should be to talk to our families and loved ones.  Get out the box of tissues and bottle of wine, because this isn't an easy discussion.  Sit down and make a plan.  Write it down.  Come to an agreement.  And, because I am an organ donor, I always encourage parents to think about their children in these discussions.  Considering the death of your child is a horrible thought, but when you comes to terms with the possibility and make a decision regarding organ donation, you know a part of your loved one carries on.

During the week I met an 8 year old heart transplant patient who was visiting the hospital promoting blood and organ donation.  She was born with a heart defect that required multiple surgeries as an infant.  A couple of years ago, she developed a fatal complication and would have died without a transplant.  Luckily, someone else's family made the decision to donate their child's organs, and this young girl received their heart.  Now she's involved in promoting organ donations across the country.

Since I'm getting married in a few months, it's the perfect time to talk about final wishes.  My fiance knows I want to be an organ donor.  Take anything needed.  I'm not, after all, going to take it with me.  My mother and I have had the discussion.  I know her wishes should she become unable to vocalize them.  Sad, yes.  But a few moments of sadness will lead to a great relief of burden should the time come when I ever have to make a decision regarding her care.  I'll know what she would have wanted, and I will be able to carry out her wishes.

OK, off the soapbox.  The countdown continues, and we're into the final week... woohoo and boo because the painful attending is coming back... BUT, it is the final week...
CCU Countdown:
Days until the end of the rotation:  8
Actual number of days I will be working during that time: 7
Days left until the painful attending returns:  1
Number of days until my next 24 hours off:  7 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 2 1/2 - I have a multisystem organ failure that has to count as an extra 1/2 pt due to all the work needed
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)



Thursday, December 27, 2007

Working for the Weekend

CCU Countdown:
Days until the end of the rotation:  10
Actual number of days I will be working during that time: 9
Days left until the painful attending returns:  3
Number of days until my next 24 hours off:  9 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 2 1/2 - I have a multisystem organ failure that has to count as an extra 1/2 pt due to all the work needed
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)

Wednesday, December 26, 2007

Wait a Minute, Mr. Postman!

Today was a very dull day.  Which is good for a Wednesday.  We didn't have grand rounds, so I had to sit through rounds.  Luckily, rounds were over quickly, and there were no radiology rounds - meaning sitting in front of the computer and looking at angios and echos.

The most exciting thing for me today is that I mailed out my wedding invitations.  That kinda makes it just that much more real.  Real scary.  Eeek!!  That means I just have 8 more weeks to get ready.  I feel like there's so much still to do.  Luckily, my Maid of Honor Nicole seems to have a more level head and is keeping me reined in.

So, for now, the countdown continues:
CCU Countdown:
Days until the end of the rotation:  11
Actual number of days I will be working during that time: 10
Days left until the painful attending returns:  4
Number of days until my next 24 hours off:  10 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 2, I think, sometimes it's hard to keep track of the patients that go to private service.
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)

Tuesday, December 25, 2007

Silent Night

I spent the day at the hospital.  I took a call day so that everyone else could leave and enjoy their Christmas Day.  I called my mom mid-morning and got the report from the night before.  She enjoyed the gifts I had sent, and the extra special basket of sugar-free goodies from my fiance.

All in all it was a nice, dare I say, quiet day in the CCU.  I had one admission, and one sort of excitement toward the end of the day.  For the most part, I had about five hours of watching a CSI marathon and almost all of "Goldeneye" uninterrupted.  Mmmm, Pierce Brosnan as James Bond.  I could just watch him all day long.  For me, there is no more perfect Bond.  But, I digress.

If you've followed my prior posts, I think by now we've established some of the rules to follow when it comes to drinking.  Something I don't think has come up to this point, mostly because I see people in the ED once and not for several days in a row, is the discussion about what happens to people when they drink excessively for days and weeks and months on end and then come to the hospital where they're not allowed to drink:  a little something known as the DT's.

You're ok for the first couple of days.  Normal for the most part.  Then around day 3 you start to get a little anxious.  Maybe, a little more irritable.  Your heart rate starts going up and your blood pressure might go up as well.  Then the fun starts.  You start imagining things that aren't there.  You get confused.  You might even get physically argumentative.  If your medical team is unaware of your alcohol intake (and granted most patients lie when it comes to alcohol consumption which is why as a general rule since med school we've been taught to double anything the patient states is the amount of alcohol they admit to consuming), you might get placed on thiamine and folate and some Ativan (Lorazepam) to help you avoid the mental confusion aspect part.  When you start having seizures, that's a bad thing, and you could actually die (so admit to drinking alcohol and how much.  Please.)

If they don't, and you lied (of course you did) about the amount of alcohol you consume, you can go into full blown DT's (delirium tremens) which includes shakiness, severe mental status changes, lethargy, etc. and end up like my patient who is now on a ventilator after he became somnulent to the point he couldn't remember to breathe.  He would barely breathe when we shook him or called his name, but then he would go off into a stupor.  So, now he's got a breathing tube.  His girlfriend called later, and I had to tell her that he was on a breathing tube.  I couldn't tell her why though, there's this thing called HIPPA which is basically a patient rights document that states your medical information can't be shared with anyone not directly involved in your care.  I am sure she would tell me how much he actually drinks... if only I could ask her...

Some shots of downtown Buffalo.  I love the city, especially at night.  Merry Christmas to all!


CCU Countdown:
Days until the end of the rotation:  12
Actual number of days I will be working during that time: 11
Days left until the painful attending returns:  5
Number of days until my next 24 hours off:  11 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 4
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)

Monday, December 24, 2007

It's Going to be a White Christmas

All the phone calls have been made.  All the rush is over.  Now, it's just another quiet evening at home.  Somewhere across the country my mother is sitting in church for the 4:30 p.m. Christmas Eve service.  Afterward, she'll stop by the house to pick up the gifts and her famous potato salad and then head over to my aunt's house.  They'll eat tamales, sopa, potato salad, plus a number of other goodies.

Around 9, the males in the family will sit to play nickel and dime poker.  For the first time in a couple of years there won't be a female, me, joining them.  Hopefully next year.

Around 10, the children will begin to wonder how soon they can start separating gifts so that they're ready at the stroke of midnight.  Tradition holds that we start with the youngest and work our way to the oldest.  You just sit around in anticipation of getting to open your gifts.  Usually, around that time, my mother and I would leave and go home.  We'd turn the TV onto midnight mass at the Vatican while we opened our gifts.  We'd sit and talk and laugh about what we'd received that year.

Finally, around 2 or so we'd go to bed:  already planning our breakfast of leftover tamales, or ham, or whatever sounded good for the next day.


Mom promised she'd keep the tradition.  She's not going to open the gifts I sent her until she gets home later tonight.  Since it's going to be around 2 or 3 in the morning for me, and I took call at the hospital tomorrow, I won't be able to call and hear as she opens her gifts.  But, I'll talk to her tomorrow and hear how things went, the latest gossip, the usual raves about her potato salad, and it will be almost like I am there... almost.

CCU Countdown:
Days until the end of the rotation:  13
Actual number of days I will be working during that time: 12
Days left until the painful attending returns:  6
Number of days until my next 24 hours off:  12 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 2
Number of long call shifts remaining: 1
Number of patients: 3 - that's what I had when I left, we'll see who's still around tomorrow
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)