I couldn't think of a title for today's entry, so I decided on the next song to play... and, surprise surprise it was "Dead Man's Party," which believe it or not is actually kind of appropriate.
When I was applying to medical school, I had to take a test called the M-CAT (Medical College Admissions Test.) On the night after I took the test, I invited people over for a "Dead Man's Party." Everyone was invited to dress in black. They were to "BYODF or V" bring your own dead flesh or vegetable for the cook-out. I threw the party because after taking that test, I had done essentially everything I could do to be accepted to medical school, so I could die in peace.
Kind of how I feel now.
I think I have done everything I can to make sure everything goes well for the wedding. I shipped the last boxes today, I've arranged for kitty care, I have sent out information to all the participants. At this point it's just sit back and wait for the week to pass.
Of course, I still need to pack, but like I was telling one of my bridesmaids, I could essentially walk onto the plane with the clothes on my back and everything I need is in California.
So, I am enjoying my evening. Spending time with the children. Watching the hours tick by on the clock. Wondering if I am forgetting anything. Wondering if everything will go okay. Wondering if I forgot anything. Wondering.
Friday, February 15, 2008
Thursday, February 14, 2008
My Funny Valentine
So, the programs are printed. The napkin rings are finished. All the favors have been made. I have a small stack of boxes ready to be shipped to my matron of honor's. I burned two CD's with wedding music that the DJ did not have, including music for my ceremony. What else do I need to do...???
A year ago I got engaged. We delayed setting a date until I knew if I was going to stay in Minneapolis or move to a new city. When I was accepted into the program here in Buffalo, we set the date based on when I would be getting vacation. I told my fiance he had a choice: we could get married soon, or he would have to wait 3 years until I finished residency. You can guess what he chose.
My Matron of Honour and I worried we'd never get everything done in just 4 months. Ludicrous, you need at least 6, right? There were times I wish I had 6, and others where a weekend in Hawaii would have been just fine. I knew one thing, I was not getting married at the "Chapel O' Love" in Vegas. (You have to have watched "Back to the Future, Part II" to understand.) But, we managed to secure a nice spot by the ocean and a small intimate setting. As another movie reference, I did not want "My Big, Fat Greek Wedding."
Anyway. Here I am: thinking about the past, and pondering the future. Did I make the right decisions then? Am I making the right decisions now? I have no doubts about getting married. I have no doubts about the man I am marrying. Did I ever imagine it would be like this? No, not really. But then, I've always taken "the road less traveled," and I have to admit I've had a very interesting life so far. I've seen and done things most people can't even begin to imagine.
This is the sort of thing I would have written on my 40th birthday. But of course, I didn't know where I was going to be then. I didn't know I would be here now... a week before one of the biggest events in my life... sitting, alone with the kitties, wondering... what's next?
Happy Valentine's Day!!! Hope you're hugging your teddy bear close tonight! I'll be with mine very soon...!
Wednesday, February 13, 2008
Over the Hump and Going Downhill Fast!
Sometimes I think of Winston as the "neglected child." When I first got my cats, I was going to get 2 females. We've never had males as pets. Mom always said females were better. The lady at the cat shelter said a male and female would do better together, so I tried it.
Sofie is my baby. She follows me everywhere, sits on my lap, sleeps between my knees, misses me when I am gone, etc. Winston is just there. He cries when he wants to be fed and is generally annoying as he is ALL CAT. He gets into everything. And, when he's not being annoying he sleeps; hidden away. He only comes to the bed at night when it's cold, and then it's on the bed, off the bed, on the bed until I get so frustrated I lock him out of the room. And, then he cries. So no one sleeps until he finally settles down.
As I said, the neglected child. So I am highlighting him today. He is a beautiful lean mean hunk of a cat with the best fur. If he would only let me pet him. C'est la vie. The next adoptee will definitely be a girl.
Anyway, today was Grand Round Wednesday. I got a chance to talk to the ED doc on call when the hockey player came in a few days ago. He filled us in on the stabilization and management in the ED. Very cool.
I opted out of the last day of vaccinations. I am so far behind on wedding things, and I have to ship them out by Friday! I did manage to get some odd and end things done (like the song list.) I can't believe I leave on Saturday for California. I got a sitter for the kitties and a dress for the rehearsal. Now, if I can just get those favors finished...
Community Photo Challenge - Self Portrait
Self Portrait - And the music was appropriate...
Original 1989 - SLR Canon AE-1, the "Workhorse" of Photojournalism which was my degree in college. Photo shot, developed and printed all by me... still has a slight chemical smell.
Updated 2008 - Point and Shoot Sony Cybershot, don't have to think about the F-stops any more...
and, just for fun, me & one of the fur babies, Sofie
and run through the Warholizer
The "Warholizer" can be found: http://bighugelabs.com/flickr/warholizer.php
http://journals.aol.com/mariebm56/aol-community-photo-challenge
Tuesday, February 12, 2008
Tubes is Tubes
Well, another day of anesthesia and of vaccination screening.
I lucked out and ended up with the same anesthesiology attending. He guided me through two successful intubations. Good for me.
Of interest, there's a hockey player that was injured at a game a few days ago with a potentially life-threatening injury to his neck. The attending who performed the surgery with the attending that has been shown on television was performing surgery on one of my patients today. Of course, everyone was asking him about the surgery, so I was able to hear about the case. It's amazing how often the story is so different when you read it in the news, and then you hear the back story from those that were actually there.
I was a surgery resident, and I can remember many times reading about a trauma that would come into our ED in the Twin Cities in Minnesota. I remember talking to the patient and getting their story, hearing the policeman's or EMT's story, and then reading the printed version in the paper. I can understand how it can be so tempting to email or call reporters when you have a story because sometimes they just don't get all the facts just right, and it can drive you crazy when you know the whole story. HIPPA aside, people must have their privacy.
I also participated, for the the third time, in the mass vaccination against the Hep A exposure in one of our local towns. I think I heard they've vaccinated almost 8,000 people so far. It's been quite the learning experience from many standpoints. Given that I am interested, not so much in public health, as mass casualty and disaster planning, it's been interesting to see how something like this is coordinated.
In training, you hear about setting up the Command Center, there's Information Officers, there's triage, there's flow and safety control, etc. It's very different to see everyone in action and the issues with coordinating so many different groups. As I said, an invaluable learning experience.
Ok, time for bed. Grand Rounds Wednesday and no clinical work for me which is good because of spending time in the Vaccination clinics I haven't had much time for wedding things, and I have to find a dress for the rehearsal. How many days left...?? =o
I lucked out and ended up with the same anesthesiology attending. He guided me through two successful intubations. Good for me.
Of interest, there's a hockey player that was injured at a game a few days ago with a potentially life-threatening injury to his neck. The attending who performed the surgery with the attending that has been shown on television was performing surgery on one of my patients today. Of course, everyone was asking him about the surgery, so I was able to hear about the case. It's amazing how often the story is so different when you read it in the news, and then you hear the back story from those that were actually there.
I was a surgery resident, and I can remember many times reading about a trauma that would come into our ED in the Twin Cities in Minnesota. I remember talking to the patient and getting their story, hearing the policeman's or EMT's story, and then reading the printed version in the paper. I can understand how it can be so tempting to email or call reporters when you have a story because sometimes they just don't get all the facts just right, and it can drive you crazy when you know the whole story. HIPPA aside, people must have their privacy.
I also participated, for the the third time, in the mass vaccination against the Hep A exposure in one of our local towns. I think I heard they've vaccinated almost 8,000 people so far. It's been quite the learning experience from many standpoints. Given that I am interested, not so much in public health, as mass casualty and disaster planning, it's been interesting to see how something like this is coordinated.
In training, you hear about setting up the Command Center, there's Information Officers, there's triage, there's flow and safety control, etc. It's very different to see everyone in action and the issues with coordinating so many different groups. As I said, an invaluable learning experience.
Ok, time for bed. Grand Rounds Wednesday and no clinical work for me which is good because of spending time in the Vaccination clinics I haven't had much time for wedding things, and I have to find a dress for the rehearsal. How many days left...?? =o
Monday, February 11, 2008
Vaccine for the Masses
So, this last week it was announced that a produce stocker at a local grocery store had been diagnosed with Hepatitis A; by far, the least serious of the Hepatitis viral illnesses. Anyone who had eaten raw fruits or vegetables from about the prior three weeks was being advised about the potential exposure, and the county and state health authorities were offering the vaccine or immunoglobulin to anyone who thought they might be at risk. Oh yeah, btw, the store had over 80,000 purchases of potentially affected fruits and vegetables.
So, this weekend, as part of the SMART (Specialized Medical Assistance Response Team) Team I helped do medical screening as part of the process. Close to 3000 people came during the first day, about as many on the second, and they opened a third clinic today, and I haven't heard the numbers yet. But, there were enough that we ran out of immunoglobulin and are having another clinic tomorrow and most likely on Wednesday.
The risk of someone actually contracting Hep A. Very small. However, this was a great test of the disaster system, especially since it has been training for mass innoculations should there be a smallpox or anthrax outbreak. From that stand point, it's been a very interesting experience. At least it gets me out of Anesthesia.
Yes, good old adult anesthesia. I was forewarned that you could have up to 6 intubations in a shift at Children's Hospital and be luckily to get that many intubations in the other 2 weeks spent at BGH. It's just that you're competing with students, anesthesiology residents, and student nurse anesthetists. So you have a very short amount of time to have an attending be comfortable enough with you to allow you to intubate. Plus, the cases are much longer. The short cases are all staffed by CRNA's who put in LMA's for the most part, and there's no great challenge in stuffing something down someone's throat.
At least my attending today, out of the two cases, did allow me to attempt an intubation on the second case. It was a rather larger patient with a big head and neck, and I could only see the very bottom corner of their vocal cords when I lifted with the blade. I didn't feel bad when I stepped back and the attending took a look because he had to struggle for a few moments as this patient's trachea was very forward located, and they did have a very big head. Eventually, they were intubated and the case proceeded, but this is the perfect situation to have this happen in. Again, if this patient came into the ED and needed to be urgently intubated, at least now I have an appreciation of the difficulty, and the attending talked me through the steps of the intubation and gave me a lot of pointers on how to make things easier.
More of the same tomorrow. Still cranking out wedding programs and favors. The days are passing WAY too fast...
Friday, February 8, 2008
Practice Makes Persons More Comfortable
Ok, so today was my last day with the pedis (pronounced pee-dees, meaning pediatric patients). I got in 6 more intubations, three of which were on the teeny pedis: A 1, 4 and 6 month old. My other 3 were on a 3 year old who swallowed a penny that got stuck, and two 15 year olds, one with appendicitis and the other having some hardware removed from a childhood surgery.
The first 3 surgeries were on the infants. Considering my experience yesterday, I was on hightened apprehension when I was first handed the "blade." I had already been "breathing" for the patient by keeping an open airway and ventilating them with an airbag. As I grabbed the blade and gently eased the head back, I had the attending talking me through the steps: "head back, sweep the tongue, find the epiglottis, lift to the corner, visualize the cords, insert the tube."
I didn't initially see the vocal cords, but then I lifted (with the attending holding my hand and showing me how much pressure I could exert) again and there were the cords. I slid the endotracheal tube in, put the ventilator back on, and the attending listened and confirmed placement. "Whew!" I think that's when I finally took a breath again.
We discussed the fine tuning of my technique, and the next two intubations went more smoothly. One had some slightly difficult anatomy, and I initially intubated the esophagus, but that was quickly remedied, and I successfully intubated the trachea on the second pass. The 4 year old was much easier since I had done all the 3 - 6 year olds on Monday. Of course, the 15 year olds were the easiest since they were more like adults, and I had already done a number of those in the Emergency Room.
So, now I have the weekend free. My dress arrived safely in Southern California, and there's one less thing to worry about. Now if I can just get those darn programs and favors finished...
As for the pic today: on D's (This and that, and hockey) advice, I invested in Paint Shop Pro and am playing with the program. We'll see what I can come up with.
Thursday, February 7, 2008
Not at all like Baby Bunnies
She's all grown up now...
I learned several good lessons today: infant anatomy is nothing like a rabbit's, and babies don't don't do well with no oxygen. You might be reading this going "duh," but until you're in the position of trying to intubate a 4 month old baby, thinking you're ready, and suddenly hearing the pulse ox (monitor of O2 saturation) drop lower and lower, you don't realize just what a delicate and precarious position you're in no matter how prepared you think you are.
Let me go over a few things. A pulse oximeter is a monitor of the O2 (oxygen) saturation in your blood. Just like in school, you want to be in the "A" percentage range, high "B" maybe. (92 - 100%). You might have been to a doctor who puts the little red light on a finger and measures your oxygen saturation. That's the pulse ox. In the OR, it's connected to a bigger unit that also measures heart activity and breathing rate.
Most anesthesiologists that I've met are trained to listen to the sounds the machine makes. At 100%, the machine beeps at a certain frequency with every heartbeat. If the O2 sat drops, the machine starts beeping in lower and lower tones. That way, if the anesthesiologist is intubating or writing notes, they can tell something is happening because of the tone. During surgery, you get real used to listening to the monitor, and I would even look up every once in a while during a case if I heard it suddenly going down.
When you go to place a breathing tube in a normal adult, you "pre-oxygenate" by giving them several breaths with the mask; almost like when you are about to dive into a pool and you take a number of deep breaths before holding your breath. Adults can go for a short while before their O2 sats start to drop. Babies don't have the same kind of reserve.
In the time it took me to tilt the head, find the vocal cords and try to put the tube in, their O2 sat had already droppedto 79%. Bad for baby, and bad for everyone else's blood pressure including my own. The anesthesiologist had me step back, he gave the baby a few more breaths with the mask and oxygen and the baby's O2 sats came back up. He then placed the breathing tube.
Once everything was settled, he gave me some words of advice and told me that infant intubations are very difficult because you're used to working with adults and have the time, not so with the wee ones. He assured me I would get more practice in, and that I would get it in eventually. A lot of people have asked me why as Emergency Medicine doctors we do an anesthesiology rotation, and it's for this very reason. You need to "practice" in a controlled environment so that when that infant comes rolling in the ED doors at 3 in the morning, you know exactly what to do and have that sense of urgency that comes with experience.
It was a slow day in the OR for me today, and that was my only intubation attempt. This was o.k. with me since by that time my cold pill (the six hour kind) was starting to wear off, and I really could use a nap. Hopefully, tomorrow will be a better day as I spend my last day with the pedis.
I learned several good lessons today: infant anatomy is nothing like a rabbit's, and babies don't don't do well with no oxygen. You might be reading this going "duh," but until you're in the position of trying to intubate a 4 month old baby, thinking you're ready, and suddenly hearing the pulse ox (monitor of O2 saturation) drop lower and lower, you don't realize just what a delicate and precarious position you're in no matter how prepared you think you are.
Let me go over a few things. A pulse oximeter is a monitor of the O2 (oxygen) saturation in your blood. Just like in school, you want to be in the "A" percentage range, high "B" maybe. (92 - 100%). You might have been to a doctor who puts the little red light on a finger and measures your oxygen saturation. That's the pulse ox. In the OR, it's connected to a bigger unit that also measures heart activity and breathing rate.
Most anesthesiologists that I've met are trained to listen to the sounds the machine makes. At 100%, the machine beeps at a certain frequency with every heartbeat. If the O2 sat drops, the machine starts beeping in lower and lower tones. That way, if the anesthesiologist is intubating or writing notes, they can tell something is happening because of the tone. During surgery, you get real used to listening to the monitor, and I would even look up every once in a while during a case if I heard it suddenly going down.
When you go to place a breathing tube in a normal adult, you "pre-oxygenate" by giving them several breaths with the mask; almost like when you are about to dive into a pool and you take a number of deep breaths before holding your breath. Adults can go for a short while before their O2 sats start to drop. Babies don't have the same kind of reserve.
In the time it took me to tilt the head, find the vocal cords and try to put the tube in, their O2 sat had already droppedto 79%. Bad for baby, and bad for everyone else's blood pressure including my own. The anesthesiologist had me step back, he gave the baby a few more breaths with the mask and oxygen and the baby's O2 sats came back up. He then placed the breathing tube.
Once everything was settled, he gave me some words of advice and told me that infant intubations are very difficult because you're used to working with adults and have the time, not so with the wee ones. He assured me I would get more practice in, and that I would get it in eventually. A lot of people have asked me why as Emergency Medicine doctors we do an anesthesiology rotation, and it's for this very reason. You need to "practice" in a controlled environment so that when that infant comes rolling in the ED doors at 3 in the morning, you know exactly what to do and have that sense of urgency that comes with experience.
It was a slow day in the OR for me today, and that was my only intubation attempt. This was o.k. with me since by that time my cold pill (the six hour kind) was starting to wear off, and I really could use a nap. Hopefully, tomorrow will be a better day as I spend my last day with the pedis.
Wednesday, February 6, 2008
Low Immune Response
The dress is packed and shipped. Almost all of the favors are done. Half the programs are done. The catering is FINALLY settled. And, I have a cold.
It's well known that stress lowers your immune response as does cold weather. Winter in Buffalo plus last week's night/day/night schedule really did a number on my defenses. So, I am hitting the bottle tonight, Nyquil, and hope to sleep better than I did last night.
At least today was Grand Rounds Wednesday, so no clinical work for me. I got to come home early, run those errands - like shipping all of my wedding items - and take a nap. Now, having finished some odd and end things here, I am ready for bed.
Maybe tomorrow my head won't feel like it weighs 20 pounds instead of the standard 8, and I won't feel like taking a Yankaur and sucking out anything I can reach followed by some deep NT suctioning to get whatever's left over. For you non-medical folk, I could explain, but it's probably better that you don't know what that means.
Until tomorrow, more pedi intubations I hope, and no slobbering into my mask...
**funny story, stop reading now if you're grossed out by mucous:
When I was a medical student I was doing a surgery rotation in Cardiothoracic surgery. Those cases typically last about 5 - 6 hours. One day I had a cold, so I timed taking my dose of cold medicine (the six hour kind) until about the time the patient would be going into the OR. I figured it would at least cover me for the whole case. Well, you can imagine what happened. The patient was 1/2 hour late getting into the room, and so we were running late on the case. Usually, when we start "closing" you can almost predict about 1/2 hour or so to finish all the suturing and applying bandages.
So, at about the 5 1/2 hour window my cold pill starts to stop working, and I can feel the congestion starting to build up in my sinuses. We get to closing and my nose starts running. I have my face mask on, but I can feel a little dripping starting to happen, and I try to quietly sniff as much as I can to keep it back. I see the CV fellow (fellow = resident who already graduated now getting advanced training in a specialty) looking across the patient at me every once in a while but not saying anything.
We get the patient closed, start applying the bandages, and the nurses start to take down the sterile field. I step back and start to take my gloves and gown off, and as they start to load the patient I ask the fellow if I can be excused for a minute and that I will be right back. He looks at me with a slight grin and says, "Finally going to blow out that loogie you've been working on for the last 1/2 hour?" I was so embarrassed but quickly ran to the ladies' room where I took off my mask to find it, you're right, full of the mucous that had been running/dripping out of my nose.
I quickly washed my face, blew my nose and grabbed another cold pill out of my locker and then casually went back to the OR to help move the patient up the ICU. I think that was the worst cold experience I ever had. Thank, God, there's now 12 hour strength cold tabs.
Tuesday, February 5, 2008
Community Photo Challenge - Love
I was trying to decide what to shoot for this challenge, and while packing my dress to send it west for my wedding in two weeks, I was suddenly inspired. A year ago on Valentine's Day, my fiance asked me to marry him. Coincidentally, the Valentine's Day card I gave him that morning had a little hang tag that said, "Yes."
These are three different shots using the regular, sepia tone, and B&W features on my little Sony. I like them as a series.
http://journals.aol.com/mariebm56/aol-community-photo-challenge/
Monday, February 4, 2008
Piglet and Friends
So, today was my first day of anesthesia, and I am doing a week at the Children's Hospital so I can be comfortable intubating small children. Today I was with a great anesthesiologist who took the time and patience to teach me a lot about intubating (putting breathing tubes in) children. And, after showing me the first time, he let me do the intubations for the surgeries. A total of five!
I think I mentioned earlier that I took an intubation workshop when I was a surgery resident. Aside from mannequins and models, we actually intubated small animals with comparable anatomy. And, what do you know, they were right. Pedi's throats are very different, and the small piglet I did to represent toddler age children was very similar. Plus, I had the added bonus of intubating children in the ENT (ear, nose and throat) room, most of whom were having their tonsils taken out. So, not only did I have a different anatomy to deal with but usually really big obstructive tonsils.
One issue I did have was playing vampire. I don't know what it is. When I was a third year medical student on my anesthesiology rotation, I had the same problem. I think I went through 4 or 5 patients before I got my first IV running. And, these were veterans, all with huge ropey veins! But, then one day I got it right and made most of my IV lines with no problem.
Today I was 2 for 6. The anesthesiologist would give me two tries and then do it himself. But, he was very patient and didn't let me give up or stop trying. During the case, once the patient was under and settled, he would take me through the steps, demonstrate with larger needles on their own wrapping, and tell me how to do better the next time.
So, all in all a good day. I won't see this anesthesiologist again until Thursday. Hopefully, everyone else will be as friendly. We'll see as the week goes along.
I think I mentioned earlier that I took an intubation workshop when I was a surgery resident. Aside from mannequins and models, we actually intubated small animals with comparable anatomy. And, what do you know, they were right. Pedi's throats are very different, and the small piglet I did to represent toddler age children was very similar. Plus, I had the added bonus of intubating children in the ENT (ear, nose and throat) room, most of whom were having their tonsils taken out. So, not only did I have a different anatomy to deal with but usually really big obstructive tonsils.
One issue I did have was playing vampire. I don't know what it is. When I was a third year medical student on my anesthesiology rotation, I had the same problem. I think I went through 4 or 5 patients before I got my first IV running. And, these were veterans, all with huge ropey veins! But, then one day I got it right and made most of my IV lines with no problem.
Today I was 2 for 6. The anesthesiologist would give me two tries and then do it himself. But, he was very patient and didn't let me give up or stop trying. During the case, once the patient was under and settled, he would take me through the steps, demonstrate with larger needles on their own wrapping, and tell me how to do better the next time.
So, all in all a good day. I won't see this anesthesiologist again until Thursday. Hopefully, everyone else will be as friendly. We'll see as the week goes along.
Sunday, February 3, 2008
Promise of a New Day
Well, it was a boring Super Bowl, at least to me, where commercials are concerned. A final "Hail Mary" play would have been awesome, but sometimes the underdog just has to win.
I start anesthesia tomorrow at the pediatric hospital. It should be interesting considering I've never intubated anything small, except for ferrets, rabbits and piglets during an airway class. Also, I heard I will be doing IV's which I haven't done since 3rd year medical school, and NEVER on the pedi population. So we'll see.
For now, it's crash time and hope I am awake and perky in the morning... of course, I am a morning person....
I start anesthesia tomorrow at the pediatric hospital. It should be interesting considering I've never intubated anything small, except for ferrets, rabbits and piglets during an airway class. Also, I heard I will be doing IV's which I haven't done since 3rd year medical school, and NEVER on the pedi population. So we'll see.
For now, it's crash time and hope I am awake and perky in the morning... of course, I am a morning person....
Saturday, February 2, 2008
Final Friday Fracas
That was my last look at the ambulance entrance to the small town hospital where I've been working for the last month. It was just after 5:00 a.m., and it had been one helluva night. I alluded to my musical selection hoping it wasn't going to be predicative of the night, and it was.
When I got there, there was already a 2 hour wait for non-urgent cases. After developing a "room congestion" problem where we couldn't get patients in or better OUT of the E.D. we increased to a 3 - 4 hour wait. One thing I have to comment on, when people are told they're going to have to wait several hours, they usually leave unless they're really sick.
Better for us in that we don't have to deal with patients that could wait to see their physicians in the morning or wait until Monday. However, those that do stay around (because they have nothing better to do?) and aren't very urgent are the type of patients that push us over the edge and lead to heavy sarcasm and disdain for most people.
When I have a patient come in and say they have 10/10 pain, they've been constipated for over a week, they were seen in the E.D. a week ago AND have been seen within the last week by their PMD, AND they haven't taken anything for the pain or tried to do anything for their constipation, I take pause. I think back to my last threat that I would personally rip the arm off of any patient who lay comfortably in their bed and said they were having 10/10 pain and beat them with it. If that then was a 10/10, what would they now rate their prior pain? But, I don't. Hippocratic oath and threat of legal retribution aside, because I am a good person. Yep, I tell myself that every day as I slip into my white coat and go forth to face the masses yet again.
We saw 28 patients between 7 p.m. and about midnight. That's not a lot when you consider the times I told you ECMC had their 20 rooms full, plus the Fast Track rooms and the hallway. But there is more than one doctor on at a time. At this small 9 bed E.D., had I not been there (and, really, since I am in training I count like about 1/2 a doctor), there would only be one doctor. You have to be fast on your feet, clear of mind, and able to multi-task like a one-armed octopus at a paper factory. (Don't know how I came up with that analogy, I think I heard it somewhere.)
Suffice it to say, we were busy. My mix of patients included:
- girl with toothache. Seriously, good dental care and stop smoking. Pain meds and go see your dentist.
- man with eyelid surgery infection. Poor form: if you're going to operate on someone you take responsibility for the care of your patient. You don't leave them without coverage. We had to call in another eye doctor, not from the same group to come in and clean up the mess since this patient's sutures and wound were falling apart.
- woman with cough - not bronchitis, post-nasal drip. It's difficult treating a patient with heart disease and high blood pressure for congestion as the best decongestants interact with their medications. But, a quickie Google search, and I found some alternatives.
- victim of domestic abuse with finger fracture. I feel bad she got beat up, but then less so when I found out she was well known for getting drunk, along with her husband, and then getting into physical rows with him. Both have been in several times for fixing this or that wound/laceration/broken bone. She gets a splint.
- drunk with broken shoulder. He was helping his friend down some stairs and then fell himself. We couldn't let him go home alone until he was sober, and he couldn't sleep because of the pain so he wandered up and down the corridor asking when he could go home. He was still there when I left.
- 10 days of constipation and nothing was working. We gave her one of the known GI bombs - Magnesium citrate. It will usually clear out anything in your intestines from top to bottom. I honestly don't know what else to give if that didn't work. I warned her to be home in half an hour after drinking it. I've heard stories... I didn't want to see the results.
- guy with earache. Adults can get ear infections. He did. He got drugs. He went home. Waited 3 hours, and I had him out in 15 minutes. He was pleasant enough.
- teen with asthma attack. Again, don't smoke if you have asthma and don't go and roll all over the floor at your friend's house who has dogs, oh, and carry your inhaler with you. She was fine by the time I saw her. She didn't like the lecture her mother and I gave her about the dangers of smoking. Who knows.
- 2 women, 10/10 abdominal pain. If you're not lying on the gurney, curled up in fetal position, crying and calling for your mama, I don't believe you. I've examined your bellies and you've gone through childbirth. Please, I've heard you "forget" the birth once you've had your baby, but still. One I talked about the beginning. She was carrying on a conversation with "drunk with broken shoulder" who was in the next bed when I left, and the other got sent home with some anti-acids.
- and, finally Alzheimer's feisty lady who'd been in a car accident. She wouldn't let me examine her. She took a swing at me. And, since she was obviously moving all of her limbs and walking just fine as she tried to escape out the door, I would say she wasn't injured in the car accident. The daughters agree that without sedation she would never lie still for a CAT scan of her brain, and since we'd already torture the poor woman just by making her wait for so long, they took responsibility for her and said they'd bring her back if there were any signs of a concussion.
Well, that's it. I took a long nap and am trying to tire myself out so I can switch back to daylight mode. I have today off to enjoy the Big Game - Go Patriots! I will also continue working on wedding stuff since we're now in the month of February... eek!!
Friday, February 1, 2008
One More Trip to Go
Hope the song isn't foreshadowing tonight's events. It's my last shift at the rural hospital where I've been rotating for the past month. I have been so tired lately that I haven't blogged, and it's like any discipline, you have to do it consistently or else you get lazier and lazier... so I am making myself write today so I can get back on track.
Here's the video from Wednesday morning after I arrived at the hospital parking lot here in Downtown Buffalo.
My car is stopped and you can see some vibration from the wind. Winds were blowing 30 - 40 mph with gusts recorded to the 70's and 80's.
One of my colleagues and I actually had to link arms leaving the hospital to get back to our cars after our meetings because the wind was so strong. Driving home, there was a semi flipped over on one of the off-ramps, and I hit near white-out conditions at my off-ramp.
Driving to work that night wasn't too bad. It was very windy and I couldn't use my cruise control like I usually do because of the gusts. I had to keep adjusting my speed. We had a total of 5 patients that night. One with a newly-found brain tumor. They got shipped to the Stroke Center, MF Gates in Buffalo.
The other interesting one was having a heart attack as he walked in the door clutching his chest. He received thrombolytics (clot busters) to help break up the clot. It was amazing to see him go from severe to mild to minimal pain all within 30 minutes. By the time he was packed in ambulance to be shipped out to the receiving cardiac center his EKG had gone back to normal.
Last night I was running late, mostly because I was so tired I overslept and then took a nap and then just lost track of time. Some thoughts on the patients:
- when you fall, try to think "tuck and roll" to protect your hands and wrists, that would have helped one of my patients who wound up with no broken bones, just a wrist strain. The other who just fell sideways ended up with 2 broken ribs. Nothing to do for those except pain control and to encourage deep breathing as there's a high likelihood of developing pneumonia.
- some kids just get fevers and we don't ever know why. However, if you bring them to the E.D. they're going to get poked and stuck in innumerable ways because we have to think about potentially fatal complications. This little pedi (pediatric patient) did just fine and didn't look that sick. They'll be seeing their pediatrician today, so we know they have good follow-up.
- and then I had 2 cases of pancreatitis: one was a chronic pancreatitis patient who came in vomiting, nauseous and looking for pain meds, and who really did have pancreatitis (lipase, a marker, was about 3700, normal is < 100) even though as ED personnel we get skeptical given all the pain med seekers we see. The second came in with what sounded like some reflux/heartburn pain. We do routine "belly labs" meaning looking at liver, kidneys and pancreas function and their lipase was close to a thousand. We quickly scanned the gallbladder which is a common cause and didn't see any obvious stones. They were admitted and will have a definitive study in the morning.
That's it. My last shift is tonight, and Iam hoping for a good Friday night. I have the rest of the weekend off and I want to start it on a good note.
Here's the video from Wednesday morning after I arrived at the hospital parking lot here in Downtown Buffalo.
My car is stopped and you can see some vibration from the wind. Winds were blowing 30 - 40 mph with gusts recorded to the 70's and 80's.
One of my colleagues and I actually had to link arms leaving the hospital to get back to our cars after our meetings because the wind was so strong. Driving home, there was a semi flipped over on one of the off-ramps, and I hit near white-out conditions at my off-ramp.
Driving to work that night wasn't too bad. It was very windy and I couldn't use my cruise control like I usually do because of the gusts. I had to keep adjusting my speed. We had a total of 5 patients that night. One with a newly-found brain tumor. They got shipped to the Stroke Center, MF Gates in Buffalo.
The other interesting one was having a heart attack as he walked in the door clutching his chest. He received thrombolytics (clot busters) to help break up the clot. It was amazing to see him go from severe to mild to minimal pain all within 30 minutes. By the time he was packed in ambulance to be shipped out to the receiving cardiac center his EKG had gone back to normal.
Last night I was running late, mostly because I was so tired I overslept and then took a nap and then just lost track of time. Some thoughts on the patients:
- when you fall, try to think "tuck and roll" to protect your hands and wrists, that would have helped one of my patients who wound up with no broken bones, just a wrist strain. The other who just fell sideways ended up with 2 broken ribs. Nothing to do for those except pain control and to encourage deep breathing as there's a high likelihood of developing pneumonia.
- some kids just get fevers and we don't ever know why. However, if you bring them to the E.D. they're going to get poked and stuck in innumerable ways because we have to think about potentially fatal complications. This little pedi (pediatric patient) did just fine and didn't look that sick. They'll be seeing their pediatrician today, so we know they have good follow-up.
- and then I had 2 cases of pancreatitis: one was a chronic pancreatitis patient who came in vomiting, nauseous and looking for pain meds, and who really did have pancreatitis (lipase, a marker, was about 3700, normal is < 100) even though as ED personnel we get skeptical given all the pain med seekers we see. The second came in with what sounded like some reflux/heartburn pain. We do routine "belly labs" meaning looking at liver, kidneys and pancreas function and their lipase was close to a thousand. We quickly scanned the gallbladder which is a common cause and didn't see any obvious stones. They were admitted and will have a definitive study in the morning.
That's it. My last shift is tonight, and Iam hoping for a good Friday night. I have the rest of the weekend off and I want to start it on a good note.
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