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.
Friday, November 23, 2007
Thursday, November 22, 2007
Giving Thanks...
- 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....
Monday, November 19, 2007
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.
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.
Wednesday, November 14, 2007
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.
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.
Tuesday, November 13, 2007
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.
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.
Sunday, November 11, 2007
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...
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...
Wednesday, November 7, 2007
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:
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:
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