Me is sick. It hit me yesterday....sore throat, malaise, achey, tired...blah. It hit Mr. Big today. Tonight both of our pathetic souls camped out on the couch and watched the news, then took a nap. There is one thing nice about being sick: it let's you do things that you normally feel guilty doing, like lazing around the house. Unfortunately for me, I'm on call tomorrow from 8am to 8am, so no rest for the wicked. I'm just praying for a good day. I'm due for a nice, calm call shift.

What I'm listening to: Defying Gravity from Wicked (I have to brag that I went to college with Kristen Chenoweth. She's just as nice as she seems, too!)

Over My Head

When I'm on call, 5am seems to be the bewitching hour of every disaster I encounter. Like that old saying, "the hour is darkest just before dawn". This morning, I'm trying to put out a minor disaster when I got paged by a nurse who works in the physical rehab unit about a patient who'd had heart bypass surgery a week or so ago and is now diaphoretic and out of breath. I tell the nurse to put 100% oxygen on her and I'll be right there. I get down there and the poor lady was absolutely drenched in sweat, complaining of chest pain radiating to her neck, is severely out of breath, and her blood pressure is 70/30. Worried she's got a PE, I order stat labs: a chest xray, cardiac enzymes, blood gas, an ekg, and morphine. I'm seriously contemplating intubating her at this point, but she seemed to be maintaining her oxygenation okay.

While this was going on, I called the on-call pulmonologist and told her what was going on. While we're talking, the lady's blood gas comes back normal and her labs showed she was adequately anticoagulated. The pulmonologist told me she likely was not having a PE but she needs to be transferred to ICU and I need to call her cardiologist (who had already ben called but was slow in calling back). I get word that one of the nurses calls him and he is on his way. We started getting the lady ready to transfer. She was scared and really hurting. By this time I'm thinking she's having an MI. Her cardiologist walks in, looks at her, and I start telling him the labs I drew. He was pretty rude. First of all, he asks the patient if she's been participating in rehab or if she's just been lying in bed. She's so out of breath she can't answer very well. He then starts chewing on me, telling me that you can't have an MI after heart bypass therefore the cardiac enzymes I ordered are pointless. "Did it ever occur to you she might be having a PE?" he asks me accusatory. I told him it did but her blood gas is normal and her INR is 2.8. He's pretty pissed off. I tell him we have an ICU bed for her and he said she didn't need one, just transfer her to intermediate care (sort of in between a regular hospital bed and ICU). He then asked me if I'd bothered to order a chest xray and I told him one was just taken but I hadn't had time to see if was in the computer yet to look at it. He stomps off and I didn't see him again. The nurses helping me were angry that he was so awful to me. We got the lady transferred to the new room, on the cardiac floor. Her new nurses (experienced cardiac nurses) were clearly alarmed at her condition and didn't understand why the cardiologist was so flippant about it. I stay another 10 minutes and then realize there's nothing more I can do, she is the cardiologist's patient now and he needs to write her admission orders. 15 minutes after I left, she went asystolic and quit breathing. Finally, the cardiologist realized how sick she was. I mean, who am I, a mere intern 6 months out of medical school, to tell him when a patient is sick or not? I felt a bit of redemption, but it was at the unfortunate expense of the patient. She's still alive, but now she's on a ventilator and when I left, they were performing a ton of tests to try and figure out what happened to her. As I walked out of the room, he patted my back and said, "good job". I guess he knew he was wrong.

I got back to the call room and realized what a close call that was. This was my first experience with a patient who has heart failure and is decompensating right in front of me. If we delayed her transfer just 10 minutes, she would have either died in her rehab room or worse, died in the elevator on the way to the cardiac floor. Both locations don't offer much hope of survival. It still scares me when I think about it. I don't want to be on call anymore-ever.

Merry Christmas!

Hope everyone had a good one.

My carrot cake turned out...weird. I think I'll probably throw away the recipe. When the main ingredients were pine nuts, carrots, and fennel seeds, I should have figured it would taste odd. Sorry, Giada.

This was an odd Christmas. I didn't have anything to do today. With my family getting together on the 23rd and 24th, it left today with nothing to do. Mom and I were going to go to a movie, but we couldn't agree on one then she decided she didn't want to spend the money. Then we decided she would come over and we would hang out and I would make Turkey Casserole for dinner (yum!). She called me at 2pm and said she just wanted to stay in, partly because her back was sore. Hmmph. I was a little miffed. I wish she had told me sooner. I could have made other plans, namely, driven a couple of hours to have dinner with my college friend and her family. But at 2pm, it was too late. I wish I had a dollar for every time I've had to ignore a sore back and gone about my day. I've had back pain since I was 10 years old. I've learned to ignore it. Today I kept thinking of all my friends and what they were doing. They all have husbands and kids. I'm the only single one and it makes holidays weird because everyone does things with their own family. I sometimes feel like the "ugly spinster". That being said, maybe with each passing year, that's one year closer to having my own family!

Other than today, my Christmas weekend was pretty fun and I got lots of rest. I'm really looking forward to being on call tomorrow night (she says, sarcastically).

mascarpone, anyone?

I'm going to make a carrot cake tomorrow that I saw Giada make on Everyday Italian a few weeks ago. The problem? I can't find any mascarpone cheese. I saw some at SuperTarget last week, but do I dare even think of setting foot in a Target on Christmas Eve so I can buy a small tub of cheese? I don't think so. Instead I bought cream cheese. I hope it works.

Today was better. I went to my dad's tonight and had a nice time. My step sister and her family weren't even there so that totally cured the "do I get them a present" problem. They did buy me something, but I really don't think they'll care I didn't reciprocate. I'm really excited about going to my mom's tomorrow. We always have a good time and I bought everyone cool presents that I think they'll like.

I wish Mr. Big was here for Chistmas. I miss him. : (

What would YOU do?

Christmas is a time of giving, right? Well, I have a question. Where do you draw the line? I have a step family that came along well after I became and adult, meaning, we aren't the "Brady Bunch". To be bluntly honest, I consider my step family to be "my dad's 2nd wife's family". I'm not close to my dad, either. I won't get into the reasons why, but let's just say our relationship is on the brink of disaster. It's also always been pretty clear to me that I'm the least favorite of his children. So here's the problem: I buy a present for my dad's 2nd wife, but am I really obligated to buy presents for her daughter, husband, and three kids (from 3 marriages)? We have a general distaste for each other. I'm sure they think I'm a snob and I personally don't approve of the poor decisions my step sister has made since her mom married my dad. We don't talk to each other and we only see each other once a year. So, why should I buy them all a present? Up until now, I've always sucked it up and gotten them SOMETHING, but this year I just don't have it in me. I can't stand my step family, and in my mind, buying a present that you don't really want to buy is worse than not buying one at all. I see it as dishonest. Christmas should be about giving to people you want to give to, without the pressures of strange blended families. Just because my dad married into their family, does that mean I have to be as well?

Sadly, I'm afraid my predicament is that of the "typical American family". I was 18 when my parents separated. It totally devastated me. Who gets divorced after 36 years?? People always talk about how hard divorce is on children, but it's also hard on adult children. Birthdays, holidays, and special occassions are always awkward in my family. Sometimes we have to have two celebrations because God forbid if my dad has to be in the same room as my mom. Christmas is one of those times. If I'm ever lucky enough to have a husband and kids of my own, I will make Christmas the happiest time of year for them, not the saddest.

All these deep thoughts now require some chocolate....

I turned 36 in October. Here are some photos that I finally download from my camera:





The birthday bowling party. Me with my neices




My 36th birthday and my neice's 10th birthday

Typhoid Me

It seems like everyone I come in contact with these days dies. None of these deaths have anything to do with me, but they are just happening. Remember the guy from 2 weeks ago? Well, there have since been two more. There was a guy I assisted my surgeon on in putting in an AV graft so he could have dialysis. Well, just a few days after he was discharged from the hospital, he had a bad car accident and died a few days later. Question I have is, was he driving? I mean, the guy was paranoid schizophrenic and was not very compliant on his meds. I sure hope he didn't hurt anyone else in the accident.

The other guy I admitted to the hospital on Sunday. He was an older gentleman and came to the ER complaining of an itchy rash that he'd had for 3 weeks (not really an emergency, but whatever). The reason he got put in the hospital is because his blood glucose was 573! He wasn't in any distress and didn't know it was that high. An attending doctor took over his care the morning after I wrote admission orders. Out of the blue yesterday he just went into asystole and died. I feel so bad for his wife. They were so nice when I spoke with them Sunday. This just completely blindsided her. Then today, a horrible thought came to my mind: I bet he has Christmas presents under the tree. It's no wonder the suicide rate is so high around Christmas when things like this happen.

In other news, Mr. Big has gone to the Left Coast to visit his sister. I've spent the evening cleaning my house, catching up with some friends on the phone, and playing my piano. It's weird having free time! : )

I think this has been one of the most difficult weeks I've had. Remember that 2 day test I took last week? Well, I was on call the night I finished it. Fortunately it wasn't a terribly busy night, but still, I was at work and I can never sleep well at work. I thought I was going to get to go home the next morning, but instead I ended up assisting my attending in the OR until 5pm the next day! I was so tired I was near tears. Mr. Big and I went out to dinner that night then I fell asleep on his couch (something I do quite regularly these days). I went home and went to bed at 10pm (wow!) and woke up at 7am dead tired. I drove to work feeling so dejected, depressed, and that I just could not physically do this anymore. I always thought I could do anything no matter what. Well, I learned my limits this week. I should not have tried to fit so many important things into one week. I got to sleep in this morning, but I am still dead tired. I looked in the mirror this morning and my appearance scared me. As luck would have it, I'm on call tomorrow for 24 hours, then I'll have to stay at work through 1pm on Monday, which will put me close to a 30 hour shift. I'm really starting to question if I can do 3 1/2 more years of this.

I crammed almost all my Christmas shopping today online. I really hope everything gets to me on time. How on earth did December get here so fast?

Tomorrow is day 2 of my final licensing exam. Today was hard. 7 hours of questions with 45 minutes of breaktime. Tomorrow is more of the same...AND I'm on call tomorrow night after the exam.

This morning on Good Morning America, Diane Sawyer started off a story about tired docs with, "Doctors can work up to 20 and 24 hours straight. How safe are YOU?" I laughed. Oh Diane, Diane....if only you knew. Doctors are just getting warmed up at 20 hours! People aren't sick 9 to 5.

What I'm reading: Glamour's Big Guide of Do's and Don'ts (I couldn't resist! Pink and Pastor's Bride would be so proud!)

Close call

I knew the anesthesiologists' pre-op evaluations were important, but I got to see just how important they were last week. We had a man come in with multiple health problems who needed to have part of his foot amputated due to a non-healing wound. I went to go see him and do a quick physical exam. While I was there, the anesthesiologist (coincidentally, the same one who slept with my friend then never called her) came in to look at the patient's lab work and talk to him. The man takes coumadin ("blood thinner") and the lab work showed that his blood was way "too thin" for a safe surgery. The anesthesiologist went to talk to my doc (the surgeon) about cancelling the case because he was too high risk for bleeding. My doc was a little irritated about cancelling, but did agree. I was still filling out paperwork on the patient when my doc came to talk to him. He advised him to go to his doctor to get his blood thinner medicine right, then the surgery will be rescheduled for next week. I thought nothing more about the matter, and was honestly relieved that one case was cancelled that day, because as it was, I was already going to be at the hospital until 9pm. A couple of days later, my doc asked me if I remembered the patient who had his surgery cancelled. I told him I did asked why he was asking. He told me that the next day, one of the nurses called him and told him that right after the patient got home from his cancelled surgery, he dropped dead! Wow. I'm assuming it was cardiac related, but it's a weird feeling when someone dies right after you have examined them. One thing I know for certain: my doc escaped a major litigation nightmare by allowing the anesthesiologist to cancel the case. He should buy him a nice present. I have no doubt the patient would have died in the operating room during the administering of the anesthesia, and the family would have blamed it on the docs and probably sued them. It's weird though, I keep thinking of my examination of him and wondering if there was something I missed that would have hinted he was going to die in an hour. There wasn't. I specifically remember asking him if he had any new chest pain or shortness of breath. He said "no"...then he went home and died.

I have officially been grossed out!

Nothing really grosses me out. Blood, poo, puss...you name it, it won't gross me out. Oh wait, there is one thing: wound debridement. Now THAT grosses me out! Just watching it makes me think that it would qualify as some awful torture that the italian mafia would use. I'm on this new rotation, a surgical rotation with a wound care doc. The hospital I am at is the major burn referral center for the state, so we get lots and lots of burns. After a week, I figured out MOST (key word, most) burns are either self-inflicted, stupidity, and/or the result of being under the influence. It's been really busy...because of winter, I'm told. Anyway, last night the last surgery on the schedule was a burn debridement. I'd never seen one of those. Basically, the person is put to sleep and the surgeon slices off long pieces of burned skin with a crude looking tool that looks like a big cheese slicer. You keep slicing until you finally reach deep enough to bleed, which means you are now exposing live tissue (the goal). Anyway, I just couldn't quit cringing watching and listing to this "cheese slicer" cutting off long pieces of dead skin. "You wanna try it?", the surgeon asked me. I learned in medical school that you never say "no" when asked if you want to do a procedure, so I replied with an enthusiastic, "yes!". So there I was, 8 o'clock at night, sawing off long pieces of burned flesh, as if I was carving a Thanksgiving turkey, the whole time thinking to myself, "how on earth did I get here?...."

Role reversal at its finest!

So last night I'm watching football with Mr. Big and another couple. Mr. Big and the other guy were just talking, talking, talking during the game...so much that it became a bit difficult to hear the comentary. Trying my hardest to be polite, I asked Mr. Big if he would turn up the volume. He laughed and asked if they were talking too much.

a case of mistaken identity

Hope everyone had a great Thanksgiving! I had a lot of fun and enjoyed 5 days off. Mr. Big (formerly known as The Boyfriend and Big Guy) and I went to visit his parents about 8 hours away. We were pretty tired from the drive when we got there Wednesday Night. His parents decided to open some wine before we sat down to a late dinner. I went off to the bathroom and when I came out, the wine was being poured. I came up behind Mr. Big and then sidled up to him as he poured my wine. I put my arm around him in a rather close hug. I looked up at him and realize that it was not Mr. Big I had my arms around, it was Mr. Big's dad! I was so embarrassed! I know I turned 30 shades of red as I quickly removed my arms and went over to the real Mr. Big. The thing is, I'm used to Mr. Big pouring the wine, he and his dad are about the same height, and when I came up behind him I wasn't really looking at him...I just assumed it was my boyfriend. Fortunately, nobody made a big issue of it. Mr. Big thinks his dad probably liked it.

I can't believe Thanksgiving is here! It seems like we just had Christmas! Today is my last day at work before having 5 days off. I'm hoping it will be slow so maybe I will get sent home. All I seem to be doing when I'm on call is "coat-tailing", so it's not like I'm actually needed. Yesterday I was doing the pre-op evaluations for people having surgery today. I went to see this one guy who was pretty mangled from a car accident. I noticed he had tattoos all over him and when I leaned over to listen to his heart, I noticed across his neck was tattooed, "Trust No Bitch". I thought that was pretty offensive, but did I say anything? No. God forbid if I upset a patient. This man is very obviously a gang-banger. A danger. A waste of effort, and yet, he will rack up a hospital bill of close to $500,000 and do nothing to repay his debt, let alone the debt he owes to society. He will go back to wherever he lives and continue on his destructive path. I know I sound terribly judgemental and mean, but it's the same people every day, sucking up our nation's healthcare resources.

Access Hollywood report today that FedEx (the loser formerly known as K-fed) had to take a taxi home from the airport. That makes me so happy. Funny how I don't know him and yet I have this extreme disgust for him. I guess it's kind of a relief knowing there are people out that who are way more screwed up than I.

Well, I don't know why I'm so cranky today. Sorry. I hope I snap out of it.

A new obsession

Pottery Barn. I love their furniture. I love their catalogues. The Boyfriend (who now wishes to be called Big Guy on my blog), gets their catalogues in the mail. I always like looking at them, but there's something about being gainfully employed that makes me want their stuff even more. I found about $4,000 of furniture that I MUST have! I swore off cheap furniture...I'm a grown up now and want nice furniture....so I may just save my money and buy one piece at a time. I don't know much about their furniture though. It seems pretty sturdy in their store,but I don't want to buy something of low quality that is overpriced, so I have some research to do.

I guess I'm blogging about furniture because there's nothing else to blog about. Work is okay. I'm back at the universit hospital this month. Twice now, I've been told, "NURSE! Go get me a coke!". Well, there are just a few things wrong with that request:
1. I'M NOT A NURSE! Yes, they even let women into med school now!
2. If I was a nurse, I have more important things to do than to run around getting people sodas
3. If I was a nurse, a simple "please may I have a soda?" would have a profound effect on whether or not you actually got one
4. Don't ever order me around. It's bad enough being an intern. I'm not about to start taking orders from rude patients that aren't even mine.

Only 1 thing

Only 1 good thing came out of this week (and it wasn't the elections): Britney Spears finally filed for divorce. K-fed and his stupid fedora are finally taking a hike. I heard a clip of one of his rap songs this morning and he IS REALLY AWFUL! In addition, every photo I've ever seen of him with that dumb smug grin make me want to slap him and ask him why he is such a big loser.

So today I had to go do pre-op assessments on patients having surgery tomorrow. This one guy I talked to is having part 2 of a surgery. Part 1 was yesterday and consisted of removing a foreign body...a hi-ball glass to be exact....from his rectum, which had been stuck for 2 weeks. Actually, they couldn't get the glass out. They had to open up his belly, open his rectum, and try to push the glass out. It was still stuck so they finally had to break the glass in his rectum to get it out. Incidentally, the guy is also an avid meth user. His wife whispered to me that he didn't yet know that he's had a foreign body removed from his rectum. What?! How does that happen? How can you have a glass stuck up your ass and not know it's there?? Folks, this is your tax money hard at work!

48 hours and counting...

Until the end of the elections! Is anybody else REALLY tired of hearing about it? If I had the money and the time, I would individually mail every election flyer I have received back to the personal home of the candidates. One by one, everyday...they would get their dumb flyers in the mail. I love the idea. I never received my ticket to take my licensing exam in the mail. I am blaming it on the elections. I think I became overzealous in throwing away junk mail and may not have seen the skinny envelope helplessly wedged in between one candidate's pledge for "Faith, Family, and Freedom" and another's pledge for "Conservative Values"....whatever the heck that means. What I find funny is the "Faith, Family, and Freedom" candidate got divorced after she cheated on her husband. How's that for hypocrisy? God I love politicians......

Moving on.....

Where did the weekend go? Do I really have to go back to work tomorrow?

First of all, my weekend began with an unfortunate accident involving me and some Veet. I use the stuff a lot and have never had problems. This time I ended up with alkaline burns all over my legs. Talk about painful....

I dropped off The Boyfriend at the airport today. He's going to a medical conference to get some CME credits in. I have absolutely no reason not to study a lot this week. That is my goal: study a lot.

36?!

I realized when I woke up Saturday morning that I am now closer to 40 than I am 30. I don't feel like it. I feel like I'm 26 still. it's a good thing, I have a few rough months coming up. I decided to take my (final) medical licensing exam next month instead of waiting until the spring. I just want to get it over with. I have another exam in July I need to do well on, so I need to start studying as early as possible.

OK, so what did I do this weekend? I had an awesome birthday weekend with The Boyfriend. It started Thursday Night when my family went out to dinner and then bowling. Bowling is fun, but I think what I love the most is doing something with my family altogether. Friday, The Boyfriend and I went to Dallas and stayed at the Westin at the Galleria and he took me shopping. We had so much fun. It's pretty cool dating a guy who likes to shop. To make it even more fun, I helped him pick out clothes too. I got my first pair of skinny jeans (yes, I know..I swore I would never buy any) and I love them. I must have tried on 20 pairs of jeans and the LAST pair fit perfectly.

OK so we didn't just go shopping. We slept in Saturday morning and watched a football game on TV and ordered room service for breakfast. Went to an awesome seafood restaurant that night, then Sunday visited his brother and sister-in-law pregnant with triplets.

Strange..I never heard from my dad for my birthday. ~sigh~ it isn't the first time. 3 years ago he got all pissed because my birthday was going to be celebrated at my mom's house. Since he has to control everything, he decided over his dead body would he ever set foot in my mom's house, so what did he do? He skipped my birthday. About a week later, I finally got a call from him. I don't know who he's trying to hurt more, me or mom. Grow up, Dad, Mom moved on 15 years ago.

Top 10 80's Flicks

Last night I was on call when The Breakfast Club came on. I couldn't resist it! Does it seem like the movies were better in the 80's? I think so. I mean, can anyone beat the Brat Pack, I ask you?

Here's my top 10, in no particular order:
1. The Breakfast Club
2. St. Elmo's Fire (watched it again a few months ago and it seems to have lost some luster..but still worthy of mention)
3. Pretty In Pink (a Ginger with a pink promdress?? She paved the way for many future prom going Gingers)
4. 16 Candles (Jake Ryan, you're such a babe!)
5. Tootsie
6. All the Indiana Jones movies
7. An Officer and a Gentleman
8. Poltergeist
9. Better Off Dead
10. Some Kind of Wonderfull
11. Say Anything (ooops, that's 11!)

My own Gray's Anatomy

I sort of despise that show for its numerous inaccuracies. However, it seems so convenient on Thursday evenings just to watch it since it's on. That being said, I secretly cringe when people try to associate anything I do in residency with what the pseudo-interns do on Gray's. Like my haircut lady. She wanted to know all about the exciting things I do. Well, for starters, people don't want to hear about the guy with a potassium of 7.5 that you saw in the ICU, they want to hear about two people joined together in a freak accident involving a metal spear. Hmmm. So, I told my hairdresser about having to run codes in the middle of the night and how stressful that can be. "You mean like they do on Gray's Anatomy?" "Uh, no", I replied, "I actually work".

Today I got a glimpse of my own hospital gossip and it felt very much like G.A. One of my old sorority friends had a summer fling with an anesthesiologist at the hospital where I work. As it turns out, I graduated from high school with the anesthesiologist but never knew him. As soon as my friend slept with him, he never called her again. No explanation, no nothing. If you ask me, he's a bit old for that kind of behavior, but whatever. Well anyway, I ran into him today in the physician's cafeteria. I've never met him before but I heard him on the phone saying he was Dr. X and to give such and such medicine to the pt. After he got off the phone, I introduced myself and told him we graduated high school together. He said my name sounded familiar and asked how he knew me. I told him that I'm friends with X who he briefly dated over the summer. Without even blinking, he asked how she was and for me to say hi to her. I so wanted to ask him why he never called her back and how could he treat someone like that, doesn't he want to get married someday? But I didn't. I didn't want to make things worse for my friend. Other than that small glitch in his pesonality, he seemed quite nice. I wish he would just call her and tell her why he was a jerk. It's too late though, I'm sure she's moved on.

Sleeping Beauty

Wow, I think I slept all weekend! I was on call last Wednesday night and got about 3 hours of sleep. I was busy from 6pm until 1am admitting patients from the ER, then during the night I had 3 code blues. Everybody lived. After my shift, I had to stay and round on the PICU patients with my attending, then I had to stay for noon conference. I got home around 2pm, but promised one of the other residents that I would pick her up at 4pm from her Lasik appointment. My point is, I got little sleep. I realized as I was going to bed that night, that I had 3 hours of (poor) sleep in 41 hours. It's no wonder that I woke up Friday morning feeling lousy. I came home and slept for 3 hours that afternoon. Slept 8 hours Friday Night, took a nap on Saturday, then today I slept until 12:30pm! I even got a kiss from The Boyfriend when I woke up.

OK I agree, I'm seriously a big slacker, but now I feel really good!

On a sad note, one of my aunts died this morning. She fell on Friday and I'm assuming she hit her head and got a head bleed, but at any rate, she was in the ICU all weekend not expected to recover. I wasn't surprised she died. I got such a nice card from her at graduation. She patiently taught me how to read the summer between kindergarten and 1st grade. I never forgot that. I really hope I can attend her funeral this week. It would be nice to see all my cousins, too.

Rules for watching sports

This weekend The Boyfriend and I went out of town with some friends for a big football game. We left Thursday and came back on Sunday. It was really nice to have 3 1/2 days off but it sure made coming back to work hard! Friday we went to Humperdink's which (I guess) is the designated hang out for our team's fans. It was pretty much standing room only. We got there at 1pm and stayed until about 6pm, just drinking and hanging out with our friends. Saturday, we went to a watch party at a friend of a friend's house(tickets too expensive and who wants to sit in the endzone?). There were about 8 of us there watching the game. The guy hosting the get together invited his neighbors and their kids over to watch the game. My experience that day made me think about some general rules that should be followed when watching a sporting event on TV with friends:

1. Don't talk incessantly during the game, some of us actually want to watch it and hear the commentary
2. Don't exchange recipes with the person across the room when others are trying to watch the game
3. Don't ask for the results of a replay/review 5 minutes after the fact because you were too busy exchanging recipes to pay attention
4. Get a babysitter
5. Don't block the TV during every critical play by getting up to go into the kitchen for more food
6. When there are only 3 minutes left, and your team is losing by 18 points, don't make the announcement that "all we need is a touchdown, and interception leading to a touchdown, then another touchdown to win the game". You sound like a moron.

OK some of these may sounds harsh, but that girl was driving me absolutely crazy. I found out later she was driving a lot of people crazy, but we were all too nice to tell her to shut up and sit still, so instead, I'm blogging about it here for the world to see.

A 2nd Birthday

I had a patient last week that I was seeing every morning before my attending came in to see him. I'll call him Mike. His heart was failing after having a heart attack. It was so weak, he had to have an intra-aortic balloon pump placed to help blood flow inside his heart better. He was also on two IV drips just to keep his blood pressure on the low side of normal. He was already on the heart transplant list, but his weak condition moved him up to the top of the list. Everyday last week I saw him and he looked weaker each day. Thursday he was pale and depressed-to me, it seemed he was getting worse.

Friday, I came in to see him and the nurse told me that there is a chance he could get the transplant he needed that day. There was a heart available in a city 4 hours away but there were still some tests that needed to be done to see if he was a good match. I went in to see Mike and told him I'd heard the good news that he may have a heart later. His affect was flat and all he said was that he'd "been here before and it didn't work out". With that reply I knew he was losing hope. All I could thing of to say is that we could hope that this time it will happen for him. I patted his arm and left.

All day we waited to see if he would get the heart. The delays were caused by the donor having some health issues that raised some questions as to whether or not the heart should be used. The surgeon came in and told Mike what was going on. Mike called his family and talked to them for a long time, then the surgeon talked to them. Then Mike got back on the phone. When he got off the phone, he yelled, "Doc, my family says go for it!". At around 2pm, there was still one test that needed to be done, but the transplant team decided to go ahead and fly out of town to "harvest" the organ, and if it turned out that they couldn't use it, they would just fly back without it. The brain-dead donor has to be kept alive on a ventilator until the organ is removed. The shelf life of a heart is low: The surgeon has only 4 hours from the time the heart is removed from the donor to the time it goes to the recipient. I found out the hospital has a private plane always on standy-by for instances like these.

All day on Saturday I thought about Mike and hoped he got the heart. I was almost looking forward to being on call Sunday because I wanted to know if he got it. Sunday, I was up in the ICU and asked one of the nurses if he got it. She said he did! He went to surgery around 10pm Friday Night and was in surgery for 6 hours. It was almost midnight put I peeked inside his room to see if he was awake. He was watching TV and when he saw me, he smiled and said, "I got it!". I went in and talked to him for awhile. He was so animated-he had gone from this sad, sick person about to lose hope to a new person who had just been handed another chance. It really made my night better to see him so happy. He looked really good, too. His skin was pink and he seemed to be thinking more clearly.

Mike has a long road ahead of him. He will be on anti-rejection drugs the rest of his life, will probably have several future hospitalizations because just about everyone goes through bouts of acute rejection. He will probably develop diabetes from the long term prednisone use, and the anti-rejection drugs will almost certainly decrease his bone marrow production of red blood cells, white blood cells, and platelets. He is also very weak from being bedridden. That said, I've never talked to a transplant patient who was sorry they did it-it gave them a 2nd birthday.

Last month when I was on cardiology, I found out that transplants are actually decreasing because there aren't as many organ donors as there once were. I found out most donors are young adults who make bad decisions and end up having life-ending accidents. With new safety laws in place like seat belt use, less young people are dying, therefore there are less organs available. I hate it that someone has to die for someone else to live, but what an priceless gift that is!

Zombie girl

I miss my friends. I don't talk to many people outside the hospital anymore. Being busy...well...sucks sometimes. I finished a 29 hour shift this afternoon, went home and took a shower, then went to The Boyfriend's house to sleep for a few hours. Not really quality time but I like knowing he's near.

Last night was pretty uneventful, for the most part. Except for the emergent intubation I couldn't get and had to call and ER doc to come up and rescue me (thank God for the ER docs that are around 24/7). Oh, yeah, and the central line I was trying to put in a guy's neck that I couldn't get. Everytime I hit the vein and started to put the guide wire in, he would turn his head and I would lose access. The third time I hit his carotid and I decided I'd had enough. I called the central line team to come do it. I was really pissed. It's getting late in the year for me to be having trouble with procedures. If this kind of stuff happens next year, I will probably get really chewed out.

Life is looking up though. This was my last weekend to be on call for several weeks. It's about time. It has seemed like lately I'm on call every weekend. I'm really excited about this weekend though. The Boyfriend and some of our friends are going to a certain big city to go to a certain football game. Well, we aren't actually going to the game. We decided if all we can get are nosebleed seats, we'd rather watch the game in our nice hotel room, then party with our friends after the game. It should really be a lot of fun.

So, that's life for me in a nutshell!

I have a nephew. He's 26. He's amazingly intelligent, but he lacks a bit of common sense. You see, he works at a pretty upscale restaurant, and is a really good waiter, so I hear. Well, last night, The Boyfriend and I went to eat at the "sister" restaurant of the one my nephew works at. One of the guys there who was waiting tables I knew from my former days as a waitress. He came over to me and as we were talking, mentions how sorry he was to hear about my nephews mom (My brother's ex-wife). I'm confused and asked him what he meant. He said that she had died about 3 weeks ago. Wow! How come nobody told me? So my nephew's boss walks by to say hi to me (I know him as well). I mentioned about my nephews mom dying and that I had no idea and started asking him when and what happened. This death was apparently 3 weeks ago! So by this time, I'm sort of irritated that nobody in the family mentioned this little detail to me. After dinner, I called my mom to see if she'd heard this. She hadn't. So I called my brother and asked him if he knew about it. He told me that my nephew made up the story because he didn't want to go to work. What!? Who would do that? Who would lie about their own mother dying so they wouldn't have to go to work?! Who's going to die next, me?

My brother was not happy about it either, and only found out because my nephew (his son) emailed him and told him what he'd done (my brother knows just about everyone in the restaurant business, including my nephew's boss, so I guess he needed him to cover for him). Anyway, he told me that he warned nephew that this will come back to bite him in the ass. It just may have tonight. I have a feeling his boss is going to ask him why his aunt had no idea about the death in the family.

Family drama...it never stops.

My Cool, Cosmopolitan Friends!

Sunday is finally over!

I thought it would never end. I was on call from 8am Sunday until 8am this morning, then I had to stay and see patients for my rotation, then attend our noon conference. I didn't get home until about 2pm...I was soooo tired. I did get some sleep but it was pretty staggered. I had to admit 12 patients to the hospital..which takes me about 1 1/2 hours per patient, then I had 2 codes in the middle of the night. The last one was a guy the family refused to make DNR despite the fact he's been unresponsive for several weeks in the ICU...it's that whole "futile care" thing I was talking about. He's been barely hanging on for weeks, his extremities were cold and he's had no signs of brain activity. Well, he finally flatlined and the daughter wanted us to keep trying to save him. To make matters worse, she spoke no English at all and at 3am we had to use an interpreter by phone to talk to her. After about 30 minutes of CPR and epinephrine, I put an end to it all. I still can't believe what people put their loved one's through...loved ones who really NEED to die. If someone has even the slightest chance of survival, I'm in total support of making sure all is done to save them, but in situations like the one I just mentioned, it makes me angry. People deserve to die with some amount of diginity, not the way this gentleman was forced to die.

The first code I had was a guy who should not have died. I don't exactly know what happened except that his blood pressure and heart rate dropped. The nurse called the "rapid assessment team" to see him and by the time I got there (in about 2 minutes) he had no pulses so we called a code. We worked on him a LONG time. I intubated him and we kept pushing drugs. The attending got there about 45 minutes later, we worked a bit longer and he then stopped us. We weren't going to get this guy back. The family was all out in the hall crying. I'm always amazed at how quickly family can get to the hospital in the middle of the night. So after the attending had us stop resuscitation, we all just stood there. The gentleman still had some basic brainstem function and took intermittent breaths every now and then, even though his heart was not pumping blood. We all just watched him. It was a very strange phenomenon I'd never seen before. I kept telling myself that for all practical purposes, he was already dead, but to watch him breathe.....I felt uneasy. After about 10 minutes he stopped.

I watched last night's Desperate Housewives with The Boyfriend tonight. I'd forgotten just about everything from the season finale, so I was a bit confused. Confused or not, I had a good time snuggling on the couch, getting to forget about the events of last night. My boyfriend is somewhat of a goofball. I invented a new kind of kiss...the Lizard Kiss. He didn't care for that too much and started giving me Lizard Pinches. What a copycat! : )

Bedtime.

So today we all got our asses chewed out by the program director. All the guys were complaining to her about one particular nurse who "demeans" them. Our PD got mad that they didn't mention it earlier and then started yelling at us that the whole hospital is complaining about us. Oh, really? Than why didn't YOU mention it earlier to US??? As it turns out, she's gotten a lot of complaints about how the cardiac/respiratory arrests are being handled, particularly one that occurred in the radiology department. I relaxed after I heard that. I haven't run a code in about 6 weeks, so I know it's not ME that anyone is complaining about. Plus, I heard about the respiratory arrest in radiology and it sounded like a big cluster...I'm glad I had no part of that.

So that bitch session this afternoon gave me a big ol' headache but it's gone now. Oddly, the nurse that all the guys were complaining about I happen to think is pretty nice. Hopefully they will find a way to resolve their issues with her. Today was the first I'd heard of it all.

After the bitch-fest was finally over, I returned to the ICU only to find out that one of my patients had just died in a freakish way. Too hard to explain though so I'm not even going to go there. My attending was pretty upset about it. I think he had tears in his eyes when he told me about it. Everybody was pretty visibly upset.

This blog seems depresing lately. It's not that these events are anything new...this stuff happens everyday, usually I just don't blog about it.

Well I think I'm finished mourning over the results of the now infamous football game that occurred Saturday. Time to move on.

So my 2 friends from high school and I got together over the weekend. I've decided they are both way cooler than I. We are thinking of starting an US Weekly reading club instead of a regular book club, since I don't have much extra time for reading.

A couple of hours ago in the ICU, I watched a guy in his early 20's die. He took 4 bottles of Tylenol PM yesterday and was found barely breathing last night by his mother. I didn' realize you could die from Tylenol in just one day- I thought it took 3 days, but now that I think about it, I think it was the "PM" portion of the Tylenol PM that killed him that fast. I think he fell asleep, became hypoxic, and sufferred injury to his brain from the lack of oxygen. He was found barely breathing, (something I didn't think was a common side effect of just plain ol' Tylenol overdose). Anyway, so he started seizing and his heart rate kept dropping really low. NOTHING would stop the seizures and he kept at it until he finally died. It was pretty ugly. I feel bad for any family member who has to make a loved one DNR (do not resuscitate), but his mother did the right thing. We were providing futile care.

Until today, I thought I was the dumbest resident in my group. I don't think that anymore. I initially responded to the code blue since I work in that ICU and I knew it would take a few minutes for the on-call resident to get there. The nurses were telling me what was going on when one of the other residents (not the designated on-call resident) showed up and sort of "took over". He really made an ass out of himself because he started asking them really dumb questions and telling them to shock the guy. The nurses were all rolling their eyes behind his back. I just stood back and watched in amusement. Despite what they do on Grey's Anatomy, you don't shock asystole or bradycardia (yet another reason to hate that show).

Now onto less depressing issues, like fashion:

I'm debating about these new "skinny" jeans. I think it is a lame attempt to make denim look like leggings, and I'm pretty sure I don't want to re-live that era again. On the other hand, I may end up buying a pair anyway because they are the new "it" item. I swore I would never buy low rise jeans and then one day I realized I was wearing "Mom" jeans. Now all my jeans are at least slightly low rise-definitely not up to my navel! Ok so back to skinny jeans. Maybe I'll just buy straight leg jeans. The problem I have now is all my jeans are bootcut so I can't wear flats or loafers with them, so I need at least one pair of jeans that don't require heels or boots. So which is it? Skinny or straight?

And yet another good day...!

Today was fun! Funny how you get a first impression about somebody and then later they prove you wrong. I had a really bad impression of this Dr. X, because I thought he was mean to me and hated me. This week he has been really nice and telling me I'm doing a good job. Looking back, I'm glad he's been hard on me. It's made me a better, more thorough resident. My ICU notes are much better than they were even a week ago.

This morning he had me re-intubate a guy who needed a bronchoscopy. The guy had a big neck, a huge tongue, and was coughing....3 strikes against an easy intubation. I tried twice with two different blades but just couldn't see around his tongue. I didn't want to have to let Dr. X do it, because that would be admitting defeat, so we readjusted his head so it extended better, and I got the tube right in. I was soooo relieved! He was coughing and everytime he coughed, the tube would get resistant when I tried to put it in, but I did finally get it in. I got a "good job" from Dr. X, which doesn't come easy.

I resisted the temptation to get a lovely looking piece of cake at lunch today. Then Julie joined me and what did she have on her plate? A big piece of cake, so I got up and got one too.

Did I mention I started running again? It hasn't been difficult this time. I guess walking 3 miles a day does more for my endurance than I though it did. Now if only my sore knees would cooperate.....

Please wish me an easy call night tomorrow. Thanks.

Does anyone actually read this blog? I'm not really very funny and I spend a lot of time complaining.

I've been way tired this week. I was on call 24 hours Saturday and it was the worst call shift I've had to date. I was up absolutely all night and very busy. I always had a handful of patients to admit throughout the night, plus I had a lot of problems with patients I had admitted earlier in the day. One guy was dangerously hyperkalemic and I was up in the ICU for much of the wee hours trying to get his potassium down. I had a lot of nursing calls and just miscellaneous stuff. Around 2am, I was near tears and wanting desperately to just walk out so I called The Boyfriend who gave me a loving pep talk. Around 5am I was just so tired that everytime my pager went off I just thought it was funny. Needless to say, Sunday after I got home I was a complete zombie. I'm still tired. I was going to run this morning before work, and when my alarm went off, I got up, looked out the window, and went back to bed for an hour.

I did have a good day though. I got notes written on all my ICU patients before lunch, and the attending who I thought hated me told me today that the notes I wrote were "really good". : ) We got finished early and I got to go home at 3pm.

I tried out a new Yoga for Weight Loss video I got for free last week. There's just something not right about the title of that video. I'll be the first to admit yoga can be difficult, but it's more stretching and balance than anything. At least for me, weight loss involves getting your heart rate up and sweating my butt off doing The Firm videos or running.....not yoga.

Well this weekend looks promising. I'm getting together with some friends from elementary school hopefully on Sunday. We got together over the summer, but that seems like a long time ago. Plus, last time they saw me, I was sporting a different nose. I have a new one now..not yet the final product but slowly getting there every week. So, we are trying to put together a little slumber party that night and I was able to take off Monday morning. It will seem like old times. One of the friends, Pinkstripe, had the kind of mom that bought cool snacks whenever there was a slumber party. Maybe I'll drink a suicide for old times' sake. Then there was Robyn, whose mom threw her a "pizza quick sauce" birthday party. We spent the whole time making our own mini pizzas. Old friends are the best!

What a week! I'm glad it's over, except tomorrow I start a 24 hour call.

So I started this new rotation in the transplant ICU, which consists mostly of people in liver failure. I got this one patient on Tuesday who had been in the hospital for 5 days from undiagnosed but end stage liver failure. He took a turn for the worse and came to the ICU. His story was really odd. Last week he actually went to work and was "fine". He was highly educated and had a nice white collar type job. The next day his wife thought he was acting weird so she took him to the ER. I don't know how they failed to notice he was bright yellow and had spider angiomas all over his chest, but they didn't know he had liver failure. He just got worse and worse during his stay, got infected with staph, developed sepsis, then got pneumonia and it was all downhill from there. He was ineligible for a liver transplant because he is an active alcoholic. When I came in this morning he was completely unresponsive, his blood pressure was 70/30 and that was with 4 blood pressure IV's continuously flowing. His hands and feet were cold, and his pupils were barely responsive. He was dead for all practical purposes. His wife came in later in the morning and signed the paperwork to remove care. She asked the 3 of us if we would do the same if it was our family member and we emphatically nodded our heads. We decided to leave the ventilator on but we removed all of his IV meds that were keeping his blood pressure up. He died in 10 minutes. I'm so new at this and it's really weird to think that last week he was "fine" and going to work and now he's dead. I felt so weird all day about it. I see dead people quite a bit, but this was the first that I was acutally involved in the care that turned out to be futile. I feel the worst for his wife and their 14 year old son. Maybe they had made big Christmas plans this year, or maybe the family was going to get tickets to a big game next month. Not now.

So I'm really starting to think that one doctor doesn't like me too much. This month, I'm on a rotation with him in the ICU. On Friday, my first day, I went in an hour earlier than he does so I could see some patients and get the notes written. Well, it took me an hour just to write one note because the patient had been there for awhile and I had to practically read the whole chart to get an idea of what was going on. So Dr. X gets there and starts reading my note and finally asks how long it took me to write it. "about an hour" I said. His reply: Well, it's a pretty poorly written note. Whatever. I can't win.

I was on call that night too. It was the easiest call night yet! Only 2 admits and one pronouncement. One of the admits was a diabetic hooker who decided to buy cocaine with her money instead of her diabetes supplies (which she had left in somebody's car 2 days earlier). She ended up with her 2nd case of DKA in 3 weeks. "The cocaine was only 10 dollars", she told me. "Well that's 10 dollars you don't have today, isn't it?". I don't know why I waste my breath. Her life would be so much easier if she weren't diabetic....oh yeah, and a drug addict......and a hooker.

So The Boyfriend is STILL SICK!! I thought he was getting better until this weekend when he took a turn for the worse. However, his voice has taken on a raspy sound which I find sorta sexy. The main event of the weekend was watching football. I'm so happy football season is back! For some odd reason, our team isn't wearing their names on the back of their jerseys, so The Boyfriend, always trying to stay ahead, printed off a team roster he found online-except that a lot of the numbers were wrong and included people that had been kicked off the team. I couldn't help but make fun of the list and make up names when he asked who number so-and-so was. He didn't share my amusement and I got bonked on the head several times with the list during the course of the game. Unfortunately, I'm on call Saturday so the next opportunity for head bonks won't be for 2 more weeks!

The most glorious thing happened today! I got up early to go on my 3 mile walk, and I had to wear a light jacket!!! Yay!!! The summer of having 38 days of over 100 degrees is cooling off! I can't believe how fast it happened. Just last week it was 105, and this morning it was 62. Now, I realize that is not cold, but just before sunrise it's enough to make the air a bit cool. I was more than happy to wear a jacket. My whole day was good, too.

The Boyfriend brought home an unwanted guest from his 10 day trip: a virus. He's coughing and in general feels bad. We snuggled on the couch to watch tv and he was complaining he was cold. Poor thing. I gave him the world's best medicine: M&M's (not to be confused with S&M's) and head grickles. I hope he feels better soon. He never gets sick, so when he does, I feel bad too.

Did anyone watch that gloom and doom show on 20/20 tonight about 8 different ways the world could end? Geez, talk about a downer! I'll probably have nightmares all night about a giant meteor hitting my house now. Thanks Elizabeth Vargas.

So, I decided to start doing my hour walks in the morning instead of at night. I just don't have enough time after work to do everything I want to do, and spend time with The Boyfriend. And lately, I've been working until 6-6:30pm which makes it really tough. I was so good about getting exercise everyday before I started residency, but now it's become my nemesis. I feel guilty and fat. I know it's been awhile since I've worked this much, but honestly I don't remember having so little free time! To top things off, band starts next week, like I have any leftover time for that! I suppose I will make it work. I just hate feeling stretched thin. And I think this is supposed to be the easy year!

What an irritating week. I had to give one of those presentations on Monday. I thought I was really prepared and had researched every possible thing I thought I would be asked. The one thing I forgot, the patient's EKG, was the one thing they asked for. It turned out to be a big deal. One of the doctors got mad and told me (in front of everyone) that my presentation was poorly put together and that they could not ask me any questions because I didn't have the EKG. Now, that wasn't really true, there was plenty they could ask, but I didn't argue with him. I just stood there in front of the room not saying anything. It was really embarassing. If that wasn't bad enough, he then REPEATED the fact that my presentation was poor, like I wasn't already humiliated by his previous comments. I finally got to go back to my seat. Then the worst happened: My eyes filled with tears. So, not only was I reduced to nothing in front of my peers and attendings, but then I have to top it off by crying. I just looked down and got the tears to stop before they broke free and ran down my face, which would be a dead giveaway.

I found out later from a nurse that same doctor then bitched about my presentation up in the ICU to all of them. Great. Let's just call the page operator and have her get on the intercom and tell everyone in the hospital how horrible my presentation was. What a jerk!

Well today was better. Through a fortunate turn of events, I managed to get the day off except I had to go to noon conference. I actually got close to 9 hours of sleep. It was wonderful! After conference I went to The Boyfriend's house to turn on his lawn sprinklers (he's out of town). While waiting for the sprinkler to quit cycling, I polished off a pint a vanilla Haagan-Daz he had in the freezer. That may have just been the best moment of my week. I felt so content sitting there all by myself eating the ice-cream. I had no where to be and no responsibility to anyone. I should definitely buy more ice cream!

My political rant

It's election time again! Tuesday is the day we have a run-off for various offices such as Lt. Gov. (who cares?), and state senate. I know it's election time again because I am being inundated with garbage mail, recordings on my voice mail, and of course, all the stupid TV ads. They all say the same thing: I believe in faith and family, making flag burning against the law, making abortion a crime, and yadda yadda yadda. Although I do care about faith and family, I don't think it really matters if my congressman thinks so. I also don't think flag burning or abortion should ever be anyone's top priority. However, those are the big platforms in my state, which makes me think anyone who listens to these knuckleheads is simple minded. I wish somebody would run who would like to eliminate pork spending in government, would guarantee they would strive to protect our constitution and ALL its amendments (even that pesky flag burning amendment protected under the 1st Amendment. Two and Four are good ones to protect, too), and initiate some REAL medical malpractice tort reform. I'm also concerned about the war, but then, who isn't? I'd also like someone to propose we abolish property tax.

Let's talk about property taxes for a moment. It is completely insane that we have to pay a yearly tax on something we already own! Even when you have your mortgage paid off, you still have to pay the property tax. If you don't, the government will steal your house from you. In essence, it comes down to this: Even though you think you own your house, you are really just renting it from the government. That's what property taxes assure us, and it stinks. Sorry to break the bad news to everyone who thought they were homeowners.

Anyone care to wager what political party I affiliate myself with? That's right. Libertarian. That is, if my county election board would let people register as such.

I just want to close with this comment. I am so fortunate to live in this great country, created by brave men who were searching for a different way of running a country. However, if our forefathers could see what was happening to the constitution they fought so hard for, they would be ashamed of us. We are slowly allowing our government to pick apart the Bill of Rights and take away our freedoms. Think about that. Long and hard. Is that what YOU really want?

I'm a bit irritated. I got my call schedule for September and I am on call 2 Fridays, one Saturday and one Sunday. That means every single weekend of September is screwed up for me. I complained. Only mildly though. Our elected schedule maker is going to change one of my Fridays to a Thursday. I have a better idea: change the Saturday to a Thursday! I have to remember, what comes around goes around. We are all going to end up working the same number of weekends, I'll just get all mine in sooner. It is football season though. I really don't want to miss any games.

I saw one of the nurses today in the doctor's lounge and I thanked her profusely for "rescuing" me during my case presentation 2 weeks ago. Remember? It's that thing I have to do where I present an interesting patient and then get pimped to death (questioned) by a handful of attendings. I'm used to getting pimped, but not the way some of them do it. It's really frustrating. Anyway, I was really getting hammered with questions and this nurse happened to be there. The last question for me was the echo results on this patient, and while digging through my mounds of paperwork looking for it, the nurse answered my question for me (I think she works in the lab). So I thanked her today for saving me. She told me she gets irritated at how the doctors treat the residents during these case presentations, particularly the women. She enjoys going to the presentations but has noticed over the years that the female residents really get treated badly and it makes her mad, so she feels the need to help out when she can. She told me to hang in there. I started thinking about that today and I'm not sure if she's right or not. I bring hard, unusual cases to the meetings, so I figured that's why I was getting all the difficult questions, but it's the way I'm questioned that I don't like. They interrupt me before I can give them the information they want, they don't listen when I go over labwork so I end up repeating most of it, and in general it's a very adversarial environment. Sometimes I can't even say one sentence without being pelted by questions from everyone. The guys don't really get that too much, but then, they also bring mostly lame, boring cases. I don't know if it's a sex thing or not. What difference does it make? It doesn't change the fact I have to give these presentations twice a month.

On a lighter note, one of our residents switched the M and N keys on our computer in the call room. It was really messing up my typing the other day. So to get even, I put a huge, black, fake bug between the sheets in the call room. He's on call tonight. Hee hee.

Well my call shift wasn't too bad the other night. I got paged to a code 5 minutes after I got there. She needed to be reintubated which was no small task. I failed twice, then got the tube in on the third try, but somehow it came out. Then the attending showed up and couldn't get her intubated. It was pretty frustrating. The lady ended up dying about an hour later. Her family was unprepared for the news and understandably, did not take it well.

After that I got 4 admits. One of them was a guy I had admitted last month, so I already knew his story. He had hepatic encephalopathy and was pretty out of it from that. When I tried to examine him, he started hitting me and then grabbed my arms. Needless to say, that exam didn't last long.

I went to sleep around 4am then woke up at 6:30am to my pager going off. A nursing question. Then I got paged again to go pronounce someone who had died. In the middle of that I got paged to the ICU for another code. We worked on him for an hour. The family was watching us and wanted him kept alive until one more relative could get there. The problem was, he wasn't alive. We just had to keep going until the attending or the family told us to stop. So there we were, pushing epinephrine and doing chest compressions on a guy who was already dead. One of the family members, who I suspect was a doctor by the questions he was asking, finally asked us to stop. The family was all there crying and the nurses were all crying and hugging the family. One of the nurses explained to me that they had all formed a bond with the family and how nice they were. I was touched. I left around 8am and took a brief nap before I went to The Boyfriend's house. We had a great weekend hanging out. Last night I made shrimp boil for dinner and then we had vanilla ice cream with fresh blueberries and rasberries. Yum!!

Grown up boys

I am so, so thankful that there is another female in my residency class. For 3 years, there haven't been any women and now there are 2 of us. The rest are all men...or boys, I should say. One on one, they are fine, well spoken gentlemen who are fun to talk to. When they get in a pack of about 3 or more, they start acting like 3 year olds! I've never seen anything like it. They talk about their bowel movements, they call each other names, and they hit and kick each other. I grew up with two older brothers, but I don't remember any of this ever happening. I have lots of guy friends. In fact, my boyfriend is a guy, and he doesn't act like that. But, Julie, the other female resident, informed me this is normal boy behavior. She calls it "flirting". I never realized guys flirt with each other, but these guys certainly do! It sounds really funny, but it can get pretty annoying, especially when you are sleep deprived and/or cranky. You just want them to shut up and go away. That's how I felt today. Lucky me, my attending sent me home early so I got to come home for a few hours before my on call shift starts. Time for a nap!

My residency is causing kitty stress

I'm a bad kitty owner. For 3 days, one of my kitties quit using the litter box. I thought she was doing it to annoy me because I'm gone all the time. Then yesterday I realized she was sick. She started being less social, she was constantly licking her bottom (gross, I know) and she was having urinary urgency. I found a 24 hour vet yesterday by my house that doesn't charge a higher fee until 10pm so I took her there. I had to leave her there for a few hours because she couldn't produce a urine sample. When they finally got one, it was full of blood, but not infection. I felt really bad. I bet it really hurt when she had to pee. The vet told me this bladder inflammation is caused by the cat being under a lot of stress, and he asked if anything in her life had changed. Hmm...well I went from working 0 hours per week to working 60-75, does that count? It counts. Poor Sarah. The vet gave her a steroid shot and sent her home with 2 weeks of prednisone pills to get rid of the inflammation. Oh boy. Ever try to give a cat a pill? To facilitate the process, I bought a "pill popper" which is a little rod that holds the pill on one end. You put the rod in her mouth, push the button on the other end, and the pill gets shot in her mouth. In theory, it's a great idea. In reality, Sarah was having no part of that. She kept spitting the pill out. I finally got her to swallow one before I went to work. Tonight's pill went easier, but I'm not sure if I can keep this up for 2 weeks. She may be fooled now, but soon she'll know to hide when I come around.

She's feeling better. She's perked up and she's using the litter again, thank God. Fortunately I have wood floors, but I'll have to clean my throw rugs pretty well which will be no easy task.

Nothing else is new. I'm on call tomorrow night. I'm not looking forward to it.

Expensive T-shirts

Does anybody ever buy clothes from Anthropologie? I've heard all these great things about their stuff, and if anybody cares, the beautiful chef Giada de Laurantiis is married to a man who designs clothes for them. She wears their stuff all the time and looks awesome. So, since there's not a store within 300 miles of my house, I checked out their website and ordered a catalogue. Here's what I think: most of their clothes are weird. Really weird. Especially the catalogue. I went to their website looking for the shirts Giada wears, and I can't find any of them, but I can sure find all the strange stuff. The few t-shirts I've seen on their website that I like are usually sold out. Oh yeah, and did I mention their clothes are really expensive? $58 for a t-shirt! Now, as far as fashion goes, my life is divided into 2 halves: before The Boyfriend and now. My old self would have never bought a $58 piece of cotton, but now that I've become more fashion conscious, I don't even blink an eye, which is why the other day, I bought 2 shirts from Anthropologie. I had to. It was my lucky day, for I actually found some shirts I liked that weren't sold out!!! God wanted me to have them.

I had a fun weekend. Went for Mexican food Friday Night with The Boyfriend, ran errands with him on Saturday, made pizza for us that night and we watched TV, then today slept until noon, had a late lunch, then went to Barnes and Noble for a couple of hours. I'm home now. I need to work in my yard BUT IT'S TOO HOT!! Today we hit our 24th day this summer of being over 100. Today we're a balmy 103. I've had it. I'm taking this issue up with God tonight. His land is turning brown and I think he needs to hear about it. I spent 4 hours one night last week sprinkling my lawn, and did it make one difference? No! Still I have brown prickly grass.

Well I suppose I should do some reading. My cardiology doc gave me a book about pacemakers I should take a look at before tomorrow.

Oh yeah, and thanks Rhett Bomar for nearly ruining my week!!

Last night's call wasn't near as bad as last week's (which I haven't mentioned here because I'm still recovering from it!) I only had 3 patients to admit, one "prounouncement" and a cardiac arrest at 5:30am. Not bad at all. I got 4 consecutive hours of sleep, which meant today I wasn't dead tired and too dangerous to run errands. I left the hospital around 8am, went to the grocery store, went to lunch with a friend of mine, got a pedicure (and thought about my friend Robyn who is probably in dire need of one about now while she is trouncing around Europe), and had my air conditioner cleaned. Funny how when it's 105 degrees everyday, your air conditioner doesn't seem to run as well. I've never had it cleaned before and tonight my house is nice and cool. I guess next time I won't wait 4 years to have it serviced.

Tomorrow I have to give a presentation at noon on a patient that I have seen. I picked a guy who came into the ER with acute mental status changes and ended up having hyponatremia due to congestive heart failure. It's not really a hard case, but the doctors that attend these presentations get a sick thrill out of pelting the presenter with a bunch of questions. They loved the last case I presented, so now I feel like I've set the bar too high and will have a tough time meeting their expectations.

Tomorrow night I'm going to fill in and play my oboe in my old woodwind quintet. I'm looking forward to it, but I haven't played this summer so I'm sure I'll sounds pretty bad. It's Better than not having an oboe player though. I'm actually looking forward to playing. I had my oboe overhauled this summer so it will be fun to see how it plays. It looks brand spankin' new!

Rolling, rolling, rollling

Yesterday was my brother's birthday. They were supposed to go to the lake so we didn't plan anything. For whatever reason they didn't go, so I had everyone over to my house at the last minute for hot dogs and then we went bowling. I haven't bowled in 3 years. The Boyfriend, who wasn't too excited about the opportunity to roll a heavy ball on the floor to knock down pins, informed me he hadn't bowled since 1971. Ouch. So my nieces, ages 9 and 7, like to bowl with the bumper guards up so they don't gutter every ball. A crisis ensued when the bumper guards weren't in place right away. They had to bowl a couple of turns guttering the ball, each time sulking with their arms crossed across telling my brother, "I want the bumpers". Then The Boyfriend took his turn. He guttered both balls. My 9 year old niece, still trying to make a case for getting the bumper guards, went up to him and said, "You need the bumpers!". He took the news well. Imagine, a grown adult, bowling with bumper guards. The thought just made me laugh!

I've never broken 100. My 3rd game last night I bowled a 130 and beat everyone! Maybe it was all the beer I drank, or maybe it was I decided to try a new strategy: keep my eyes on the pins instead of the floor. It seemed to work really well. I can't wait to go bowling again. The Boyfriend got his groove on too and managed to beat my nieces.

Back to work tomorrow. It is my last day of being on the hospitalist team. I can't contain my smiles enough. The hours were long and I got so sick of doing nothing but writing history and physicals all day. I'll still have to do it on call, but in much smaller doses.

I heard a good joke on The Tonight Show: What is the largest export of Cuba?

Answer: Cubans. I guess you could expand that to include Mexico. If I was the leader of either country, I think I would be really embarrassed that so many people want to leave. Perhaps they should do something about that....

Has it been over a week? All my friends are WAY ahead of me on blogging, so, even though I need to go to bed because I will be up for 24+ hours tomorrow (stay off the road around 8am Thursday) I will blog.

The Boyfriend and I went to Dallas last weekend and stayed at the Westin at the Galleria. His brother and sister-in-law are about to move to Dallas so we met them there and got to see the new house they are building. I'd never met them before so that was fun too. The wife is 14 weeks pregnant with triplets so things are getting exciting for them. Now that I've seen this humongous house they are building, I want to buy a bigger house. There was a gang shooting at the 7-11 two blocks from my house recently and it has me wanting to move about 10 miles North. I love my little house though. I planted trees, crepe myrtles, refinished the wood floors, had porcelain tile put in the kitchen, painted...and now I want to move. All that work I put in is being ruined by a bunch of stupid gang bangers who have no respect for human life.

So, getting back to Dallas. I managed to spend $377 on 2 pairs of jeans and a t-shirt. it's my best work yet. Perhaps if I didn't spend so much on clothes I could afford a larger house payment!!

Now for my rant. What is it with voters?? I'm not even talking about people not in my party. I'm talking about people WITHIN my party. Today we had a primary election for governer, Lt governer, and a bunch of other stuff. Somehow I managed to vote for the candidates who lost. I'm convinced that most voters don't care about the issues and they vote by name recognition. I'm ready to get rid of career politicians and elect some new blood, but no, we have to keep voting for the same old boring people because most people who vote are not very smart. I've decided that voting should only be a priviledge to those who pay taxes. Why should somebody on welfare be allowed to vote on what to do with MY tax money?? Seems a bit like theft to me....

Well now I'm sure I've managed to piss people off with my opinions. Just so you know, I make no apologies. I worked as a social worker for 6 years and saw how great entitlement programs work. Just so you know.

I put in 75 hours last week..close to the 80 work week restriction, but I can't complain. I have friends who put in WAY more than 80 hours a week, despite the law...

I was on call all day Saturday until 8am Sunday morning, which pretty much ruined my weekend. I was trashed all day yesteray but it was my only day off all week. The Boyfriend and I went to see The Devil Loves Prada. He came along to earn what he calls "chick flick points". It was a great movie and he actually like it too...that is, the first 2/3 of it. The last 1/3 got a bit touchy-feely and I was just happy he didn't throw up in the theater. We were going to make a non-cash bet over whether or not it would be #1 in the box office for the weekend. I was willing to make the bet, but apparently the stakes were too high for him, so we didn't make the bet. He shoulda, because he woulda won the bet.

Tonight we're going out to dinner and then I'm going to walk. Granted, it's 104 degrees outside right now, so if it doesn't cool off before 8pm, the walk may not happen. I'm not on call again until Thursday night. Friday I will get to leave after noon conference since I'll be post-call, then The Boyfriend and I are taking his M6 to Dallas for a fun weekend. I'll get to meet his brother and sister-in law who is pregnant with triplets. They live in LA but are moving to Dallas soon.

"That's all." -Miranda

The Residency Diet Plan

I've been on a diet since January. I want to lose 15 pounds. I started counting Weight Watchers points and had pretty good luck, but I hit a plateau after I lost 7 pounds. I've been walking 3 miles 5 times a week for almost 1 1/2 years. During my vacation I added The Firm twice a week thinking that I needed to supplement my exercise with weights. Still, my weight didn't budge. Then I started residency. I thought I was going to gain the 7 pounds back because I don't get to walk my 3 miles as often. Granted, I am on my feet ALL DAY at the hospital but it's not really aerobic. I've also noticed I've had a ravenous appetite and have been eating like a big pig lately. Well, I guess all that doesn't matter because I weighed today and Eureka!! I lost 2 pounds in 1 1/2 weeks! The elusive 2 pounds I have been struggling with for 2 months have finally come off! Could residency be the secret potion for weight loss?

I was on call last night. I was busy until 4am admitting patients. Everytime I would get finished with one, the ER would page me with another one. It was crazy. These people were really sick, too. One lady close to my age gorked her liver with chronic alcoholism and was as yellow as an Oompa Loompa. Another elderly gentleman was so demented that he cursed me when I tried to examine him. It was endearing. I felt bad for him. Confused and angry, he didn't know where he was, and he didn't know who the family members were that had come to see him. So when he cursed at me, I just smiled. Another lady has meningitis. One guy had a liver trasplant a few months ago and was complaining of a big belly. I can't remember what was wrong with one admission, and then there's my last one. Some goon who overdosed on Soma and was a real pain in the ass. By then it was 4am and I was losing my patience with him. I enjoyed listening to him holler while the nurse put in his foley catheter. I felt like the evil witch doctor for that.

Fussbudget Love

I had a fun weekend, except for the first part. I had to take what was supposed to be the 8 hour board certification exam for anesthesiology. Since I only knew about 1/8 of the answers, it only took me 4 hours to complete. For now, the test is only used to gauge my progress through the next four years, so this year's score really doesn't matter. However, when I'm taking the exam to become board certified in 4 years, the score really matters a lot.

After the test was over, The Boyfriend and I drove my car to Wichita, KS to pick up a new car he ordered...a BMW M6! We stayed the night at the Hotel at Olde Town and enjoyed a mediocre dinner of sushi at a nearby restaurant. The waitress kept bringing us other people's food, and she tried to give our appetizer to somebody else. There was also some sort of festival in Olde Town so the streets were noisy and crowded with people. The Boyfriend said the street noise lasted until 3am. I wouldn't know. I crashed early at midnight and didn't hear a thing. That's been happening a lot these days. I can't get my book read because everytime I settle down to read at night, I end up getting sleepy and going to sleep.

So, back to the weekend. This morning we went to the dealership and picked up his car. Like. Wow. It was in the center of their showroom and the guy said it had received quite a lot of attention since they put it out. It's the first time The Boyfriend and I have ever seen an M6 (they are really, really hard to get) and I just fell in love.

After that, we went to our favorite restaurant in Wichita- Yai-Yai's. I've been looking forward to eating there for about 2 weeks. We got there we noticed there's some sort of Sunday brunch buffet going on. I asked Teeny Bopper Hostess if we could have a menu. She tells me, "they don't like to do that during brunch". Hmm. Well, that's nice and all, but I didn't really ask if "they" liked to do anything. I mean, I don't really like doing rectal exams, but I've had to do them a time or two. So I asked her again, "So can we order lunch from the menu?" Teeny Bopper Hostess says I can but they aren't really ready to cook anything. Whatever. I am truly annoyed. So we ate the brunch buffet. Sadly, it was not the same. We were both a little more than slightly disappointed. Teeny Bopper Hostess really pissed me off with her attitude. The Boyfriend thought that part was pretty funny. Apparently being a fuss-budget is one of my good qualities!

So me, The Boyfriend, and the new M6 are safely back home tonight. I have to say, the M6 got a lot of stares from people today. I got to drive it a bit tonight. I'm not sure what was more amazing, the drive itself or the fact that The Boyfriend let me drive it! If that ain't love, then what is?

My first code

Ask any resident where the worst place in a hospital to have a code is, and they'll tell you in radiology on the CT scanner. Guess where my first code was? Radiology at the CT scanner. When my pager went off, Hell, I didn't even know where radiology was! So I get there, along with my 7 other colleague-residents who came along, and there are no less than 25 people there watching the show. The lady had sort of been brought back by the time I got there, so she was quickly transported back up to ICU (without getting the CT). No sooner do we get to her room and she codes again. Fortunately for me, ICU nurses can run codes without me but I have to be there anyway so I ordered some lab work. I tried to run through my head what could be wrong, but she was so sick, it could have been anything and there comes a point where a loved one needs to decide enough is enough. Her doctor came in and then went out to talk to the family. They decided not to have her resuscitated anymore, so the nurses cleaned the patient up and the family came in to spend the last few hours with her. She died about 3 hours later.

Tomorrow I am not a house officer. I don't have to admit patients or respond to codes. I can relax. I'm glad my first week is almost over.

My first night on call...

wasn't so bad other than the face it was a holiday and I wanted to watch fireworks and eat junk food rather than hang out in a lonely hospital for 24 hours with no one to talk to.

My day started at 8am on the 4th. I did a history and physical on a new patient in the morning and was finished by noon. I sat around on edge all day just waiting for my pager to go off. Finally, at 5pm, I started to get paranoid that maybe the hospital operator had the wrong pager number down for me so I called her to make sure. Everything was fine. I tried to take a nap, but it's hard to sleep when you know you could get paged with a crisis at any moment. At 10pm I finally got paged to go see a new patient. That took a couple of hours. Then I got paged to see a guy whose family was anxious about him. I basically just took a look at him and reassured the family that he is stable.

I finally fell asleep and woke up at 2:30 this morning to my pager going off. It was an ICU nurse who needed me to come up and check a breathing tube of a patient. I didn't really understand what she was saying on the phone. So I get up there, and there's a bit of excitement because this patient was restless all night and had managed to dislodge his breathing tube and wasn't getting any oxygen from the ventilator. One of the nurses was manually "bagging" him so he could get air. I started putting gloves on and went to the head of the bed to get ready to replace his breathing tube. He was really squirming and fighting me (I don't blame him). A nurse asked me if I wanted to paralyze him. I really don't have much experience with that yet and told her I didn't want to do that because if I can't get the breathing tube in, I'll have to bag him for 15 minutes while the drugs wear off, so, I ordered etomidate to sedate him to go along with the versed they had already tried. It worked great and I was sort of able to get the tube back in. I couldn't really tell if it was in the right place, but I could hear breath sounds over both lungs and the ventilator indicated that he was getting oxygen again. I ordered a chest xray to confirm placement of the tube and then waited around for the radiologist to call me with the results. As it turned out, the tube was a little high and I briefly considered retrying and then I stopped: why fix something that isn't broken? He's oxygenating fine now, and he quit fighting the tube because we sedated him, so I decided to leave it where it was. I was so relieved that ended fine without any catastrophe. I was also glad I didn't have to call one of the ER docs to come help me with him. I managed it by myself with the help of some awesome nurses.

So by then it was 3:30am. I went back to my room, finally fell asleep and got paged at 6am. That call was just settled on the phone, but I was so excited to know my shift was almost over that I couldn't get back to sleep. I went home at 8:30am and slept for 2 hours before I had to be back at the hospital for noon teaching conference. By then I felt like a train wreck but the conferences are mandatory-even if we have been up all night. I came home at 2pm and slept another 1 1/2 hours and then got up. I felt a lot better after my 3 mile walk. I haven't walked since Sunday and I really missed it so I was glad to get to do that today. Hung out with my boyfriend tonight and now I'm going to bed early.

In all it wasn't a bad night. I'm starting to feel better about all this. What I'm really glad about is that I stayed calm during that whole ICU incident. I didn't even have to think about staying calm, I just was calm on my own.

I'm starting to think things won't be so bad after all. It's not like I'm the first person to ever be an intern. Everyone else gets through it, so will I. I talked to some of the other guys I'm with and they admitted to kinda feeling freaked out last week like I was.

Our program director took Julie and me around the hospital so we could get a taste for how each floor is organized. We met some of the nurses and they all seemed really nice. They were also pretty excited to have 2 female residents this year, since it's been 3 years since they have had any. That really made me feel good.

I met one of the docs I'll be rotating with. I asked him what time and where he would like to meet Monday morning. He actually asked me if 7:30am was too early for me. Too early? Hell no! Not when most interns have to be at the hospital at 6am! I think I'm gonna like him....

>: (

Today I got a glimpse of what my life is going to be like for awhile....and I hated it. I really don't know what to do. I can't quit because I'm in too much debt, but I really really REALLY do not want to start my residency. I don't know what is wrong with me. Today at orientation it was nothing but 8 continuous hours of "do this, do that", none of which I know how to do. It was so overwhelming that I just wanted to leave screaming. The only good thing that came out of today (and I use the term "good" loosely) is that I got assigned to the internal medicine team for my first month, which means I am responsible for running codes every other day. Why am I glad about that? Insanity, maybe? No, actually, it will get me comfortable with running codes much faster. I'll also get better at writing up admit orders, history and physicals, and discharge orders. I also found out I get every weekend this month off, unless I'm on call. The part that really made me mad though is that I'm on 24 hour call on July 4th. I love July 4th. This year I'm going to hate it. At least now I can say that I've worked an official holiday and that is it for me for the year (there are 6 holidays and 8 residents). I think that's only fair.

But in all, today really sucked. I don't want to be a doctor anymore. When we were finally freed today from orientation, the first thing I did when I got in my car was start crying. It's been off and on ever since. I picked up my diploma today from the framing store and I wanted nothing more than to fling it across the room and let it shatter into pieces. I don't think the other interns feel like this. They all seemed hideously perky and chipper today.

And I get to go back for more tomorrow.....

My last day of vacation : (

Today was my last day of freedom for a really long time. I've had 12 weeks off and have developed some pretty lazy habits. Staying up late watching The Tonight Show, Seinfeld, and Craig Ferguson, sleeping until 11am, gradually starting my day, eating breakfast at noon at Mimi's Restaurant with my boyfriend, playing online...you get the idea. Well that all ends tomorrow. I have 3 days of orientation then BAM!, my first call night I will be guaranteed to be running at least 1 or 2 codes. What have I gotten myself into?? I really hope I don't seriously hurt somebody.

One of my buddies asked me today what kind of shoes I wear to the hospital. The black ones are Clarks and the khaki ones are Merrells. I like both of them. The Clarks squeak when I walk but the Merrells are a little too tight with my Thorlo running socks. Pick your poison. Squeaky or tight. The main thought is that they both slip on and require no shoelaces.

Well I think I'll go sit on my porch and lament the end of my freedom some more.

The nightmare is already beginning.

Today I had to go up to the hospital for ACLS recertification. What's that? It's the standardized protocol of algorithms that the American Heart Association uses to treat patients in some sort of life threatening cardiac distress. I've already done it once, but it's easy to forget when you've never had to respond to (or run) a code. So today I'm there with all my new residency buddies.There are 13 of us vrs. the normal 100+ because our intern year happens to be at a private hospital (there are 8 anesthesia residents and 5 family practice interns). There were about 80 nurses at the training. The first thing the instructor tells us is that the nurses get to "tag team" for the practical exam tomorrow, but the anesthesia residents have to to it alone because we will be the ones running the codes at night for the entire hospital (except the emergency department). I'm not so much worried about the exam as I am at the thought of being the only doctor at 3am when something goes wrong (and hoping I'm not the cause of it!). Hearing that was enough to make me wish I'd never gone to medical school. Guess I better go start reviewing the algorithms..

One weird thing. I paid for my lunch in the cafeteria today. All my new colleagues went to the doctor's cafeteria and got free food. "We get free food?" I asked. "well yes, I mean, we're doctors now, right" Adam said. "I thought that wasn't until next week", I replied.