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!