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.