My month in a netshell

1. Went to NYC for an anesthesia conference
2. came back and had no power for 5 days due to Ice Storm 2007
3. came back sick with a cold that I am STILL recovering from
4. Had an altercation with a male attending who shoved me in the OR. It's turned into a big mess and now I (yes, ME!) have to apologize in order to save face and not make it difficult to get a job in 2 years (even though I did nothing wrong!)
5. Lost my voice for 2 days while I was sick. No fun talking to patients with no voice
6. went to dad's for Christmas celebration
7. had another Christmas celebration at my house
8. got drunk and danced at at fellow residents' Christmas party
9. looking forward to the college football bowl games
10. dreading next month working in the trauma ICU where I'll get to work 100 hours a week!
11. I'm not kidding about the 100 hours-thing
12. being jealous of Pastor's Bride who gets to go to Israel while I'm working 100 hours a week
13. Not being jealous of Pink who keeps taking trips to Iowa

Crazy week

Late last week I went to NYC for an anesthesia conference. I had a great time but I'll save that story for another time. I came home and found that my power was out due to Big Ice Storm 2007. My house was so cold that you could see my breath. Yikes. I shacked up at my friend Julie's until Friday when it came back on. Friday! 5 days without any electricity! My poor kitties survivied it though. None of the food in my fridge did. And my yard was a mess of branches that had broken off from the weight of the ice.

It's just been a crazy week. I came home from the conference with a bad cold, and as soon as I got back, it's back to the daily grind of 13 hour days at work, then I was on call until 7am this morning. I'm worn out. One day was particularly bad. I think it was Thursday. I developed a migraine and it just went on and on forever. I was at work and could not leave. (doctors don't get sick). I felt so nauseated that I had to put an alcohol swab inside my surgery mask. (little known fact that sniffing alcohol helps with nausea.I learned this from one of our nurses). I finally got off work that night at 7:30.

I surprised myself. I always wondered what would happen when I got a migraine at work and couldn't leave. I survived.

Well the Dog Silencer appears to be working like a charm. The dogs absolutely will not bark anywhere near my house. Even when a random cat walks by, they won't bark at it. They do, however, bark when they get out of range which makes me think I should buy another one for the back of my yard. It wouldn't be so bad, except those two dogs start barking at two other dogs nearby and between the 4 of them, it gets really loud! Especially at 2am.

So, tomorrow I am traveling to an anesthesia conference in NYC. I'm actually staying in Newark and will take a train to NYC everyday, due to the cost of all the hotels in NYC being $500 a night. Tonight I've been trying to devise a plan of travel from my hotel to Times Square. I'm confused. My hotel is adjacent to Penn Station which has two different trains, a bus, and a subway. They all go to NYC. Why are there 3 different rail systems? Which one should I take? Where will I end up? How late do they run?

Sigh. God help me. Anyone out there who knows me, knows I am going to get hopelessly lost. All by myself.

And don't even get me started on the NYC subway system. I pulled up a map of that tonight and thought I was reading some ancient hierogyphics. Why can't they all be like the D.C. rail system? That was easy to figure out!

Life is weird. I am really, really good at a lot of things. But the things I'm not good at-I'm horrible at.

Well, at least my hotel has a Starbucks. Coffee makes everything better.

Woof!

I have a problem. His name is Bentley. He is my neighbor's new dog and he barks ALL THE TIME! I can't even go into how much sleep I have lost over that dog barking right outside my bedroom window at all hours of the day and night. Talking to the neighbors about it only helped marginally. I mean, come ON! Would you want your anesthesiologist to be sleep deprived?

One night last week I absolutely had enough. I tucked a benedryl into a piece of cheese and gave it to the dog. I felt a little guilty, especially when I didn't see the dog for a few days. Benedryl is harmless, but what if he had some weird reaction? Well, he didn't. He woke me up one morning when I was post-call. He's fine.

Since I really don't want to resort to drugging the neighbor's dog everytime I want to get some sleep, I bought a new gadget called the Dog Silencer Pro. It's kind of like a dog whistle that goes off everytime the dog barks. I got it tonight and I am cautiously excited. While I was setting it up, the dog freaked out and started barking at me. The gadget sent it's ultrasonic noise (people can't hear it) to the dog and the dog actually quit barking! Could it be? Oh if only it's true!

Sleep, here I come!!

On call yesterday. Highlights of my day include:

1. providing anesthesia for a skinhead who's chest said, "In God's grace is the white race", and, "skin head" across his shaved eyebrows. He was also covered in swastikas. He killed 3 people and was being guarded closely. You know the guy is a bad dude when the sheriff actually puts on scrubs and escorts him to the OR with us and stays until he is asleep. I was glad when we finally put him to sleep, I was tired of listening to him talk. In the holding area, he kept asking me where he can find a bone saw like the ones orthopedist's use because he thinks it would be "fun to cut people up". He also likes to dine on fried blood, so he said.

2. Gang-banger trauma: My next case was a gangbanger who got shot. We spent $100,000 worth of blood products (120 units of blood) alone trying to save a man who is going to die in the next day or so no matter what we do. He was apparently wanted by the fugative task force for murder, and they called us last night wanting to know if they should take him off the list. Not yet, but probably soon.

Of course, as I'm finding out, the only people who ever die are nice people. It's hard to kill a drug addict or a gang banger.

I drove home this morning wondering if I really did society a favor in the last 24 hours. My job is so depressing.

Thanksgiving Harvest

I survived being on call on Thanksgiving. We actually were not very busy so I got to get some work done and watched football most of the day. Around 10pm we got called to do an "organ harvest". Somebody who has been pronounced brain dead and their family wishes to donate their organs. In this case, it was a teenager killed in a drunk driving accident. They took his heart, kidneys, pancreas, and liver. Organ harvests are strange. The person is legally dead, but they are on a ventilator so their body is still alive. It's actually easy from an anesthesia standpoint. There's really not much for me to do. I just have to watch his blood pressure and give some heparin when the surgeon says to. During the whole case, his chest was open and you could see his healthy heart pounding away. I could have reached out and touched it. After they clamped the aorta, the alarms on my monitors went nuts. His heart went into irregular rhythms, then asystole. My job was officially over and I turned off the ventilator and the monitors. I peeked over the curtain and they had poured ice all in his chest to cool the heart (a cold heart needs less oxygen). About 10 minutes later, it was put in this ice chest. An ambulance arrived to take the surgeon and the heart to the airport where he boarded a private plane to go out of state to perform the transplant. He has 4 hours from the time the heart comes out of the donor until it must be in the recipient, and the surgeon who performs the organ harvest comes from the recipient's hospital. That means, whoever is getting the heart is already in surgery and has his chest open and ready for the transplant when the heart gets to the hospital. Our surgeons are not involved at all. The other organs have a lot more time before they have to be transplanted, but they cannot be harvested unless there is a recipient ready and waiting. A lot of paperwork takes place before the harvest can be started.

My guess is, 5 people had a very happy Thanksgiving.

Not-so-glamorous-life

Anyone out there who thinks residency is glamorous like it is on Grey's Anatomy should think about this: I have to work two 24 hour shifts this Thanksgiving break. One on Thanksgiving and then again on Saturday. But wait! No fair! I've already worked 44 hours over the last 3 days! Oh... I'm a resident. I forgot. No family, friends, or yummy food for me. Instead, I get to hang out for 24 hours tomorrow eating a greasy cafeteria burger while all my loved ones get to eat tasty turkey and nap on the couch.

Sigh. Tell me again why I'm doing all this?

Another sigh. And Hillary and John think doctors make too much money. I'd be willing to bet THEY are spending Thanksgiving with loved ones.

Oops. I got political. I get a little edgy when I'm tired. ; )

On an interesting note, I had to provide Malignant Hyperthermia anesthesia precautions today for a man who that condition runs in his family. A very rare disorder. I'll probably never have to do that again for the rest of my career.

over-the-top embarrassing moments

1. yesterday: I'd been at work for about an hour when one of the nurses informed me that I had a big tear in the back of my scrubs and you could see my underwear.

2. Today: I was living life on the edge and took two Tylenol at the same time to treat a headache. One of the pills promptly got lodged in my throat. I started choking and eventutally couldn't breathe. One of my attendings had to perform the Heimlich maneuver on me. It worked, as evidenced by my being able to write this blog. It scared me so bad I started crying afterwards. Too bad the doc is married. That would be a great "how we got together" story.

See Robyn? This is another reason you should go to medical school. There's always a doctor around to save your life if you ever need it.

Nobody puts Baby in a corner!

I found out today that this year is the 20th anniversary of Dirty Dancing. Somebody please tell me how this happened! How did I become old enough to celebrate this momentous occasion! Pink? Michelle? Robyn?

You guys are right here with me you know...

This one is for Robyn

I had this patient today who sufferred some pretty bad injuries to her face this weekend. She had a rather angular face, but who am I to judge? Her face was bruised and swollen so I have no clue what she normally looks like. My attending kept accidentally referring to her as "he". I was embarrassed for him and he kept doing it, but to the patient's annoyance. So me, being the clueless person I am, am getting ready to intubate her. We have her on the table, I'm giving oxygen, my attending is putting meds in the IV. What to do you suppose tipped me off that this was really a dude I was dealing with? Was it his very large Adam's apple? Was it his stubbly face and square jaw? Or how about his deep voice? No! What tipped me off that this was really a guy, was that when I looked down his airway, I realized I would have to use a Mac 4 blade to get the tube down. I only use Mac 4's on dudes! That's what tipped me off! It is official. The only way I can tell apart men and women is by direct largyngoscopy to see what size blade would reach the eppiglottis.

It's official. I'm am now what you'd call in the truest sense, a Nerd.

Another example of people who dish it out but can't take it

Remember my last post about the mean bossy scrub tech who couldn't handle people giving some back to her? I've got another example. I was on call (for the 4th time in 9 days) last night when a gunshot wound guy came in. He was a skinhead who was getting drunk with his buddy when he accidently got shot right above his jewels. The bullet wound wasn't really all that serious. His friend missed all the important stuff, but he had to go to the OR for a "rectal exploration" to make sure he didn't damage any of his large intestine as well as irrigation of the wound itself. In the OR, the guy was really freaking out. Yes, this guy who spends his life scaring people and intimidating people with his "white power" BS was crying like a big baby right before we put him to sleep. Kinda makes you realize who the true cowards are in this world we live in.

Quiet Saturday

Don't ever say the "Q Word" when you are on call. It's a jinx. Q is for quiet. The minute you say it's quiet, it gets busy. Now, I'm not a superstitious person, but I'm not going to chance things, either. Plainly put, I had one of the best Saturdays on call ever. I only had 2 cases the whole 24 hours. One at 7am and one at 11pm.

My first case was kind of funny. It was a tracheostomy on a guy who has been intubated for awhile. I think I've mentioned before about fights breaking out between staff during the surgery. Well yesterday yielded a pretty good one. The scrub tech was being bossy to everyone. Yes, the scrub tech. The least educated person in the OR thought she was somehow the most powerful person in there. She was hateful to me, bossy to the nurse, and just generally being a pain in the ass. Finally, the surgeon had enough and told her that he really didn't need her in the case and could do her job for her just fine if she wanted to leave. She left, and we enjoyed the rest of the case. Of course, now the scrub tech is saying that we were all mean to her. Funny how there are people out there who can dish it out but can't take it when it's given back to them.

My other case was an extremely intoxicated fellow wrecked his motorcycle when he tried to drive it with the front wheels locked. He was nice to me, but being very mean to the recovery nurse, yelling at her a bunch. He sounded like a monster the way he was growling at her and carrying on. I finally had enough and told him he needs to be nice to the person who is giving him the pain medicine. He slept the rest of the night. Yes, I know it's mean to threaten to withhold pain meds in exchange for civil behavior, but in this case I felt it was appropriate.

They're Magically Delicious!

I have fallen in love with the new Chocolate Lucky Charms. I tried some generic ones at a friend's house last week and thought I had died and gone to Heaven. I don't think in my 36 years I have ever bought kid cereals, but yesterday I sought out and found Chocolate Lucky Charms. Imagine, those tasty marshmallows from childhood combined with the chocolately goodness of Count Chocula! It's sheer pleasure in a box! I figured while I'm at it, I might as well get some Fruit Loops, too. I always thought those cereals were awful breakfast food but you know what? They are less calories per serving than my Grown-Up Cereal. Plus, kids cereals are much tastier and may motivate me to get out of bed early enough to actually eat breakfast. Could it happen? Naw, but it's a nice thought.

Well so not many blog worthy things have been going on, really. After my wild vaca, everything else is just...boring. Today was my 12th day in a row to work. That's not really that much compared to some people, but I'm happy to have the weekend off to catch up on sleep (seeing as how I did not do that on my vaca).

So today in a big case, the scrub tech had an asthma attack. She was in her sterile gown and couldn't touch anything, so I got the inhaler that automatically comes with my drug tray and gave her some puffs of albuterol-all without touching anything but her mask and her mouth. Asthma attacks are nothing to mess around with. Many a asthmatic has died because they waited too long before they got help. I had a patient (who smokes) just last week go into bronchospasm in the middle of the case. I couldn't get her to oxygenate through her breathing tube and her lung pressures were way high. Scared me to death. Got through it, though. Long term smokers don't do too well with surgery.

So one of our interns has a 6 month old baby that was fine and dandy until a month ago when the baby suddenly collapsed and quit breathing. She and her husband (both doctors) resuscitated the baby at home and got her to the hospital. She survived but has a very bad congenital heart problem that no one knew about. Her only chance is a heart transplant. They have decided to forego surgery and bring her home on hospice. I was thinking today what a brave decision that was for them. I know it was really difficult and I hope they don't question their decision 10 years from now, wondering, "if only we had..." They saved their baby a lot of suffering in exchange for their own.

What happens in Dallas, stays in Dallas: My Vaca, part 2

I hadn't really intended on going to Dallas for the annual Red River Rivalry, but I have a group of friends that go every year, and at the last minute, talked me into going. "If you don't go, you're just going to stay home and feel sorry for yourself, wishing you had come with us," Julie told me. So I went.

Started of the day at Humperdink's for drinks and a big pep rally. Ran into a couple who the ex-boyfriend and I used to have dinner with regularly. As soon as we broke up, they dropped me. And as I would expect, I got an icy reception from the female. I have no idea why. I'll say one thing: you find out who your true friends are after a break-up.

Around 7pm, the party migrated to a strip bar next door to our hotel. A nice strip bar. Here's where things got strange. Two of the girls with us started making out with each other in front of their husbands. Then they started doing other things. Pretty soon, the crowd around our table was bigger than the crowd watching the real strippers. That's all I'm going to say about that. The girls ended up getting kicked out of the club after going to the ladies' room together. The rest of us went for pancakes. Julie and I managed to stay heterosexual throughout the evening. The funny thing is, as wild as our night was, we are all in our late 30's and were in bed by midnight. Of course, when you start partying at 2pm, midnight is a bit late.

I ended up having somewhat of an interesting weekend of my own, which I won't get into here. I just hope I don't live to regret some of the things I did. I did get to spend some unexpected time with a very special friend.

Oh yeah, and our team won. Seems sorta anti-climactic after all the things that went on. We all made it home alive and well. I was told this was the wildest Red River Rivalry Weekend they have ever had. I'm certainly glad I didn't miss out!

funny 1920's art deco train station in Baltimore. (I got to ride a train for the first time ever!)





One of my all time favorite paintings




Pink and Holiday

My Vaca, part 1

Did ya'll think I fell of the earth?

I had 10 days off. I took two trips. In 10 days, I was home 1 day. I started back to work this morning, exhausted and badly needing another vaca to catch up on sleep.

Trip #1: I surprise visited my friend, Pink, who lives in Washington, D.C. Being the shrewd, sneaky person that I am, I constructed a secret vaca to D.C. and crashed Pink's birthday party. Only her husband knew of the plan....and it worked, but barely. Pink is a shrewd, sneaky person herself, and suspected something was up, but fortunately, her parents showed up first, so she thought they were the surprise. When I showed up at her door during the party, she was speechless and teared up. Mission Completed.

We had a great time and I got to see a lot of stuff I missed back in June. ie..Spy Museum (I'm going to quit medicine and become a spy now), Holocaust Museum, and The Phillips Collection. I braved the metro by myself and managed to not get lost in D.C. while looking for these various sites. The Phillips Collection was neat because I saw some of the collection in 6th grade when it went on special tour throughout the U.S. and our class took a field trip to see it. That's when I saw a real Renoir for the first time. It was really neat getting to see my favorite painting again after 25 years.

Oh yeah, and I got to eat some great food, met a bunch of her friends, had long talks, and spent time with the sick doggie who has hemangiosarcoma.

AMATEUR TRANSPLANTS: Anaesthetists Hymn LIVE

While you were sleeping....

Last night was the worst call Ever! (or maybe it was the best call ever because I learned a lot about myself and how I handle bad situations). I finished up a 16 hour elective case at 11pm. Meanwhile the traumas just kept rolling in.

I was in the OR constantly for nearly 24 hours. I have chafe marks on my face from where my mask rubbed me. Ouchies!

a brief summary of the highlights:

Some lunatic attorney who robbed a pharmacy for narcotics last week tried to kill himself in jail and was brought to our hospital for treatment. While at our hospital yesterday, he managed to elude his guard and baracade himself inside his room, break the window, and stand on the ledge of the 5th floor for 4 hours (entertaining the media) before he finally did a swan dive off the ledge. Little did he realize he would land on the roof of the 3rd floor, thus making his dive a critical injury rather than a deadly one. We got to add him to our endless list of traumas that came to the OR last night. He was definitely the most interesting one.

I cut my finger on a contaminated knife I had just used to put in a central line on a patient. It's a more high risk cut (more blood involved) than a needle-stick, but thankfully, my patient was a 74 year old lady with ovarian cancer, and not some gang-banger drug addict who probably has hepatitis C. I still can't donate blood for a year, though. I can't believe I did that. There is a small silver lining to this: going to employee health to fill out the paperwork and get blood drawn was the only break I got yesterday.

One case I had was a guy who ruptured his spleen in a car accident. He was white as a ghost but his blood pressure was holding through our OR prep and putting him to sleep. As soon as they opened him up, his blood pressure dropped to 50 and his heart rate went up to 160. I was by myself and about had a litter of kittens right then and there I was so scared. I pushed a bunch of blood into him quickly and he did okay. I snowed him with narcotics before I woke him up so he wouldn't hurt. (hurting sucks!) Good thing I did. I snowed him so hard he didn't wake up for me, but in recovery, when he did wake up, he went apeshit and tried to attack the nurses helping him and had to be tied down.

Oh the things that happen during the night while sane people are fast asleep!

Weird things people have said to me this week

1. Wow, you have great scalenes!
2. Do you wanna see my testicles?
3. My surgery is over and you never gave me a kiss! I want my kiss!
4. Look at your juicy jugular vein!
5. I'm still waiting for my kiss!
6. It's okay if you knock out my loose tooth, it's gotta come out sometime.
7. Katy, do you mind coming over here and tying up the surgeon?


#2 was a scary guy that I was working up for a pre-op evaluation. He was a total pimp-daddy trying to hit on me. He was real inappropriate and actually put his hands on me. I should have reported it, but I was tired, it was late, and I wanted nothing more than to leave his room because I was afraid of him.

I learned today that my neck anatomy on ultrasound is incredibly clear.....the best the ultrasound tech has ever seen, and now she wants to use me as a model when she gives demonstrations.

She also informed me I have a thyroid nodule. Blah!

I'm tired. I was on call yesterday and had a busy night. My hospital OR has turned into an elective procedure OR 24 hours a day. We're also supposed to be a level 1 trauma center, but it's kind of hard to fulfill that responsibility when all the staff is too busy doing elective cases. It kind of makes me mad and I've been a little vocal about it. Elective cases are for Monday through Friday during the day. Period. Nighttime is for sleeping and traumas.

Last night was really busy for me. In July, I made up my mind to make sure I worked harder than everybody else. I volunteer for the cases, if someone else is up all night, I'm up with them. I just don't want to be known as a slacker. No need to worry. The other resident in my class that I worked with came in hungover and made it clear all he wanted to do was sit on his ass all day, so I spent all morning in a long spinal fusion case, while he volunteered for easy cases. Then I had a trauma come in. A drunk guy who was "just minding his own business" when someone slashed his throat. Pretty weird. His thyroid gland was hanging out of his neck. The big trauma came at 10pm. A lady came in with 3 broken bones in her legs. When she got to the holding area, she was really hurting, crying, and scared. I felt so bad for her, I gave her a big slug of fentanyl (I usually don't do that until they actually get to the OR). Considering her injury, I didn't think it would touch her pain, but she told me I gave her better pain relief than she'd been given all night in the ER. She was really scared and asked me not to leave her during the surgery. I just wanted to hug her and tell her everything would be okay. Her surgery went on all night. The hungover resident told me would we "tag team" her case with me, but he went to bed and left me high and dry. It was the upper level resident who got up in the middle of the night to relieve me, but I stayed until the case was over. I hate to not finish what I started. Upper level resident commented to me about how hard I work. : )

This resident is actually really nice. My call room linens hadn't been changed, and he went to the linen storage and helped me change my bedsheets. I was blown away by the kindness of that at 5am when I know he was really tired. Hungover Resident would not have done that.

On call again tomorrow. God, will this ever end? Can I physically do this for 3 more years?

Me: Average Joe

So I FINALLY got the results of my anesthesia practice boards exam that I have to take every July. It's the same exam given to become board certified, but we are given the test as residents to gauge how we are doing each year. Unfortunately, our department has big aspirations and requires the residents to score in the national 50th percentile. If you don't, you are not allowed to "moonlight" (ie...make LOTS of extra money by working on the weekends as a general practitioner- usually in a rural ER, botox clinic, or quick-care clinic). And if you do REALLY bad you are placed on departmental probation and could get terminanted if you score poorly a second time. Anyway, we got our scores today in our 6:30am conference. I managed to barely scrape by. Any other year, I would look like a total superstar by scoring in the 53rd percentile (which is good, right? It means I did better than 53% of the first year anesthesia residents in the entire country!), but not in my class. The year I applied to residency programs, anesthesia was competitive, so I'm in a class full of smarty-pants overacheivers. How I got mixed in with these brainiacs is beyond me. Almost everyone did better than I. One person did worse and I tied with another person.

Ah well. At least I'm not lamenting that I came in last. I think I'll keep quiet at work-don't want to hurt anyone's feelings.

Current Events

Despite working 13 hour days, I have managed to keep up with this week's top stories...

1. Britney Spears may have put a "hit" out on Kevin Federline. It's a sad day when Fed-ex starts to look like a responsible parent.
2. Iran's President wants to visit the World Trade Center site. Uh..Why? To gloat, perhaps?
3. OJ's in trouble....again. Maybe this time he'll have a smart jury.
4. Some nursing mother who attends Harvard Medical School sued for extra breastfeeding time during her USMLE. Denied. Sorry. You don't deserve special treatment. Residency sure won't give it to you, so why don't you start acting like a grown up and quit whining. (note to all: I am pro-breastfeeding. Anywhere. Anytime. But you don't deserve special priviledges not available to the rest of us.
5. Hillary announced her plans for HillaryCare 2.0. No thanks. Keep the government out of my doctor visits.
6. My football team is doing awesome this year and may go all the way.
7. Barry Manilow won't appear on The View unless Elizabeth is absent from the set that day. Typical. First Amendment rights don't apply to people with conservative views. Who watches The View, anyway?
8. I found out tonight from a magazine that Carmen Elektra is now a lesbian.


That's all I can think of.

What's grosser than gross?

This afternoon I took full advantage of my post call day by going to Barnes and Noble for some much needed studying. While there, I visited the ladies room. While washing my hands another lady came in. She was talking quietly. At first I thought she was talking to herself. The more she talked, I started to realize she was talking on her cell phone. OK whatever, kinda weird but surely she'll get off the phone in a second. The lady went into the stall and started doing her business, and WAS STILL ON THE PHONE! OMG!

I really cannot believe that there are people out there who think that is even remotely okay.

Ok so maybe you're wondering why I posted that random video. Well, it just reminded me so much of medical school. Just watching it gave me a mild case of PTSD. It doesn't really matter what medical school you attend, the drill is the same: you study ALL the freakin' time, and it isn't pleasant. In fact, I think my first year of medical school was one of the most miserable times of my life. This year is a close second.

So now I'm in the full swing of things. I'm either on call, post call, or pre-call. All the other days I pretty much work 12-13 hours a day. Last night I worked until 7pm. I'm really trying not to complain. I chose this. It's just by the time the weekend comes around (if I'm off) I don't want to see anyone, talk to anyone, or do anything other than stay home. I'm worried this is really depression and not work related. I guess time will tell.

Yesterday, I got to work with one of my least favorite attendings. He's a really nice guy, very personable and all, but he is really freaky in the OR. I'm pretty sure he's OCD and needs to be on medication. Just being around him in the OR makes me nervous. Our day was going reasonably well (other than the fact that he completely paralyzed one of my "asleep" patients right before the case was over. GRRRR! He's done that to me 3 times in a week! I think I'm going to have to start hiding the Nimbex when I go on break).

OK anyway, our day was going reasonable well until he freaked out when my patient moved a little while the surgery resident was finishing his skin sutures. I always start bringing the patient down off the anesthetic during suturing. Otherwise, everyone is going to be standing around waiting 20-30 minutes after the case is over for the patient to wake up. That's not good form. It slows down the surgery schedule and makes me look bad. I've never had a patient start to wake up during sutures before until yesterday. Honestly, it was no big deal. People get sutures in the ER all the time totally awake. My attending however, freaked out. Personally, I think the patient was a bit tolerant to our anesthetics because he's a big-time drinker, but anyway, my attending was quite pissed at me. So be it. He will always find something.

One cool thing happened to me early in the day. A guy I kind of like sat by me at our 6:30am anesthesia meeting!

StudyBack

Me, today, in the OR talking to one of my classmates who is now a urology resident

Him: making snide comments about how easy anesthesia is and how hard urology is
Me: How is your arm feeling today?
Him: Huh?
Me: Your arm, how is it today? Does it still hurt?
Him: What do you mean?
Me: Well, it must be hurting because somebody must have twisted your arm pretty hard to make you go into urology.
Him: silent
Everyone else in the room: HaHaaa!!! She told you, didn't she?

Snarky Me

I was on trauma call last night and was up all night helping out in a big heart case that came in. I was just counting the hours until 7am when the fresh call people came in and relieved me and the other resident. Around 6:30am, the perfusionist asked one of the nurses if she wouldn't mind going and getting her a Mountain Dew. Not a selfish request since the perfusionist can't leave the room and she had been in there since 10pm and was dead tired and thirsty. The nurse refused. She asked another nurse. Again, refused. That really made me mad, so when I got free, I went down and bought her a Mountain Dew. The case was not going well and she was probably going to be in there another 4 or 5 hours. I mean, show some mercy people! It's not like the nurses were even busy. They were all just sitting there.

Oddly enough, I lost my giving spirit an hour later. All night long I'd been thinking I'd go to Panera Bread and get a mini souffle for breakfast. I got there and realized I'd left my wallet in my locker at work. Had to drive all the way back to the hospital, park in an unauthorized spot (because the resident lot is 1/2 mile away and I'm too tired to walk that far), go back inside, get my wallet, walk back to my car and drive back to Panera Bread. By then I'm cranky because I've wasted an hour. I got inside, stood in line, and watched with disbelief as the guy in front of me bought the last souffle. I was furious! I wanted to really hurt that guy. Funny what sleep deprivation does to you.

When I got home (sans souffle), some friends had called and had an extra ticket for me to go to a big football game with them. They were on their way to pick me up as soon as I called them back. Any other time I would have jumped at that, but I was completely wiped out. Don't you hate it when you want to do something so bad, but you know you are just too tired? That's how I felt. I was so torn, but seeing as how I had homicidal thoughts toward the guy that bought the last souffle, I thought it best not to surround myself with 85,000 drunk, screaming people at a football game. That was my public service duty of the day.

Who is this?

I posted this for Robyn and Pink. If I didn't know any better, I would think this was someone else. Do you like the hat?

Hey, at least my patient is still alive, as evidenced by the monitor behind me!

Move over, Angelina!

I recently learned that I work with Brad Pitt's Aunt.

Hmmmm......

Does anyone wonder what would happen if you suddenly became sick? As in really sick? I do. If I came down with a chronic illness, I really don't know how I would deal with it or how I would pay my bills. I've always thought I'm too young to get anything really bad, but truthfully, I'm not. One of my oboe friends who can't be any older than me, just emailed me and has spent the summer recovering from surgery. We went to go see "Wicked" together in June. That night she kept complaining that her stomach was growling nonstop. I just thought she ate something bad and didn't think anything else of it. Well, it got worse and she finally went to her doctor and was found to be severely anemic. Nothing showed up on a CT scan of her abdomen (anemia in someone over 40 is colon cancer until proven otherwise). A few days later, she became really ill, went to the hospital, was rushed to the OR where they found she had colon cancer that had spread to some lymph nodes. She's spent her whole summer recovering and trying to deal with chemotherapy. The whole thing just sucks. I don't know what else to say about it. She's really lucky she has a good job and mostly likely good benefits, but missing work that much has got to be a financial strain. But in the end, I hope she is concentrating more on getting better rather than worrying about money.

This has me freaked out. I've never really thought about how I would handle a life threatening illness. I cannot afford to get sick. In residency, there is no such thing as sick. If you are breathing, then you better be at work. Funny how the medical community that cares so much about healing people tends to have the opposite opinion toward their own. I like to joke around about how "nurses eat their young", but in reality doctors do it much worse. This is a good cue for me to quit smoking. Again. For good.

I don't know why I'm blogging about this, but I keep thinking about it so it must be important. This year, I've tried hard to have a nice, fun demeaner in the OR. I insist everyone call me by my first name. It just makes the whole day go smooth when everyone is chatty and happy. It's easier to do this when it's just residents and nurses in the room, no stern surgery attendings who must have total silence in order to work. However, in doing this, maybe people forget I'm a doctor and get a little disrespectful around me. I think being a female doctor is hard. You are either not assertive enough or you are labeled a bitch. Last year I was repeatedly told in my evaluations from nurses that I was not assertive enough.

So yesterday, I was helping the other resident assigned to a case bring the patient from the ICU to the OR. He was intubated so I ventilated him during the trip. A young nurse was also with us. She was crabby and slow. It makes no difference to her whether or not the case starts on time because she is a shift worker, but the rest of us are under the gun because we don't get to go home until all the cases are done. She was already short with me because I had warned her to watch out for the patient's foot that was hanging off the bed because I didn't want it to get hit or smushed when we wheeled his bed through the doorway. Once in the room, I'm busy trying to get all his monitors situated and then I started pushing drugs through his IV to get him to sleep so the case could start. In the middle of this, the young, crabby nurse hits me in the arm and says, "Hey!" and points to some cords on the floor. One of the surgical residents saw all this and turned to her and said, "THAT, is Dr. (insert my last name)! "Oh." was all the nurse said.

I guess it made me feel good to get back up from a surgery resident. Anesthesia has such a strange symbiotic/adversarial relationship with surgery, so it's nice to be liked.

Another weird nursing event. I was in a big gynocology-oncology case in which a woman had a humongoid tumor in her belly. It looked like she was pregnant with triplets. The tumor contained 22 liters of black, stinky fluid (that's 44 pounds of fluid!) which gushed out really fast when they opened up the tumor. Anyway, with all that fluid loss, the patient starts to drop her blood pressure so we order blood. The nurses start squabbling over who's job it is to check the blood and make sure it's the right blood for the patient. I'm usually one of the people that do that, because if I'm the one giving it, I'm going to check it. One of the nurses said anesthesia doesn't do that. This caused an arguement between the nurses, then somehow the scrub tech got involved and pretty soon they were all screaming at each other at the top of their lungs. I'm just sitting back behind the curtain thinking to myself, "these people are all nucking futs!". By the end of the fight, they were arguing about something totally different than blood. Keep in mind that during the entire fight, there are 3 surgeons hard at work on this patient. It was surreal. I've never seen anything like it.

The lady survived. She doesn't have cancer.

Every Friday morning we have an anesthesia conference at 6:30am, which means I have to get to the hospital at 5:45 am to set up my room for the day. This morning, our conference was all about sleep deprivation. Imagine, a sleep deprivation meeting at 6:30! Does anyone else see the irony in that?

At any rate, we had to take this "Are You Sleep Deprived?" quiz and I flunked it. I'm sleep deprived. The funny thing is, I would have failed the quiz even if I got 10 hours of sleep/night, so I don't think residency has changed much.

Miller or Mac?

So this month I've been trying to get better at intubating patients with the Miller blade. The Miller blade is this straight blade and the Macintosh is the curved blade. To me, the curvy blade fits in the mouth better. You have to put it all the way down the patient's throat until you get to their epiglottis (you know, the little valve that keeps food from going into your lungs). Anyway,so with most people you can use either blade, but some people have way too much tissue in the back of their throat or the epiglottis is really big and floppy,then you have to use a Miller. The Miller is a challenge. It's like the bad boy in high school that you couldn't resist dating because you knew you could make him fall in love with you, even though he's had a long line of girlfriends.

There's this whole attitude about laryngoscope blades in anesthesia: The Macintosh is for beginners and the Miller is for the pros. I don't really buy into all that because some of our most seasoned anesthesiologists use the Mac, but still, I'd like to get to a point where in an emergency, I could use any blade someone handed me to intubate. I've had a bunch of failed intubations trying to use the Miller, but today, I got all of them. They were easier airways to intubate, but at least that's a start.

So I put this young guy to sleep today who was absolutely scared to death. Tatoos all over his body, and yet he is freaked out about having surgery. Much to his surprise, he didn't remember anything about the surgery and couldn't believe the surgery was over when I woke him up. Before the surgery, I promised him it would be that way, but I could tell he didn't believe me. Ha! I love being right.

A weekend to remember...

Holy Cow, I know I drank too much tonight. I just got back from a party hosted by one of our anesthesiologists where I .....kareoke'd! Yes, me. Shy me. I got up in front of people and sang. Of course, this was after being given several shots by another resident. I think I sang "Maragaritaville". How appropriate. Thank God I only live 7 blocks away from this party. It's a wonder I can type. I think there may have been photos taken. Great.

What else happened?

Had an interesting day Friday with Dr. Macho Yeller. Fortunately he stayed out of my room all day because he had a crisis in another O.R. By the time he was able to devote me any attention whatsoever, I had my patient breathing on her own and about to wake up. He did tell me "between you and me" that I need to have a more "bring it on!" attitude toward my cases and not be so nervous. Noted. From now on, I'll just endanger my patients and act like I know more than I really do.

Postcall: I drove to Tulsa yesterday afternoon to visit a friend from college. I had a weird feeing about the trip, like I might die or something on the way. Well, it just so happens that a severe thunderstorm hit right when I was leaving and it following me all the way to Tulsa. I was a nervous wreck by the time I got there. We went to Cherokee Indian Casino that night. I'd never been to an indian casino before. Interesting. We had an awesome dinner there, then went to the club to hear one of their friends play in his band. We had a good time people watching. Actually , it made me sad. All of these people seemed like they worked really hard for their money all week, then blow it all on booze and gambling. But the night took an interesting turn when a huge bar brawl took place right in front of our table. It started off as an arguement between two men then escalated when one took a swing at the other, then all of a sudden it involved several men. It was an all-out fight. One guy was in a headlock until he passed out on the floor. I surprised myself and without thinking, immediately went over to make sure he was okay. As soon as I got over there, he woke up. I decided to just get out of the way and go back to my table and watch the fun. Looking back, the fight was so bad, I'm extremely lucky I didn't get hurt. Perhaps next time I should mind my own business. Pretty quickly, security came out and put everyone in handcuffs and hauled them off. I was actually pretty impressed with how it was all handled. Apparently, bar fights are a rare thing there and I should feel lucky to have witnessed one.

That's about it. I went to lunch with my college friend, then we raided Kirkland's for some home-type stuff. I can't wait until I'm finished with residency and can live wherever I want and buy whatever i want. Maybe I'll move to Tulsa. It could happen.

Time to sleep off my night, after all, I kareoke'd tonight.

What the normal people do

Today I got to be a normal person. I got to sleep most of the night on call so today ended up being a day off instead of a day of sleep. I got to put on normal clothes, fix my hair and know that it's not destined to be ruined by a scrub hat, put on lipstick, and go to lunch with a friend. I looked around the restaurant and thought to myself, "so this is what normal people look like". : )

Last night wasn't too bad. I had a good feeling about it. Since I'm at the bottom of the food chain in our department, I had to carry the emergency airway phone, in case anyone needs intubating in the middle of the night. It rarely rings, so when it rang at midnight, I didn't know where the noise was coming from. Intubating someone in the hospital reminded me so much of my intern year, but easier. I'm required to call my attending for those situations, so he came and helped. There's something about having your attending there that just makes everything not so stressful. Can't get the intubation? Let the attending do it! Well, this one was easy so I looked like a total superstar. Finished. Wrote a note about the situation, left a copy for our billing secretary (oh by the way, what I did just earned the department $800), restocked the tackle box full of emergency airway knick-knacks, and went back to bed.

I just saw the schedule for tomorrow and I'm with Dr. Macho Yeller. My stomach already hurts. My goal tomorrow is to mend things with him.

Mini-Hurricane-Hell-Storm

The strangest thing happened overnight. What looked exactly like a tropical depression hit last night. I don't live in a hurricane state. I live in the Midwest. We had rain predicted as remnants of a hurricane that hit Texas a few days ago was supposed to come through. Mr. Weatherman predicted about an inch of rain for the entire weekend. Yesterday it started raining around 5pm. No big deal. Then around midnight, the rain did something weird. The storm organized itself back into a tropical depression, complete with an eye, lots of wind, warm rain, tornadoes, and rain bands..then dumped 7 inches of rain on us overnight. I've never seen anything like it. I woke up at 5am to the loudness of the storm and couldn't believe it when I turned on the TV and saw on the radar what looked exactly like a mini-hurricane over my state. Very strange. I know, this sounds like no big deal, but it was really an oddity. There's flooding everywhere, and I was starting to get concerned about my house..but all is well.

I guess I won't do my Sunday Night ritual of watering the lawn tonight. : )

I'm trying to think positive about work tomorrow, but the truth is, I'm still upset about the events on Friday. I guess I just need to be thankful that I am me and not the miserable, unhappy person that my attending is.

Who needs meth when there's Starbucks?

A Starbuck's Doubleshot at 6am this morning left me jittery and hyper. I wonder what meth would do? See Robyn? Doctors require lots of coffee so you would fit right in...

Hmm. I hate to complain. It seems to be a common theme lately. First, I want to reiterate that almost all the attendings are absolutely great to work with. I know almost all of them really like me. I can tell. The ones I talk about here are the minority. Really, there's only one left that I just can't tolerate. It's the same one who told me to extubate the woman who was still too weak to breathe a couple of weeks ago (and I'm starting to think he did that on purpose to "set me up" for failure). I'll start by describing him a little more. He's from a foreign country and he speaks very loud and fast. When I say he speaks loud, what I mean is that a normal volume for him is what I consider yelling. After awhile, hearing it just grates on your nerves. He also struts around with his chest out like he's some kind of womanizing macho man. I don't know if he looks down on women or not, it's hard to say. My own doctor is from the same country and he acts nothing like this guy.

Back to today. I had a really bad day with him. He wasn't even my attending, but this morning there was just a very minor event in the OR and I needed an attending present and mine got held up in another OR and couldn't help me. So Dr. Macho Yeller came in. He was pissed and started yelling at the nurse for telling him my problem was an emergency. Nobody told him it was an emergency. I defended the nurse and told him that. Then he started in on me. He talks so loud and fast it makes me really nervous to the point that when I'm around him I just become emotionless and clam up. I think this really frusterates him because later that day he pulled me out in the hallway and lectured me about communicating with him better and how I come off as being abrupt toward him. Anyway, after that event, he paged me about every 30 minutes bugging me about this and that. Later he wanted me to go give a lunch break to another resident. The case required sedation only and he told me to set up a propofol pump with a 20 cc syringe. Well, the pump requires a 60 cc syringe. Putting a 20cc syringe in it will cause it to deliver the wrong dose of sedation. Any idiot could figure that out. When he walked in the OR and saw the 60 cc syringe, he got pissed and yelled at me once again. I told him why I did it and he told me I was wrong. I'm not wrong. Why can't he just be reasonable? Why does it have to be a battle of the wills? Why would I want to underdose a patient's sedation by using a syringe that is 2/3 smaller than the one that's designed for the pump?

After the resident came back from lunch I left to go help do post-op rounds on patients. When I got to the hallway, I just started crying. I couldn't help it. I'm so tired of being beat down by this guy. Everytime he sees me he picks on me. My friend Julie passed me in the hall and we crept off and found a quiet corner to talk about it. She kind of wonders if my being emotionless around him is messing with his head because he's used to evoking a response in people. You know, I'm a 36 year old woman. He's not going to get a response from me. I'm not some starry-eyed young thing who thinks he's God. I'm a little more grounded than that. How do I get along with this guy without losing who I am? I'm seriously concerned I've become his target for the year. Why me?

Annoying Intern

We have this annoying intern rotating with us this month. He's going to be one of our anesthesia residents next year. I've heard nothing but negative things about him...immaturity...sexually harrassing nurses...ADHD behavior...you get it. Monday "I got" to have him in my room. At first, I was open and thought I'd give him a chance. Hmph. That got squelched pretty quick. Here's how one of our first conversations went. (just a wee bit creepy and annoying)

Annoying Intern: So are you married or single?
Me: single
A.I. : Are you happy being single?
Me: uh, well... my boyfriend and I broke up a few months ago so this probably isn't the best time to ask me that.
A.I. What does he do?
Me: He's a doctor but he retired way early.
A.I.: Wow! He must be really old! How old is he?
Me: He's not old. Like I said, he retired way early.
A.I. : Why? How old is he?
Me: He made some good investments and now he doesn't need to practice medicine.
A.I.: What investments?
Me: ___(insert answer here)
A.I. : But he's going to run of money and have to go back to work, won't he?
Me: No
A.I.: He's got THAT much money?
Me: yes
A.I.: Did he buy you a car?
Me (amused): no
A.I.: If he was my boyfriend, I'd make him buy me a car!
Me (even more amused): Well, he probably would have if I'd asked him, but that's not the kind of relationship we had.
A.I.: I'd still make him buy me a car! What's he do now?
Me: well right this minute I couldn't say (probably asleep like any sane person would be at this hour), but he researches his investments quite a bit.
A.I. : He's going to run out of money.
Me: I doubt that.
A.I. : why are you using Lactated Ringer's instead of Normal saline for IV fluids?
Me: LR has good stuff in it. NS has a lot of sodium and you can give someone too much.
A.I.: So does LR
Me: yes, but not as much.
A.I. : How come you just have the gas set on 1.0 MAC?

So that's the jist of my morning with Annoying Intern. I love it when people question every thing I do. For a minute I thought I was talking to a 5 year old. Sadly, Annoying Intern is in trouble. He skipped our Wednesday afternoon lecture and went home early. Even after he was paged, he didn't show up to the lecture. This REALLY pissed off Teddy Bear Attending (not a good idea). Tomorrow will be interesting.

I hope I was never like Annoying Intern. I probably was.

~sigh~ bedtime is getting earlier each night. I thought I only needed 7 hours at night. Not anymore. Not when I work hard all day.

Me, tonight, getting ready to take a shower: I caught a glimpse of myself in the mirror and at first didn't recognize my naked body. "who is that skinny girl?" I thought to myself. OMG! It's me!!! Totally made my day. I haven't been this thin since 1999.

I walked 2 miles (instead of my usual 3) in 100 degree heat tonight. I thought I was going to have a heatstroke. August weather is not my favorite here.

Holy Smokes I am tired. It's only Monday. I had all weekend to rest. And yet I'm still exhausted. My old neighbor Patty came over tonight and even commented how worn out I looked. I guess I should be. I worked over 80 hours last week and the time I'm at work, as fun as it is, is pretty stressful.Being in charge of someone's life during surgery is stressfull. You have to time everything just right so they'll start breathing on their own at the end of the case, but yet you don't want to turn the gas off to soon or they might remember something from the surgery. I'm starting to realize it's an art. But I digress. Back to being tired. I'm going to bed earlier and earlier. I've come to care less about having a life, and more about getting sleep. I'm officially a true old person. I've even ordered a bunch of herbal supplements to ward off bad things that are waiting to happen to me when I'm older.

My last case today was an emergency I&D on a guy with a big abscess on his hand. It took 400mg of Propofol and 250 mcg of fentanyl just to make him unconscious. That's about twice the normal dose. He woke up while I was intubating him, which warranted getting more meds. My attending was shocked. I'm thinking the guy is a big alcoholic. He also woke up really fast at the end of the surgery. And he was wide awake and not groggy. Totally blew my mind.

I've finally started extubating by myself. I did 4 today and some on Friday. It's not so bad. I just wait until they can follow commands and I do it. So far, so good.

Remember that case I had last week where my attending made me extubate a patient too weak to breathe? He's been bugging me about the case everyday. I wish he'd freaking leave me alone about it. I'm sick of hearing about it. The whole thing was his fault anyway...The other residents told me that if it makes it to M&M, it's going to be really obvious to everyone that the incident was his fault, and not to worry about it. I think they're right.

And one last parting note, will it every rain again? Will it ever be cool outside again? It's 9:15pm and 92 degrees outside. Need I say more?

My secret New Year's resolution

Did anyone make a New Year's resolution that they kept secret from everyone? I did. I didn't even tell my BF because I was afraid of it. So here it is. My resolution was to either be engaged by the end of the year or end my long term relationship. Sounds seriously shallow doesn't it? It's not that I wanted to end the relationship, but geez, how long do you need to date somebody before you know they are The One? I knew how I felt and I'd hoped it would go the marriage direction..but it didn't. Deep down I knew he wasn't as into me as I was him. He always kept one foot on the ground. There was always an excuse. For a long time our big impasse was that he wanted a wife that stays home. This year I accepted the fact that despite all my years of hard work, I loved him much more than my job and was willing to quit medicine. Then the excuse was a little more personal (and hurtful) that I won't even mention. Then it was "are you willing to move?". Perhaps I'm a bit slow, but I finally had to realize all these excuses were just that...excuses. They were just a smokescreen to cover the truth which was he wasn't that into me. If he had been into me, none of these little details would matter. Has anyone here ever had to face that harsh reality? You give years of your life to somebody that didn't even want you? Years you can't get back? My brain understands all this but I sure wish my heart did...

What I've been listening to: Tegan and Sara "i won't be left" and Regina Spektor "I never loved nobody fully". It's like these songs were written just for me!

Book I'm planning on buying: Emily Post's "Etiquette". I went to 4 bookstores today and they were all sold out. I'm kinda glad about that. It means that other people care about manners too! Oddly, I suspect Ms. Post would advise me not to air my dirty laundry on a blog!

TGIF

I just can't describe how happy I am the weekend is here. I haven't had a whole day off in 2 weeks, and I am exhausted. I worked 12 hour days almost every day this week. The extra money is nice (we get $15 every 15 minutes after 3pm we work), but sometimes having time off is worth more than the money itself...especially after Uncle Sugar takes his share. It looks like I will be buying a new couch this year that I've had my eye one (not that I'll ever be home to take nappies on it).

The last two days have been fairly uneventful. I had a small bit of excitment today when I was "waking up" a 19 year old guy who had elbow surgery. I'm just now starting to do wake-ups by myself, so I'm pretty insecure. This kid woke up hard. He bit down so hard on the breathing tube (is it okay if I call it an ET tube now?), that he wasn't getting much air, THEN he totally went ape-shit on me. He tried to get off the table and started thrashing around. At first, I was just worried he would hurt himself, then I worried he was going to hurt me or the surgery resident, who had to practically lay on him to hold him down. Keep in mind, he's still hooked up to the ventilator and has an ET tube sticking out of his mouth during all this chaos. I called for any anesthesia attending to come in and help me, and one of my favorites came in. He's a big teddy bear, but I would never want to make him mad. The guy started thrashing around again, and Teddy Bear Attending told me it's normal for young men to wake up like that. He got him to calm down (by telling the kid the police were there and watching) and I got his tube out without any problems. I don't think I'm going to volunteer for any surgeries involving young men....not that I have any say in the matter.

In all though, as much complaining as I do on here, I really like what I'm doing. Anesthesia is way cool. The wild stories are fun to look back on, and in a strange, sick way...working hard feels really good. Resting feels good too though, and thankfully, I have the next 3 weekends off, and my 10 consecutive days off in October is just around the corner! And football season is coming! Ain't life great?

M&M-not just candy anymore

I got my first M&M case, and it wasn't even my fault. For those of you who don't know, M&M is not a tasty candy...it's Morbidity and Mortality conference. Basically, if you screw up a case and there is a bad outcome, you get to present it in front of all your colleagues as a "learning" experience...but if you've watched Grey's Anatomy, you learned that it can be a pretty traumatic event for the presenter. Lots of accusations and arguing. Fortunately, I've never seen one like that in my program.

OK anyway, back to the screw up. This lady had renal failure and was paralyzed at the beginning of the case by my attending with a drug (rocuronium) that is metabolized by the kidneys. Well, since she has kidney failure, they don't work too well and can't get rid of that particular drug too well, so it will have a lasting effect. About 30 minutes after the case began, I was sent into the room to replace the CRNA who was running the case, as it was time for him to go home. The lady was sick as Hell. Her blood pressure was horrible and I kept having to give her phenylephrine. All through the case, I was checking her "twitch reaction" to see if she was still paralyzed. She stayed paralyzed way longer than she was supposed to and because of the extent to which she was still paralyzed, I could not give her any of the normal medications to reverse the paralyzation (neostigmine and glycopyrrolate). So, at the end of the case I'm worried. I called my attending and told him the case was over and she had no twitches so I couldn't reverse her. He sounded annoyed and came in the room. He checked her twitches, fully expecting me to be wrong. I was right. He gave her reversal drugs anyway, even though she wasn't supposed to have any yet. She sort of started breathing on her own so we took her off the ventilator. Her effort was pretty minimal and she was only marginally following commands, but my attending told me to pull out her breathing tube. Guess what happened when she got to the recovery room? She quit breathing! Big surprise. She had to be re-intubated emergently and placed on a ventilator. When I left, she still wasn't breathing on her own and had earned a stay in the ICU. I was pissed. For one, this wasn't my case to begin with. 2. The lady was already a train wreck 3. I didn't think she was ready to breathe on her own, but Hell, I'm just a first year...I do what my attending says 4. because I did what my attending said to do, now I get to present this mess at M&M. Blah!

Happy Times

Today I went shopping with my mom. We had a "sales tax free" weekend on clothes. I didn't really plan on buying anything, but I figured there would be good sales along with no tax. Hmmph. I didn't buy anything on sale. I never like anything on sale. One of my friends once told me that the reason why something is on sale is because no one else wanted it. But don't be disappointed- I did manage to spend $300 on clothes at Banana Republic. Nice clothes. Where and when I'll wear them is my guess, but they are nice. I wear scrubs all day and I never go out, but it's still cool to have nice clothes waiting in my closet if I ever decide to quit being a hermit. Maybe someday I'll even get asked out on a real date. My closet is ready, even if I'm not.

So the happy thing about today is that it was the first day I've gone shopping since I've lost weight. I'm guessing about 10 pounds. I could totally tell! 10 pounds doesn't seem like much, but I could tell a big difference. I even had to get smaller sizes than normal in some stuff. What's not to be happy about? Another 5 pounds, and the thought of wearing a bikini probably won't scare me.

Well, I'm over my cold. Thankfully, it didn't stick around. I was on call all day yesterday. It was my first weekend call. It wasn't too bad. I can say that being on call for anesthesia is tons better than being on call during my intern year. There are other residents around, and I always have an attending there if I get into a bad situation. Basically, I'm not lonely on call anymore.

So between the 4 of us, there were probably 12 cases. I did 4. My first one was some lady who seemed pretty retarded from her years of drug use. She had a submandibular abscess that was about to close off her airway. It was really gross. Her induction was interesting. We used ketamine since we didn't know if she was pregnant or not. She really flipped out. She sounded like she was having sex.

My next case was just an I&D, but what pissed me off was the orthopedic resident got snarky with me because the case took too long to start. I told her we just got out of another case, it's not like we've been sitting around all morning. She was then mad because her case got bumped for the submandibular abscess. Well, I don't make the schedule, plus, that case was an emergency...hers isn't. My attending was pissed when I told him later what she said.

My next case was a guy who got hit on his motorcycle by a truck. He ruptured his spleen and was bleeding inside his belly from it. That was kind of exciting because we were pushing blood really fast into him. It's pretty cool watching people go from pale to pink after they get some blood in them.

The last one was a 3 hour monstrosity and by then I was pretty tired. A typical car wreck vicim with lots of fractures that they had to reduced and fixate. I had no idea it would take 3 hours. I should have gone to the bathroom before the case started.

I'm still too chicken to extubate by myself. I can't quite get the feel for how you know exactly when to pull the tube so they don't bronchospasm. Plus, I don't quite have the timing right on when you turn down the gas and let the patient start waking up. AND, since I'm at a teaching institution, the surgery residents take about 4 times longer to do a case then the real world, so the timing is tricky. I always end up just turning off the gas when the case is over and then have every one stand around an embarassingly long time waiting for the patient to wake up. Oh well. I had to wait on them. They can wait on me.

I've figured out anesthesia is the black sheep of medicine. All the surgery departments hate us. I don't know if they're jealous or what, but they all bad mouth us. They get pissy if it takes us 30 minutes to prep for a case because I'm a new resident and maybe I can't get the arterial line in fast enough, but yet they take an extremely long time in their cases. It's pretty hypocritical if you ask me. We constantly have to remind them that they take a long time, too.

It just bothers me to see surgery residents who are my equal that think they can talk down to me. I need to start standing my ground, because if I don't, it will just get worse. The sad part is, they learned this behavior was okay from their attendings.

~sniff~ I have a cold. ~sniff~ I couldn't figure out why I've had a sore throat and a cough for the past two days. ~sniff~Then today it hit me. I have a cold. Eureka. ~sniff~ And this whole time I thought it was the cigarettes. ~sniff~ I think I'll go to bed.

I hate having a runny nose. ~sniff~

Is it the luck o' the Irish?

This has been a really good week. Really good. Monday and Tuesday were awesome. I was on call yesterday and they didn't have me come in until 3pm, so I got to sleep until noon. I had to give a talk on positioning patients and the elderly for anesthesia, then start my call duties. There was only ONE case leftover from the day. I got the patient to the PACU at about 7pm then settled down to watch Southpark with the two other residents. We had no other calls after that....and we were on level 1 call! Is it because I'm Irish? Were all the gangbangers at parenting classes and didn't have time to kill each other?

This morning in the Female Physicians Locker Room (which is no bigger than a friends' closet) one of the attendings warned me to be careful on the way home, because with a good night like that, I'm bound to get hit by a truck!

Today is go home and hug your pet day

Today my attending was running late and had to have a colleague help me start his case. One of the other anesthesiologist said that one of his cats died and he had to bury it before he came to work. When I saw him, I asked him what happened. He said he went outside this morning and found part of his cat in his backyard, apparently it got eaten by an animal. He heard a loud commotion outside early this morning but assumed the two kitties were just fighting like they always do. He was pretty upset about it all day. He found the other cat outside, too...visibly shaken up. I felt really bad for him. He couldn't talk about it without tearing up. So, go home and hug your pets today.

This one's for Dan and Libby

Snakehead Fish Haiku

oh, you ugly fish
why do you ruin our great river?
perhaps you don't care

those snappy teeth bite
and eat all the other fish
you weren't invited

I hear your soup heals
that is why you were brought here
but you got away

now we're stuck with you
and we're trying to destroy you
but to no avail

No more diets for me!

Great news, everyone! I don't have to diet anymore! I got my ass chewed out so bad today that there's none of it left!!

You would think I was the worst resident ever if you heard the way my attending today was acting toward me...all day. We had this awful tumor debulking which turned into a big bloodletting. My attending kept leaving the room to tend to another case. While he was gone, my patient's blood pressure kept dropping and wouldn't respond to any drugs I gave her. She was losing blood, and the surgeon asked me to hang some he ordered. I did. When my attending walked in and saw the blood going in, I really thought he was going to have a stroke right then and there. He stopped the blood and was so mad at me he told me to go take a break and leave the room. I was actually afraid to go back in the room after my break, but I had to. When I got back, he's in a frenzy because they lady is losing blood and now he can't get the blood I hung earlier to go in fast enough!! She ended up getting a total of 5 units. Did he ever sound appreciative that I tried to anticipate her decompensating before it actually happened? No! He waits until she's in trouble and then decides to start aggressive therapy and make everyone around him miserable because he's so high-strung. I got bitched out again later over the incident when the case was over. I got a lecture about TRALI. (Well you know what? TRALI is rare and if she doesn't get blood, she won't live long enough to get TRALI!) OK so, I think I got it now. Don't give blood without calling you. Apparently I'm not capable of recognizing hypovolemic shock due to blood loss...

It was just everything I did that pissed him off. All day long...So that's what I mean when I say I have no ass left. While he's bitching me out, the surgery resident chimes in and tells him in my defense that her attending ordered the blood. It made no difference. I'm a naughty resident.

I never want to work with him again. I've gotten stuck with him 3 times now and I don't know why. I'm giving him a horrible evaluation. The worst thing is, I heard his angry voice so much today, I can't get it out of my head now that I'm finally home. None of the OR staff like to work with him, so why he is allowed to teach new residents is beyond me. He doesn't teach. He just barks orders and bitches you out for every single thing. He had me so nervous I was shaking all day...to the point where one of the nurses noticed and commented about it. I lied and told her I was hypoglycemic. Thank God the tears stayed away until I got home.

It's going to be a long 3 years.

Tammy, Michael, and Posh, Oh My!

Did anyone watch Tammy Faye's interview on Larry King the other night? Even if you didn't approve of the scandal that took place in the 80's, it was hard not to like her during the interview. She was uplifting, funny, and showed an amazing amount of faith. It was quite touching. Cancer reared its ugly head during her interview. For those that have never seen end stage cancer, it was hard for me to watch too, and I see that stuff everyday. Definitely not the Tammy we are all used to seeing. RIP Tammy...

Now onto Michael Vick. ~sigh~ Do I even need to waste the energy in mentioning what a despicable person he is? I hope the NFL does the right thing on this one and cans him. Playing football in this country should be a privilege, especially with all the money that they earn from endorsements and tickets paid for by the public. Anyone in that position is held to a higher standard and they well should be. Emmit Smith, in all his brilliance yesterday, stated that he felt "they" were going after Vick because of who he was. Yeah, Emmit. Thanks for the input. Why don't you spend more time playing football and less time giving interviews about a guy who supports the extreme torture of innocent animals! Oh God, I just can't even put into words the amount of disdain I feel for this guy. Who doesn't love kitties and doggies?

And Posh, baby-I'm sorry I disparaged you on my blog the other day. Apparently you DO have some fans out there, as Pastor's Bride quickly pointed out to me. YOU are an important person. YOU make a difference in people's lives. You're good enough, smart enough, and DOGGONNIT, people like you! (But I bet you already knew that!)

see you folks tomorrow!

How to meet a guy over 35

Yesterday Oprah had a segment on "how to meet a guy over age 35". She had a hot guy on giving advice to all us single ladies. He said to always leave the house looking good because the places you meet guys are the places you go to run errands. Taking that advice to heart, I decided to look extra nice on my lunch/mani-pedi date with Pastor's Bride. Later, I was out running errands and decided to stop at Johnny's for a theta burger. This friendly elderly man opened the door for me and struck up a conversation with me:

Friendly Elderly Man: Hi! Are you going inside?
Me: yes, I think so, if this is the door for to-go orders
Friendly Elderly Man: Yes, you just go right through there. What is your name?
Me: Kate
Friendly Elderly Man: It's so great to meet you, Kate. My name is _____ and this is my sister _______. I think it is so neat that you are going by yourself to get dinner out.
Me (smiling): well, it's nice to meet both of you.
Friendly Elderly Man's Sister commenting to Friendly Elderly Man: She has beautiful teeth!
Me: I hope you guys enjoy your dinner.
Friendly Elderly Man: You too, Kate!

I guess the advice Oprah's male friend gave was good advice, I was just hoping to meet somebody closer to 35!

Does anyone else find Posh and David extremely annoying? I mean, what is the fascination with them? I think my life is much more interesting. I get to sit in a chair and manage someone's life during surgery!

So last week I blogged about things I did wrong last week. Now I'll list things I did right:

1. I put in 2 arterial lines this week. Each of them took me about 15 seconds!! I guess all those nights last year spending 30 minutes trying to put a-lines in people with a blood pressure of 60/40 is paying off

2. I didn't "chase vital signs" like I see some people do.

3. Got all my intubations, even the one where I had to lean sideways on the CT scanner to get the tube in.

4. I thoroughly documented an inappropriate position a patient was placed in during a long surgery (with her arms raised above her head). Now that she has a nice brachial plexus injury, it's in the chart that the surgeon wanted her that way.

5. I got much more efficient in taking my patient to the PACU and setting up my stuff for the new patient without anyone having to wait on me.

6. I made it to work on time every morning (5:30am)!!

7. I was left by myself during my cases almost all week. When I took my pulse to see how nervous I was, I was bradycardic instead of tachycardia. (yes, I am a nerd)

8.I didn't whine or complain within earshot of anyone important who could make my life difficult.

9. I realized even if I have a not-so-nice attending assigned to me for the day, I'll get through it just fine because they'll probably leave me alone in the room anyway.

10. I'm so busy during the day, I only have time to drink 1/2 coke a lunch as opposed to the 4-6 per day I usually drink. Now I'm no longer having SVT's.

11. I surprised Julie this morning by making a positive comment (despite it being the unGodly hour of 5:45am when I said it)

Can't wait til tomorrow... : (

As new residents, we're supposed to call our attending the night before our cases to discuss the "plan". We all got "talked to" because we haven't been doing this. We're supposed to do it even if the patient is not in the hospital. I paged my attending tonight. Here's how the conversation went:

Dr. X: ThisisDrXandIjustgotpaged.
me, cheerfully: Hi, this Katherine, your resident for tomorrow and I was calling to go over our cases we have scheduled. None of them are in the hospital so I can't tell you anything about them other than the procedure.
Dr.X: Then why are you calling me?
me: because we all got in trouble today for not calling
Dr.X: then I'll see you tomorrow. (click)

Nice, I can't wait to meet this guy and hear what words of wisdom he will undoubtedly want to spend all day sharing with me.

I don't like grumpy doctors. Almost all of them are nice to me because I'm fun to talk to in the OR. I hope this one I have tomorrow gets over his snarky mood.

I'm excited to have the whole weekend off. No tests this time. I was really wanting to go to Dallas and visit my best friend/ex, but through a weird and sudden turn of events last week, we aren't friends right now...maybe never. I may have finally reached a point where he's hurt me more than I love him. So I will hang out at home this weekend, get a mani with pastor's bride, study, SLEEP, earn some easy moonlighting money, and pretend like nothing is bothering me, when actually I dont think I could feel more alone or broken.

Oh good. Ambien just kicked in. Time for bed. 04:30 comes early....

I had my second day where I'm really glad I picked anesthesia. I've noticed it depends on how much autonomy my attending gives me. Today I was left pretty much the whole day to my own devices...except for the take-off and landing. I got my first nasal intubation today. My attending was pretty happy about that because I defied the "see one, do one, teach one" law of medicine because I'd never seen a nasal intubation. Being alone is a little scary but I'm starting to feel better about it. I mean, after the fiasco Friday with the ventilator shutting off, can being alone get any worse?? My second case today required a LOT of pain meds which made me a bit nervous, but it's not like the guy is going to quit breathing or something. Anyway, I guess what I'm saying is that today was FUN! As far as residency goes, I think I picked the coolest one. I mean, yes, cutting people open is kind neat too, but you have to go through a miserable 3 years before you get to do anything on your own. Simply not worth it to me. Nor is the life you lead after a surgical residency..

And, one of my attendings told me he heard I was a good resident. Maybe he was just buttering me up, but why would he need to do that? I do think being female has been an advantage. Everyone has been really great to me and several attendings have said they are really happy to see more females in the program. Yay for girls! At this point, I don't care if being female gets me nicer treatment.

So here are some pet peeves in the OR:
1. I absolutely hate it when people are transporting a patient to the OR and they let the bed bumb into walls and other obstacles in the hallway. I think it's careless.
2. I also hate it when the patient is being transported from the OR not completely covered, or wakes up from anesthesia not completely covered. No reason why someone needs to wake up naked or partially exposed. Would you want to?

Should I complain about work? ......uh....okay! I had my first Snarky Surgeon Experience today. I was assigned to a CT guided laser ablation of a liver lesion this morning with one of the other residents. It's in the CT room using one of the weirdo ancient anesthesia machines that I don't know how to use. Plus,the patient was 1 1/2 hours late so we were all just standing around waiting. Well, the minute she shows up, the surgeon expects us to have her on the table asleep. When that doesn't happen, he starts bitching at ME about the hold up. (Uh...excuse me? Need I remind you that the case is starting late because of YOUR patient?) Then my resident started being mean to me in front of all the staff (surgery intern, med student, surgeon, and nurses). I can take criticism if it's warranted, but have some decency and don't do it around people from other departments. That's really poor form. Normally I have a pretty thick skin for that but lately I've just had enough of people treating me bad and it hasn't taken much to break me down. I felt so humiliated I wanted to cry. I guess he sensed that because in front of everyone, he apologized for his behavior several times. What he was trying to say came out the wrong way and he felt really bad. The day did get better and he's actually a pretty decent guy and I have a new respect for him. It takes a big person not only to apologize but to do it in front of everyone like he did. You just don't see that too much, especially with doctors. I wish more people in my life would do that. But then again, the more I think about it, people do what they want. "To hope, is sweet"...

So I realize everyone is anxiously awaiting a kitty report. Apparently all the vomiting WAS from the renal food and not uremia, as I'd feared. I've had no puking kitties at all since I switched their food 2 days ago. Even Mini-Lion-Hell-Cat is eating well. I'm glad I didn't spend another $200+ at the vet only to find out it was food intolerance.

tough decision

My kitties were diagnosed with chronic renal failure earlier this year (due to their age, not the pet food scare). I had to change their food to a low protein/low phosphate food to take some stress of their kidneys. Well, it hasn't gone well. I've tried 3 different brands, and all of them make them sick. The last brand I tried made them vomit several times a day. I found myself coming home to a mess everyday, and God forbid if I'm gone for a weekend- then there's REALLY a mess. Yesterday I realized I'm basically on Puke Patrol. (I guess that's better than Poop Patrol which is what my friend Pastorsbride is on.) Anyway, the vomiting is just getting worse and one of the kitties looks dangerously thin. I made the tough decision today to put them back on their regular food that they've eaten their whole life and enjoy. It will probably cause their renal failure to progress faster, but I think it's better to have a cat that is able to absorb food and stay at a healthy weight. I means what's the point of being on a renal diet if you can't tolerate the food? Well, since I changed their food today, neither of them has vomited. That's a good sign.

My test yesterday was awful. I had a real false sense of security on Friday. I'm quite certain I scored in the zeroeth percentile and will be called into our program director's office.

Speaking of tests, if I have to pass a drug test in order to get paid, shouldn't people on welfare have to pass a drug test in order to get my money that I had to take a drug test to earn for them in the first place? How un-PC of me to pick on people who won't work...

And yet a bit of good news: My dad is out of the hospital and it appears that it is unlikely he has lung cancer. He leads a charmed life.

A proud moment

Today at the grocery store one of the chaplains from my old hospital was in front of me in line. She said hi to me, and I immediately knew who she was!! I recognized somebody out in public!! Maybe I don't have prosopagnosia after all.... Then Friday, I actually went up to an upper level resident and called him by name to ask him a question. It was really him. I didn't get the name or the face wrong! What's happening to me? Am I finally metamorphosing into a normal person with facial recognition?

The first week is over..

Wow. What a crazy week. I just now realized I'll never have a first week of anesthesia ever again, thank God. Today was especially crazy. I was assigned to a big case...a Whipple Procedure. I wanted to get lots of sleep so I would feel good today, but instead my neighbor's 4 dogs barked all night, until about 4am when a big storm hit and their owners brought them inside. Great, my alarm goes off at 4:30! So I got to work way early to set up the room. I got to put in an arterial line, and I got to put in a pulmonary artery catheter and float it in for the first time. That was pretty cool. It took us an hour after the patient was in the room to get all the monitors set up before the surgery could start. About an hour into the case, my attending leaves for awhile and I settle down to start charting an hour's worth of vital signs. I heard this really weird noise come from the back of the machine and then the apnea alarm started going off. Wha??! I didn't think that could be right. I looked at the breathing tube and it was still in and connected to the circuit, but there was no fog in it, which told me the patient was not breathing. I about wet my pants. The patient's oxygen level was still fine, but I wasn't sure how long that would last. Anyway, I was very calm and told the nurse to get on the intercom and have my doc come in, then I let the surgeon know what was going on. I was just about to switch off the automatic ventilation system to the manual system when he came in. I really thought I had screwed something up and that he would be able to fix it. Well, as it turned out, it was not a Katy Malfunction this time... the machine actually failed. We had to manually ventilate the patient for awhile while the tech came in and tried to fix the machine. No one could figure out why it broke so he ended up calling some "anesthesia machine hot line" and they told him to just turn off the whole machine and then turn it back on (kinda like rebooting a computer when it quits cooperating). That actually worked. I'm glad it worked. The case went on 4 more hours and it would have been hard to manually bag the patient through the rest of it. I'm going to be leary about that machine from now on.

I'm home really late and I have to take my yearly anesthesia training exam tomorrow morning. It's the test anesthesiologists take to become board certified. As residents, we are required to take it every year to monitor how we progress. Our program requires us to score above the 50th percentile to stay off probation. It's a lot of pressure. I planned on studying tonight but I'm just absolutely exhausted. I think I'm going to do okay though. This morning our program director happily announced to our department that the new anesthesia class scored really well on our anesthesia knowledge test we took on our first day. It's a national test and we are compared with everyone nation wide. I did really well on it (not as well as I'd hoped) and scored way above the 50th% percentile (and this was after I was up all night with some weird stomach bug and showed up to the test dehydrated). One of the attendings told me I'll probably do just fine tomorrow. I'm really happy for our class. We got such a bad reputation this past year because of a lot of stuff that went on, and it's so nice to have the program director happy with us and bragging about us. She's really big on test scores, so if you have high scores, that gets you out of a lot of harassment from the attendings for an entire year. I am all about that.

Argh. I gotta go study. I get to sleep in Sunday! I haven't had a good night's sleep in 2 weeks!

Things I've screwed up on this week

1. dropped a whole vial of fentanyl on the floor, smashing it into tiny pieces
2. drew up a bottle of heparin thinking it was lidocaine. Fortunately I'm slightly OCD and always recheck the bottle after I draw it up. Of course, if I were truly OCD, I wouldn't have incorrectly drawn it up. Even further, if I were OCD I wouldn't have drawn it up at all because I would still be at home washing and rewashing my hands. OK bad humor there...
3. fell slightly asleep this morning during 6am conference...while sitting right next to my program director. Yikes. One of my annoying (male) smart-ass cohorts asked me if Sleepy was my favorite of the 7 dwarfs.
4. turned the stopcock on an IV the wrong way after giving some drugs. A few minutes later I notice that IV fluid had dripped all over the floor.
5. missed an intubation because the patient's mouth was clamped shut. (Ok that's really not my fault)
6. Was talking to my attending about our patient who is breastfeeding and doesn't want to delay it after surgery. I then said, "we can't give her versed because it will cross the placenta.." Uh, yeah. I think she got rid of her placenta when she had her baby.
7. That's about all I can think of. I'm sure my attendings could provide plenty of more screw ups.

It's 8:14pm. I'm already showered and in my jammies. Am I sick? No. I'm simply tired from getting up at 4:30 every morning. This week has been Hell. We started anesthesia. Today was my 4th day in the OR, and I'm already getting left by myself with the Big Mysterious Machine that has all sorts of alarms and noises. My eyes glued to the monitors, I pray nothing too catastrophic happens. I'm just now starting to understand the Big Mysterious Machine and how it works.

Wanna know what I did the first 2 hours of today? Here's a rundown:
4:30am: alarm goes off. I'm not asleep. I've not slept all night. I drag myself out of bed. I look every bit as bad as I feel.
5:30am: arrive at work and make a mad dash 3 blocks to the hospital, testing life by crossing against the light (but nobody is out driving at this godforsaken hour anyway, so what's the dif?)
5:40am: in dressing room, change into scrubs and go to OR
5:45am: mess with Big Mysterious Machine and try to figure out how to check the system
5:50am: change back into dressy clothes and go downstairs for my presentation
6-6:45am: give a presentation to my fellow residents and program director
7am: change back into scrubs and go back to OR to finish getting ready for the first case

Did that make you tired? I did all this before most of you woke up. To add to the chaotic day, I slept maybe 2 hours last night so not only was I dead tired, but I had that nauseous feeling all day that I get when I'm exhausted. Fun times.

So this is why I'm already in my jammies.

In other news, my dad has been in the hospital all week with a pretty bad pneumonia. While I was out of town last weekend, he got really sick. Tomorrow he is getting a thoracentesis and then later they are going to probably run some tests to rule out lung cancer. I didn't know he was sick until Monday Night when his wife called me. I wasn't able to visit him until last night. Tonight I was simply just too tired. I think he understands but I still feel guilty.

I really hope everything turns out okay. I really, really, really cannot take anymore bad news this week. I've had way more than my share. Enough to ask God if I've somehow upset Him.