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.

Not something you hear everyday

Something interesting I heard a CRNA say to a confused, combative patient as he was waking up from surgery:

Leave your penis alone or else you will hurt it!

Why is this?

Today we had a long talk at work today about the big S.A..... Substance Abuse. If we start abusing narcotics, we'll get sent to a $30,000 3-month treatment program for physicians that our health insurance doesn't cover.

Now here's my question: Why is it if I get caught abusing narcotics (a criminal act) I get 3 months of leave for drug treatment, but if I want to have a baby (a non-criminal act), I only get 2 weeks of leave?

Well, here's why I do know: Next month we all get to start peeing in a cup, and I don't think it's for a pregnancy test.

A funny conversation

People are so funny. They say the oddest things without realizing it. For instance, at church this morning, an elderly lady came up to me and introduced herself to me. I told her I was "JoAnne's daughter". "Oh! You're the doctor!" she exclaimed. "Well, yes", I said. I didn't really know what to say. She asked about my specialty and residency and such. When I told her I will be an anesthesiologist, she said, "Oh, they are just as important as the doctor." I thought that was funny. Anesthesiologists ARE doctors. Maybe she meant we are just as important as surgeons.

There's an old joke about the curtain in the OR that divides the space between the surgeon and the anesthesiologist. It's called the "Blood-Brain Barrier". The surgeon is on the blood end, and the anesthesiologist is the brain. Really, people don't realize how important our job is. It tends to get minimized because nobody is awake to see what we do. Other doctors tend to talk smack on our profession..honestly, I think it's out of jealously. We tend to be a happy bunch, we like our job, and we make just as much money (sometimes more) as the surgeon who still has to run a clinic and do hospital rounds.