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!