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.

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.

More photos from D.C.

The Vietnam Memorial. More amazing in person than it could ever be portrayed on film. Robyn, is apparently a weird factoid buff and informed us both that the designer for the memorial was a student who turned in the design as an assignment. Her professor gave her a B grade for it. The funny part is, her design won...and her professor's did not!



Me and Pink at a famous restaurant on a roof. The view is better than the food. If you go there, don't order the smoked turkey salad.



Robyn and Pink on the Metro. Kinda blurry, but they still make the train a much better place!



All of us standing in front of our future home.

intern graduation

Julie and me at our intern year graduation last night

Stampeded!!

I came home yesterday afternoon after being on call all night, and this is what greeted me in my front yard! I was so dumbfounded as to how and why those cows made it to my yard. Pretty funny! My yard looks like it belongs to an 80 year old lady. Hoping my neighbors hadn't seen the spectacle yet, I lugged all the cows to my backyard. Of course, ALL my neighbors saw the cows and apparently discussed with each other whether or not I did that on purpose. I finally saw a note attached to the big cow, telling me I'd been stampeded. It's a funraiser for my church, and if you donate money, the youth group will put these cows in the yard of your choice. It's so nice to be loved. I'm still trying to think of a way to get my brother back.

Miss me? Last week I went to Washington, D.C. and hung out with 2 friends from elementary school. I AM back in one piece. I came back so tired that I was convinced I needed another vacation. We had a great time and fit absolutely everything we could into 5 days. Since I'm not near as funny as my friend Robyn...aka Pastor's Bride, you can read her blog about our trip. She summed it up quite nicely...

http://imarriedthepastor.blogspot.com/




My friends



My friends and me on a boat on the Potomac. If you look really closely, you might see the infamous Snakehead Fish that now plagues the river...or you might not. Or even worse, you might see a Penis Fish that has Robyn worried. Then again, last I heard these were only found in the Amazon.



This is what's left of our feet after tromping all over Washington D.C. all day. I realize now, flip flops were probably not the best foot attire for long walks. I have sores all over my angry feet to prove it.


To change the subject, today was my last day of my intern year. I can't believe it. I'm sad. I love the hospital I am at and will really miss everyone. Last night when I was on call, I went by all the ICU's and said goodbye to the nurses. Today I said goodbye to my attending docs I've had throughout the year. Just an outstanding bunch of people. Tonight was our graduation. I just can't believe it's over. Parts of it have been pure Hell but overall it was a great year. I remember some of my call nights being so bad, that I wanted to walk out and never come back...but I couldn't because I can't afford to walk away. Some call nights I cried after having to give bad news to families. Some nights I cried just because I was so tired and didn't think I could get through the night. I'm finished.

I'm concerned that my tales at work are convincing Pastor's Bride NOT to go to medical school, especially my post about my shoes getting puked on. As long as I don't share any of my poo stories with her, maybe there's still a chance.

I've given up on Pink...she doesn't like to wear Merrell's. Then again, she could be a dermatologist. I hear they get to dress up.

Hospital things you will only see on TV

In this month's issue of Glamour, there was a list of 10 romantic things that only happen on TV. It was pretty funny. There was only one thing on there that I'd actually done. Yes, I'm guilty of having had sex while wearing a bra. I admit it.

OK, now for my take on things that only happen in the TV Healthcare System:

Dying, critically ill patients are never in respiratory distress, and they are only on the minimal amount (ie..nasal canula) of oxygen.

Critically ill patients always have rosy cheeks and plump, glossy lips.

Birthing scenes are never bloody.

The babies come out looking like 2 month olds.

Hospital staff are all skinny and look like models.

Anesthesiologists are all deadbeats, show up to work drunk, and then they abandon their patient in the OR when they find out he has a bomb in his abdomen.

All the doctors are handsome looking GQ types who have all the time in the world to hang out, chat, flirt, have sex, and go on long lunches all while on duty.

The residents are never tired and they all have great hair, even when they respond to a code blue with Bed Head.

The sun is out when the surgery residents go to work.

The patients are all rich and beautiful.

Everyone speaks English.

Everyone's scrubs are custom made, form fitting, and very flattering.

Someone gets "shocked" out of asystole and 5 minutes later is talking and "will be just fine".

No one ever gets tired after giving 2 minutes of chest compressions.

Drug seekers are easily identified because they are disheveled and have torn clothing.

In an emergency, all the drugs you need are right there, already drawn up in syringes, and ready to go in a moment's notice.

Doctors never get puked on, peed on, bled on, cough mucused on, or pooped on.


Hmm...that's all I can come up with right now.

My last weekend intern call!

It was as bad as I expected...maybe worse. I was up fo 30 hours.

Got to work at 8am. Rounded with my pulmonology attending until noon.

The highlights of my insane night include:

Admitting the mean, drunk homeless guy at 1am who smelled so bad I thought I was going to vomit when I walked in his room. I didn't think it was possible to smell that bad.

Trying to intubate a girl in the ICU with cystic fibrosis and having her jaw clamp so tight when I gave her sedation that I had to paralyze her (by myself) to get the tube in. I was shaking I was so scared. They say you never forget your "first time". Well, I'll never forget the first time to give succinylcholine by myself. One thing that was nice to hear was that the ICU nurse and the respiratory therapist that assisted me said that was one of the calmest intubations they have been in. Little did they know how scared I felt and the ONLY reason I was calm was because they were calm. ICU nurses are truly a gift from God.

Not being able to intubate a guy and having his oxygen sats drop to 20 because he was difficult to ventilate with a bag/mask. I think that's about as scared as I've ever been on call. A stat call to the ER doc saved me (and the patient!).

Getting called at 4am because a new patient with atrial fibrillation suddenly became unresponsive. His oxygen saturations dropped and I had to intubate him without giving any sedation, causing him to have a vagal reaction and drop his heart rate low enough to make us call a code blue. Got him intubated without any problems, and thought maybe he'd had a stroke with the a-fib, but couldn't get him to the CT scanner because his blood pressure was low. I tried to get his blood pressure up as much as I could but nothing worked. 20 minutes on the ventilater he suddenly woke up and started responding to us and answering yes/no questions. He died 2 hours later from what turned out to be a huge clot in his left ventricle.

After all this, I had to round on a bunch of pulmonology patients until noon today.

A hangover feels better than how I feel today.

I'm grateful none of these events happened to me last July when I was a brand spankin' new intern. They would have had to carry me out in a straight jacket.

Ugh! I'm so tired.

I started my month of pulmonology Friday. I have to be at the hospital to round at 7am then be available for consultations in the afternoon. It's not really all that bad, I'm just not quite used to getting up so early. This time next month it will be like sleeping in.

Anyway, I got 3 consultations yesterday afternoon then I was on call last night. I got home today around 1pm and just collapsed into bed but really didn't sleep very long. I've been dragging the rest of today with my "post call headache" I always get when I'm sleep deprived.

Earlier this week my ex boyfriend moved to Dallas. That has been difficult to deal with. We had a fun weekend but he's been busy and distracted with the logistics of moving, so I probably won't hear from him again for awhile. I think he's mad at me, too. I guess I said some things that he took as me trying to make him feel guilty. He got real pissy with me the last time we talked. The thing is, he's always gotten on to me because I don't talk about things that upset me until I get really mad. Now that I am, he thinks I'm trying to make him feel bad. Whatever. Either way, I can't win.

I'm just really, really stressed. I start my official anesthesia residency in 3 weeks. That in itself is enough stress, but I also have to take our in-training exam too. We have to score in the 50th percentile to stay off probation. Plus the break up still feels crappy and to top it off, he's moved away. It all just feels like it's coming together at once. Did I do something wrong?

Vigilance

I'm so disappointed. I heard today one of my favorite upper level residents got caught under the influence of drugs by one of the attendings at work. He is off to physician's rehab and whether or not he comes back is uncertain. Unfortunately, this is pretty common in anesthesia. I'm so tired of hearing how our speciality has the highest drug abuse rate of all specialties. As much as I'm tired of it though, I can't get complacent. It can happen to any of us. All I can say is, I hope it doesn't happen to me. A friend of mine today told me 1 in 8 residents. That seems high. That means somebody in my residency class will have a problem. I can already wager who that will be. "Vigilance" is supposed to be the motto of anesthesia when it comes to patients. I guess that also should be applied to how we conduct ourselves, as well. Never let your guard down.

Just the same, I'm sad he probably isn't coming back. He was really nice.

I'm on call tomorrow. It's my next-to-the-last weekend call of my intern year (Yay!!!). I hope tomorrow gives me some peace. Monday Night was crazy. I had 5 code blues, which is a record for me. It was absolute insanity from about 8pm until 5am. You just never can tell what's going to happen on call. None of the patients died that night, but two of them did the next day. It amazes me how sick people can be yet they continue to hang on. Sometimes modern medicine is not a good thing. A year ago I took an oath to do no harm, yet I'm not allowed to let a terminally ill person (in lots of pain) die unless they or the family have signed a DNR. To me, that is doing harm.

There's a nurse practitioner that works in the NICU where I am this month. She makes it pretty clear to all the residents that she doesn't like us and that she is "the captain of the ship" (even though she's not, the NICU DOCTORS are). Anyway, I've spent the month avoiding her because I find her super annoying. Every Wednesday the NICU staff meets and discusses issues with the babies. She manages to monopolize the topic every week by talking about...what else? Herself!

Today was no different. For one thing, let me point out that she dresses completely inappropriate for an ICU setting. She wears heels everyday with short suits (that her girls practically pop out of). Today she was laughing and talking about all the times she's almost fallen and dropped babies because her heels got caught on something. I just sat there, completely appalled that she thought that was funny. I wanted to blurt out, "maybe this wouldn't happen if you were wearing appropriate shoes for the ICU". I kept quiet. No one else seemed to think any of this was alarming. I bet OSHA would. In fact, I bet OSHA would find my story quite interesting.

I do know this: If I was the mother of a sick newborn in the NICU, I would be absolutely pissed if she almost dropped my baby because of a stupid clothing malfunction. I would make it clear she is not to touch my kid ever again.

Yikes, suddenly I've turned into a lioness protecting her cub.

OK I know I was Debbie Downer in my last blog. It happens. I'm just a bit annoyed by my life. I worked hard to get where I am, and I'm having a lot of doubts and no reward. The next 6 months will make a big impact on my attitude. Another thing is some of the other residents are just outright being stupid and lazy...ie..refusing to see patients in the ER when our attending doc asks them to see them. When our program director finds out, there's going to be Hell to pay, and we're ALL going to pay for it. I'm not looking forward to that, especially since I'm doing what I'm supposed to do. I work with a bunch of spoiled children. I can't wait to see how they'll respond to having to do REAL work come July 1 when the anesthesia part of our training begins.

This morning at church we talked about how God has a plan for everone and you can't rush it. I need to keep that in mind. Just please somebody tell me that I'm not going to end up husbandless and childless.

I cooked 2 big dishes this weekend that I saw on Food Network. Paula Dean's slow cooker macaroni and cheese...(the ultimate comfort food), and The Barefoot Contessa's spaghetti and meatballs. Quite tasty. Her meatballs required veal, which I don't eat, but I managed to replace it with a tasty substitution. Yum. That and 2 glasses of wine and I'm feelin pretty good about now.

Started a new book loaned to me back in February "Everyone Worth Knowing" by the same author who wrote "The Devil Loves Prada". So far, I like it. It's trendy.

I also watched 2 movies this weekend, both featuring one of my favorite actresses, Reese Witherspoon. Sweet Home Alabama and the one where she goes to law school. Did anyone know her dad is a doctor in Tennessee? I did.

nightmare vs. nightmare

I am in a funk.

I woke up this way.

I had this awful nightmare that I residency matched out of state except for my intern year. All of a sudden here it is, 6 weeks until the end of my internship, and I had not started looking for a place to live and I had no money saved up for the move. Even worse, I was having to move to a place where I knew no one. It felt so lonely. I woke up in the middle of the night and stared at the ceiling for the longest time, convincing myself that it was all a dream and that I'm not moving to Kansas City next month. I've been thinking about this dream all day, it bothered me THAT much. It's not that Kansas City is a bad place. It's not. It's how alone I felt.

Eureka, I think I understand it all. I hate my life right now. I'm lonely, I may as well move to Kansas City. I was thinking about the new med school grads and how great they are feeling about now. Last year was so different for me. I was so happy to be graduating and excited about residency and even more excited that I had matched at home where my boyfriend is. Then, a few months ago, everything changed. The boyfriend announced suddenly one night at dinner that he's unhappy and is moving out of state. In the span of 10 minutes, my dreams of spending the rest of my life with him were over. It's not fair, really...he's the one moving but I'm the one feeling lonely. I've reached this uncomfortable fork in the road. Do I live in the past, or do I look toward the future? The Past is so comfortable. I know The Past. The Past was my best friend. The Past knows me and all my quirks. But The Past is moving away. Leaving. The answer doesn't get more clearer than that. I can hear the phrase now.."if he's moving away, then he's just not that into you". If only I could wake up from THIS nightmare!

So today, I stopped at the gas station to get a supply of diet coke for tonight since I'm too lazy to actually go to a grocery store. I was annoyed because the sales lady at Ann Taylor would not grant me the sale price on some clothes I bought Saturday, that naturally, went on sale 2 days later. Actually, they do grant you the "sale" price if something goes on sale within 2 week of it being bought, but the clothes I bought were not actually on sale. The sales lady was more than happy to explain that the 25% off on things in the store was a "promotional rate", not a sale. I got pissed and told her it was the same thing. She again explained to me the difference between a promotion and a sale. I looked at her and said, "it's a sale!" and walked off. You know, when you put down $350 at a store only for the things to be 25% off 2 days later, I think I have a right to be angry. Calling it a promotion is just shady. I'm seriously thinking of calling their corporate office.

OK back to the gas station. I walk in and there's this creepy looking man in line just staring me down. I thought I had a booger on my face or something. I actually checked my blouse too make sure it was still buttoned, 'cause he sure was looking at me weird. So I get in line with my cokes and he comes back to the line to get change for the arcade game (why is a grown man playing a game at a gas station??). Oh no. He starts to talk to me. He then says, "you must be buying those cokes for your daughter or husband". Without even blinking, I replied, "yeeeep!"...grabbed my sodas, and walked out the door. I can only imagine the turn that conversation would have made if I stupidly said, "no, I'm not married, they're just for me."

So let's talk about work for a minute. There are 6 male residents, me, and another female. The other female is doing a month long rotation at another hospital, so I'm stuck babysitting. I call it babysitting because that's what it feels like. When these guys all get together during down time (recess), I try to get away. They exhaust me. I feel like I've been working all day at a daycare when I'm around all of them. I grew up with brothers. It was nothing like this. I really hate it. I'm tired of their disgusting conversations about porn, if they prefer women to wax, shave, or do nothing to their genitals, etc. It's like they don't even know I'm sitting right there....or they don't care. I'm tired of their dumb junior high jokes of smearing a chocolate bar on the toilet so I'll walk in and think it's poo. Every day I put up with this shit. I'm sick of it. My ex boyfriend says they do this because it's their immature way of flirting because they like me and see me as "one of the guys". I really do not think they like me. I don't want to be one of "the guys". I'm not one of "the guys". I'm a lady....in what apparently is still ( I hate saying this) very much a man's world. Last time I checked it was 2007. I have this new respect for older female doctors. I cannot imagine how awful they must have had it.

My favorite beauty stuff

feel free to add to this list!

1. PurMinerals 4 in 1 pressed mineral makeup
2. and their bronzer
2. Dove cream oil body wash
3. Jergen's natural glow daily moisturizer (thanks, Robyn! Now I have a tan!)
4. Opalescence 35% tooth whitening gel
5. Tigi Factor S smoothing lusterizer (for hair)
6. Maybelline Lash Discovery mascara
7. my Braun/Oral B rechargeable toothbrush
8. BreathRx mouthwash
9. Clinique buttershine lipstick in apple brandy
10. Clinique 7 day face scrub
11. Biore pore strips
12. Eucerin extra protective facial moisture lotion
13. Aveeno positively radiant daily facial moisturizer
14. Fresh everytime 5 day antiperspirant (great for us girls who truly sweat. Thanks, Pink!)
15. Aveeno ultra calming foaming facial cleanser
16. Coco Chanel eau de parfum
17 Chi straightening iron

Did you know?

3tablespoons of canned bee maggots has 65 calories?
2 ounces of canned catepillars has 60 calories?
and that 1 ounce of raw silkworms contain a mere 60 calories?

It's all in this new calorie counting book I bought yesterday. I've been reading it all morning along with watching Sunday morning's lineup of infomercials (by the way, I NEED a cordless magic bullet). Yes, I'm bored. I'm at the hospital and on call until 8am tomorrow. It ain't so bad anymore. Due to a very lucky turn of events last week, the residents aren't called by the ER anymore to admit patients. That means all I do is take floor calls and run codes. There are never many floor calls (especially since I don't have to write admission orders anymore) and there will probably only be 2 codes today (based on previous experience). Not sure how long this luck will last, but I am enjoying it. I'm quite sure as soon as our boss finds out we haven't been doing admissions on call, she will find some way to ruin it. But for today, all is well with the world.

Payday!

Don't you just love payday? I went with Robyn to get a much needed mani-pedi. It would have been perfect if I didn't have such a migraine which lasted ALL DAY until about an hour ago. I even had to break out the leftover pain meds from when I had surgery last year. Now that's a headache!

Tonight I stimulated my dopamine receptors by going to Ulta and buying some new makeup. That store is absolutely dangerous. I've never browsed in there before...until tonight. After I left, I realized they didn't charge me for a make-up bag I bought. I debated going back but I had just been to the grocery store and didn't want my frozen food to thaw. I feel bad. It was only $15, but still, I feel dishonest now. Argh!

Now if anyone is wondering, dopamine is your brain's reward center. I was told by a friend that it has been proven that women get high from shopping, thanks to our dopamine receptors being stimulated.

Mini Lion Hell Cat

BEFORE



AFTER


Today Sarah went to the groomer for the first time ever. I've never had a cat's hair cut short before, but my vet recommended it because Sarah is old, has really long hair, doesn't groom herself as well as she used to, and as a result, gets a lot of mats in her hair that are hard to cut out. I really thought she would be mad about the events that transpired today, but much to my surprise, she seems quite happy with her new look. She's been prancing around the house ever since she got home..and purring like crazy!

Eat Crow

I found out today that Sheryl Crow wants us all to use one square of toilet paper to wipe with. Uh...right. Remind me that if I ever meet her, I should never shake her hand.

What is it with Hollywood? Why can't they just stick to what they know?

Leave me and my gun alone, don't tell me to conserve energy while you fly around in your private jet (ahem, John Travolta, Al Gore to name a few), and please, don't dictate to me how much toilet paper to use!

Sad times

My beloved Merrell's got puked on last night by a patient.

Those darn boys!

Last night I was admitting a horribly sick lady who needed an arterial line. I spent at least 30 minutes poking her poor wrist trying to get arterial access. She had virually no pulse which made my job just about impossible. I finally gave up. By noon today, she REALLY need the line put it, so 2 of the other residents went up and did it. They came back down over an hour later and told me that they got it right in on the first try. I believed them. I spent the afternoon feeling bad about my procedure skills and that I let the boys show me up. I found out tonight that wasn't the case at all. Adam couldn't get the line in, and it took Jay (a former phlebotomist) 20 minutes! Those boys! I'm starting to realize I'm not any less competent than they are-they just don't talk about their failures.

Darn you, Clinton!

Last night I was watching a behind the scenes show about Stacy and Clinton's "What Not To Wear". I couldn't believe it when Clinton pulled off a pair of Merrell's EXACTLY like the ones I wear to the hospital everyday and said, "please don't tell anyone you saw me wearing these!".

I love my Merrell's and Clinton dogged them!

A conversation with my friend Robyn yesterday:
Robyn: Hey, what have you been up to?
Me: Just got off work from a 30 hour shift.
Robyn: Oh, is that all?

Hee hee. I thought that was funny.

I had a really busy night. The biggest event was getting called at midnight to see an 82 year old lady the nurse couldn't wake up. I thought she'd been given too much pain medicine, so we tried to give her some meds to reverse the pain meds. That didn't work. I'd been told she threw up several times before I got to her room. While I was in the room, she started having really loud stridor, which had me worried she aspirated vomit since she was unconscious. I went ahead and transferred her to the ICU and then intubated her. I really thought she would be okay once all the meds wore off. I ordered a CT scan of her head, just as a precaution to make sure she didn't have a stroke. The next morning, before the results came back, I went to go see her and look at her chart to see what her doctor had written, since I knew by then he would be there. Her whole family was in there and I saw her husband sitting in a chair next to her, sobbing uncontrollably. I was so touched I was drawn to tears. I didn't realize this at the time, but they must have just been told of her CT results. Unfortunately, she had a severe bleed in her head that caused her brain to herniate badly. That explains why she was unresponsive. The family decided to remove life support, and she died later that day.

I just can't get the image out of my head of her elderly husband crying at her bedside. This sounds horrible, but it made me never want to get married and experience what he is going through. Sooner or later, everything ends. I am in control of nothing.

Fake Bake

Always dreaming to be a sun goddess, I sprayed on some fake tan tonight. If it's how I remember Coppertone's QuickTan worked in the mid 80's, I'm expecting to wake up tomorrow with brown splotches all over me...but hey! It's worth a try! Trying something once every 20 years doesn't hurt. Can I be a sun goddess? Please? I don't even have to be dark brown, just something darker than blinding pale would be just fine.

I was supposed to study tonight, but instead, I smoked cigarettes out on my porch and dreamt of a bigger house filled with Pottery Barn furniture.

I would like to start running again tomorrow. I come up with all kinds of excuses not to. The first week is always the hardest, and I always manage just fine. My latest excuse to not run is that I started some new BCP's last week. Strangely, they have noticeably increased the size of my girls and now they are sore. I don't want to upset them by running.

Good Friday

Today is April 6th. APRIL 6th! And today it snowed. I had to bring in all my potted plants as it's going to get into the 20's at night. I just can't believe it. I'm so glad I didn't go buy a bunch of annuals last weekend like I was planning on doing.


Today I bought a new journal. It's the nicest (and most expensive) one I've ever had. It's #29. I've kept one since I was 10. Whenever I start a new one, I always wonder what the pages are going to say when it is finished. #28 is only a few hundred pages long, yet it took me 7 years to write. My life now, is vastly different from how it was in 2000 when I started it. I've always liked keeping a journal. It's fun to go back and read stuff. I sometimes wonder what the point is though. When I'm dead, my family is going to have a box of homemade books that will just collect dust. They are worth nothing to anybody, except to me. Actually, I'm not sure I want anyone reading my journals. If my parents ever read them, they would be shocked. In junior high and high school, I was profoundly depressed and for awhile, I self medicated with alcohol that I stole from my dad's liquor stash. I would be so embarrassed if they knew what was really going on with me. Looking back though, how could they not have noticed something was wrong? They should have known. Any parent who pays just a little attention to their child would have noticed and intervened. Well, at least I had enough gumption to intervene on myself.


I'm on call tomorrow. Blah! I absolutely hate weekend call. It's the most boring, tense, 24 hours ever. I will spend Sunday attempting to attend church (if I'm not just dead tired) and then going home and going to bed. What a FUN weekend I am in for. At least the weather is going to be crappy, but I will unfortunately miss my neice's 8th birthday. Blah!

Amazing

I just read on CNN that Keith Richards admits to snorting his father's ashes mixed with cocaine. You just can't make that stuff up, folks! I dont even like it when I get water up my nose while swimming, I wonder what it would feel like if a loved one were up there?

Prosopagnosia

Ok so I have this embarrassing problem that I can't seem to fix. I have a really hard time recognizing faces. I've always been this way and as I get older and meet more and more people, the problem is only getting worse. Today I was at Barnes and Noble studying, and the chief resident of our program for next year came over and said hi to me. I had no idea who he was. He didn't even look familiar! He had to tell me who he was, which I think embarrassed him. I tried to make light of it and told him that if he'd been wearing scrubs and a mask, I would have recognized him. God, I'm such a doof...

I really hate this. I don't know if something is not wired right in my brain, or if it's just that I don't really pay attention, but it really bugs me. My ex always thought it was kind of cute and endearing...we'd watch TV and I would get all confused about the plot because I couldn't remember who people were.

Now people I have everyday contact with, I remember just fine, but if I see you somewhere out of character, I'll have no clue who you are. I know this is probably normal for some people, but this goes way beyond normal. I'm to the point where I don't approach someone to say hi because I'm afraid I'll have the wrong person (it happens a lot)! I hide it by being friendly to everyone, just in case I already know them. Time magazine published an article last summer about this and it was like I was reading about myself. I think my case is mild, but some people can't even recognize their own face in a mirror!

One of the other interns, Adam, came up and said hi to me in the doctor's lounge one day. I'd never seen him without his glasses and I had no idea who he was. He looked at me like I'd lost my mind.

In a field where networking is so important, I see all this as a hindrance.

After the storm

We had a huge storm late this afternoon that lasted several hours. I stepped outside and this was waiting for me!!


I Was on call last night. Had one of the best nights yet. Only one admission at 5pm. Slept from 8:30-10pm, then responded to a cardiac arrest which kept me busy (and sweaty) for well over an hour. My pager didn't go off (except for one of my friends paging me at 3am) again until 7am! I got to sleep all night, or at least lay in bed wondering when my pager would go off. It's never really good sleep on call. Plus, the bed is uncomfortable, the blankets are thin and impersonal, and the room is always too hot or too cold.

At 7am I went to go verify a patient death and I saw one of the nursing supervisors. She asked if I was on call tonight. I told her I wasn't. She told me she wishes I was on call every night. I laughed and took that as a compliment. She then told me that everyone in the hospital really likes me and wishes I was on call more. Wow. Now I really took that as a compliment! I wish that would get back to my boss!

Since I got some sleep on call, I actually got to enjoy my day. I came home and walked 3 miles, then I met pastor's bride at the mall for pedicures and lunch. Pretty toes and yummy food, what more could a girl ask for?

Annoyed at Mom part 2

I love my mom. She drives me crazy. I love my mom. I wish she would leave me alone. I love my mom. I can't stand being alone with her. I love my mom.

My mom is a challenge. I know I am a disappointent to her. She can be so mean, and the thing about it is, she doesn't see anything wrong with it. She's critical of everything I do and if I call her on it, she pulls the "poor me" thing and tries to make me feel guilty. A few months ago she told me she wishes my personality were more like hers. Ouch. I'm glad I'm not loud and histrionic. My friends are too ( I think).

I've been avoiding her like the plague lately. I haven't been all that happy and I know talking to her will make me feel worse. Case in point, a few days after my boyfriend and I broke up, she called me and left me a lengthy message on my voice mail stating that I should try and reconcile with him because "he has a lot to offer me". Wow. That really hurt my feelings. A few days later when I tried to talk to her about it, she flew off the handle saying she just can't say anything right to me anymore. Well, I guess not if she's going to go telling her broken hearted daughter to risk rejection and go grovel, as if the break up was my fault. I then get sadly told, "well, I was just hoping you would one day marry", as if I am a spinster beyond my years. Personally, I thought I had a lot to offer him as well, but did she say that? No.

We didn't talk for a week and then she acted like nothing was wrong. Because to her, nothing ever is wrong. She's perfect and we are all her ungrateful children.

Right now we have this annoying little feud over the cause of bladder infections. She doesn't believe me when I say they are from bacterial contamination of the urethra, usually fecal contamination. Tonight she called me and tried to pull an "I told you so" about it. She had visited her urologist and told him her theory of why she keeps getting the infections. It's because she works all day at a computer and she doesn't go to the bathroom enough. He agreed with her, and she couldn't wait to tell me. So I said, well that's true, but bacteria doesn't just spontaneously develop in the bladder without a source. It still comes from the urethra but if you don't urinate enough, it ascends into the bladder and multiplies, making it easier to develop an infection. She STILL didn't believe me, so I asked her why she even asks my advice if she's not going to believe me? We got into an arguement about it and she told me she was never going to bring up the subject with me again. Oh damn, that breaks my heart! This must be my karma. My last 2 boyfriends are doctors and they used to get annoyed when I would argue medical stuff with them. I totally get it now. I don't mind people asking me medical questions, but if you're going to argue with the answer, then don't ask!

Here's the deal. All this stuff seems like no big deal, but I'm already at my 99% patience level with her, so all it takes is a little nudge from her to piss me off. She even laughed one time and told me she likes to say irritating things to me because it's funny to her to get a rise out of me. Is that not the bitchiest thing? I told her that she may think it's funny, but that's the reason why I don't like to spend time with her.

I'm sorry I'm so cranky lately. I'll try to do better.

Deep thoughts....by Me!

So this last 6 weeks have been tough. Really tough. The 3 people I know who actually read this already know each day has been a challenge.... I had this moment of truth tonight: I got through the last 6 weeks without him and it didn't destroy me! All through my 20's I struggled with an eating disorder. Remission...relapse...remission...relapse. My senior year in college I was dangerously thin. Everyone knew I had a problem...except me. I spent so much money on counseling trying to figure out why I am like this. I was SO afraid of what this break up would do to me after going 5 years without a slip-up. Have I lost some weight? Sure, but not in an unhealthy way. I did something different this time: I made sure I ate something everyday, even if I didn't want to.

Break ups have always brought out the worst in me. I learned why in counseling, but before that I always did some very foolish things that just made it worse. Not this time. I vowed to handle things nicely. And why not? I spent 1 1/2 years building a solid friendship with him before we dated for 3 1/2 years. It was a wonderful 5 years. Am I hurt? Yes. Angry? Yes....but it certainly doesn't justify bad mouthing someone you care about all in the name of wounded pride. The only thing I wish I could take back was an angry e-mail about him that I sent in a moment of weakness to a mutual "friend" of ours. She had emailed me telling me she heard the news and was really sorry and would call me soon. I wrote her back telling her vaguely what happened and inserted my own commentary here and there. I never heard from her again. I thought she was my friend and I was looking for sympathy. Now I'm worried she's gossiping to people what little deatil I told her. Funny how I work 60 hours a week but she is the one too busy to check on me. Anyway, I made things as right as I could by telling my ex about it over our "closure over coffee" talk a few weeks ago. He wasn't happy, but I would rather he hear what I said from me. The old me would have bad mouthed him to anyone who would listen, in hopes it would get back to him and hurt him as much as he hurt me. Did he cheat on me? No. Was he a lying drunk? No. Was he physically/emotionally abusive? No. So what gives me the right to say mean things?

Then tonight it hit me. I really like who I have become. I don't need to say unkind words I don't really mean. In fact, not a night goes by (even when I'm on call) that I don't say a prayer for him and hope that he is okay. However things turn out in the end, I know I will be okay. I have a great career ahead of me, I have great friends, neices who think I'm way cool, and maybe, just maybe, if I'm lucky I'll meet a wonderful man who wants to spend the rest of his life with me.

The Evils of Trans Fats

My New Year's resolution this year was to cut out all trans fats. ALL. If it has trans fats, I don't eat it. The former Mr. Big has been telling me for a long time how evil they are, and I know they are...but I didn't truly commit to giving them up for good until this year. That means no crackers, fried donuts, all sorts of things you'd never think of. Today I got to realize the fruits of my sacrifice. I got my fasting cholesterol check back today and I couldn't believe it. My total cholesterol was down over 50 points to a level well within normal range. Even better, my LDL (bad cholesterol) level was also down over 50 points, which is now normal too! I compared them from my labs taken just a year ago and the only difference I can think of is those naughty trans fats, because I didn't take any drugs. Give them up now! It really works!

The only thing that wasn't so great is that I found out I have iron deficiency anemia. I don't know what else to do about that. I take supplements. It's not like I can just quit being female, nor do I want to! Being a girl is fun.

In other news, I now have not one, but two kitties that are officially diagnosed with renal failure. I wasn't surprised. They are 14 years old which is ancient. The attitude I'm taking is they have had a great life. If all the other things out there don't kill a kitty (cars, accidental poisoning, fights) it will eventually die from renal failure. I've never had a cat live this long, so this whole renal failure thing is new to me. They eat special food now and it appears to be helping. They don't act any different, it's like nothing is even wrong.

Work is the same. I'm the resident on call during the day for the hospital this month and it has been quite a challenge. There's a crisis nearly everyday that I have to deal with in a moment's notice. Most of the time, they involve acute respiratory distress and require immediate intubation. I always come out of those situations shaking and really sweaty, relieved no one died. It happened today right after lunch with a lady who I think had a pulmonary embolus. She was just about to crump.

I knew this year would be challenging but when I think about the responsibility we are given as interns, it scares me. I've learned how to handle so many life threatening situations, but I have no idea how to do easy things, like splint a fracture or sew a wound....not that an anesthesiologist would ever do those things but it would be fun to know!

True Confessions

Today I was informally voted "least likely to cheat on a boyfriend/spouse" by the other residents. True, am I a St Bernard..loyal, always. This afternoon I cheated on someone. My hairdresser. I went to a new lady. I woke up Monday Morning and realized I have a terrible affliction called "Mom Hair". Julie, one of the other residents, realized the severity of the situation and quickly made an appointment for me to see her lady today. The first thing I noticed when I went to Julie's place was the average age of the clientelle. Very trendy which made me feel intimidated. I'm not cool. I don't even pretend to be cool. The average age of the salon I go to is probably 50. I liked this place though and the lady who cut my hair, as radical as she looked, did a great job and was really nice. I'm always wary of trendy haircutters because the first thing they want to do is cut ALL your hair off. In this case, she actually wanted to keep it longer than I did, which gave her immediate credibility. My hair is a now slightly longer version of The Rachel. I really like it a lot. My head feels lighter!

Today was Doctor Appreciation Day at the hospital. Free food, massages, etc.I had been on call all night with very little sleep and lots of crazy events that occurred that I'll just save for another day. Anyway, the hospital was offering free lab work to all the doctors so I got the whole shibang...lipid profile, thyroid test, blood count with differential, and a complete metabolic profile. In all it's probably worth around $300. I looked awful. Hadn't brushed my hair and it was all falling out of my ponytail I'd slept in.The lack of sleep definitely showed on my face. The lady was drawing my labs and I was telling her I was one of the residents. She said she'd seen my photo (they have photos of all the residents on every floor) and told me I was one of the prettiest doctors in the hospital! That just made my day! It was even cooler that she felt comfortable telling me that. Now, I'm not bringing this all up to brag. My friends who read this blog know I've been feeling pretty bad about myself lately...it was just nice to hear a compliment from a complete stranger.

"Is everything okay?", my boss asked me today. "Lately, everytime I look at you, you seem a million miles away". That's how my mid-year evaluation began today. How do I even begin to explain where I am? My best friend and lover for 3 1/2 years...the man I wanted to marry suddenly ended things for reasons that still perplex me. No matter where I go or what I do, this sadness never leaves me. Then I come to work, a chance to escape from my personal life and I get griped out along with the other residents on a weekly basis for behavior that I'm not even guilty of. I'm tired of it. Tired of everything.

This week was particularly difficult. It's been a month. Things should be getting better, but I still feel the same empty, lonely feeling. Monday morning didn't help things. I woke up with a horrible headache from grinding my teeth in my sleep...something I do when I'm under a lot of stress. The headache was still lingering when I got called to a code blue up on one of the floors. I got up there quicker than normal because I was right by a waiting elevator when my pager went off. I got up to the room and it was chaos. This 25 year old man was in bed, unresponsive. I could tell by looking at him he was already dead. Nurses were frantically trying to get an IV line in with no success. This guy had just been discharged from the hospital when he suddenly collapsed while getting dressed to go home. "Does he have a pulse?" I asked as I climbed to the head of the bed to get ready to intubate him. He didn't. CPR was started while I quickly intubated him. Something was wrong with the defibrillator and there still wasn't an IV in. One of the other residents jumped in and put an IV in the guy's neck so we could start giving epinephrine. Finally, the defibrillator started working. He was in v-fib. During the next hour, we gave him countless rounds of epinephrine, shocked his heart 10+ times, gave him a bolus of amiodarone then started a drip. A few minutes later the respiratory therapist had to suction his breathing tube because pulmonary edema fluid was coming up the tube. While she was suctioning, bloody fluid shot out of the tube like a geyser, hitting everyone who was standing around. We worked on him for an hour and never got him back. Finally I told everyone to stop. He was dead. Everybody was crying. He had some agonal respirations for about 5 more minutes while the nurses cleaned him up so the family could see him. It wasn't real breathing, just reflex breathing that sometimes happens when a healthy brain is dying. "Make sure he has stopped doing that before the family comes in or it will freak them out", I told everyone. He stopped about 2 mintues later, but the fluid kept coming up from his lungs for a long time. I wrote a death note in the chart and managed to make it to the elevator before I started crying. That was by far, the worst code I've had this year. The medical examiner accepted the case for autopsy, but then called back 20 minutes later saying they were going to rule the death as a pulmonary embolus.

The next day I was working on a discharge summary, depressed about my personal life, and still upset about the 25 year old man that couldn't be saved. Another resident, Adam came in and sat by me while he signed charts. "How much are you smoking now these days?" he asked me. "About half a pack a day", I replied. Adam looked at me and said, "you know you're better than that". Looking back, I think that is the nicest, most caring thing anybody has said to me all week.