So I don't really have a title to this post. I just finished my month in the pediatric ICU and it was actually a lot of fun. The kids are fun and most of the time, they recover from illness so much faster than adults.

Except Saturday. Saturday morning is a day I hope to forget but probably won't. We got a 16 year old boy medi-flighted to us from a rural hospital. He had overdosed on drugs on a camping trip and had a full cardiac arrest. When he got to us, a brief neuro exam told me he was most likely brain dead. To actually declare him brain dead requires what we call a "brain death exam" and we can't do it until his body temperature and pH are normal. In other words, there can't be a metabolic reason why he has a positive brain death exam.

So how do you tell a mom that? I had an hour to contemplate this before she got to the hospital-before the whole family got to the hospital. I took a long, audible deep breath and just told them straight out. How sorry I was...his brain was without oxygen too long....he overdosed....and he was most likely brain dead. Then the worst came: His mother didn't believe me. That's the hardest part. You don't want to be mean, but you also don't want to give them ANY hope that their loved one will turn around, because they won't. Brain dead IS dead. To tell them any different would be cruel and it would only draw out their pain. My attending came in and reiterated what I said. More family showed up and a fight broke out between them, pointing fingers and blaming each other.

I drove home completely depressed and it stayed with me the whole day. I felt guilty when I enjoyed my favorite song on the radio. I felt guilty getting to watch college football later that night. People complain that doctors seem so removed from compassion and deliver bad news without emotion. It's not that they don't care. They really do. But there comes a point when you let the daily grind of other people's tragedy completely destroy you.

The next day I went in and the resident on call told me that overnight our patient stabilized enough to complete a brain death exam. He was dead, as I figured he would be. His mother wanted him to be an organ donor, but his organs were too damaged from lack of oxygen. His ventilator was turned off. And that was it.

God Bless Ketamine!

We were doing a tubal ligation aka..."tubes tied" yesterday when for whatever reason, the spinal didn't work all the way. The patient really let out a yelp when the surgeon gave her "test pinches" to see if an incision would hurt. So I did what we do when this happens. I whipped out the Ketamine. I LOVE that stuff! Give it to the patient and they go off to LaLa Land, complete with good pain relief and some mighty interesting hallucinations. It is it is similar to PCP so basically you are giving the patient a legal acid trip during surgery. In recovery, most of them comment on "seeing things" during surgery. It's always fun to tell them that it was perfectly normal and it was from some special medicine they got. Oddly enough, elves seem to be a popular hallucination that gets reported. I'm not sure if I would want to see elves during surgery, unless of course they were from the North Pole and were bringing me lots of presents!

I took a hiatus from blogging

Well, quite frankly, I've been too busy to blog. And when I'm not too busy, I have nothing but complaining to do, and who wants to read that?

So, I've been working nights on OB for the past 2 weeks. Until yesterday, I was really starting to feel like a vampire. Nights are cool. There are less people around, and there is more time to chat with the nurses. There are also no "suits" around. That being said, I'm glad to be a normal person again. I'm glad this month is almost over. I like OB and all, but it's a grueling schedule. When I'm off work, I'm lonely because I've neglected all my friends and now nobody calls anymore. It hasn't helped that I've been sick, either. 2 weeks ago I had an upper respiratory infection which is fine and all, but it causes me to have asthma which isn't fine. I finally got over that, only to get a random UTI which was completely annoying. I'd probably get fired if I called in sick, so I just suffered through it.

Last night I HAD to get out in public, wear normal girl clothes, and do something normal, so I organized a "girls' night out" for the few girls in my program. There's Julie and me, then we just got 3 new girls (yay!). The guys are ALWAYS having their guy parties and don't invite us. So now, at least there are enough girls to legitimately have girls' night. All we did was go to dinner but it was fun, especially for vampires who never get out!

I just keep reminding myself in 2 years this will all be over and I can start dating again, go on fun vacations, have a big house with a pool and cool parties...

Things I've learned while on trauma call

1. Don't ride on a motorcycle on an interstate going 80mph while standing on the seat
2. Don't attack a police officer with nunchuks
3. don't let a priaprism last more than 24 hours before you get medical care
4. don't get shot (this covers the majority of our traumas)
5. being in a gang will cause #4. Don't join a gang.
6. if you are drunk, it's probably a bad idea to try and drive your car through a house
7. crashing your motorcycle and then getting hit by a car afterwards, may cause your arm to get torn off
8. don't go near a rotating airplane propeller
9. don't ride on an ATV
10. If you are too young to drive and don't know how to drive, don't take the parents' car out for a joyride with friends.
11. Getting a speeding ticket is a better alternative than shooting yourself in the head to avoid one. 6 people now have new organs thanks to that guy.

I'm back!

Argh...not much to blog about.

Last week when I was doing kids' anesthesia, a little 5 year old girl woke up in the middle of my case and started screaming. Scared the daylights out of me. I've never had that happen, and she was on more than enough anesthetic so I don't know how on earth she woke up. Anyway, so far she doesn't remember anything. I feel so bad about it. She's already got cancer and I may have now caused her to get PTSD.

I caved this week and ate chips and queso this week (one of my lent sacrifices). Still doing okay on the sweets though.

I was on call last night. An entertaining night. I did anesthesia for a poor guy with a priaprism. (Robyn will like that one). The surgeons drained his penis but it doesn't appear to have worked, so today he was going to have a Quackles Procedure. Just the sound of that makes me laugh. Quackles Procedure. I kept saying it over and over last night.

I didn't go to bed until 4am. My other case was a prisoner who was set to go on trial for murder yesterday so he decided to hoard his medications and take them all at once. Unfortunately, he passed out on his arms and gave himself a bad case of compartment syndrome so he had to have bilateral arm fasciotomies. Sucks to be him. Then again, if he hadn't killed someone, he wouldn't have been in prison, and he would not have wanted to kill himself. So there you go. It's his fault.

I put in a central line in him last night and had a lot of trouble getting it in. When I finally got a look at the chest film, what was supposed to be a right subclavian line crossed over and went all the way into his left subclavian. That was odd. Had to stay up and fix it, which was why I went to bed at 4am. Fortunately, I did not hit his lung.

And the last of my news....I bought some new Merrells tonight. They are chocolate brown suede lined with some kind of wooly-fleece which surrounds my feet in snuggly softness. I'm on call tomorrow and I can't wait to wear them!

Hillary versus Obama

Just kidding.

So It's been 11 days since Lent. I gave up all sweets and all chips. Without dieting, I have already lost 3 pounds! I only cheated once, and it was when I grabbed a peppermint candy after lecture one day, forgetting that I'd given up all sweets. What I did give up was the constant snacking on garbage that I do all day at work. Most of it is hunger driven because the only thing really good the hospital gives us is plenty of cookies and chips. Then there's the drug rep who brings us little miniature candy bars. Between all this, I figured out I'm eating an extra 900 calories a day. Yikes. Well. That's over. Who knew that just cutting out needless snacking could result in weight loss? So simple, yet so challenging.

Caution!

When working in the MRI room, make sure you take off all metal objects! They will either 1. get sucked into the machine or, 2. break. Last week I forgot to take off my watch and it promptly quit working, frozen in the exact time that I walked into the room. Strangely enough, it miraculously started working again a week later.

Can anyone explain this to me?

Out of the frying pan and into the fryer...

I was soooo happy to be finished with my trauma ICU rotation. As it turns out, I just traded in one nightmare for another. I had my second day of kids' anesthesia and it's really crazy. Kids are scary. They turn on you for no reason. Like today. My second case is cruisin' along and all of a sudden the baby became hypoxic and turned this awful grey color. We called a cardiologist to come in and do a quick enchocardiogram, but it yielded no information.

I got home and realized this is the first time in 2 months I've gotten home while it's still daylight, so I went on (what used to be) my daily 3 mile walk. While walking, a bird flew over and pooped on me.

Uh, God? Did I do something to upset you?

Almost....!!

Ah, nothing like the eve of my last day in the trauma ICU. My Hell-Month is over. I never have to think of it or dread it ever again. No more taking orders from surgery residents ever again.

I did like some of this month. I like getting to know the families of the patients and working with all the nurses. Everybody was really nice. I just don't like rounding all day. It's boring. I also felt like the surgery department's scut monkey, but that's a whole other story.

This month was rough. I lost some patients that I really cared about. The hardest part was watching their families suffer. I wish I could just bear half the weight they are feeling. The thing about the trauma ICU is, most of the patients are younger. It's filled with the 17 year old brain dead boy who just made a bad decision while driving...too new at it to know better. Or there's the 83 year old lady who was in a car accident and broke both her hips-and injury she won't survive. Then there's the 27 year old guy who got shot in the head and now there are 3 people alive today because he donated his organs to them. Anyway, you get my point. It's emotionally exhausting. Now I know why some doctors seem cold and emotionless. Doing this day in and day out would make anyone clinically depressed and divorced. I didn't spend enough time there to become that way. I hugged parents after their child died and then went home and cried myself.

To throw another event in all this, my 39 year old stepsister died suddenly 2 weeks ago today. She had been sick with an asthma exacerbation and in the hospital for a week. Back home, she still felt bad and just stayed in bed. Unfortunately, that set her up for a pulmonary embolus. I don't think she ever knew what hit her. She was short of breath and vomiting, then she was dead. Everyone in my family though it was her heart. I told my brother that 39 year old women don't drop dead suddenly from a heart attack, they die from clots in their lungs.

She and I weren't close at all. In fact, we hardly spoke to each other. We had some..er...differences of opinion on things. Now I'm left feeling guilty that I wasn't more friendly to her. I wasn't mean to her, but I wasn't nice either. I was nothing. She has three kids, two of which my dad is now raising because their dad's don't want them. I'm going to try and make it up to Angie by being good to her children.

This month is finally coming to an end and I can at least get some of my life back! I finished a 27 hour shift this morning. It was a horrible night. Our trauma center was so busy and all the patients that came through were critically injured. I think we had 5 new admissions, in addition to the ones we already had. Just about everyone is on a ventilator and one unfortunate woman actually has brain tissue oozing out the back of her head. I had the miserable task of talking to her family about her poor prognosis. What do you say to someone who's only child just got shot in the head?

The stuff I've seen this month is so horrible that most of it I can't write about. I'm looking forward to not being exposed to all this human cruelty and getting back to just doing anesthesia.

An apology to my friends

I've neglected all of you lately. I missed getting to wish everyone a Happy New Year and all that. My excuse is a lame one: I've just been working All THE TIME. If I'm not at work, I'm in bed (sleeping). I worked 90 hours this week, which left no time for me to do anything else. Sadly, New Year's Eve I was in bed by 9:30pm because I had a 24 hour shift starting at 6am the next day. I hated it. All this being said, I think about all ya'll a bunch and hope everyone's year is starting off good!

What has made me so busy is my trauma ICU assignment this month. It's notoriously known as the worst month of the anesthesia residency, because the hours are so long. It's also depressing. Just about everyone has traumatic brain injuries from various accidents, whether it is putting up Christmas lights and falling off a ladder, or mostly, car accidents and gang members shooting each other. Most of these guys are on a ventilater and not showing much hope of coming off. Some of the awful trauma I see makes me want to never leave my house, for fear of ending up like these guys.

I just woke up from sleeping all day after a 30 hour shift last night. We're having our annual anesthesia department party tonight which is pretty fun. Everyone dresses to the hilt and we have free food and drinks. What am I going to do instead? Order out sushi and watch back-to-back episodes of "Flip That House". I just want to stay home tonight and chill.

My month in a netshell

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

Crazy week

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

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

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

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

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

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

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

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

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

Woof!

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

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

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

Sleep, here I come!!

On call yesterday. Highlights of my day include:

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

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

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

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

Thanksgiving Harvest

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

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

Not-so-glamorous-life

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

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

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

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

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

over-the-top embarrassing moments

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

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

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

Nobody puts Baby in a corner!

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

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