This is the part where I cry

I went to the doctor the other day. You know the one I mean...THE doctor.

What I learned: I have gained 10 lbs since residency started.

My blood pressure which is usually 105 was 130!

Holy cow! Maybe I was just nervous. Maybe when you are going to THE doctor they should wait until the appt is over before they take your blood pressure. Just a thought.

Time to start running again. No excuses. Not even if we get Ice Storm 2007 part II.


Tonight I have to go shopping for a cocktail dress to where to an anesthesia party Saturday Night.

Gee, I wonder what size dress I will end up buying.

Mean Me

I'm starting to be mean. I've noticed when I'm on call, I have a lower threshold of getting mad and speaking my mind than I normally do. I start to say what I'm thinking without keeping my mouth shut. My first victims Sunday morning were some construction workers who came into the call room area at 8:30am and starting doing work. If that wasn't bad enough, they knocked on my door, woke me up, and said they needed in my room and would be there all day working on the cables in the ceiling. I'd had enough. "Look", I said, "I'm here for the next 30 hours and this is the ONLY time I'm going to get any sleep..." I lost that battle. My pager started going off soon after that anyway. I apologized later to those guys. They were just doing their job.

There weren't anymore victims until about 6:30am the next day, when I got paged with the Rapid Assessment Team to go see a patient (who is supposed to be in dire straights for us to get called). I get to the pt's room and there was no nurse to be found to clue me in on why we were called. The patient was just calmly lying there and I asked her if she was okay and she said she was. I went out to the nurses station and asked who the nurse was for that room and why is nobody in there to fill us in on why we were called. She explained she was standing in the hall to direct all the responders what room to go to. Well, that's great and all but she's supposed to be in the patient's room helping us since she's the only one who knows the patient. I was more than a little short with her. I felt bad later and apologized. I was right, it is a rule that when you page the team you must have somebody at all times in the patient's room so we know what's going on, but I thought long and hard later about how I came off. Here I am, this young, snot nosed doctor, getting snippy with a 50-something nurse who probably has more years of nursing on her belt than I have years of breathing. In my exhaustion from being up all night, I forgot to treat her like a person. I hope I don't let that happen again.

So that night, I had 3 rapid assessment team calls, 8 hospital admissions, and a code blue (that I successfully resuscitated only to find out that the pt had a signed DNR in her chart that somehow none of the nurses knew about). I felt really bad about that one. She did die later that night.

No more licensing tests for me...I passed!! Not quite the score I wanted or expected, but I passed and that's really all that counts.

Such a relief....

Ice Storm 2007!!

If you watched the news where I live, you would think it was Armageddon. The drama started last Monday when they predicted an ice storm would hit Friday. Yes, Friday. They talked endlessly about it all week until.....Friday, when it happened. Sleet began to fall and the news soon went on simultaneous coverage for 24 hours. Can you believe it? 24 hours of non-stop Armageddon-Ice-Storm-2007 drama. I loved the storm. I was on call Friday Night and because the roads were so bad, people decided they just weren't sick enough to come to the hospital, which meant an easier night for me. Yes, it's all about me. I was still busy though. Just not AS busy. The storm pretty much lasted all weekend. I woke up Sunday Morning to sleet pelting the windows and roof and.....thunder! It was glorious!! Not so glorious to the 100,000+ folks on the eastern part of my state. They got freezing rain and lost power. That happened to me 5 years ago and it was a complete drag. I'm lucky I live in a big city and was only out of electricity for a day. Those poor people are in smaller towns and it may be weeks.

Now, getting back to "Ice Storm 2007" (insert dramatic music here just like the news did), I went to the store Tuesday Night to buy a few things "just in case". There was a thoughtful sign up at the store warning us all of the impending doom and giving us helpful advice on what staples to buy. Included on that list was of course, cigarettes. I did a double take. Cigarettes? YOU HAVE GOT TO BE KIDDING ME! Yes, by all means, be sure and stock up on cigarettes in case you can't get to your neighborhood 7-11 during the storm. Good grief. That is pathetic. Whoever put that sign up should be ashamed of himself. In fact, I think I will write them and let them know.

Sadie post op

Feeling groggy. She hated the pink bandage where her IV was placed

This week has not been eventful. My board scores were mailed to me yesterday so I'm kinda waiting on pins and needles for them to get to my house.

The guys in my residency program are starting to bug me a little. Just stupid little things that annoy me, like them sleeping in the female call room and using our bathroom and then getting pee on our clean floor. Gross. They also act like they know everything, which is also starting to bug me.

Remember the lady I blogged about who had bad chest pain, was out of breath, and her cardiologist blew me off at first? She suffered an anoxic brain injury from that morning and was never able to come off the ventilater. Her family has been divided as to how her care should be handled. It turned into a Terri Shiavo sort of thing. For all practical purposes, she is in a coma and will never come out of it. I found out today the family finally agreed on removing her from the ventilator and letting her die tonight. It's the right decision in my opinion but I'll just never forget being one of the last people to talk to her and knowing how scared she was. She was in so much pain that she asked if I would rub the back of her neck for her. So I did. I'm convinced she knew she was going to die.

That's really about it. A big ice storm is supposed to hit tomorrow and I'm on call then until Saturday morning. Hopefully I'll be able to drive home okay because I sure don't want to spend my whole weekend at the hospital!

My dishwasher is broken. I have to wash my own dishes. Therefore, I have no time to blog.

Boo bees

I have to go back to work tomorrow. Not only do I have to get up before 11am, I have to get up at 5am!! Thank God for Ambien, otherwise, I'd be getting 4 hours of sleep tonight instead of 7 or 8!

I guess I am ready to go back. My intern year has been pretty fun so far. I'm half way finished now, and with my licensing test over (hopefully I passed), I can just cruise for 6 months until I start doing anesthesia. All of my friends are just now starting to study for it and are getting stressed....not me!

Sadie is feeling much better. She's acting much more like her old self and she's not meowing all the time (in an attempt to tell me her teeth really hurt). I bought her one of those water bowls that recirculate water and then it comes out a little spigot to simulate a real faucet. I'm not sure if she's drinking out of it yet, but she hasn't been spending all her time in my bathroom waiting for me to turn on the sink faucet, so I think she must be (that's how she likes her water). Now she has fresh flowing water even when I'm gone, which, when I'm on call, is about 30 hours. It's important for her to get plenty of water now.

Mr Big and I went to Pottery Barn today. I finally decided what kind of bedroom furniture I'm going to buy. I'm pretty excited. I love their stuff and he bought me a very generous gift certificate to their store for Christmas. I can't wait to get my furniture!

Mr. Big told me a funny joke today: What goes, "BZZZZZZZ....BOO! BZZZZZZZZ ....BOO!" ?
Answer: boobies!

Sad news

Well, so I wasn't totally in the clear about my kitty's health. I took her in to the vet today for her major tooth cleaning. I picked her up tonight. She was still sorta out of it and the vet came out to talk to me, which is probably never a good sign. Anyway, they had to pull 5 teeth because she had developed abscess underneath them, which were probably very painful (insert guilty feelings here). The really bad news is that her labwork shows she has renal failure. I guess I knew deep down that was coming. She has been drinking a lot more water over the last few months, almost competing with me for the sick faucet because that's how she's always liked her water.

Now I have to decide how far I'm willing to go with her illness. I changed her cat foot to a special renal food (no problem there) but the vet was talking to me about giving her subcutaneous fluids every week, hypertension medicine, and supplements. As much as I love my little buddy, she's still a cat. Forcing all that stuff on her, despite the good intention, would drive her insane and she would not tolerate it well at all. She's already hating the antibiotics and pain meds she got sent home with. Lucky for her, that's only for a few days. I was reading online about kitty kidney transplants and I couldn't believe somebody would put their pet though that. It's interesting for research, but kind of crazy. How much does that cost, anyway?

On a good note, Sadie is meowing a lot less tonight. Either she is still sort of drugged or her mouth is feeling a lot better (again, insert guilty feelings here). Imagine, having a mouth full of abscessed teeth and not having it treated right away. I wish I had done something sooner. I just didn't know.

Smelly Cat

I have a Smelly Cat. When I hear Phoebe's song on Friends, I think of Sadie. Her breath is absolutely awful! It has gotten so bad lately that I can smell her breath when I'm just in the same room with her. I've put off taking her to the vet because I haven't had time but I also was afraid of hearing that she had kidney or liver disease. She's almost 14 years old and I've been lucky thus far in having a healthy cat, so I was just waiting for some bad news. I'm off this week and the first thing on my list of things to do (after finally getting over most of my nasty cold) was to take her to the vet. I was relieved to hear that she "only" has bad gingival disease that will require a thorough teeth cleaning under anesthesia. I signed her up for Thursday morning. Funny the things we will do for our pets.

She didn't much care for the visit today for two reasons: 1. the friendly boxer doggie in the waiting room who just wanted to see what was in my pet taxi 2. the rectal thermometer


http://www.youtube.com/watch?v=ETQfuzNGT58&mode=related&search=

Me is sick. It hit me yesterday....sore throat, malaise, achey, tired...blah. It hit Mr. Big today. Tonight both of our pathetic souls camped out on the couch and watched the news, then took a nap. There is one thing nice about being sick: it let's you do things that you normally feel guilty doing, like lazing around the house. Unfortunately for me, I'm on call tomorrow from 8am to 8am, so no rest for the wicked. I'm just praying for a good day. I'm due for a nice, calm call shift.

What I'm listening to: Defying Gravity from Wicked (I have to brag that I went to college with Kristen Chenoweth. She's just as nice as she seems, too!)

Over My Head

When I'm on call, 5am seems to be the bewitching hour of every disaster I encounter. Like that old saying, "the hour is darkest just before dawn". This morning, I'm trying to put out a minor disaster when I got paged by a nurse who works in the physical rehab unit about a patient who'd had heart bypass surgery a week or so ago and is now diaphoretic and out of breath. I tell the nurse to put 100% oxygen on her and I'll be right there. I get down there and the poor lady was absolutely drenched in sweat, complaining of chest pain radiating to her neck, is severely out of breath, and her blood pressure is 70/30. Worried she's got a PE, I order stat labs: a chest xray, cardiac enzymes, blood gas, an ekg, and morphine. I'm seriously contemplating intubating her at this point, but she seemed to be maintaining her oxygenation okay.

While this was going on, I called the on-call pulmonologist and told her what was going on. While we're talking, the lady's blood gas comes back normal and her labs showed she was adequately anticoagulated. The pulmonologist told me she likely was not having a PE but she needs to be transferred to ICU and I need to call her cardiologist (who had already ben called but was slow in calling back). I get word that one of the nurses calls him and he is on his way. We started getting the lady ready to transfer. She was scared and really hurting. By this time I'm thinking she's having an MI. Her cardiologist walks in, looks at her, and I start telling him the labs I drew. He was pretty rude. First of all, he asks the patient if she's been participating in rehab or if she's just been lying in bed. She's so out of breath she can't answer very well. He then starts chewing on me, telling me that you can't have an MI after heart bypass therefore the cardiac enzymes I ordered are pointless. "Did it ever occur to you she might be having a PE?" he asks me accusatory. I told him it did but her blood gas is normal and her INR is 2.8. He's pretty pissed off. I tell him we have an ICU bed for her and he said she didn't need one, just transfer her to intermediate care (sort of in between a regular hospital bed and ICU). He then asked me if I'd bothered to order a chest xray and I told him one was just taken but I hadn't had time to see if was in the computer yet to look at it. He stomps off and I didn't see him again. The nurses helping me were angry that he was so awful to me. We got the lady transferred to the new room, on the cardiac floor. Her new nurses (experienced cardiac nurses) were clearly alarmed at her condition and didn't understand why the cardiologist was so flippant about it. I stay another 10 minutes and then realize there's nothing more I can do, she is the cardiologist's patient now and he needs to write her admission orders. 15 minutes after I left, she went asystolic and quit breathing. Finally, the cardiologist realized how sick she was. I mean, who am I, a mere intern 6 months out of medical school, to tell him when a patient is sick or not? I felt a bit of redemption, but it was at the unfortunate expense of the patient. She's still alive, but now she's on a ventilator and when I left, they were performing a ton of tests to try and figure out what happened to her. As I walked out of the room, he patted my back and said, "good job". I guess he knew he was wrong.

I got back to the call room and realized what a close call that was. This was my first experience with a patient who has heart failure and is decompensating right in front of me. If we delayed her transfer just 10 minutes, she would have either died in her rehab room or worse, died in the elevator on the way to the cardiac floor. Both locations don't offer much hope of survival. It still scares me when I think about it. I don't want to be on call anymore-ever.

Merry Christmas!

Hope everyone had a good one.

My carrot cake turned out...weird. I think I'll probably throw away the recipe. When the main ingredients were pine nuts, carrots, and fennel seeds, I should have figured it would taste odd. Sorry, Giada.

This was an odd Christmas. I didn't have anything to do today. With my family getting together on the 23rd and 24th, it left today with nothing to do. Mom and I were going to go to a movie, but we couldn't agree on one then she decided she didn't want to spend the money. Then we decided she would come over and we would hang out and I would make Turkey Casserole for dinner (yum!). She called me at 2pm and said she just wanted to stay in, partly because her back was sore. Hmmph. I was a little miffed. I wish she had told me sooner. I could have made other plans, namely, driven a couple of hours to have dinner with my college friend and her family. But at 2pm, it was too late. I wish I had a dollar for every time I've had to ignore a sore back and gone about my day. I've had back pain since I was 10 years old. I've learned to ignore it. Today I kept thinking of all my friends and what they were doing. They all have husbands and kids. I'm the only single one and it makes holidays weird because everyone does things with their own family. I sometimes feel like the "ugly spinster". That being said, maybe with each passing year, that's one year closer to having my own family!

Other than today, my Christmas weekend was pretty fun and I got lots of rest. I'm really looking forward to being on call tomorrow night (she says, sarcastically).

mascarpone, anyone?

I'm going to make a carrot cake tomorrow that I saw Giada make on Everyday Italian a few weeks ago. The problem? I can't find any mascarpone cheese. I saw some at SuperTarget last week, but do I dare even think of setting foot in a Target on Christmas Eve so I can buy a small tub of cheese? I don't think so. Instead I bought cream cheese. I hope it works.

Today was better. I went to my dad's tonight and had a nice time. My step sister and her family weren't even there so that totally cured the "do I get them a present" problem. They did buy me something, but I really don't think they'll care I didn't reciprocate. I'm really excited about going to my mom's tomorrow. We always have a good time and I bought everyone cool presents that I think they'll like.

I wish Mr. Big was here for Chistmas. I miss him. : (

What would YOU do?

Christmas is a time of giving, right? Well, I have a question. Where do you draw the line? I have a step family that came along well after I became and adult, meaning, we aren't the "Brady Bunch". To be bluntly honest, I consider my step family to be "my dad's 2nd wife's family". I'm not close to my dad, either. I won't get into the reasons why, but let's just say our relationship is on the brink of disaster. It's also always been pretty clear to me that I'm the least favorite of his children. So here's the problem: I buy a present for my dad's 2nd wife, but am I really obligated to buy presents for her daughter, husband, and three kids (from 3 marriages)? We have a general distaste for each other. I'm sure they think I'm a snob and I personally don't approve of the poor decisions my step sister has made since her mom married my dad. We don't talk to each other and we only see each other once a year. So, why should I buy them all a present? Up until now, I've always sucked it up and gotten them SOMETHING, but this year I just don't have it in me. I can't stand my step family, and in my mind, buying a present that you don't really want to buy is worse than not buying one at all. I see it as dishonest. Christmas should be about giving to people you want to give to, without the pressures of strange blended families. Just because my dad married into their family, does that mean I have to be as well?

Sadly, I'm afraid my predicament is that of the "typical American family". I was 18 when my parents separated. It totally devastated me. Who gets divorced after 36 years?? People always talk about how hard divorce is on children, but it's also hard on adult children. Birthdays, holidays, and special occassions are always awkward in my family. Sometimes we have to have two celebrations because God forbid if my dad has to be in the same room as my mom. Christmas is one of those times. If I'm ever lucky enough to have a husband and kids of my own, I will make Christmas the happiest time of year for them, not the saddest.

All these deep thoughts now require some chocolate....

I turned 36 in October. Here are some photos that I finally download from my camera:





The birthday bowling party. Me with my neices




My 36th birthday and my neice's 10th birthday

Typhoid Me

It seems like everyone I come in contact with these days dies. None of these deaths have anything to do with me, but they are just happening. Remember the guy from 2 weeks ago? Well, there have since been two more. There was a guy I assisted my surgeon on in putting in an AV graft so he could have dialysis. Well, just a few days after he was discharged from the hospital, he had a bad car accident and died a few days later. Question I have is, was he driving? I mean, the guy was paranoid schizophrenic and was not very compliant on his meds. I sure hope he didn't hurt anyone else in the accident.

The other guy I admitted to the hospital on Sunday. He was an older gentleman and came to the ER complaining of an itchy rash that he'd had for 3 weeks (not really an emergency, but whatever). The reason he got put in the hospital is because his blood glucose was 573! He wasn't in any distress and didn't know it was that high. An attending doctor took over his care the morning after I wrote admission orders. Out of the blue yesterday he just went into asystole and died. I feel so bad for his wife. They were so nice when I spoke with them Sunday. This just completely blindsided her. Then today, a horrible thought came to my mind: I bet he has Christmas presents under the tree. It's no wonder the suicide rate is so high around Christmas when things like this happen.

In other news, Mr. Big has gone to the Left Coast to visit his sister. I've spent the evening cleaning my house, catching up with some friends on the phone, and playing my piano. It's weird having free time! : )

I think this has been one of the most difficult weeks I've had. Remember that 2 day test I took last week? Well, I was on call the night I finished it. Fortunately it wasn't a terribly busy night, but still, I was at work and I can never sleep well at work. I thought I was going to get to go home the next morning, but instead I ended up assisting my attending in the OR until 5pm the next day! I was so tired I was near tears. Mr. Big and I went out to dinner that night then I fell asleep on his couch (something I do quite regularly these days). I went home and went to bed at 10pm (wow!) and woke up at 7am dead tired. I drove to work feeling so dejected, depressed, and that I just could not physically do this anymore. I always thought I could do anything no matter what. Well, I learned my limits this week. I should not have tried to fit so many important things into one week. I got to sleep in this morning, but I am still dead tired. I looked in the mirror this morning and my appearance scared me. As luck would have it, I'm on call tomorrow for 24 hours, then I'll have to stay at work through 1pm on Monday, which will put me close to a 30 hour shift. I'm really starting to question if I can do 3 1/2 more years of this.

I crammed almost all my Christmas shopping today online. I really hope everything gets to me on time. How on earth did December get here so fast?

Tomorrow is day 2 of my final licensing exam. Today was hard. 7 hours of questions with 45 minutes of breaktime. Tomorrow is more of the same...AND I'm on call tomorrow night after the exam.

This morning on Good Morning America, Diane Sawyer started off a story about tired docs with, "Doctors can work up to 20 and 24 hours straight. How safe are YOU?" I laughed. Oh Diane, Diane....if only you knew. Doctors are just getting warmed up at 20 hours! People aren't sick 9 to 5.

What I'm reading: Glamour's Big Guide of Do's and Don'ts (I couldn't resist! Pink and Pastor's Bride would be so proud!)

Close call

I knew the anesthesiologists' pre-op evaluations were important, but I got to see just how important they were last week. We had a man come in with multiple health problems who needed to have part of his foot amputated due to a non-healing wound. I went to go see him and do a quick physical exam. While I was there, the anesthesiologist (coincidentally, the same one who slept with my friend then never called her) came in to look at the patient's lab work and talk to him. The man takes coumadin ("blood thinner") and the lab work showed that his blood was way "too thin" for a safe surgery. The anesthesiologist went to talk to my doc (the surgeon) about cancelling the case because he was too high risk for bleeding. My doc was a little irritated about cancelling, but did agree. I was still filling out paperwork on the patient when my doc came to talk to him. He advised him to go to his doctor to get his blood thinner medicine right, then the surgery will be rescheduled for next week. I thought nothing more about the matter, and was honestly relieved that one case was cancelled that day, because as it was, I was already going to be at the hospital until 9pm. A couple of days later, my doc asked me if I remembered the patient who had his surgery cancelled. I told him I did asked why he was asking. He told me that the next day, one of the nurses called him and told him that right after the patient got home from his cancelled surgery, he dropped dead! Wow. I'm assuming it was cardiac related, but it's a weird feeling when someone dies right after you have examined them. One thing I know for certain: my doc escaped a major litigation nightmare by allowing the anesthesiologist to cancel the case. He should buy him a nice present. I have no doubt the patient would have died in the operating room during the administering of the anesthesia, and the family would have blamed it on the docs and probably sued them. It's weird though, I keep thinking of my examination of him and wondering if there was something I missed that would have hinted he was going to die in an hour. There wasn't. I specifically remember asking him if he had any new chest pain or shortness of breath. He said "no"...then he went home and died.