This one is for Robyn

I had this patient today who sufferred some pretty bad injuries to her face this weekend. She had a rather angular face, but who am I to judge? Her face was bruised and swollen so I have no clue what she normally looks like. My attending kept accidentally referring to her as "he". I was embarrassed for him and he kept doing it, but to the patient's annoyance. So me, being the clueless person I am, am getting ready to intubate her. We have her on the table, I'm giving oxygen, my attending is putting meds in the IV. What to do you suppose tipped me off that this was really a dude I was dealing with? Was it his very large Adam's apple? Was it his stubbly face and square jaw? Or how about his deep voice? No! What tipped me off that this was really a guy, was that when I looked down his airway, I realized I would have to use a Mac 4 blade to get the tube down. I only use Mac 4's on dudes! That's what tipped me off! It is official. The only way I can tell apart men and women is by direct largyngoscopy to see what size blade would reach the eppiglottis.

It's official. I'm am now what you'd call in the truest sense, a Nerd.

Another example of people who dish it out but can't take it

Remember my last post about the mean bossy scrub tech who couldn't handle people giving some back to her? I've got another example. I was on call (for the 4th time in 9 days) last night when a gunshot wound guy came in. He was a skinhead who was getting drunk with his buddy when he accidently got shot right above his jewels. The bullet wound wasn't really all that serious. His friend missed all the important stuff, but he had to go to the OR for a "rectal exploration" to make sure he didn't damage any of his large intestine as well as irrigation of the wound itself. In the OR, the guy was really freaking out. Yes, this guy who spends his life scaring people and intimidating people with his "white power" BS was crying like a big baby right before we put him to sleep. Kinda makes you realize who the true cowards are in this world we live in.

Quiet Saturday

Don't ever say the "Q Word" when you are on call. It's a jinx. Q is for quiet. The minute you say it's quiet, it gets busy. Now, I'm not a superstitious person, but I'm not going to chance things, either. Plainly put, I had one of the best Saturdays on call ever. I only had 2 cases the whole 24 hours. One at 7am and one at 11pm.

My first case was kind of funny. It was a tracheostomy on a guy who has been intubated for awhile. I think I've mentioned before about fights breaking out between staff during the surgery. Well yesterday yielded a pretty good one. The scrub tech was being bossy to everyone. Yes, the scrub tech. The least educated person in the OR thought she was somehow the most powerful person in there. She was hateful to me, bossy to the nurse, and just generally being a pain in the ass. Finally, the surgeon had enough and told her that he really didn't need her in the case and could do her job for her just fine if she wanted to leave. She left, and we enjoyed the rest of the case. Of course, now the scrub tech is saying that we were all mean to her. Funny how there are people out there who can dish it out but can't take it when it's given back to them.

My other case was an extremely intoxicated fellow wrecked his motorcycle when he tried to drive it with the front wheels locked. He was nice to me, but being very mean to the recovery nurse, yelling at her a bunch. He sounded like a monster the way he was growling at her and carrying on. I finally had enough and told him he needs to be nice to the person who is giving him the pain medicine. He slept the rest of the night. Yes, I know it's mean to threaten to withhold pain meds in exchange for civil behavior, but in this case I felt it was appropriate.

They're Magically Delicious!

I have fallen in love with the new Chocolate Lucky Charms. I tried some generic ones at a friend's house last week and thought I had died and gone to Heaven. I don't think in my 36 years I have ever bought kid cereals, but yesterday I sought out and found Chocolate Lucky Charms. Imagine, those tasty marshmallows from childhood combined with the chocolately goodness of Count Chocula! It's sheer pleasure in a box! I figured while I'm at it, I might as well get some Fruit Loops, too. I always thought those cereals were awful breakfast food but you know what? They are less calories per serving than my Grown-Up Cereal. Plus, kids cereals are much tastier and may motivate me to get out of bed early enough to actually eat breakfast. Could it happen? Naw, but it's a nice thought.

Well so not many blog worthy things have been going on, really. After my wild vaca, everything else is just...boring. Today was my 12th day in a row to work. That's not really that much compared to some people, but I'm happy to have the weekend off to catch up on sleep (seeing as how I did not do that on my vaca).

So today in a big case, the scrub tech had an asthma attack. She was in her sterile gown and couldn't touch anything, so I got the inhaler that automatically comes with my drug tray and gave her some puffs of albuterol-all without touching anything but her mask and her mouth. Asthma attacks are nothing to mess around with. Many a asthmatic has died because they waited too long before they got help. I had a patient (who smokes) just last week go into bronchospasm in the middle of the case. I couldn't get her to oxygenate through her breathing tube and her lung pressures were way high. Scared me to death. Got through it, though. Long term smokers don't do too well with surgery.

So one of our interns has a 6 month old baby that was fine and dandy until a month ago when the baby suddenly collapsed and quit breathing. She and her husband (both doctors) resuscitated the baby at home and got her to the hospital. She survived but has a very bad congenital heart problem that no one knew about. Her only chance is a heart transplant. They have decided to forego surgery and bring her home on hospice. I was thinking today what a brave decision that was for them. I know it was really difficult and I hope they don't question their decision 10 years from now, wondering, "if only we had..." They saved their baby a lot of suffering in exchange for their own.

What happens in Dallas, stays in Dallas: My Vaca, part 2

I hadn't really intended on going to Dallas for the annual Red River Rivalry, but I have a group of friends that go every year, and at the last minute, talked me into going. "If you don't go, you're just going to stay home and feel sorry for yourself, wishing you had come with us," Julie told me. So I went.

Started of the day at Humperdink's for drinks and a big pep rally. Ran into a couple who the ex-boyfriend and I used to have dinner with regularly. As soon as we broke up, they dropped me. And as I would expect, I got an icy reception from the female. I have no idea why. I'll say one thing: you find out who your true friends are after a break-up.

Around 7pm, the party migrated to a strip bar next door to our hotel. A nice strip bar. Here's where things got strange. Two of the girls with us started making out with each other in front of their husbands. Then they started doing other things. Pretty soon, the crowd around our table was bigger than the crowd watching the real strippers. That's all I'm going to say about that. The girls ended up getting kicked out of the club after going to the ladies' room together. The rest of us went for pancakes. Julie and I managed to stay heterosexual throughout the evening. The funny thing is, as wild as our night was, we are all in our late 30's and were in bed by midnight. Of course, when you start partying at 2pm, midnight is a bit late.

I ended up having somewhat of an interesting weekend of my own, which I won't get into here. I just hope I don't live to regret some of the things I did. I did get to spend some unexpected time with a very special friend.

Oh yeah, and our team won. Seems sorta anti-climactic after all the things that went on. We all made it home alive and well. I was told this was the wildest Red River Rivalry Weekend they have ever had. I'm certainly glad I didn't miss out!

funny 1920's art deco train station in Baltimore. (I got to ride a train for the first time ever!)





One of my all time favorite paintings




Pink and Holiday

My Vaca, part 1

Did ya'll think I fell of the earth?

I had 10 days off. I took two trips. In 10 days, I was home 1 day. I started back to work this morning, exhausted and badly needing another vaca to catch up on sleep.

Trip #1: I surprise visited my friend, Pink, who lives in Washington, D.C. Being the shrewd, sneaky person that I am, I constructed a secret vaca to D.C. and crashed Pink's birthday party. Only her husband knew of the plan....and it worked, but barely. Pink is a shrewd, sneaky person herself, and suspected something was up, but fortunately, her parents showed up first, so she thought they were the surprise. When I showed up at her door during the party, she was speechless and teared up. Mission Completed.

We had a great time and I got to see a lot of stuff I missed back in June. ie..Spy Museum (I'm going to quit medicine and become a spy now), Holocaust Museum, and The Phillips Collection. I braved the metro by myself and managed to not get lost in D.C. while looking for these various sites. The Phillips Collection was neat because I saw some of the collection in 6th grade when it went on special tour throughout the U.S. and our class took a field trip to see it. That's when I saw a real Renoir for the first time. It was really neat getting to see my favorite painting again after 25 years.

Oh yeah, and I got to eat some great food, met a bunch of her friends, had long talks, and spent time with the sick doggie who has hemangiosarcoma.

AMATEUR TRANSPLANTS: Anaesthetists Hymn LIVE

While you were sleeping....

Last night was the worst call Ever! (or maybe it was the best call ever because I learned a lot about myself and how I handle bad situations). I finished up a 16 hour elective case at 11pm. Meanwhile the traumas just kept rolling in.

I was in the OR constantly for nearly 24 hours. I have chafe marks on my face from where my mask rubbed me. Ouchies!

a brief summary of the highlights:

Some lunatic attorney who robbed a pharmacy for narcotics last week tried to kill himself in jail and was brought to our hospital for treatment. While at our hospital yesterday, he managed to elude his guard and baracade himself inside his room, break the window, and stand on the ledge of the 5th floor for 4 hours (entertaining the media) before he finally did a swan dive off the ledge. Little did he realize he would land on the roof of the 3rd floor, thus making his dive a critical injury rather than a deadly one. We got to add him to our endless list of traumas that came to the OR last night. He was definitely the most interesting one.

I cut my finger on a contaminated knife I had just used to put in a central line on a patient. It's a more high risk cut (more blood involved) than a needle-stick, but thankfully, my patient was a 74 year old lady with ovarian cancer, and not some gang-banger drug addict who probably has hepatitis C. I still can't donate blood for a year, though. I can't believe I did that. There is a small silver lining to this: going to employee health to fill out the paperwork and get blood drawn was the only break I got yesterday.

One case I had was a guy who ruptured his spleen in a car accident. He was white as a ghost but his blood pressure was holding through our OR prep and putting him to sleep. As soon as they opened him up, his blood pressure dropped to 50 and his heart rate went up to 160. I was by myself and about had a litter of kittens right then and there I was so scared. I pushed a bunch of blood into him quickly and he did okay. I snowed him with narcotics before I woke him up so he wouldn't hurt. (hurting sucks!) Good thing I did. I snowed him so hard he didn't wake up for me, but in recovery, when he did wake up, he went apeshit and tried to attack the nurses helping him and had to be tied down.

Oh the things that happen during the night while sane people are fast asleep!

Weird things people have said to me this week

1. Wow, you have great scalenes!
2. Do you wanna see my testicles?
3. My surgery is over and you never gave me a kiss! I want my kiss!
4. Look at your juicy jugular vein!
5. I'm still waiting for my kiss!
6. It's okay if you knock out my loose tooth, it's gotta come out sometime.
7. Katy, do you mind coming over here and tying up the surgeon?


#2 was a scary guy that I was working up for a pre-op evaluation. He was a total pimp-daddy trying to hit on me. He was real inappropriate and actually put his hands on me. I should have reported it, but I was tired, it was late, and I wanted nothing more than to leave his room because I was afraid of him.

I learned today that my neck anatomy on ultrasound is incredibly clear.....the best the ultrasound tech has ever seen, and now she wants to use me as a model when she gives demonstrations.

She also informed me I have a thyroid nodule. Blah!

I'm tired. I was on call yesterday and had a busy night. My hospital OR has turned into an elective procedure OR 24 hours a day. We're also supposed to be a level 1 trauma center, but it's kind of hard to fulfill that responsibility when all the staff is too busy doing elective cases. It kind of makes me mad and I've been a little vocal about it. Elective cases are for Monday through Friday during the day. Period. Nighttime is for sleeping and traumas.

Last night was really busy for me. In July, I made up my mind to make sure I worked harder than everybody else. I volunteer for the cases, if someone else is up all night, I'm up with them. I just don't want to be known as a slacker. No need to worry. The other resident in my class that I worked with came in hungover and made it clear all he wanted to do was sit on his ass all day, so I spent all morning in a long spinal fusion case, while he volunteered for easy cases. Then I had a trauma come in. A drunk guy who was "just minding his own business" when someone slashed his throat. Pretty weird. His thyroid gland was hanging out of his neck. The big trauma came at 10pm. A lady came in with 3 broken bones in her legs. When she got to the holding area, she was really hurting, crying, and scared. I felt so bad for her, I gave her a big slug of fentanyl (I usually don't do that until they actually get to the OR). Considering her injury, I didn't think it would touch her pain, but she told me I gave her better pain relief than she'd been given all night in the ER. She was really scared and asked me not to leave her during the surgery. I just wanted to hug her and tell her everything would be okay. Her surgery went on all night. The hungover resident told me would we "tag team" her case with me, but he went to bed and left me high and dry. It was the upper level resident who got up in the middle of the night to relieve me, but I stayed until the case was over. I hate to not finish what I started. Upper level resident commented to me about how hard I work. : )

This resident is actually really nice. My call room linens hadn't been changed, and he went to the linen storage and helped me change my bedsheets. I was blown away by the kindness of that at 5am when I know he was really tired. Hungover Resident would not have done that.

On call again tomorrow. God, will this ever end? Can I physically do this for 3 more years?

Me: Average Joe

So I FINALLY got the results of my anesthesia practice boards exam that I have to take every July. It's the same exam given to become board certified, but we are given the test as residents to gauge how we are doing each year. Unfortunately, our department has big aspirations and requires the residents to score in the national 50th percentile. If you don't, you are not allowed to "moonlight" (ie...make LOTS of extra money by working on the weekends as a general practitioner- usually in a rural ER, botox clinic, or quick-care clinic). And if you do REALLY bad you are placed on departmental probation and could get terminanted if you score poorly a second time. Anyway, we got our scores today in our 6:30am conference. I managed to barely scrape by. Any other year, I would look like a total superstar by scoring in the 53rd percentile (which is good, right? It means I did better than 53% of the first year anesthesia residents in the entire country!), but not in my class. The year I applied to residency programs, anesthesia was competitive, so I'm in a class full of smarty-pants overacheivers. How I got mixed in with these brainiacs is beyond me. Almost everyone did better than I. One person did worse and I tied with another person.

Ah well. At least I'm not lamenting that I came in last. I think I'll keep quiet at work-don't want to hurt anyone's feelings.

Current Events

Despite working 13 hour days, I have managed to keep up with this week's top stories...

1. Britney Spears may have put a "hit" out on Kevin Federline. It's a sad day when Fed-ex starts to look like a responsible parent.
2. Iran's President wants to visit the World Trade Center site. Uh..Why? To gloat, perhaps?
3. OJ's in trouble....again. Maybe this time he'll have a smart jury.
4. Some nursing mother who attends Harvard Medical School sued for extra breastfeeding time during her USMLE. Denied. Sorry. You don't deserve special treatment. Residency sure won't give it to you, so why don't you start acting like a grown up and quit whining. (note to all: I am pro-breastfeeding. Anywhere. Anytime. But you don't deserve special priviledges not available to the rest of us.
5. Hillary announced her plans for HillaryCare 2.0. No thanks. Keep the government out of my doctor visits.
6. My football team is doing awesome this year and may go all the way.
7. Barry Manilow won't appear on The View unless Elizabeth is absent from the set that day. Typical. First Amendment rights don't apply to people with conservative views. Who watches The View, anyway?
8. I found out tonight from a magazine that Carmen Elektra is now a lesbian.


That's all I can think of.

What's grosser than gross?

This afternoon I took full advantage of my post call day by going to Barnes and Noble for some much needed studying. While there, I visited the ladies room. While washing my hands another lady came in. She was talking quietly. At first I thought she was talking to herself. The more she talked, I started to realize she was talking on her cell phone. OK whatever, kinda weird but surely she'll get off the phone in a second. The lady went into the stall and started doing her business, and WAS STILL ON THE PHONE! OMG!

I really cannot believe that there are people out there who think that is even remotely okay.

Ok so maybe you're wondering why I posted that random video. Well, it just reminded me so much of medical school. Just watching it gave me a mild case of PTSD. It doesn't really matter what medical school you attend, the drill is the same: you study ALL the freakin' time, and it isn't pleasant. In fact, I think my first year of medical school was one of the most miserable times of my life. This year is a close second.

So now I'm in the full swing of things. I'm either on call, post call, or pre-call. All the other days I pretty much work 12-13 hours a day. Last night I worked until 7pm. I'm really trying not to complain. I chose this. It's just by the time the weekend comes around (if I'm off) I don't want to see anyone, talk to anyone, or do anything other than stay home. I'm worried this is really depression and not work related. I guess time will tell.

Yesterday, I got to work with one of my least favorite attendings. He's a really nice guy, very personable and all, but he is really freaky in the OR. I'm pretty sure he's OCD and needs to be on medication. Just being around him in the OR makes me nervous. Our day was going reasonably well (other than the fact that he completely paralyzed one of my "asleep" patients right before the case was over. GRRRR! He's done that to me 3 times in a week! I think I'm going to have to start hiding the Nimbex when I go on break).

OK anyway, our day was going reasonable well until he freaked out when my patient moved a little while the surgery resident was finishing his skin sutures. I always start bringing the patient down off the anesthetic during suturing. Otherwise, everyone is going to be standing around waiting 20-30 minutes after the case is over for the patient to wake up. That's not good form. It slows down the surgery schedule and makes me look bad. I've never had a patient start to wake up during sutures before until yesterday. Honestly, it was no big deal. People get sutures in the ER all the time totally awake. My attending however, freaked out. Personally, I think the patient was a bit tolerant to our anesthetics because he's a big-time drinker, but anyway, my attending was quite pissed at me. So be it. He will always find something.

One cool thing happened to me early in the day. A guy I kind of like sat by me at our 6:30am anesthesia meeting!

StudyBack

Me, today, in the OR talking to one of my classmates who is now a urology resident

Him: making snide comments about how easy anesthesia is and how hard urology is
Me: How is your arm feeling today?
Him: Huh?
Me: Your arm, how is it today? Does it still hurt?
Him: What do you mean?
Me: Well, it must be hurting because somebody must have twisted your arm pretty hard to make you go into urology.
Him: silent
Everyone else in the room: HaHaaa!!! She told you, didn't she?

Snarky Me

I was on trauma call last night and was up all night helping out in a big heart case that came in. I was just counting the hours until 7am when the fresh call people came in and relieved me and the other resident. Around 6:30am, the perfusionist asked one of the nurses if she wouldn't mind going and getting her a Mountain Dew. Not a selfish request since the perfusionist can't leave the room and she had been in there since 10pm and was dead tired and thirsty. The nurse refused. She asked another nurse. Again, refused. That really made me mad, so when I got free, I went down and bought her a Mountain Dew. The case was not going well and she was probably going to be in there another 4 or 5 hours. I mean, show some mercy people! It's not like the nurses were even busy. They were all just sitting there.

Oddly enough, I lost my giving spirit an hour later. All night long I'd been thinking I'd go to Panera Bread and get a mini souffle for breakfast. I got there and realized I'd left my wallet in my locker at work. Had to drive all the way back to the hospital, park in an unauthorized spot (because the resident lot is 1/2 mile away and I'm too tired to walk that far), go back inside, get my wallet, walk back to my car and drive back to Panera Bread. By then I'm cranky because I've wasted an hour. I got inside, stood in line, and watched with disbelief as the guy in front of me bought the last souffle. I was furious! I wanted to really hurt that guy. Funny what sleep deprivation does to you.

When I got home (sans souffle), some friends had called and had an extra ticket for me to go to a big football game with them. They were on their way to pick me up as soon as I called them back. Any other time I would have jumped at that, but I was completely wiped out. Don't you hate it when you want to do something so bad, but you know you are just too tired? That's how I felt. I was so torn, but seeing as how I had homicidal thoughts toward the guy that bought the last souffle, I thought it best not to surround myself with 85,000 drunk, screaming people at a football game. That was my public service duty of the day.

Who is this?

I posted this for Robyn and Pink. If I didn't know any better, I would think this was someone else. Do you like the hat?

Hey, at least my patient is still alive, as evidenced by the monitor behind me!