Saturday, July 31, 2010

The poll Part 2

For those of you who don't know, we are expecting another addition to our clan. We don't yet know if it's a little man or a tiny little woman, but we will be finding out in a few weeks. Since it worked out pretty well last time, I think I will again have a weekly poll with our name options for you to vote on. Just so that there's no ambiguity, I will posting facetious names. Again, these are not real. Mindy and I have already decided that Zeal-for-the-Lord will be his name if he's a boy, and Taquandafaqweyah if it's a girl. So look on the banner to the side every week and cast your vote for names.

Friday, July 23, 2010

Small Truths

I am in Utah with my family while Spiff is getting ready to head to a month-long away rotation. Gunner and I miss him. I still can't imagine being away from him for that long, and I am hoping that he has a good experience at this new hospital and new rotation.

Gunner and I traveled on Wednesday, and I learned a few things on this trip:

1. Southwest is hands down the best airline company I have flown with. Their employees are generally friendly and helpful. I enjoyed my experience with them, and they even just changed their policy to allow people to check two bags for free, PLUS a carseat as a free special item. Awesome. I also enjoyed the layover since it was a chance for Gunner to get off the plane, run around, and use some of his energy. I no longer think that the best way to fly with kids is non-stop.

2. Traveling with a 21-month-old lap child is not fun. Never never do it.

3. When your child is throwing a screaming tantrum on the airplane 30 minutes before you're scheduled to land, no one looks at you. No one makes eye contact. No one offers to help, not even the flight attendants. They put their heads down while occasionally send vicious glances your direction, and make you feel like there is something else that you should be doing in order to control your very very very loud, bored, overtired, uncontrollable child. And yes, it is very embarrassing to be the mother of "That Child".

4. While I was being so very embarrassed by my tantrum-throwing one-year-old, I noticed that people were throwing the nasty looks. And while I desperately wanted Gunner to stop screaming, (Please Just Stop Screaming!!!), there was also a vindictive little part of me that thought, "Well, if no one is going to look at me or say anything nice at all, then he might as well scream! Scream, baby, scream!" I apologize to all the people who may be on future flights with me. I also promise not to pinch my child or make him cry on long as you're nice to me.

5. It is much nicer to fly when the toddler falls asleep during take-off and wakes up during landing at the destination. I would love that to happen every time. Hopefully Gunner will read this post and behave accordingly when we fly home in a month.

6. I love love love the West. It's gorgeous. The mountains are so very beautiful. The dry heat is tolerable. It cools down at night. There is sometimes even a nice breeze! When I sweat, it actually does something to cool off my body! I am a Western Girl, and I am made for this type of weather. It is going to be very difficult for me to go home and back to heat plus humidity. Spiff might have to do some major convicing in order for me to go back. (Not really, Spiff. We love you and will be with you wherever you are. All I'm saying is that I want you to eventually bring me back...for good.)

Now it's off to a week-long camping trip and a visit to Yellowstone Park. I'm hoping to see some wild life, and I'm looking forward to cool weather. (It's supposed to get down into the low 40s at night. Doesn't that sound glorious?!) I'm sure you all wish you were me right now.

Wednesday, July 21, 2010

MICU part 2

I have learned a lot on this subinternship. I thought I would learn a lot about the administrative stuff, writing orders, all that crap. I have, but I've also learned a lot about thinking about disease. Consider the following comparison: treatment of disease is like hiking through the forest. At the beginnig of my third year, I was barely able to recognize anything abnormal, to notice that there were trees in this forest as 'twere. I was too focussed on walking along the path and getting the motions of a physical down. By the end of third year and where I am now, I can see trees, and occaisionally discern between types of trees. I can now recognize when something is abnormal and know what to do about it. But I still see a lot of individual trees. What my attending does which I cannot, is to stand back, and say "this is a 3rd generation mixed forest of deciduous and coniferous trees, typical of the pacific northwest, most specifically the costal region between latitude 35 and 50 degrees north. I can say "this guy is hypotensive, hyponatremic, hyperkalemic, is covered in non-blanching livedo, and has 2+ pitting edema of his lower extremities. He is also anuric." This pt does not immediately scream SEPSIS to me, although he does more now than he did 2 weeks ago. It's really hard to put all the pieces together and parse between the important,the urgent, and the less-important, and identify a unifying diagnosis and come up with an appropriate treatment plan. I guess that's why I'm still a student, huh? At least watching my brand new interns, I can see myself doing what they do and being able to at least function at that level.

Tuesday, July 13, 2010

Bad things happen at night

It's true. I'm on my medical ICU rotation right now (MICU) and I'm on overnight call every 4th night. I usually sleep for 2-3 hours a night when I'm on, and then go home at 12 or 1 the following afternoon. That adds up to about 30 hours on at once, which happens every 4 nights so I work about 75-80 hours a week. This is a foreshadowing of internship. I have had two firsts for my medical career during this rotation.

Last tuesday night, we got a transfer from an outside hospital. It was an 84 year old lady with a history of small bowel obstruction, dementia, and coronary artery disease. She arrived on a levophed drip (powerful vasoconstrictive medication for maintenance of blood pressure), and intubated. Her family had allegedly retracted her DNR status and now wanted a full court press. We were barely able to get a femoral arterial line in, and when we checked the CT from the outside hospital, it confirmed our clinical suspicion that the bulk of her bowel was dead. Surgery was reluctant to take her to the OR, for the obvious reason that she would likely not survive her operation. We contacted her family and they informed us that they wished us to withdraw care, which we did. She expired about 10 minutes later as we watched.

Four nights ago we received a call that one of our patients was seizing, had probably aspirated, and was now becoming bradycardic (her heart was slowing). We ran upstairs, started bag masking her, and had to begin CPR. After several rounds of vasoactive drugs, her heart actualy started beating again and she returned to her baseline, which was incredible. This was my first experience in a code and I'm glad that I did 6 weeks of anesthesia to practice bag masking pt's, since that was my job.

MICU has been quite intense, that's for sure. I do enjoy the complexity of these patients, but caring for them is like trying to replace the transmission in a truck, at night, by flashlight, at gunpoint, when you're a bicycle mechanic. It's really hard for me to see the big picture, I can spot many of the abnormalities, and piece some of the parts together, but placing all of them together as part of a coherent whole is far beyond my current knowledge base.

Saturday, July 10, 2010

What's On My Mind

We're back from a much-needed and great vacation to Michigan. We saw some family and spent time with some wonderful friends. We left the cabin with mixed feelings, being ready to be off of vacation, but not ready to leave our friends who live far from us. We were not quite ready to start life again, and were wishing for a few more days to decompress at home before Spiff started into 4th year.

But, we got home, and he started right up. Starting 4th year is sort of a strange thing. For the first time, he isn't starting up the same big thing as the rest of his class. Everyone picks their own schedules for 4th year, and so everyone has something different to start off the year. Some of his classmates are studying for and taking Step 2. Some are doing research electives. Some are out of town. Some are doing dissection with a very flexible schedule. And some, like Spiff, started off the year with a bang by doing an intense sub-internship. He is in the MICU (adult intensive care unit), and he is on a Q4 overnight call schedule for three weeks. The means that he has to spend the night at the hospital every fourth night for three weeks. It's pretty intense, he has to do a whole ton of rounding (like 8-12 hour each day!), and he's tired. I know there are residencies that do this kind of schedule for several years in a row, so I can't complain, but it's still a tough thing to start up with.

And then in just two weeks, Spiff heads up to Rochester, MN for a 4-week anesthesia away rotation. Gunner and I will be leaving to visit my family for those four weeks, and while Spiff is enjoying a nice, month-long interview process, I will be enjoying my family. We will be camping and visiting Yellowstone (which I haven't seen for 11 years). I will also be running this event with my sister. I'm not in very good shape, so I'm a bit nervous to tackle the distance and altitude. But as long as the team doesn't care that I'm super slow, I'm just excited to do such a cool event with one of my favorite running partners ever!

Also, we're enjoying Spiff's sister, Mhana's, adventures while she researches doctoral paper material in France for the Summer. Check out her blog here. She writes good, that one.

I also recently found out that one of my good friends from college has breast cancer. It has spread to her bones and is incurable, although the doctors say it is treatable. She is only 33, has a wonderful husband who loves her, and has three little kids. I can't stop thinking about her and how unfair the situation is. I keep praying that her treatment will give her years with her children, but it even that doesn't seem good enough. I want her to grow old with her sweet husband. I want her to see her children to adulthood. I feel so helpless. And I am already grieving for her.

Spiff and I have discussed many times recently how we seem to have so many good friends who are going through terrible trials in their lives. My friend with cancer, another good friend who's pregnant wife had cancer on her tongue (thank goodness it was taken out and she is cancer free for now), good friends with infertility problems, friends who's children have been diagnosed with serious health problems. They have all been on my mind and in my prayers. While I am so grateful for my own family's current health, I find myself feeling guilty being grateful that it's not me. At least for now.

I feel so helpless. I wish I could do more for these people I love so much, and each and every one of them have been shining examples of how we should handle trials that come our way. They rely on the Lord. They share their experiences with those who love them, so that we can all at least pray for them. I'm sure they suffer more than they show, but they certainly do seem to handle things better than the way I imagine myself handling similar situations if I faced them.

And that is what I have been thinking about lately. Now I'm going to bed. Hopefully Spiff can get a few hours of sleep in the on-call room at the ICU tonight.