Flaming Gorge

There are times when I get really, really homesick. Usually it’s when I’m tired of dealing with the layers of responsibility and the daily rush, rush, rush. Today is one of those. I’m getting claustrophobic again, when I get need to get out of the city and breath fresh air and not be around anybody for a few hours. Growing up in a town of 250 people was in many ways difficult, but I do miss the slower pace of life and the solitude.

(Not my picture. Stolen from here which has some absolutely lovely pictures of Utah. This is not five miles from where I grew up.)

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My talk went well, by the way. I didn’t get nearly enough time to prepare and had my usual pages of random quotes that I shuffled around (I’ve gotten quite good at reading out of the corner of my eye since I started teaching Sunday school), but I did have a good opening, I made people laugh and I didn’t lose my place too many times. I even used last week’s horribleness as a object lesson as how one ought not to be the foolish virgin. Hopefully the next time I speak in church (which I doubt, now that I’m back on the radar, will be another 7 years), I’ll remember this lesson.

And I’m done with all of my clinic notes. This week will still be busy as I have to finish the discharge summaries that I neglected last week, but it should definitely be better. I’m on call tomorrow; guess that probably means I should be getting to bed, eh?

I am so glad it’s Friday. I’m on call tonight, which means that I can avoid the freezing cold weather for 30 hours. By the time I’m released, the weather forecasts that it’s going to be a balmy 20 degrees. I may not even need the extra layer of sweats over my pants tomorrow!

I overslept this morning, arrived to the hospital an hour late. I tend to be chronically on the “a little late” side, but it’s been a long time since I actually slept through my alarm clock and awoke in a panic. It didn’t help that it now takes an additional ten minutes in the morning to get ready with having to blow dry my hair and put on the three extra layers of clothing.

It’s been absolutely insane around here. On Tuesday, I received 4 different pages from my program director; I was post call and blissfully slept through them and didn’t get them until the next morning, where I found out that unless my clinic notes were completed ASAP, I was going to be put on suspension. I didn’t think I had that many open (I had had 31 last week, I worked on a bunch, was down to 27 and of those 10 of them I had finished and was just waiting for the attending to finish their part). But it was apparently too many and I was in trouble. So, I spent most of Wednesday night, any free time on Thursday and all morning getting all of the notes done and sent on to the attendings. They’re all done, but it was a massive devotion of time, and now I’m behind in discharge summaries and other stuff. It never ends.

Project number two on top of this was helping Chris out by massively editing/revising a personal statement. He found this absolutely amazing research fellowship to apply to, run by no other than Dr. Atul Gawande, my hero. It’s always a time-consuming project editing his papers. He tends to think and write in fragments, forgetting all of those lovely linking thoughts and words to keep everything running smoothly. I tend to be a much more verbous writer, which he doesn’t like, so edits often go back and forth several times before we’re satisfied. Unfortunately because we now are residents and have no free time, we didn’t have a lot of time to work on it. He sent it off yesterday and I still wasn’t entirely satisfied with the conclusion and felt that there were other areas that could have used polishing, but oh well. He’s promised me a great gift from India (he’s going in two weeks) as payment and if he gets it, I’m definitely using my vacation time to try to stalk meet Dr. Gawande.

Reason number three it’s been insane: I started my medicine clinics this week. It’s going to be a good change. I really like the attending that I’m working with; we’ve worked together on the wards last year and while he’s intense and sometimes difficult to read, he’s also a great teacher. He loves to do procedures and he believes in taking full ownership of the patients–no referrals out unless it’s absolutely important, which I love. He spent 15 years doing medicine in Nepal which probably explains some of his attitudes. Yesterday was a little bit frustrating; new department, new way of doing things, feeling a little bit like a medical student again, but I’m sure it’ll get better.

I’ve still got a lingering sore throat and my fellow has now developed a cold as well and I’m sure, infected me again. Sometimes I hate evidenced based medicine: I know very well that antibiotics are not going to help, but I’m just so tired of the dwindles.

I’m giving a talk in church on Sunday, on self-reliance. When he asked me, Bishop said that I was an “ideal” person to give it, that was before the above trouble, I guess. I’ve lived here two and half years and they finally managed to catch me with a Sunday that I was free and not post-call; actually I haven’t spoken in church since 2001, right after the terriorists attacks, eight years is a pretty good record! The VA blocks access to the LDS website, but I’ve managed to circumvent that; I just can’t print anything off which is great for the environment but not so good for my preparation. I’m more than a little nervous…

So to sum up: I’m hectically busy (I’ve just admitted another two patients so I have to rush away to finish their orders). Mom, I got your email, will look for the package, a few oranges sound nice but would probably freeze before I could eat them. Becks, here’s the update on my life. Barbara: I did get your Christmas card! Thanks! Still haven’t made it to the post office, but hopefully will next week, maybe a Christmas card for Easter. Ellie: I’m so glad you wrote! Please tell me more on how you’re doing. And to everybody else: hi! I’ll hopefully get to talk to you later.

Pissing off the ER doctor means no sleep for you. So even when they are being idiotic and asking you for permission to discharge a patient home, which permission you are not allowed to give on the basis that you are the resident and not the fellow or attending and therefore have no say in anything, please try to be nicer (I know, I know, you were super nice… but there was that note of baffled condension in your voice).

I knew that going into call with no patients was a call for badness. Nature abhors a vacuum, after all.

*heads off to admit yet another patient*

I figured out how to access LJ here at work! Yay!

Wow, has it been a busy two weeks. I’m back over at the VA on the cardiology service and there hasn’t been a quiet day yet. We’re just slammed with patients, the entire hospital is, really, all of these people who decided that they’d just stick it out for the holidays and now are coming in with raging pneumonias and cellulitis, and more pertinent for me with chest pain or florrid congestive heart failure. I admit virtually every day, on call (the 30 hour stretch) every 4th night and for the vast majority of the last two weeks, I’ve carried most of the team as well as most of the ICU patients because none of my patients could be discharged home and just kept adding up.. The call nights have been long so far. I’m not quite to the “neurology call night” busy level, which is the definition of a busy night.

Worse, I’ve still been sick. Had a sore throat every day for over a week. Make that two weeks. This morning, I woke up without a sore throat and was so excited… only to have it return this afternoon. If it’s still here by the time I go home tomorrow, I’ll have one of my coworkers write me a prescription. Nice knowing those in power. 🙂

My fellow just left for the evening. As he was walking out the door, he spouted off last minute reminders of tests that needed to be ordered or checked up on and then, he bolted back to ask me if I was “single, married, children?” Bizarre.

I have the whole weekend off. It’s going to be bliss.

I never made it to the post office to get stamps and mail off Christmas cards. Would you all still want them now? Every year, I swear I’m going to get them off and every year, I forget that I work beyond the hours that the post office is open. *sigh*

I know that there have been several emails, voicemails, telegraphs that I have missed and am behind in responding to and for that I beg your forgiveness and patience. I’m also behind on 8 discharge summaries, 2 dictations, 6 evaluations (from October) and 31 one clinic charts. I’m failing everybody right now and just trying to stay above water.

Anyway, I’m off to order dinner (frozen custard, snickers flavored. And something else), but just wanted to check in and let every one I’m alive. 🙂

33 hours. I was at work for 33 hours straight. I worked 33 hours straight without sleeping and somehow made it home and did not kill myself or others. And then when I tried to sleep this afternoon, my pager kept going off.

I still have 8 daily progress notes to write and 2 procedure notes before I really fall asleep tonight, but it’s not going to happen. I don’t know what the consequences are if I don’t get them done, but seriously, I had 10 patients that I saw this morning and a to-do list of at least 60 items before I could leave and I wasn’t going to stay for another hour to finish the notes, and I’m still to exhausted to do them now.

I performed a subclavian (missed it and the fellow had to get it. I was doing so good!) and an art line on one sickish patient, sipped a cup of black current juice with the nurses (who I don’t really know so it was awkward), admitted a couple more, got called urgently to evaluate another patient who wasn’t quite as sick as promised (thank goodness) and then 2 minutes later got called to admit another patient to the ICU. I then spent something like 2 hours trying to get ahold of the fellow so we could discuss a plan on how I was to take care of this patient. Good times.

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I’m still sick myself, with an enlarged tonsil and earache on the right side. Pain control is working (I drool otherwise) and I’m afebrile, so I know it’s just this nasty cold, but I keep freaking myself out thinking that it’s an abcsess and OMG! what if it needs to be drained! There are reasons that I make a very poor physician to myself.

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In better news, one of my best friends rang in her new year by giving birth. Meghan Anne joined the world sometime this evening and by picture, she’s just absolutely gorgeous. We’ve been awaiting her arrival forever. 🙂

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I hope you all had an awesome New Years and more importantly, I hope you all have a wonderful year. 2009 is going to be a good year. We have a perfect month after all to look forward to. 🙂

And now, I have bed to look forward to. Ah, sleep, how I love thee!!