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14th February 2009

code four

I should be trying to go back to sleep. But my mind is reeling, preventing my tired eyes from staying closed.

I just lost a patient. The term is “pronounced dead”, which always seems so ironic. There’s no death until I say so. If I didn’t, is that non-beating heart still alive?

I’m a different person than I was as a naive medical student, where I had not seen or experienced death and cried for hours over the death of my fist patient. It’s a rare week when I don’t have a “code 4” proclaimed on somebody, and usually, we’re not too successful in bringing them back. Or if we do bring them back, they persist in vegetative states, their brains deprived of the oxygen, and I wish that we would not even tried, but that, that is not living.

Today was different. I can’t offer many details, because of HIPAA rules, but this patient was young. It’s the old people, the ones that we break fragile bones doing compressions, those with long histories of coronary artery disease, those are the ones who die from codes, not patients who had come in for completely unrelated reasons. We had had such hope for this patient, things seemed to go well and we had these moments of success before it quickly turned bad again.

My intern is devastated as he spent a sleepless vigil at the patient’s bedside, and it’s his patient, not some random person on a sign-out sheet, but the patient he’s been managing for the past week. My med student is numb and already back asleep.

I used to cry over my patients. I don’t do that any more. I told the family “I’m sorry, we couldn’t bring {patient} back” and watched the tears and sobs start, and I only got a prick in the back of my eyes. I don’t think I’ve grown hardened over the years. I’m a huge advocate of a “good death,” a death that minimizes suffering and prolongation of the process. I call the patient by name when I pronounce them, and I tell them goodbye as I leave the room; I know they can’t hear me, but I hope that their spirit knows that I tried, that God knows that I tried.

There’s going to be an autopsy. Maybe then, I’ll get some answers and some peace that there really wasn’t anything more that I could have done.

posted in On doctoring, Patient Stories | 7 Comments

12th February 2009

a question for my photographing peeps

Anybody out there know any good tutorials on how to figure out aperture, shutter speed, f-stops and ISO? So far, I’ve read Ken Rockwell’s tutorials on how to set up the Nikon D40 and how to use the different menus, which was very helpful, and Pioneer Woman’s tutorials, but I think I need a step-by-step explanation. What I’d really like to do is take a class through the college, but I have neither the time nor the money for that. So online it is.

I got some lovely pictures during my weekend with Susan:

Alice with dimples

but I’d like to learn how to blur the background more. And take better pictures of flying model airplanes.

Beuller? Beuller?

posted in Photography, Susan, Those Rare Days Off | 2 Comments

11th February 2009

mentor

Mothers in Medicine, another blog that I read, occasionally has “theme days, where everybody writes on certain experiences. Today’s happened to be on “mentoring”, which I found to be apros, as I reconnected with one of the attendings that I most admire today. She was my attending back when I was an intern and I really loved her style of teaching and examining the patients efficiently. And then I found out that she had papered some of the articles that originally looked at resident work hours and had campaigned for reform, which is a favorite topic of mine as well.

She’s starting a new research project, one that I find intriguing and afer I had signed up to participate, I linged afterwards to talk to her. Long story short, she has some other research topics that I’m really interested in, including a pilot study that she wants to start this summer. I’ve needed to find a research project to get involved in, to boost up my resume if I decide that I want to do fellowship as well as be eligible for graduation, and I had been having problems finding a project that I was interested in. I’m very excited. I’ll be meeting with her later this month to work out details. It’ll mean that my life will be even busier, but if it gets my name in a journal, it should be worth it.

She’s also been my inspiration because she didn’t date at all in med school and residency and is now married (to a non-medicine guy, imagine that!) with two beautiful children and has been an example of how a balance life of career and motherhood can work.

posted in Uncategorized | 0 Comments

10th February 2009

my oh so interesting life

Pumpkin pie on a post-call day = excellent post-call day, even though nothing else exciting happened. I had some sleep last night, we only admitted 5 patients, but I still came home utterly exhausted and slept for hours. I had some interesting post-call dreams, where I dreamed that I was dreaming something that I had dreamed before. I woke up with a headache over trying to figure out what was real and what wasn’t.

Tomorrow entails doing dishes, folding laundry and introducing a friend to the loveliness that is Colin Firth in a cravat. It is my mission in life to bring Pride and Prejudice to the lives of all those around me. Forget medicine, this is my real calling!

Link of the day: The Happiness Project. I discovered this blog several weeks ago and really enjoy the practical advice. I’ve been using her resolution charts to creating some change in my life.

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9th February 2009

Mark it on the calendar

I’m no good at secrets. Keeping secrets, oh I’m good at that. There’s no HIPAA compliance issues with me. But my own secrets always seem to fall flat on execution.

The last time I went home (or was it the time before?), I tried to surprise people with my arrival. Liz, of course, had to be told that I was coming so she could pick me up, but then Laura found out so I didn’t get to see her shocked face when I showed up on her doorstep demanding a place to sleep, and since nobody else knew I was coming, everybody had made plans and I barely got to see anybody. Very disappointing. Not this time. I’m announcing it from rooftops.

I’m going to be in SLC on March 6 and flying to Phoenix on the 12th for a few days before I head back home again. And I want to see people and party as only we 30-year-olds-with-kids-and/or-careers can do. Monday afternoon/night looks like the best night for me. It’s the perfect idea for FHE anyway: to spend time with the Plethora family. Laura will have just given birth, so I can’t commandeer her home as usual. Anybody else want to host?

It is nice to have something to look forward to. I’m not looking forward to the $15 a leg checked luggage fee and I have to say, while the price of gasoline has gone down, the price for plane tickets certainly hasn’t.

posted in Uncategorized | 1 Comment

8th February 2009

back to life

I am almost, almost ready to go back to real life. I could have done with another day or two (or week) off, but this was enough to recharge my batteries and dust some of the fatigue and bitterness off my shoulders.

I got semi-lost coming home, as I was on my cell-phone pretty much the entire way and thought I had missed a turn in a construction zone (I didn’t, it was just not marked), so I spent an extra hour driving through the moon-lit fields of rural Wisconsin. I was the only car on the road and at times it felt like I was the only human in existence. It was a lovely detour. I forget how much my soul craves the solitude sometimes.

I’m on call tomorrow… I suppose I should be getting some sleep now, eh?

posted in Uncategorized | 0 Comments

7th February 2009

Photographic evidence

Thousand words right here.

From Visit with Susan

I’ve taken over 210 pictures in the last day. Mostly of the baby, who moves very fast and doesn’t trust me (I rather startled her this morning when she walked into the bedroom and found me instead of her mother), so there are a lot of blurred, blank stares. I promise that she does smile very becomingly at her parents who dote on her. There should be no question in this child’s mind of how loved she is. I’m going to try to experiment with family photos (and maybe repeat “engagement photos” with Suz and I. It’s been 7 years now, we’re due for another set) tomorrow. I can’t wait!

The day’s events included waking up to a breakfast of crepes, playing with the baby, going to eat at a Thai restaurant, where the mild green curry was definitely not mild, visiting every single Asian market in the area (4) looking for masaman curry paste (every store had a different fish odor), napping, eating homemade vindaloo curry and chocolate chip cookies, and going to the model airplane show, where I got even more blurry pictures (see the above masterpiece). Maybe I’ve a future in abstract art? There is a surprising number of middle-aged men who are into model airplanes, I was hoping for a slightly younger crowd. Had fantasies of meeting eyes across the controls and I’d become a airplane junkie, traveling the model airplane circuit in support of my special someone (kidding, just kidding).

Now, Suz and I are sitting next to each other on the couch, each blogging about our day. 🙂 For my part, it’s been just about perfect. Even the weather warmed up into the high 50s (luckily, since I accidentally left my winter coat at home) and has been gorgeous. Can I stay here forever, please?

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6th February 2009

bliss

Plans for this weekend:

  • visiting the library
  • going grocery shopping
  • watching episodes of LOST
  • getting Alice (the babe) to warm up to me (it’s been a few months since I last saw her, but maybe she’ll remember me?)
  • taking pictures of the babe (first chance to really play with my camera. Could I ask for a better subject than a two-year old’s grin?)
  • sewing my regency dress
  • cooking and consuming delicious food
  • E-fest amateur electric plane festival!! (a pylon race! helicopter crashes! combat! night-flying!)
  • staying up way too late talking and opening up my heart
  • remembering exactly why Susan has been my bosom friend for so many years (almost 12 years)

This was exactly what the doctor ordered. 🙂

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5th February 2009

reasons #500,435,562 why I’m still in residency

I wonder if there will ever be a time when I feel confident in my abilities to take care of clinic patients. Hospital patients, even though they are sicker and more complex, don’t bother me (too much. Don’t worry, there’s no an ounce of cockiness in me. Except that I know more neurology here at the private hospital. But that’s not hard). I have the labs, the xrays, the ancillary support and the time to figure out what’s going on. When a patient is admitted to me, I can concentrate on that problem and the one or two other medical problems to go along with it and everything else, I can, if not ignore, document and not worry about it. I have pharmacists to consult, time to look up articles, time when I can go back and ask the questions I didn’t get to the first time. I’m very efficient at it; I can see a new patient and have a good idea of what’s going on within 20 minutes.

It seems like an entirely different world in clinic, where I have a limited amount of time to get the patient’s entire history and yet pressure to produce answers right away. Symptoms that have been going on for years, I have to address and I’m expected to have a solution right then. I have no labs, no supporting procedures that I can order and have done by the next day. I feel like a fool because I haven’t done pelvic and breast exams, prostate and rectal exams, except for very specific cases, since I was a medical student. I don’t know the subtlities in how to treat erectile dysfunction or allergic rhinitis, because those patients don’t get admitted to the hospital.

My classmates don’t seem to struggle with this. I’ve never “belonged” in the clinic world and I feel it more and more acutely every week. I’m enjoying the medicine clinics much more than the neurology clinic, but I think that’s just because I’m new. Every week, I’m so drained and discouraged afterwards.

I keep waiting for that someday when it’s supposed to get easier.

posted in Uncategorized | 1 Comment

4th February 2009

and I don’t look good in leggings

I haven’t quite known exactly what my mood has been recently. Having all of the free time has not exactly been conducive to actual productivity. I’m so worn out and tired and somewhat depressed (despondent, I think would be more apt) that I haven’t done much for the past couple of days, but laundry and watching YouTube movies (Groundhog’s Day on Feb 2, course, North & South yesterday, and Jane Eyre today). I did get my antenna and digital converter set up, but that’s hardly an achievement as I have a Christmas tree still up and scattered stuff everywhere and dishes in the sink. I’m frustrated, a deep soul restlessness type of feeling, which is hard to define and harder to shake.

Chris got his fellowship position. The ending to his personal statement must have been better than I thought (or else they overlooked that due to the rest of his impressive resume, which, since I also helped him put together looks pretty good) and he’ll be going to Boston in June. For 2 years. I’ll be done with residency by the time he gets back. So much for having my friend nearby. I’m an emotional schizophrenic, wavering between ecstatic happiness (Boston! I’ve never been to Boston (in the fall)! Atul Gawade! We did it!) and moroseness. Usually the happiness wins out; tonight…

There is sunshine ahead. A weekend with Susan and her babe in two days (really just one long call day). A week of vacation  to Utah and Arizone in a month (I’ll be looking for tickets tomorrow). Presents from India. Glorious rays of sunshine. I just need to shake of the chill and clinging fog.

posted in Uncategorized | 1 Comment

3rd February 2009

the gentleman of milton

To the people out there who knew of the existence of North & South and had not insisted on my watching it years and years ago: You are no longer my friends. To hold this from me! Hmph.

Now I’m conflicted. Darcy or Thornton?? I mean, I thought Colin Firth did an amazing job with the smoldering glances and tortured pining. Richard Armitage can give him a run for his money and then some.

Maybe you should decide: The mini-series (with french subtitles)! Only click if you have four hours to spend. You’ll never get away!

(runs off to slip in another viewing of the ending before bed)

***

As a complete aside, my most amusing story of the day: after I had gotten sign out that there were “no overnight events” with a particular patient, I discovered that the patient had had a minor procedure with some major complications, requiring emergent surgery and intubation where patient subsequently coded and required CPR to restore heart rates. He stabilized after that and as everything happened before 7 or so (I had left the hospital sick some hours before) I guess, technically, “no overnight events” was accurate. Boy, was it a shock, though!

posted in Uncategorized | 2 Comments

2nd February 2009

blech

This may have been one of the worst post-call days yet. I did get some periodic sleep (so it could have been so much more awful) and then woke up this morning sick. As in, I-think-I-got-food-poisoning-from-my-spinach-salad sick. I was sick enough that had it been any other day, I would have left and have one of the other residents cover, but as it was, we were already short a resident so that wasn’t an option. I finally managed to get away and I’ve spent the day sleeping and only now have been able to tolerate some sprite and bread. Good times.

To make up for the TMI of this post, some YouTube videos that friends have posted that have caused much amusement in my convalescence.

The Weepies – Can’t Go Back Now. The Weepies+puppets=awesomeness

German fashion show. My friend Brooke linked this on her blog, wishing that she understood German. I’m not sure that I do–the images are searing enough!

And now, I’m going back to bed.

posted in Uncategorized | 1 Comment

1st February 2009

perfect month

When I was a little girl, I was a weird little girl, who scoured calenders and discovered that the magical month of February, so abused and maligned for its cold, frigid days and single-awareness event, had the potential of being a perfect month, filling equally every spot in a 4 week calendar in a beautiful rectangle when the 1st fell on a Sunday. I remember using my computer and plotting out which years this would happen. It was a rather rare occurance, because leap year would happen and mess everything up (stupid leap year) and honestly, I thought I would never see it; I’d be old and withered like when Halley’s comet comes again.

February 1998 was a perfect month. I was 19. Feburary 2009 is a perfect month. I am (appropriately, some would say) 11 years older now. And I still get just a little bit of a thrill seeing the calendar on the side of my blog that is a perfect 7X4 rectangle. I am not determined to fill up every single one of those squares with a perfect link. 🙂 I told you I was a weird child.

***

I’m on call today, which so far hasn’t been bad. I even managed to slip in a nap; since I didn’t get to bed last night until 1 am (serious grousing over the single LDS male population here), it was needed. I’m back at the private hospital this month. I had forgotten its many quirks and frustrations, such as the complete incompetence to deal with neurological problems (it’s a sad state of affairs when I come here and feel like an expert) and the complete unwilliness to do anything without a bloody consult. There’s one episode that I’m still fuming about because it’s utter mismanagement of this patient and I am powerless to do anything. I hear bad-mouthing of academic centers all of the times because part of the care is given by relatively inexperienced interns and residents. True, but we have supervision by attendings who keep up on the research and for whom money is not the driving force. I’d rather receive care, any day, at a academic center.

*deep breath*

On the happy side of things, I get out most days by 1-2 pm and I usually sleep on call. Yay! Oh, cold, deceiving sun, how I have missed you! I have so many goals to achieve this month. Finally getting time to explore my camera a bit. Taking down my Christmas tree. Going to the gym (really don’t like my gym. It makes it difficult to get inspired to go there). Watercolor painting some of my photos. Sew my regency era dress. Clean my kitchen. Do my taxes. Study for the neurology in-training exam (that probably ought to be the number one priority, but somehow it’s not). There’s no way everything getting done, but it is awfully nice to have the extra time that I can dream about filling.

posted in Uncategorized | 0 Comments

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