I took over 150 pictures of the ward Christmas part tonight. Probably 120 of them are crap, but it was fun playing around with the flash and ISO and driving other people nuts. I just love it so much.

It’s raining right now. Earlier today, I had to wear an extra sweater because it was so cold. Supposedly it’s suppose to get warm up to 50 tomorrow and then down below freezing the next day. Makw up your mind, Wisconsin weather!

I have to be to work at 6ish tomorrow morning so I can be done and be to church on time as it’s the Christmas program. My microwave heat bag has just finished getting warm and I’m ready for bed. 🙂 I do love these cozy winter nights.

From flowers

To my anonymous friend, a thousand thanks! The box labeled the bouquet as “Winter Cheer” and it certainly did that. I don’t think this smile has left my face all evening. What a wonderful surprise! I think I was even more touched to realize that the gift was because somebody had read my entry from a couple of weeks ago and decided to help make a wish come true. You all are amazing and I am so grateful to have such loving, wonderful people in my life.

One of the pharmacists that works in our unit is leaving and her going away party was tonight. I was having a hard time motivating myself to go: too cold outside, it’s been a long week and going to bed early again sounded like a fantastic idea. Plus, Milwaukee being light-years behind the rest of the civilized world has yet to enact a smoking pan in restaurants and pubs (Madison has a smoking ban. You would think that it’d be pretty easy to make it state wide) and I don’t inhaling cigarette fumes, nor do I enjoy smelling like an ashtray afterward. But friendship and the promise of Swing Dancing Thursday Nights lured me out of my cocoon.

There was no dancing. Instead, there was another private party that another hospital was throwing, who took over the stage and closed the kitchen so I couldn’t eat the potato skins I was so looking forward to, and worse, started singing karoke. The women were wearing either skimpy clothing that I froze just thinking about or these bright jewel-colored dresses that came to the knees and were belted above the waist. Straight out of the 80s. I think Claire Huxtable wore an identical dress in several different episodes of the Cosby show. If these are coming back in style, I don’t want to know.

And now I’m really sleepy. Luckily, my attending doesn’t want to round until 9:30, so I’m sleeping in. It almost makes up for the 7 o’clock rounding earlier this week.

Night all.

I’m so tired, physically, emotionally, that as soon as I finish typing this, I’m going to bed.

I’m hoping that the extra sleep will make tomorrow go by a little easier. I got extremely emotional about a patient and the unreasonable stubbornness and stupid surgical pride of his attending today and just about lost it. I’m just frustrated because the family members have expressed their wishes and the patient’s wishes, but because the attending differs, well, then. The attending’s ego will be bruised for a days, but it’s the family who will have to live with the consequences and it infuriates me.

I’m not sure if critical care is for me. And for entirely different reasons than when I first started this month.

***

My christmas cards are going out this weekend, so if you want one, send me your address at jcd1013@gmail.com or reply to this post.

***

Also, I think I left my half-eaten burrito on the back of my car. Poor little burrito…

I don’t hug my patients.

I shake hands, hold hands, touch shoulders, caress knees, hand over kleenex. But I rarely hug, which is unusual for me, as I love to hug. I swear, I have “HUG ME” tattooed across my forehead, which is especially discerned by all the boys that I wish to date. One hug from me, and I’ve suddenly become the sister. But it is a level of intimacy that I just don’t cross with patients, just as I never call them by their first names either.

Today, there was a patient on my clinic schedule who I had been dreading to see. A few months ago, I gave her a diagnosis that is one of those nebulous, “is it really real” diseases, a diagnosis that requires more emotional and psychiatric rather than neurologic treatment. She was very unhappy at that time, but agreed to the treatment plan that my attending and I outlined. I hadn’t hear anything more from her since then. When I saw her on my schedule, I braced myself for a very long clinic with lots of counselling and tears.

You can imagine my surprise and delight when I walked in the room and met a transformation. She had followed up on the treatment plan, gotten the assistance and help that she needed and she had not had any further symptoms since she saw me. She was virtually a new woman, with a smile that lit her face and I could not keep the same from my face.

When she left, she asked if she could hug me. We hugged tightly before she left.

I felt healed by the encouner, a little pessimism washed away. It was a good day.

From white elephant FHE

I love white elephant gift parties. I gave away a stuffed whale and got this loot instead. The sword came in handy when Jared stole the Bop! magazine from me. It had pictures of Hanson in it! *pout*

Imagine my delight when I discovered that not only did I get a sword, but a DVD of Bonanza and postcards of painted cow statues! Wow!

I bought a Christmas tree!! It’s fake and cheap and sparse on the full, fluffy branches, but hey, Charlie Brown loved his little tree and I’m rather fond of mine. I gave in to my inner desires and bought all purple and silver ornaments. With the ornaments up, it doesn’t look too bare. My friend Erika came over tonight; we assembled the tree and arranged ornaments and topped the evening off with hot apple cider.

It also gave me a chance to play around a bit with my camera. Still learning (Erika performed in her church today and I brought my camera and took fuzzy photo after fuzzy photo. It was only afterward that I discovered that the lens was in manual focus mode), but I’m so overwhelmingly in love with the pictures that I’m getting already.

From Christmas

(Click for the other pictures of my tree)

Rounding at seven tomorrow morning, which means I have to have my patients seen by then. So I guess it’s goodnight!

After moping today for being left out of activities and gatherings, I realized this evening that not only had I forgotten about the formal masquerade ball tonight (some of my friends were really excited about it; I’ve already attempted to get all of the guys involved to dance before and was much more realistic), I completely and totally spaced my friend’s Christmas party on Tuesday. I did nothing that night, just went to bed early. I feel absolutely horrible.

I did get to see a few hours of sun this afternoon, finishing work a couple hours earlier (it’s hard not to get cranky when you woke up at 6 with the thought of getting done early and your fellow announces at noon as you’re putting the finishing touches on the sign out sheet that your patient needs a central line (he didn’t) and he expected you to do it) and took the opportunity to play around with my camera a little bit. The problem with getting a new camera in December is that there isn’t a lot of varied scenery to shoot. Snow. And more snow. I still haven’t done much more beyond the automatic settings, but that will come. Some pictures will be forth coming. 🙂

(Mom couldn’t remember what blanket she had sent me to keep me warm. Hence, the inaugural photo of my beautiful new camera. Love it already.)

Being a resident and supervising interns is hard work. I don’t think I’ve ever worked with such a clingy intern before. Intern paged me every 15-20 minutes until around 1 in the morning and it was all that I could do not to get snippy on the phone. Because if I had done that, and something serious were to happen to one of her patients, then she would have hesitated calling me. It’s a difficult balance between too much autonomy and too much supervision. She was completely resistant to my efforts to give her more autonomy (and talking with my friend who is her resident every day, it wasn’t just last night), but it’s something that I need to work on.

I’m tired and have to be up early tomorrow. My snowblower is missing a bolt and the little spout that directs the snow now flops and I end upblow the same bit of snow over and over again. We’re interviewing candidates for next year and we take them out to dinner so I didn’t get a chance to go by home depot before so I’ll have to go bright and early so I can come back and clear the sidewalk before I go to work. Ugh.

In the meantime, I’m sharing this:

Since I’m in the critical care unit, I see many patients who are coming in with devastating injuries. These families, already dealing with the tragedy and pain of an injured loved one, are now having to make difficult medical decisions and so often, they are making these decisions without knowing what the wishes of their loved one are. Those with the most peace have had the discussion, they are comfortable in knowing that they are doing what their loved one who do if they could speak.

Engage with grace is a website that is trying to help with this problem. Here’s some of the statistics they provided:

• 73% of Americans would prefer to die at home¹, but anywhere between 20-50% of Americans die in hospital settings.²
• More than 80% of Californians say their loved ones know exactly or have a good idea of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.³
• Eight out of ten people say it is very or somewhat important to write down EOL wishes, but only 36% actually have written instructions.⁴

After my first months on the NICU, I completed the paperwork for a durable power of attorney (which actually needs to be redone, since I didn’t have it witnessed properly) and sat down with my parents to have the talk about my wishes. My friends who are also residents have said that they have “the talk” every couple of years, so that wishes are understood.

I encourage everybody, regardless of age, regardless of health to have a conversation with the person that you would want to make your medical decisions if you couldn’t.

I swear that when I was an intern, I was able to make the decision to treat a urine infection without requiring the assistance of my senior. Or when my senior said “I’m going to be doing a procedure and won’t be available except fo emergencies for the next 30 minutes, in the meantime, here’s what to do for so-and-so patient” I didn’t page 5 minutes later asking what to do on so-and-so. Intern is going to be the death of me.

It’s been a long day. It’s going to be a long night.

Felt like wasting time. I have to go to bed now, because I’m on call yet again tomorrow, and am still feeling sleep deprived and we’re rounding early. (As an aside, it is supposed to snow all day tomorrow, meaning I have to dig myself out again post-call before I can sleep. And more head traumas as people slide on slick roads which translates to more 4 am consults from neurosurgery when they decide that they don’t want to operate after all with means less sleep. Am somewhat bitter at Mother Nature who is not doing a great job of nurturing right now.)

1. Started your own blog (I have several right now. Most are just mirrors of my original livejournal, but I do have my own that will be revealed officially to the public as soon as WP 2.7 is released and working properly).
2. Slept under the stars (Several times)
3. Played in a band (I jammed with my 8th grade guitar class but I don’t think we ever made a band)
4. Visited Hawaii
5. Watched a meteor shower
Read more

I think I hate post-calls days more after each one. Busy day yesterday, I finished with all of my work around midnight and then had to wait to talk to a family about next plans of action and didn’t actually get to bed until around 2. I had a couple hours of fragmented sleep, but then was awoken at 4 for a consult and that was it: just enough to trigger a migraine, making me sick the remainder of the morning. I actually was so sick and so tired I went downstairs and slept in the call room for an hour before slogging home. There, thankfully, wasn’t much snow but it was enough that the snow plow has blocked me from entering my garage and the wind has picked up creating large snow drifts. So I’m parked out front and I’m going to bed. I’ll deal with the snow later.

BTW, I think all attendings should be flogged if they engage in petty pimping sessions when you’re post call. Exactly what is my tired, overworked brain supposed to be learning in that situation??

Goodnight all.

ETA: Some people write “drunk entries”, I write “post-call” entries. I think the misspellings are the same in both. Oi. 🙂

Congrats to me! I completed the challenge for National Blogging Month and posted an entry every day for the month of November. Of course you guys knew that, since you had to slug through my often meaningless meanderings.

I had planned on composing this grand post to cap off my month, a post that would stand as tribute to my achievement. But of course, I’m on call. I’ve got my daily progress notes (from this morning) to write, xrays to follow up on, a patient in the ER to see and 3 other admission/consult notes to write. I just barely got dinner (didn’t get breakfast or lunch – I had plenty of snacks so I wasn’t completely starving), and things are finally slowing down for a moment so I could catch up. So I guess the fabulous horn-tooting post will have to wait.

Shall I continue for the month of December as well?

It’s snowing right now, they’re expecting 9-12 inches of snow. I hadn’t forgotten how much I love (not) driving home post call in a snow storm and shoveling/snow-blowing all afternoon instead of sleeping. Hi Milwaukee winter! I had missed you!

It’s probably a sad reflection on my priorities when I tell you that the only Christmas shopping that I’ve done has been for me.

But that’s only because I’ve been saving up to buy this for months now, and researched every price available and when I saw the bargain price, I couldn’t resist.

Yes, I bought my camera.

Isn’t it pretty? I found it at a reputable dealer online for over $250 dollars off the suggested retail price with the two lens that I wanted. I haven’t found a better price in the months that I have been saving my pennies. I’m still sort of hyperventilating from the purchase; even though it was a steal, I never make frivolous purchases, but I know once my hands are on it, that will pass. I can’t wait to try it out!

(Psst, for those who might be interested, I bought mine at Adorama. They have other kits there of the Nikon cameras that are a steal as well.)

*grumble grumble*

My chief resident sent out the holiday schedule earlier this week, so we would know who was covering each service and could plan our time better. I noticed that I wasn’t listed to work at all until Sunday, which I knew wasn’t right. We have 4 days off a month, and my four days are later. Because I know from personal experience how overwhelming the neuro ICU can be on the weekend (splitting 12-16 patients between 2 people is hard enough; when they’re sick enough to be in the NICU, it can take you a half hour to just gather information on each one, much less actually see them) and since that’s the service that I now belong to, I decided to do the morally right thing. Instead of sleeping in and going out to shop* for Christmas presents and a Christmas tree, I went to work. We were promised that even though it wasn’t an official holiday per the hospital, the neurology department was still treating it as such and therefore only needed to be there until approximately 12-1pm. Half days are so deliciously refreshing (sun! air! couch!) that they almost feel like a full day off.

I was done with everything by 1:30. I had admitted a new patient, talked the plan over with the fellow, written orders, confirmed results from the consult services, rechecked labs, finished notes and updated the signout sheet. And my fellow wouldn’t let me go. First, it was making sure the radiology would do the study we needed. Then it was signing out to the resident who was on call that day. Then it was waiting for the fellow who was going to start on the service starting that day; he was supposed to show up at 3, he didn’t arrive until almost 4. Then it was the back and forth decision of whether or not to place a central line in our new patient (patient left for the above study, removing that decision). Finally, both of the fellows left, leaving me to go around and write all of the orders that they had decided were suddenly needed.

I finished at 5:30 pm. Happy holiday to me.

(Did anybody understand the above paragraphs? I swear I really wasn’t trying to be cryptic.)

This is an important month for me. I love neuro critical care. I love the complexities of patients broken down into easily managed systems. I like the procedures (even though it’s been over a year since I did a central line or an art line. At one time I liked them). I like that it’s evidenced based. I just don’t know if I like it enough to do another 2 years of fellowship. More years of training, with long hours and which would require starting to do research now so I have a resume that looks impressive. And I don’t like research. All for a career that will always be demanding and time-consuming and I don’t know if I have the physical or emotional endurance for a lifetime of being an intensivist. I’ve been trying to make up my mind about this for months, mulling over both sides and never quite getting to a decision that felt right. So I’ve given myself this month to figure it out.

*Actually, after the news of the worker getting trampled to death at the Wal-Mart in Long Island, I’ve decided to continue my tradition of avoiding shopping on Black Friday, permanently. Because, that’s insane.

I went to a friend’s house for Thanksgiving dinner. When I called her yesterday to confirm, she mentioned that there was not going to be any pumpkin pie served. No pie! I almost took back my RSVP. Luckily, another friend invited me over this morning for pumpkin custard (aka pie without the crust) with lots of whipped topping and things are okay with the world again.

It was certainly a different Thanksgiving this year. I hadn’t met my friend’s parents at all and the little I knew, I wasn’t sure if I’d get along with them (particularly her father). Which, thankfully, wasn’t the case. They were very warm and friendly and engaging and even my friend, who is usually very quiet even when it’s just the two of us was much more open and talkative. I ate too much of course, but I think I managed to keep it at 2000 calories, rather than the usual 4000 calories that we Americans reportedly consume on this day of feasting.

There are so many things for which I am thankful. I try to be grateful and thankful on a regular basis, but in the spirit of recording it for remembrance, here’s the short list:

1. Family. I am so thankful for my supportive, loving family who have been there even in the long distances. I have the greatest parents in the world, who take the time to drive out every year so that we can fix all of the little things around my house that I can’t always get to. I have sisters who are so much fun to talk to; even though we are drastically different in temperament and personalities, we have always gotten along well. I have grandparents who I love to spend time with and I don’t see them nearly often enough.
2. Friends. I don’t think there enough words in the English vocabulary (or the Eskimo either) to express my eternal gratitude for the friendships that I have made through the years. They mean everything to me.
3. Safety. My heart is with those in Mumbai and their families. It is a scary world that we live in, but I am so thankful that I have been cocooned somewhat away from it.
4. My house. I love love love my house and its little nooks and raspberry bushes and many, many leaves. I love that it keeps me warm, that I have a comfortable bed to sleep in and a fabulous couch to sit on.
5. My computer. Not only is it gorgeous, but it keeps me connected with the world around me.
6. My faith. My membership in the LDS church has been one of the most sustaining influences in my life. I appreciate the daily comfort from the belief that there is a loving, understanding Heavenly Father who wants what’s best for me. I appreciate the bonds of fellowship that are formed in the church, for the guidance of my leaders, and for my relationship with my Savior.
7. My job. As much as I grip about it, I am grateful for the continual learning and the challenges that being a resident provides, that it stretches my mind on a daily basis. I am thankful for my patients who allow me to be a part of their lives. I am grateful for the nurses with whom I have collegial relationships of respect. I am especially thankful for Maryann, my nurse who answers all of the calls from my clinic patients (as well as the rest of the residents in my program). She is a saint (and yes, I tell her this often).
8. My health. So far, i’ve managed to go 2.6 years without surgery. I’ve had some close calls (I have a feeling that I’m going to have to have both wrists worked on), but I’m grateful that I’ve been able to complete so much of residency without too much interference. I’m not thankful for the weight gain that has accompanied the lack of surgery, but there’s hope for changes in that department as well.
9. Prepositions. Don’t know how I would have constructed the above list without them.

I love YouTube. Love it. How did the world survive without it? Thanks to YT, I can waste my days watching music videos of coordinated treadmills, watch clips of the Beaker performing Ode to Joy or singing Carmen, learn about cardiac arrthymias by watching a mad german doctor dance them out, or revive my infatuation with Everwood (there’s really a lack of clips even on YT, but good news: there’s a rumor of release of more DVDs next year!).

But the best part is finding all of the old movies that I loved as a kid online. Some of them: bad. The Boy Who Could Fly? Wow, sorry mom for the hours that you had to endure of that movie. (Although it made me realize how clueless of a kid I was. Never even knew that there was a scene of *horrors* underaged drinking.) Some of them: awesome. Toby Tyler (which has since been sadly taken down) and A Little Princess are still fabulous.

Tonight, I’m settling down to watch The One and Only Genuine, Original Family Band. I don’t know when the last time it was that I saw it, but I have had some of the songs in my head during the election season (It’s time for a man! And he is the man for the time!). And I just found The Witching of Ben Wagner there as well! I can’t wait.

I went over to a friend’s house tonight to have some hot cocoa and catch up. She’s a medical student, which I know exactly how overwhelming and consuming and exaperating that can be. Talking to her reminding me of all of the drama that med school can entail (I’m so glad I’ve left that behind!!) She’s been in much the situation that I was in those many years ago with Chris and Candice, only she’s in Candice’s position and another mutual friend is right where I was 5 years ago–stuck in the middle and not sure how to get out. Their friendship has been strained to say the least and it’s been bothering me. I do really regret how things turned out between Candice and I, this failed friendship. Years have gone by, she has barely acknowledged my existence since that day (although, she’s friends with Chris on Facebook and contacts him occasionally there. Kinda burns me up a little. He’s the one who broke your heart, honey!) and my experience in med school was radically changed after that. Her friends were no longer my friends, I was excluded from a lot of activities and Chris became the inseparable chum.

In any case, I kinda made it my mission to intervene here because I could see the direction it was going. Don’t know if I did any good (I felt a little like a matchmaker); we’ll see. I’m not sure if an intervention would have helped our friendship then either–I did try on multiple occasions to reach out and explain and was met with deaf ears.

Med school: junior high all over again.