Wednesday, November 23, 2011

The LOL Surgical consult

Call nights are long- often filled with incredibly boring periods, peppered by intense moments of trauma codes. This night was no different,  we had more ER consults than trauma codes. A good thing for the people involved, but for us, at hour 19, well, a bit of trauma does the exhausted body good-caffeine? Ha! No need with a healthy dose of adrenaline- stabbing, gunshot or 3, housefire with a pregnant woman- that'll getcha going.

I got a consult on an older AA woman. She had an abscess- but it was not specified where. I have learned that getting in on the bread and butter cases, the ones that the interns and residents don't want, are the ones that I want. I can DO them- and learn from them. 

I did my H & P. the history revealed no major medical issues. No surgeries or injuries save a broken tooth or so. 3 kids, all normal vaginal deliveries. +FM of the typical DM, CAD, HTN- but thus far, she had none of the above. Did not smoke, drink, do drugs.  No waving red flags.  Okay! I can DO this! So, her issuse seemed to be just isolated- painful and isolated.

This poor, tiny 78 year old woman had an abscess on her mons pubis. Big one. Denied waxing, was not sexually active.  She was married, but her "man" had been living with another woman for the past 20 years. She was a-okay with this. No one else in her life-lived alone.  She did call her husband when I was interviewing her to ask him what other meds she took- Vit e was pretty much it.

The PE revealed she had the worst...um...well, yeast infection that I had ever seen, and honestly, guys, hope never see again. It was..."impressive". Put that in your admission note and that'll catch someone's attention. As I said, she  denied DM, however, just as I was beginning to ask all the questions, leading at least my differential that such an infection tends to come from in a woman who denied ever being sick, the RN pops her head in "Her BGL is 511". As I was being told this, she was grabbing her Big Oreo Pack out of her purse to munch on. I told her that Oreos are probably off the menu for a bit.

At least I had one answer to one of her problems.

Clearly, however, the other issue was going to be done in the OR. Poor thing. She had a red, hot, fluctuant mass, about 6cmX10cm.  It did not go thru to bone from what we were able to assess in the ED.

 Here is where it gets funny.

She had never been in the hospital. She wanted to take EVERYTHING home- the empty IV bags, the chucks, her phone was out-she was snapping pictures everywhere. I have one of her-she wanted to have one of both of us on my phone too so I'd never forget her. (Not like I could forget her...).

She was so cheerful, so optimistic, and upbeat. She was sitting up in the OR when we got in, talking to everyone a mile a minute. I am sure she was nervous, but none the less, a truly bright spot in the rotation for everyone who touched her that night.

Later, I found out she had been putting Icy-Hot on her "'fected part". I came into her room for her post op check and she had it out to apply it to the open drainage area.  I can only imagine the pain that would have been. I had asked her on initial interview if she had done anything to make it feel better, I guess I needed to ask if she did anything to make it feel better that failed. That I would consider a fail to be sure. She then admitted to putting cabbage compresses on her "'fected part" too. Her post op went smoothly- her BGL were labile as would be expected, but medicine did their magic and they were eventually controlled.

And now, in all the ways that so many of the rotations went in Detroit, her story is so much deeper, sadder and still astounding to me.

Frankly, Sad.

Remember that phone? All those pictures? She had a chronicle of her life in pictures on her phone. If anyone ever got her phone, the things that they would see. She could hardly see her phone, but she took pictures still. When she was showing them to me, about 1/2 way back was a picture of a man in a casket.

 I was taken aback...what in Gods name did she have that for?  I asked of course (I always ask...just my nature). She knew him- he was her neighbor. He had been shot, in front of her, outside her apt. And yes, she had pictures of him on the sidewalk, dead. She knew who shot him.  While telling me about this, she covered her mouth, asked if she was going to Hell because she had lied to the "Po-lease" because she knew that if she admitted she knew, she might be next. You don't live that long on the east side of D-Town if you're a dummy. She clearly is no dummy.  If there is a God, this woman is certainly not going to Hell. She has been there- but her cheerfulness and joy in the world was bigger and greater than what surrounded her.

She said she had pictures of all the people she had seen at funerals. All her friends kids who had died. All the people in her building who had been shot and killed over the years.

She told me that she slept in front of the window now, watching to see if anyone was coming. I am a white girl from the country and I have one thought about guns besides ban 'em. I want FAR away from them- esp if someone I don't know is carrying them.  Her thought was that if she saw who was coming, she could get away. She was scared but it is what she knew. Me? I'da picked a door. A solid door.

I don't remember her name, I have her picture still. I hope she is okay. She was discharged home after 2 days stay to get her glucose under control. I hope she followed up- and I hope that somehow she has found some peace and quiet in her life.  Yes, I asked SW if they could somehow help, but no- nothing to do. She was A&OX3. Frankly, she was a great example of survivor, strong, beautiful, an optimist in the light of all that is so difficult about D-Town.

This happened well over 2 months ago. I am ending my stint of being in Detroit for rotations. Overall, I have gained such an appreciation of the deep recesses of humanity that exist downtown. Yes, it's a terrible place, but under the layer of grime and filth, there really is something very special about the city. The grit, the simple acts of survival that profoundly effected my rotations there. Certainly I learned something about medicine or at least I hope so, but I also learned a lot about people. I actually do believe that the city can be brought back.

There are a lot more stories- more blog posts to come. It's a lot of driving to get to and from- easy 2 1/2-3 hrs a day. I won't miss that! Makes for no time to write anything. A2 next month....

Saturday, September 17, 2011

The entire patient

is what we treat.

A pt came in to us. Seriously hurt because they had done something stupid when consuming a bit too much alcohol. Well, a lot too much, really. Lucky because no one else got killed. He hurt himself worst of all, but his companion will be feeling the pain for days.  He ended up being surgical to fix some seriously broken bones in his face.

(you ortho-gods, bones, bone fragments, breaking bones, moving bones-def not for me.... I give you credit.)


As a good PA student, I researched his EMR thoroughly. It had been mentioned that he had an ID band on his wrist from our hospital when he came in. I asked him when he was alert enough if this was so, and it was indeed the case- he had been DC'd just a couple of weeks before.  Shocking- admitted for another trauma that was associated with ETOH. And further back, in the past 6 months he had been in our ED over 6 times. Not always admits, but always trashed.


Each time for ETOH abuse/issues. Levels were all over 200. Each time. Some MUCH higher. And most of these incidents were involving a several thousand pound vehicle traveling at high rates of speed. Anyone seeing any red flags?? I was holding his hand, and thinking how much he had cost our system, how close he has come to killing people. According to his EMR, he would spit at MD's when angry. None of that right now, he was a scared kid.


He was younger than my daughter, older than my son. I talked to him about quitting. He said he wants to, but he tried and he couldn't do it alone. I told him this meant NEVER drinking. He said he knows. He said he wanted that. He wanted rehab. 

I accompanied him down to the OR later. He was polite, we kind of knew each other at this point in time. I admit still being irritated with him, and feeling cynical- he was driving without a license,  he was responsible for several other injuries we were treating that day.  What made me think my simple little "You GOTTA stop drinking before you kill yourself or someone else" talk would make any sort of dent in his disease?

A family member was escorted into the room to see him. It was a woman, who right away went to his side and started to rub his back. I introduced myself and she told me she was his grandmother. She asked me a bit about his injuries, and what to expect. I reiterated to her some of what I knew, and what I had told him- his physical injuries were serious, but the most important thing was that he must stop drinking.

She looked right at me and said "He has to learn to love himself first, then the rest will be easy. I want him to get through this- he has a lot to deal with when he gets out of here. My only concern today is that he knows he is loved, and that he is loveable, and that I am here for him. That's my only concern today for him today. The rest will come."

She proceeded to tell him some of that, and I watched her bend over him, whisper to him, rub his back. While he was in and out of awareness, she told me a bit more about him.  She was his dad's mom, that his mom was not a loving person, and that she had said to him after he had come into us that she wished he had died. Her son just had been getting help with an addiction to drugs. "He's stepping upto the plate- it's taken him a long time, but he's here."  Her grandson had worked for the city but had gotten laid off with the latest cuts. When telling me the background, we both were teary. She then prayed over him-for his recovery, the surgeons hands and the calmness that is needed in the OR to make her grandson better. Her faith, despite mine being questionable, filled that cubicle. It was bigger than anything else in that hospital at that point.

His mom came, clearly inebriated. Grandma left then, so the rest of the family could come in.

During his post-op check, he was doing very well. He responded well, wounds looked great. I told him that his grandma had been there- and what a remarkable woman she was. He said he loved her.

I then told him this: To have someone love you so much is a gift. It's a gift very few have. It's provides more riches than most have. It may not put food on the table, but it puts something into your soul, your heart that is just not possible to reproduce. It's not something one should ever take lightly, and indeed it's a kind of responsibility to know that someone loves you that much.

For me, it was a reminder. A chuck under the chin to remember that the story is far more than the EMR might indicate. It's complex, sad, heartbreaking. But there are threads of golden woven through that glint thru the ugliness that permeates so many stories we see. Keep looking for the golden. You might find it.



I'm glad you're here....

Yesterday I observed a surgery that was not performed by one of our surgeons, but one from another service. We had had this patient for as long as I have been there, and has been my patient since getting to our hospital. I asked the if I could observe the day before, and was told to page the attending to ask.

I don't do that. Call me chicken if you want. I'll take that rather than the wrath of an irate attending that is about to perform miracles in the OR on a patient I care about. I want that attending to be in a really good, balanced mood when they take that blade into their hand, not irritated with a student-much less a lowly PA student.

So, I went down to pre-op with the pt and waited for someone who knew something about anything. The resident showed up and I asked him when the attending might be there. He said..."I'm glad you're here. I already talked to him about it- he's cool with it."

I admit- I got a bit hot and bothered. In a good way. Those words made my day. Quite possibly my rotation. Not one other person has said that to me since starting rotations;I miss that feeling of being a valued part of the team. Even as a tech, the RN's would comment on my being there- that they were glad to be working with me that night. I know I make a point of telling people that their presence is a good thing- that I appreciate them caring if I see them do something above and beyond. When teching, I have even emailed a RID (Really Important Doc) and said how much I appreciate their care of a patient. That might have been a bit too "annika" but I don't really care.

So, thank you Dr. C, you made my week. I stayed late to watch the surgery, but instead got a boost of needed energy.

Surgery

So, as I said in the previous post, I am in surgery.  I am surprised to say that I love the ED part most of all. I mentioned before that I had considered a residency in ED- one focused on Rural medicine that is in NY. I kind of dropped the thought off of my local radar, just because A)money-I need to make some of that green stuff and the sooner the better! and B) thinking that not having the continuity of patient care might limit my enjoyment.

 Nope. Not so. It's actually good- I can care, and deeply care, about getting the patient better enough to get them to the next step of their recovery and that is good. I love the intensity, the need to bring all aspects of my (limited) training to the forepart of my brain, balancing the medicine, surgical aspects in the resus bay. I of course am watching and learning right now. But, my head is swimming with thoughts.  

So, the thought of the residency is back. Strongly. I think it might be great. I think I might like it. And since nothing else has really grabbed me yet during rotations, maybe this is it. Stay tuned.

I also admit feeling like I have not learned nearly enough thus far in my rotations. Not nearly enough. I also admit that I wanted to be at UMMC for many of my rotations. Thus far, I have gotten none of them. Zero. I miss the U, miss the environment that that place provides. There were endless opportunities to learn there- endless. I miss that a lot. I also miss the caring that the U seems to have at the center. I am not seeing that out in the "real" world, and I find that sad.

So help me GOD....If I see/hear of another person slamming a NG tube down someone, without lube, and hurricane spray--forgetting lido-jelly even for a moment as a possible assist-and then wonder why the patient was so miserable and refusing another NG tube, I wish the NG curse on them some day. Because when I asked, I was told "it takes too much time".  Oh boy...If I were not a student, and somehow could mention what I really thought, they'd get an earful.  Say whatever you want, it's the wrong thing to do.


I have seen several surgeries but none of the usual suspects...no appy, lapchole, bowel obs for me! Nope, was in on a massive lac to the back of the neck where the C-spine was...right... there...and the clot that had formed was as big as a small baby. I kid you not. I have seen orbit repair with screws, plates, mesh. I have seen more I and D's- seemingly the bread and butter of surgery-forget hernias! I have seen an exploration of an orbit from a possible self-inflicted GSW...I'll tell that story at another date. 


I have learned a lot I admit. Most of what I have learned is this: 

  • Who you work with is as important as what you're doing
  • Driving over an hour to work is plain and simple NOT for me
  • I need to be someplace where patient centered care is at the fore-front at all times
  • I need to be someplace where you're striving to always be better, so the patients get better
  • I need to always be able to learn, to push past what I get and enter into areas that I feel lost and need the compass of those wiser than me to survive and thrive
  • Saying I don't know is okay as long as you make sure you will know soon
Till later. I have a hot date with First Aid and Surgery Recall, never mind Casefiles!

The rotations keep rolling

I am currently in my surgical rotation. Parts, I love. Parts I dislike. I have seen a lot of what I do not like in me coming out- dealing with one of the team members is quite challenging for me. I have 2 more weeks. I canwill be nice, and think good thoughts about this person and know at the end of it all, I would rather have me than that person taking care of my patients. And if you "know" me, that's saying a lot.

I finished psych. Outstanding preceptor, but horrible rotation. I am rotating in an area where despair is the norm, and the genetic pool is riddled with mutations. Psych is a hard one for me, because we can't fix it. Not one bit. Our meds might make a difference, but does it really change the illness? No, it'd be a fix, but not a change. In many ways, it's like a cancer, but a never-ending-never-changing sort of cancer. Lifelong CLL. But worse. I admit wanting to fix things, to make things better. Inpatient psych, esp as a consult service really can't do that, nor does it pretend to do this. Perhaps that's why there are so many tools and ways to pigeon hole the patients. A DX is essential, and knowing what their GAF is becomes important. How does axis III change axis II?  I? Perhaps intellectualizing all this allows for the MP to keep some distance, and allows for better care. I don't know, and I know that I am not going into psych.

That's okay. I am ok with that- there are so many things I want to go into, ruling one out is in my best interest right now.

Saturday, July 16, 2011

A rather nice week at the office

On the "interesting cases" kind of note- Saw an honest to God spontaneous Pneumo ("Large" according to the radiologist...wish I could have seen the films, to correlate PE findings with visual understanding).

Yes, Tall, skinny kid. But No SOB, nor any other serious "OH DEAR GOD" signs. Just an amazing MD who caught it during (yup) a routine PE. I'd bet that the kid was kind of miserable and made the appt. He had not been in for 3 years.  I did notice fairly pink (red?) cheeks, which I remember seeing in my CO2 pts before. No ABG or BG to see, I am sure they did that at the ED. I'd also like to have seen that, but honestly, I am hoping it's venous, as this kid was already scared enough. Just writing about it gives me the heeby-geebies. My biggest issue is knowing that he might be in for a world of pain. And, came into the office without family attached to his side. In his car.

Ugh.  But nods to an amazing peds MD who A) Caught it, and B) called me in to hear it. Did not say "This is what this is" but let me listen, and think. What I heard was cracking, and "far away" sounds on auscultation. Only way I could describe it.

Monday, July 11, 2011

Mrs A

I had not been back at the U for long, so had not acquired my ICU shoes all that well yet when a pt entered my life in a way that few patients ever will.

She was on "the list" and had been several times. Each time, you get to "stay on" for a certain amount of time, and then, get taken off, moved out of the ICU (usually at least), have another full work up, and get re-listed. This happens several times for some patients, and it, I am sure, is most frustrating. Our unit remains one of the few that have not been renovated to the degree that being in the 2010+ years seems that it should be- and whomever designed the rooms clearly had never taken care of a patient that was on precautions. 


Mrs. A had done the List Dance several times by the time I had really gotten to know her and her family. She had a devoted husband who kept her laughing, and family that cared. She was lucky that way. What she was not so lucky in, however, is exactly how sick she was. Obviously, being on the list meant something was seriously wrong, but also she kept getting those little annoying nosocomial infections. Okay, that is a huge understatement; she never came down with one of the Big Ones (MRSA, VRSA, C-Diff) but the ones that take one off the list but aren't that terrible to actually have.

Her husband had left for the evening, and she called me into her room. I asked her what she wanted and she said "I don't want to be re-listed". It was more than that, really but the end result was she was done. She had had it, and just was tired. At this point, she thought she had been in the hospital for about 6 months. I called in our Fellow (after explaining that I was not the person who needed to know this, but someone that might be able to actually DO something about this needed to hear this from her.) We all cried but clearly, we all understood. One can only take so much. Her reason for staying the path thus far had been for her husband- as I remember it, she said she was really ready months earlier, but she knew he would not want her to make that decision. I was not there the day of the family meeting, but clearly, when one loves as deeply as they loved each other, the decision was made.

Problem was- she had to stay with us. Her meds were not ones that could be stopped quickly and she could not be D/C'd to hospice on the meds. So, weaning began. She did well, and things went as smoothly as can be.

Mrs. A comes back to me a lot during my thoughts of special patients. But this weekend I had a very special Mrs. A moment. Ann Arbor has a lovely thing called Top Of The Park where local musicians play. There is some serious talent in the area. A man named Levi Johnson  and his band played this past weekend. As I am wont to do, I began to dance- his was a funky, motown sound that makes even the most tired of feet move. He began (as a black man) to sing "Play That Funky Music White Boy" which brought me back to the last time I saw Mrs. A.

I asked Mrs. A what she wanted most of all and her answer was some good music. Her husband was there- and I asked what that was exactly. I was thinking my Jack Johnson and Michael Fronti might not be it.  I was right- They wanted some good soul or funk-  70's type music like- oh- "Play That Funky Music White Boy" So, thank you to  iTunes, I downloaded a few songs, we closed the curtains and turned the iPhone up as loud as we could  and danced. Well, she moved in her bed and her husband and I danced. I remember that moment, and knew then that this was to be one of those moments I'd never forget- a white woman, in scrubs, in a tiny ICU room, dancing with a black man, and his wife moving as best she could, to the sounds of Motown.  I realized  then and know now, how absolutely lucky I am to have known them, their love, their courage.

Mrs. A died a week or so later. Her husband was there as were a few of our nurses that went to stay with her at the end.  Someone posted a picture of her before she got ill- and she was startling in her beauty. The thing was, I saw that beauty from the inside of her, and it remains one of the most beautiful things I have ever known. My memory of her lives to this day.

Friday, July 8, 2011

Pediatrics

I am currently in the beginning of my peds rotation in Ann Arbor. I have an amazing preceptor, who loves to teach (there is so much to be said for that!) and the practice is far more varied than I expected in Ann Arbor.


He has been practicing for over 30 years. But, he stays young, and strong, and everyone loves him. They are not dependent, however, on him, and he is busy enough that having people call in, or only RV when needed is the norm. As I said he loves to teach, and takes a lot of moments to teach, which are great and welcome for me. 


I've seen 2 mono's (one clear case of mono, and one not-so-clear but both spot tested +) and 2 cases of Pityriasis rosea. Mono, I expected, but pityriasis not so much. I always figured it would be a board question and that's that. But the herald patch was noted in one kid, and the other one not as clear a beginning, but the christmas tree pattern was clear. "Score!"  


I think this is my last easy rotation, so I hope that I use the time well. Other than that, things are heading towards Nick leaving, and I am heading towards being an empty nester.  Feels kind of good! At least today it does....



Monday, June 20, 2011

FP

I am ending the rotation next week. It's been a great rotation for many reasons- FP is a nice sorta gig, as you can actually follow up and try to help a patient change their lifestyle so they might enjoy healthier living.

So, for the first week... My pt. (and this is the generic pt's- and believe me, there are a zillion just like this.)  DM-Type 2, NID, HTN Stage 1, add a bit of elevated BMI, a bit 'o drinking on the weekend- and maybe the weekdays. Maybe they smoke. Um. and the cardio they have (and this counts to them) is walking from the car to the door of their office.

Me:
So, you know that smoking (fill in the rest of the blanks) causes X,Y Z.
Pt:
Yes, I do. I have tried many times to stop. I just can't.
Me:
That's great! Keep trying. You can do it! There are ways that we can help you...(fill in the blank)
Pt:
Yeah, I got that patch/Pill/Gum once before. I stopped for a month/3 months/6 months and then started again.
Me:
Okay, well, I think that's great! Now, the next step is to try again.
Pt:
That sounds good.     Yeah, maybe I can do it.
Me:
Wow- that's great! So, comeon' back in 4 weeks, and we will talk again.

Fast forward 5 weeks:
Me:
So, how are you doing?
Pt:
Well, I tried x,y and z and I cut down to 19 instead of 20 a day.
Me:
Well, Good...now, what can we do to help that move along faster for you?
Pt;
Well, I am not sure.

So, reality is this: When they are motivated to change, they will. I hope that I motivated some one person to change their lifestyle just one smidge to make their lives healthier. But I am not sure. I admit my conversations now lean towards

Me:
Do you smoke?
Pt:
yes, about a pack a day
Me:
Okay, you know you're going to get the lecture. You know it's bad for you and I want you to know that when you decide to quit, we are here to help you in any way we can. Until you want to quit, there really is nothing I can do to help you.
Pt:
Thanks. I've heard it all before.

We all know that we shouldn't smoke. Should drink in moderation. Should exercise. Should not eat junk, but eat at home, healthy foods filling our diet. But we don't- okay, some do, and I admire them. But I know I don't always. This past year is a great example. I have been a sitting, unexercising, icecream eating slob. I swear that this will change- when?

When I am darn good and ready. But it's HARD and its internal. I know all the reasons to be good- including feeling better. But, other than that. it comes from an internal place that just don't have the ability to tap right now. So, developing the knowledge that it's hard- yet still mentioning it at each and every visit is essential. I also have to say I bring it up in my ED conversations (the joys of being a student- no clock on my head).  I hope to make an impression to my patients with advice on healthy living- and I'll keep trying to be an example.

That road to hell is well paved

Nick is officially a college Freshman, Jas has come and gone, and I have 2 more official FP days with Dr. B.  Hard to imagine that I am almost 15% done with the year. Um...really?

I don't know enough. That is what I know the most. The rest is just mush in my brain, and I am hoping at some point in time it clicks. As for now, Thank God for Epocrites and my other iPhone programs. I use them  a lot, and am ever grateful for the quick glance to make sure I "get" it- and hopefully get it right.

I had one day that I found difficult. A pt came into the UC facility that I was working with. He was young, and had 3 small children with him. There was no other family with him, and the kids were, well, kind to say, un-disciplined. Now, I give my kids (or rather gave...sniff. No more kids for me! One all grown and one ready to be an adult....) a fair amount of free rein. But, there were certain things that they knew crossed the line. And perhaps I might have flown off the handle a few times, who knows...(they might and I do), but overall, I was never horrified by them in public.  Actually, I have to say they usually made me proud.

So, this situation was tough for me. These kids needed to behave- Dad was in pain, sick, and needed a bit of a "best not to go to soak in the lake after getting a huge 'tat on your arm...and if it looks hot and inflamed and has smelly stuff oozing out of it- might be a good idea to head to your friendly ED/UC without your kids, before you have a full-blown abscess or 3 in your arm" kind of talk that you give to all your patients that come in. Well, maybe not exactly that, but...you can imagine something like that might be said to a supposed pt that might be presenting to you some day.  Just sayin'.

So, there was that line of pt needing my attention, and the kids demanding my attention. Kids won for a bit, only because I was afraid that they might end up needing a head CT from them bashing each others heads into the walls....

So, I left, and felt bad. My job was my patient- not the kids. My job was to take care of him, not his kids. My job was to treat him, not judge his parenting. For the first time, I felt that I learned something- from the patient, not a book. There is a great video...Every Person has a Story that says it better than I can- a training video from Chik-F-La. I have NO idea why that day I did not remember that important part of caring is...caring, but I am sure to remember from this point on. I have no idea what or how these kids got to be there, but surely they deserved more of me.

I would never have thought I'd have needed a lesson such as this- usually I am the one that points this out to others. But, in a very nice, yet direct way, someone showed me, and I appreciate it.

We learn more by being at the bedside than we learn from books. I am grateful...always.

Sunday, May 29, 2011

What I say vs. What I do.

So I did indeed say I wanted to write more in the blog. I have evidence that this is a good thing -The Academic  Life in Emergency Medicine Blog- which has reference to blogging as being good for medical education and promoting self awareness, increasing compassion...which everyone needs more of, but I seem to have in abundance and actually gets in my way at times (how's that for a sentence!). The ED rotation work has shown me that I had best pick up the speed....but I care if they are anxious about their kids and their work and their...I digress again Argh!

Obviously I have not done this better blogging thing. But I have thought about it. That road to hell is indeed paved with good intentions. So, here I am. And I have over 100 pts to log, a garden to ready, and a week of grandkids, kids, graduation, parties, and...more. But the strange thing is I have been thinking about a few patients -a lot.

What has stuck is the patients that stick. Yeah, I know-terrible prose. But I have experienced a few patients with stories that have really stayed with me over the years-the ones that wake me and I think- what went wrong? Or right? or what could I have done now that might have made the outcome better? And so, I'll mention them again, maybe some for the first time but...and hopefully, when I have some time, I will expand on their stories as I remember them.  But for now....

There was the man who came in the the unit late one night- he was youngish, 50's? Had a hx of cardiac issues. He came in with his with his family-  all were scared. As the medics wheeled him past, he looked at me, and said...I am really scared I am going to die. 

Anyone that knows and heard this statement knows it's not one that you want to hear. Especially in this sort of pt. You'd think he'd be fine- he should be fine. But that sense of forebearing makes me nervous- always evokes that "thump" in the pit of my stomach. I was hooking him up and looked him right in the eye and said "we are going to do everything we can to make sure that does not happen."  Dangerous statement- because while we can do everything, some things can't get fixed.

So without details, he did indeed die. I, of course, felt I had let him down. But the strange thing was this: He was still there. I mean it. Still in the room, still felt totally alive. His heart pumped nothing, his lungs exchanged no O2, his brain had not one discernible electrical wave. I have wrapped many a body, and some I believe were long gone in spirit before we readied them for the family and the final visit.  This man was very much there, as confused as the other humans in the room when the code was called. This is a man that was not ready to die. Wanted to live. Wanted to see his kids grow, marry, and carry his grandkids. He wanted to do what most get to do, and don't even appreciate. His body died long before his soul was ready.

Often when wrapping a body, there is light talk, and sometimes laughter- it's a horrible task, really. That last zip as we close them inside the bag- it is so horribly finite. So, laughter can ease the time and stress of the task. There are some realities that happen at the end of everyones life that have to be taken care of. Some are not so nice, and really rather smelly. So, yes, while it seems terrible, there are some very bad jokes told- some bad situations that we've gotten into that do cause giggles to escape when it seems quite wrong.

For this gentleman, there was no talk, just whispers, and then, a soft prayer-for the transition he so badly did not want to take to go smoothly, because he was kicking and fighting the entire way. I spoke to him when doing my work- and I admit, tears were there. Because I really had let him down- a promise made that I could not keep...medical science had let him down. But finally, it was his body that had really let him down- while there are some things that can be fixed, so many can't. He could not be fixed.

He I will never forget.

Sunday, May 15, 2011

Combined three into one.

So, I combined my blogs. No reason other than I already feel splintered, and having three blogs somehow made that feel even worse, and stymied any attempts to continue to chronicle things in my life.

Because what I know now, more than before, is that the things I value all meld together in some sort of pattern that is me. Sometimes, it feels disparate but overall, what is true is that all of the things that I value are all of the things I care to write about. So, hopefully they combined and it works. I'll try and tag correctly if I ever decide to go back and read something.

So a few things- First. I value and believe in HIPAA.  So, if there is something that refers to a patient, I have TOLD and ASKED that patient if it's okay that I write about them. And yes, even a few pictures! They knew obviously. Probably from this point on, there won't be patient picturess, as I am no longer a tech, but something between knowing nothing, and knowing something. (I assure you that I am more on the Nothing end of the continuum still, and am becoming more and more aware as the days pass that I had best put something between my ears that might indicate I know something.) If I ever DO have pictures, well, then, I have asked at least once and probably more than once, called my psychiatrist, discussed with friends, co-workers (who won't give a damn) and called my lawyer. So, if anyone ever reads this and things- OMG! She's crossed the line- remember the above, and add a bit of knowledge that I live in a world of guilt and if I ever did anything like "that" (dadada da...) I'd off myself.

Then, have to add that these are MY thoughts, my feelings, my everything, inc. misspellings, and errors of all sorts. So, forgive me. I am sure I will cringe and squirm when I read them, but perfection is not the goal, but the aim.

Then, I am going to link to a few really REALLY good blogs. Okay, these are mostly medical. But if I link it's probably worth the click. Because there are a few out there that A) know their shit, and B) do a good job, be it ernest or humorous. And are really good storytellers and sharers of knowledge. So, click and I promise to not lead anyone astray.

And finally, I am not anti- health care reform. I DO believe we waste resources. I DO think we need to get some control. I DON'T think Medicaid works well. I DID vote for Obama, and will again. I DO know we don't have the right formula. But I think we are getting there. I realize this is quite unpopular. But, so be it. You can quit now. I believe that we have to choose for ourselves how to die, and therefore, how to live. You choose to smoke, over eat, sit too much? Well, uh, I don't know what to say. I'll take care of you, but you will hear about it. Because that is my belief. We need to take care of us.

And while we all make mistakes, it's what we do when we veer from our path that is what we really are. I believe this. So- I try very hard to not judge what someone has done when they make a mistake, but rather how they are dealing with it.

I am pro-choice because I am pro-life. A wanted life is a good life.

So, there you are. Disclaimers now that it's an all in one.

Saturday, April 30, 2011

First rotation starting....

And it's family practice with Doc B as he calls himself. I am looking forward to the experience, but also scared Si*tLeS* at the same time.  I don't even know WHAT to study- and therefore am feeling a bit- um, well, scared that he might ask me some sort of question right off the bat like..."So, this patient has a CR of 2.3, and blahblahblah and so what do you think is the real problem." I'd answer something like" well, I guess he is in renal failure of some sort?" and know that I know there are several sorts of renal failure but...what kind am I thinking of?

I would have NO idea. None.

Sigh. Got a lotta learning going on, I tell ya. Lots.

Sunday, April 10, 2011

Doc

video
1Today, I was able to ride Doc...it's been forever, and I just am in heaven. AND...


LOGAN WAS FINALLY BORN! 8. 1 oz and 20.5 inches long. It's amazing. Its been an emotional day to be sure; tears thru huge smiles.

So, here is the video of Doc, at least I *think* so! He was an absolute ROCK STAR!!!

Tuesday, April 5, 2011

One thought!

It's the end of 3rd semester....yes, yes, yes.

Need a blog post on The Adventures of the POPES- because if life wanted to make sure that we are made quite aware that we are NOT in control, I can point out POPES and my adventures.

Til then...

Wednesday, March 9, 2011

been too long

but so be it. I am really glad I had this blog to look back at- loved seeing what happened earlier, and loved seeing what has happened because there has not been a lot of that in the past year.

I have not really seen the horses, not spent any time with them, but overall, still am kind of involved on a peripheral level with their day to day lives. Doc is back home, so I now have 4, which really is way too many. But that's okay, I guess, until something better comes along for Doc. I think that 3 is probably too many, but I think I can manage 3, and always have someone to keep the other one company. Seems kind of silly, but oh well. I do think the three boys are a good combo, and while Doc adds nothing negative to the group, it remains that these are one expensive hobby!

Rotations starting means that perhaps I can start riding again...depending on the rotation, I guess. I worry because I don't know if I can balance things well enough to "do it all" but want to try and figure it out. I need to add it in, because I have taken so much out it's kind of hard because there is not a lot of me left. lookin' for some me!

I also want to try and figure out the best way to work things overall. First, car issues, Trailer issues, care issues, barn issues, animal issues, house issues. The balance of all of these, while maintaining sanity. Working on that might be the most important thing I do in the coming year.

Well, Dumb and dumber on in class, and off we go to whatever comes on for the next class session. I've given up knowing, and frankly caring.

a thought

when someone says "do something!" what they mean may not be even close to what you think they mean. I think this might be an important thing to realize as a practicer of medicine. Because we can't assume anything, but I bet we do!

So, third semester. yup- here I am. I am not sure exactly how, but that's okay. I look forward with both fear and joy towards rotations, and can't wait until I get my first assignment. I hope I get to ease in slowly- PLEASE no surgery as my first! :) Psych? Maybe. OB? Maybe. But I'd live to save surgery, IM, FP for much later, thank you very much.

Things are somewhat quieter at home. That is good. I have not enjoyed the process that we have gone thru at all.