My Life In 3 Stages

Last night my call night was so crazy it seemed like an episode from Scrubs. Unfortunately not the happy musical one. Call day started off with a 45 y/o guy with lung disease suddenly took a turn for the worst and his heart stopped for no good reason. The only people around at the time was another intern and I so we started CPR right away, thankfully upper level residents were there in less than a minute but the thought of directing a code still scared the shit out of me. As I pushed on the man's chest I could feel bones breaking but the only thing I could think about was "allow full recoil of the chest...100 times per minute..." The patient's heart beat came back but he ended up coding 3 more times before his family said we should let him go.

Less than 30 minutes later I got called for a 48 y/o woman with metastatic cervical cancer that ate through her abdomen and was visible on the outside of her body. She was still full code because her family couldn't decide between letting her go peacefully and wanting to save their mother. In the end they put it all up to the only son, who also happened to be the youngest, leaving him to bear the guilt of deciding one way or another. Prior to coming to the ICU we were told all she did was cry in pain day and night. My newly minted second-year resident is very nice but easily overwhelmed. When the shit hits the fan she usually turns to me for guidance, not because I know what I'm doing, but because I'm usually the calm one (and sadly I'm older than she is). In this situation she freaked out because the family still wanted everything done and the woman's heart was about to stop. The nursing staff got upset when I told them to let the family into the room to see how sick the patient was and hopefully prompt them into making the right decision. It took a good 30 minutes of explanations and careful negotiating before the son decided to let her go. There was so much anger in him for being forced into making the final decision that he forbid the rest of the family from seeing her in her last moments. Thankfully towards the end of her life he allowed his siblings in and they shared her last moments together. She died less than an hour after the first patient.

My last patient is a 42 y/o guy who was healthy until two months ago when he developed and persistent cough. He went to the doctor and was told he had lung cancer that metastasized to his brain. Most of his right lung is filled with cancer and his good left lung developed a massive blood clot yesterday morning. When I spoke to him about his code status he would just tell me "I'm not going to die. Do everything to keep me alive." As his breathing grew more difficult our team wanted to put him on a ventilator before he crashed but he refused. As long as he was thinking clearly he was adamant he did not want to be intubated, but if he was going to die he wanted the vent. All night long his respirations ran in the high 40s. Usually at that rate people get too tired to breath after a few hours or become confused as their blood becomes alkalemic. He somehow managed to last all night with me checking up on him every 2 hours. Finally today at noon he admitted he was getting tired. I spoke frankly that he would probably never get off a vent if he was put on one. It was weird because I was "selling the code" to him. I told him we would probably break ribs if we had to do CPR because it is that violent of an event. I told him the oncologists had no treatment that would cure him. Finally he decided on a "chemical code" meaning no CPR, shocks, or intubation but only IV meds. I think he didn't want to feel like he was completely giving up on living but we all knew that for him it was futile. He was homeless and had no family so the only person he had to talk to was the social worker and myself. I wanted to stay with him a while longer but because of our work rules I can't be in the hospital for more than 30 hours and I was already at 31.5 so they kicked me out.

I wonder if that bed will be empty in the morning. What a night.

Oh Shit! I'm An Intern

So I meant to blog after my first night in the hospital but it also happened to by my first night of call on the MICU and you'd be surprised at how busy you can get when you're taking care of people about to die. Luckily for me no one on my service died but the next night the other team had three patients pass. Yikes.

The general hospital is 70 years old and she shows her age. The elevators are slow, the bathrooms are tiny and disgusting, and the inside looks a lot like a jail or mental ward. Despite that it has a certain charm. I like to imagine the hundreds and thousands of patients that have gone through those halls and all the people who have taken care of them. In the lobby there are pictures of the original county hospital in the 1800s with pictures of the old docs and nurses. It's pretty cool to work at someplace with that much history.

Having said that I am freaking tired. At first I used to think "80 hours a week, wow that's rough" but I just calculated my hours and I've worked 92 hours in the past week. I see now how difficult it can be for people to maintain those work hours. Where those extra 12 hours are going to go are beyond me.

Today I was in a clinic getting an orientation from one of the attendings. It was fine except for the fact that she kept leaning in really close to make some remarks. I cringed each time she invaded my personal space. There were times when she literally almost ran her face into mine. I had to fight the urge to spit at her like a llama or camel. The thought made me almost laugh out loud. Tomorrow I'm on call again. Oy.

=O --- (<-- me spitting)

-This Space For Sale-

A few days ago we had our orientation for my residency program. The day began by picking up our schedules, packets of information, and bag filled with goodies. I thought to myself "wow, that's really cool" until I flipped open the bag and found it to be a full of pharmaceutical sponsored stuff, including the bag itself! We were given a pocket medicine ($50), Sanford ($10), and all kinds of pens, retractable badge holder, various books about antibiotic therapy, etc. It is very different coming from an institution that is pharm-free to this. As our morning drew to a close we were given an hour and a half break during which time we were to take our composite photo, pick up a pager, oh and peruse the wares of about a dozen pharm vendors all set up in the area. That's right, we had vendor time actually part of our orientation day. I was accosted left and right by the pharm reps. One of them yelled out "Do you want a book bag?" to which I replied "No thanks" and she immediately said "No you need one" and thrust the bag towards me. I had to leave the building and wander the medical center because I was so disturbed/disappointed/annoyed. Some of my classmates also seemed uncomfortable with the "fair" but the majority stocked up on all the free stuff they could get (including some fancy things like USB hubs). Afterwards I had lunch with my classmates and was dumbfounded as one of them (who stopped to get something from every vendor) mentioned the company that gave us the bag no less than six times in casual conversation. Usually along the lines of "I wonder if we can even prescribe ___" and "I wonder what ____ also gives out, I need..." To the credit of my institution they are going to be Pharm-free starting in a month or so. Phew.

Spring Cleaning

My parents are pack rats. They were born in Burma, one of the top ten poorest countries in the world (and recently hit by a cyclone) and so have the mentality "waste not, want not" but to the extreme. For instance, my mom will wash and save every glass jar she's ever bought. Think spaghetti jars, jam jars, you name it, she has it. She probably has about 30 jars of various sizes. My dad is very do-it-yourself oriented and so has tons of stuff along those lines. The problem is that my parents will save things, forget the have it, and then buy something new. My dad has, and I kid you not, 13 boxes of nails, 3 circular saws, 4 drills, 2 jigsaws, and about two dozen screwdrivers. I, on the other hand, love to throw shit away. If I haven't used it in at least a year or so it goes into the trash. This sometimes...ok often...leads to some head butting between my parents and I. Upon my return home I threw away 3 large garbage bags of old clothes that my brothers and I wore from the 4th grade through high school (remember high school for me was 10 years ago). Not only has no one worn those clothes in over 10 years but they were all moth ridden and threadbare. I then cajoled my mom into cleaning out their 3 car garage (however only one care barely fits in there, the rest is packed to the ceiling with junk). Over the past few days we have given 3 carloads of crap the goodwill and thrown away a good dumpster full of crap. And there's still more! Yikes. I was telling my mom how ridiculous it was that she had cashed checks dating to 1976 sitting in a shoebox. At that moment my 92 year old great aunt turned to us and said "I have an eyeliner pencil that is over 50 years old!" Touche. =P

See one...

What a week. We had to learn Advanced Cardiovascular Life Support (ACLS) this week. Now I am officially certified to run a code. The easy part is just memorizing and following the algorithm to respond to each situation. The hard part is not getting overly excited in the process and miss steps, although just about every attending so far has said you can get more dead than dead. Good thing to remember. We had to take a 4 hour test / teaching session today where everyone got to demonstrate what they learned but running a mock code. It was very interesting to see what my colleagues are like. Very interesting. I'll leave it at that for now.

I bought an actual CD for the first time in years today. I think the last CD I actually purchased was...hmm...actually I can't really remember. It was painfully obvious when I took off the cellophane wrapping and was dumbfounded by that stupid extra tape that runs along the casing edge. I got Missy Higgins - On A Clear Night mainly because I have fallen in love with the song Where I Stood. I love it and I refuse to buy mp3s from the Nazi's of the digital music world (iTunes). [I love that Xanga lets me upload the song to their site but play it on this one]

Mission Accomplished

Four years ago, right when med school started, we were all instructed to write a letter to ourselves. That letter would be sealed away and returned to us at graduation. I just opened my note and found a dollar inside and my note dated 10/12/04 which read:

Dear Rabbit,

I hope you still want to go out and change the lives of the kids who made you want to be a doctor in the first place. I also hope you've found someone to love, even if its over, better than falling for the ones you can't have. I will try to work hard so you'll be in a good position. Right now I am most concerned with doing well in school, finding a good guy, and getting a dog. The three D's. Doctor, dick, and dog. =)


Awesome.

Potpourri

So I'm finally back in LA for good. It didn't hit me until Friday afternoon that I was leaving Sacramento for good and I had a mini freak-out that lasted for an hour or so before I came to my senses. I think I was ready to leave Sacramento. It's not a bad city, in fact it is a very easy city to live in. There is enough stuff to do to keep you generally occupied, not too much traffic, close to Tahoe and SF, and has a reasonable cost of living. The downsides are the ridiculous allergy-inducing pollen and trees, relative lack of new places to go or things to do, and the fact that it is Sacramento. Maybe I'll be back some day, but for now it doesn't look like it.

I'm not sure if I like blogger better than xanga. Adding pics or audio files doesn't seem as intuitive but we'll see what happens.

I cut the fingernail of my right pinky too short and now it's a little tender. I hate it when that happens. Damn.

I don't know if any of the folks out there have ever used Winamp as their mp3 player but that thing has gotten out of control. I loved the old form that was just a reliable mp3 player. Now it has all kinds of crazy add-ons and it wants to manage your videos, portable mp3 players, podcasts, check book, 501K, and dating life. Calm down Winamp! Damn.

Here's a video of Peanut doing the worm dance she does when she's playing with a toy. She also spends quite a bit of time on her back (in general). Go figure.