Uno Mas Dia

Yep, that's it. One more day.

This month has been a test in stamina. I was going to say that it has felt like a marathon, but having run a marathon, I actually thought the marathon was tougher.

Last night I admitted somebody with an asthma attack to the CCU service. At 2:30 this am, I just didn't have the spark needed to try to block the admission. I didn't have the energy anymore to tell the ER resident it was bullshit admitting this patient. I didn't have the energy to tell the medicine service to admit this patient for asthma. Rather, it was easier for me to spend the half hour and admit him to my service knowing that we would treat his asthma and send him home today. The best part of admitting him was knowing that my attending was going to have a minor fit, and that was part of the reason to not fight the admission. Every call I've blocked at least 2-4 bullshit admission to the CCU service, and quite frankly last night I just couldn't care less about bullshit admissions...

Sinking Ship

Bailing out a sinking ship, with a spoon.

It is 3am.

I'm in the ER. I have 3 admissions in the ER. Patient #1 is intubated after acute decompensation having had a new heart attack. Patient #2 is in florid heart failure. Patient #3 is pregnant with twins (yay for being med-peds, I can handle twins and know some OB), and may have had, or be having a heart attack. I'm just opening the chart when the ER residents finds me to tell me about admission #4...

"Code Blue, Cardiac ICU."

Two thoughts:
1) You've got to be fucking kidding me.
2) Oh fuck, who is it now.

I run back to the Cardiac ICU, having left it 5 minutes previous.

Let me explain...

All hell broke loose about 1am. I knew I wouldn't sleep. Ms G was having unstable angina, and she was screwed. Would she go for cath? Would she go for emergent bypass? Forget the details, but the idea was to medically manage her overnight, and likely she would go for cath in the am, bypass in the pm. Except that I couldn't get her pain free when this all started for the 3rd time at 1am. And her EKG wouldn't normalize. Wicked ischemia. Likely infarcting as well. Oh, and now her blood pressure is down to the 70s. Hypotensive, 8/10 chest pain, EKG changes. Not a good combo.

And then they call Code #1 of the night. Adios Ms G... run off to another part of the hospital. Bring Code #1 into the CICU, the ICU resident (thankfully a med-peds colleague) is helping me stabilize her, getting in central lines. Now I have 2 very unstable patients, on opposite sides of the CICU. And I have 3 admission in the ER which have all come in since 1am.

So, there I am, running up the 2 flights of stairs, wondering which of my patients has coded. I have 2 likely candidates, but also there are 4 other patients who are on the suspect list. And much to my horror/surprise/relief, it's a cardiac surgery patient. That small sigh of relief is knowing that it isn't a patient I'm responsible for. And interestingly, the nurse (who is phenomenal) had kindly told me this guys story earlier on in the night. Which is immensely helpful since now I'm running the code and I already know his story.

3:45 am he is pronounced.

And the night just doesn't get any better...

Somehow, though, the morning comes.

9 admissions
2 codes
1 frazzled senior resident.

Sunday New York Times

Post call. Managed to sleep last night. After a wild start to the day, things settled, and I actually slept more last night that I had on all the previous call nights this month-COMBINED. So, the cloudless blue skies, and changing leaves, and new tires on the Liberty beckoned a little day trip in southern Vermont, cruising the dirt roads and old dead-end logging roads. Finally settled to read the New York Times, outside. Perfect escape from civilization, and some much needed mindless driving, listening to music, and being in the mountains.

White Russian & Into the Wild

I remember vividly being at Coors field, for a Rockies game. Mike and I were there. It was an afternoon game in the middle of the week. A carefree day. We got there early to have a drink before the game started. The bartender asked me what I wanted, and I ordered a white russian. I asked the bartender if she knew how to make one, and she acted all blond and put on this act trying to figure out what was in it. I didn't know that they were a common drink. I tipped her well. That became my drink in that period of my life. A White Russian. I drank them clubbing at Proteus. I occasionally had them after working night shift in the ER. I'd sit on the couch, relax, and sip a white russian, and our cat (Guinness) would lick the cup afterwards getting the last few drops. What 21 year old drinks white russians?

Chris McCandless drank white russians. I was reading Into The Wild at the time. I had a group of friends at that point in my life who got it. Who understood that the most valued things in life were morals, and honesty. That life wasn't about settling down and collecting trophies. This side of the story isn't presented so clearly in the movie, but it is clear in the book.

Seeing that movie reminded me of who I was when I was 18, 19, 20, 21, and last night, part of me was saddened by who I have become. Though, in a way it has been refreshing. I've thought about this more and more today. The movie was a wake up call reminding me of things I use to believe, which are still true, and reminding me how I wanted to live my life. It was a gentle nudge to getting back on track. It was a gentle nudge reminding me why I am in medicine. It was a gentle nudge reminding me what I value in my life.

I think I'll have a white russian thursday when I'm post-call and ready to sleep.

Into the Wild

It's very late, and I should be in bed by now, but I went and saw Into the Wild tonight. I have lots of thoughts, that will have to wait til I have some time to jot them down.

In a box in Colorado, I have an autographed copy of the book, from when Krakauer spoke at the Tattered Cover in LoDo back when I was in college. And at that engagement, were some family members of Chris McCandless-it was very moving. I hope that when people see the movie, they remember that this was a real person.

I doubt many people will get it.

Black Cloud

"Every month, one resident gets the black cloud designation. This month, it's you."

Yeah, thanks. Why me? I dunno. 9 admission last night. 8 admissions Thursday night. 3 patients transferred from outside hospitals arrived in the CICU within 5 minutes of each other. The fact that the sickest patients who remain intubated were ALL admitted by me in the past 1-2 weeks. The fact that on our current list of patients, I have admitted more than half of them. The fact that on my last 2 calls I have gotten, at best 30 minutes of sleep-TOTAL.

Oh, maybe I get it.

But ya know what.. even with that black cloud *knock on wood* I'm keeping afloat, and there haven't been any unexpected outcomes.

Time for a nap.

Health Food

This is a pretty cool article on easy things to incorporate into every day eating. I'm reading this as oatmeal-chocolate chip cookies are baking. I wish they would have included oatmeal daily with blueberries for breakfast.

Post call yesterday I went and hung out with Jess and Amy and their adorable daughter Mirena, then joined up with David and Dale for the Friday gay mens pot luck dinner (I'm always the youngest, by a decade maybe-but it's a nice group). Then I had a quick scotch with Ted-who may be the only other single male resident in our group so we had a nice commiseration session about life in the valley. And then I crashed.

Today's agenda:
1. Baking cookies for work
2. Going to the gym
3. Nothing.

Yep that's right. Nothing. Absolutely nothing. I may stare at a blank wall for the rest of the day and listen to music. This is my only day off this week and I'm afraid my neurons need a day to not process any information. I'm on call again tomorrow.

Cheers,
B

Double Red Bull Breakfast

I confess that by this morning I needed the ultimate jumpstart. A double red bull for breakfast.

It's funny what 30 hours of being awake will do to you. This is the second call where I was in bed for maybe 10 minutes out of my 30 hour shift. Think about how long 30 hours is...

Thankfully it was a steady pace, and not too out of control. There was a period this am, about 6:30 am when I got my 7th admission of the night when I just had to shrug and make my way to the ER to start the new admission.

Young at Heart

Or young, with old hearts may be more appropriate. I wish I could count the number of times somebody has remarked recently on how YOUNG our patients are right now. 39, 41, 42.. all in the Cardiac ICU on vents.

On call last night. Decent night.

Couldn't fall asleep cause one of the patients, who was stable, had some issues that were perplexing, and all night long I fought the urge to CT him (my clinical exam gave no indication for the CT), but then I caved at 6am hoping that the CT would give some miraculous insight into what was going on.. and alas the images didn't have the answer.

B