The Flask

It's weird the things you pack when you're headed away.

I'm half way through packing up the kitchen. And I came across my flask.

Ironically, somebody had a flask at dinner last night. (I'll just let you use your imagination on that one). And I kind of wondered where my flask had migrated off to. I hadn't used it in a while. Oh wait, the last time I used it was backpacking... Whiskey (Jameson) on the Appalachian Trail with Johhny K. Ah yes...

So, there it was, hiding in the cupboard.

Before Johnny K, the last time I had used the flask had been in Ireland. It was in my suit pocket at a med school function. I am almost too embarrassed to admit that the flask was used to add whiskey to coke. Those were the poor years. Mixed drinks were expensive.

Why did it even make it to Ireland? Because it was a gift, from a very dear friend, whose wedding I participated in 2 days before moving to Ireland. I basically flew back from that wedding, spend a day in Denver and then flew to Ireland. The flask was just part of the luggage at that point.

Over the past few days of packing, I've been setting things that need to go to SA in a box. Books. Certain photos (most photos are now on the computer). My extra phone. Foreign money. My passport.

And tonight, I put that flask in the box. It seems silly to take the flask to SA...

I can only hope that at some point in the coming year, I find myself in the Drakensberg Mountains, sharing my flask with new friends, while remembering the great friends who have supported me for many years.

Running

I'm on the run.

I'm making a real effort to start running regularly again, and not to just codes in the hospital. I forced myself onto the treadmill, once, and on rare occasion twice a week during the winter. That's a total lie, I can think of one week where I was on the treadmill twice.

Anyway, this past Tuesday was beautiful. I was done at a decent time, and decided to escape away and go for a nice trail run. I picked a gentler path than normal, and ran for about an hour, covering just over 4 miles. And paid the price. Oye pain on Thursday. But, no pain, no gain.. right?

I'm hitting the wall today.

In my post-call-mental-slumber, concentration seems to be lacking. I only have 2 goals today. Get some packing done, and finish a presentation I'm giving tomorrow morning. Packing has been a minor failure. I can't quite part with some books that I haven't opened from med school. The books are all packed. The storage closet has been emptied. Basically all that remains is sorting through clothes. Moving day will be Friday.

I can't resist the pull of the beautiful sunny afternoon.

I'm going to have to give in and make a break for trail run #2. Surely it will hurt less than earlier in the week!

Wild Things

Yesterday was a tease. Offering what the summer will bring, but also what I will have to give up for a while.

Temperature in the 70s. Blue sky. Off of work by 4. As was KZ. So we met up, she picked up the kids and we went to the park. Got to hang out, playing on the swings, going down the slide. And then going for a stroll on dirt paths around the park, in a very cool wooded area. Darn, forgot the camera.

Bedtime rolls around, and the priceless moment was getting to read Ian and Emily their bedtime story. Emily was in my lap, Ian was propped up hanging off my side, and both were grabbing and turning pages. Growling. Showing fangs. Hoping that I get many more nights like this before I leave, and hoping that there is a day when I get to read bedtime stories to Ryan, Jordan and Haley too. Wishing that all the kids in my clinic had parents who would actually read to them at night...

Have Visa, Will Travel

Well, much to my delight and surprise, I got my passport back today. Have stamp allowing multiple entries as a temporary resident for the next year!

I am headed back to SA!

SHIT!

I have microwave popcorn..... AND NO MICROWAVE!

Let me think about this for a minute...

How did this happen. When I bought microwave popcorn, I had a microwave. Oh, that's right, I'm giving away what I can, and I freaking gave away my microwave! MORON! I don't use it all that much, but now, dammit, it's 1am I am wide awake (for reasons that are unclear to even me), I have the munchies (and a lack of food). I have no chocolate stash. I have no ice-cream stash. I don't want health food at 1am, that doesn't satisfy a craving for badness. Popcorn would have done it..

I'm going to go experiment in the kitchen.. certainly the kernels don't know they are suppose to only pop in a microwave, I'm going to try and pop them in a skillet with oil...

Wish me luck.

My Rorschach Inkblot Test

"An Iraqi army soldier looks on as a woman picks up rice at a checkpoint in Sadr City, Baghdad. The Shia suburb is suffering food shortages as troops clash with the Mehdi Army militia."

-BBC-

What's your reaction???

My Verdict on Pike Place Roast

I understand why they did it. Getting back to the purity of coffee. Getting back to the fundamentals of what makes a good coffee, or coffee good.

Fresh roasted is best. Blue Bottle knows this. That guy built a coffee company with fresh being the core concept. Coffee older than 48 hours is not fresh, and he gives it away. Starbucks started out small, with fresh roasted coffee, then exploded into a coffee empire, offering pure roasts, exotic blends, and a confusing array of lingo and ordering styles. You're average Joe gets his cuppa and likely ruins the taste with splenda and soy. Wait, I mean the average Joe uses milk and white sugar, carbo queens go for the splenda and soy..

Joe likes the whoosh of a can, not the whirl of a grinder. Joe doesn't care if the coffee is from Latin America, or if it's a Yemen. (Yemen, being my all-time favorite coffee).

Starbucks proved that they can master blends and roasts. They are good, but mass production of blends can't be best, because by the time you get those coffees to a consumer, they are no long have freshness. Local coffee roasters offer freshness.

The idea is great. Mass roast one blend, and bring back freshness. The Starbucks I visited yesterday had coffee roasted on 3/29. That's pretty decent.

That one blend is Pike Place Roast. I think it is very mediocre. But that's what they needed to do. Find one blend that east coast coffee wimps would drink, but not too dilute that hardened west coasts fanatics would avoid. I think Pike Place Roast accomplishes this...

That's my opinion.

Random Thoughts

1) This morning, I packed up my book shelf, and dismantled the kitchen table. I have to be out of the apartment in 2 weeks. Reality bit me in the ass. 3 boxes of books. Sadly, there are about 5 books to be read still, and I kept those ones out. I'm not sure these boxes will be unpacked. When I moved to Ireland (almost 8 years ago), I packed up 4 or 5 (maybe more) boxes of books, thinking someday I would be back and unpack those books and display them in my home. I'm not sure when I'll ever really settle down long enough to unpack all these books. And maybe I should just learn how to part with books...Or *gasp* use the library.. Maybe I should just ship these boxes to Colorado to join the other boxes of books.

2) VISA. Applying for my South African Visa tomorrow. To me, this is the real final step. There are some small things like getting an international drivers license, applying for medical indemnity coverage etc, but this makes it real.

3) I would drink Animal Dung Coffee.

4) My hair. I am growing it out. And right now it is in that frizzy annoying short-long phase. If I hear one more person tell me that the grey makes me look "distinguished," I am going to develop even more of a complex and may consider getting my hair darkened, which is a total waste of money, but I don't want to look distinguished. Actually, if I want to look distinguished, I'll wear my glasses. Shit, maybe I am more vain than I realize.

I am going to bed now.

Sundays

Heather, my old flatmate from Dublin came for a visit this weekend. It's been over 2 years since we've hung out (when I went to see her in Pittsburgh). It was like old times. We reminisced about the simplicity of life in Dublin, and the things we took for granted there. We had dinner at The Blue Heron (one of my favorite places) Friday night, and then a drink at the Montague Book Mill, and then made our way home and watched episodes of Sex and the City. Saturday we went to Brattleboro and Shelburne Falls, the two places here I would move to in a heart beat, except they are too far from the hospital. This morning we went to Karin's for brunch, and had a great time hanging with her and the kids. And like that, the weekend is mostly over. Weekends are going fast these days...

JR

Last week the ER resident called me to admit a patient. "I have an eight-year-old boy with pyelonephritis. And he has rash." Interesting, I remember thinking, you don't really get a rash with pyelonephritis.

I made my way down to see JR. As I knew I was already going to get out of work late, I decided to take my time and make some small talk with JR and his mom before I asked them all the medical questions.

So, I asked him about what he liked to do. And he told me he liked to knit. I was taken aback. What 8 year-old boy likes to knit?? He told me how he has knitted scarves and also a hat. This was no normal 8 year-old boy. We talked a bit more, and the more we talked, the more inferior I felt.

"So, JR, can you drive a car?"

"No, I can't reach the pedals." Well, I was glad to know that there was one thing I could do that JR couldn't!

Even before asking him or his mom any questions, it was very obvious that he did not have pyelonephritis. As we talked, I was looking at the rash on his hands, looking at the injection of his conjunctiva, and looking at his red cracked lips. It was time to stop the chitchat and get down to figuring out what was going on...

After taking a history, examining JR, and looking over the labs, I suspected that he had something more serious than just pyelonephritis.

I talked to JR's mom and told her that I was concerned about what was going on. She asked me to call her partner, who worked in health care, and discuss what I thought was going on. And I told them I suspected that this was Kawasaki's. But it was too early to make a diagnosis.

I explained to mom #1 that they would have a new residents taking care of them in the morning.

"But, we like you. Will you please be our resident?"

Our team size was alread a little unruly, but how could I turn down taking care of this cool kid, with two moms, and an interesting/complex medical condition.

JR had a rough course. There was disagreement about whether he had Kawasaki's or some infectious cause. He failed initial treatments. And on day three, he was looking worse. We had multiple family meetings daily discussing his care, and what more we could/should do. We called the Kawasaki specialists in Boston, and were on the verge of transferring him. Thankfully though, he responded to the second course of treatment, and went home a week after coming into the hospital.

When I went back to work on Monday, they have left me a card with their number, and an invitation to come over for knitting lessons...

They were the coolest family that I have taking care of, and if I ever have a family, they would be one of my role models.

Reunited

Here are a few clips from this past weekend. Kevin is a great pal who is now a Specialist Reg (Senior Resident) in ER in Edinburgh. The summer I stayed in Dublin he was one of the residents on the team I was on. Anyway, we had a great weekend. Had to do loads of shopping on Sunday, because his was one of the 20,000 bags stranded at Heathrow Airport. WANKERS!

Photos from Satuday.. hanging out with friends from work.

19 & 3

19-the number of days I have worked in a row.

3-the number of months until I am on an airplane moving to South Africa

Haunted Halls

"So, you're leaving for a year, you're not getting paid, and it's not going to count-so you'll still have a year left when you come back. Why would you do that?"

90 days to go. I don't want to be asked again.

I know exactly where I was 2 years ago on this night. I was on-call on the pediatric ward as an intern.

Today, when I walked past the ICU, I was very aware that it was 2 years ago last night that Gabby died in our ICU. And the next day, the only thing I could think to do was go to work and know that being on call would keep me busy and keep my mind occupied so I wouldn't think about the horrible loss at that moment.

And today, when my co-residents ask me the why I'm leaving for a year, I'm reminded that I am on outlier in my residency program. There use to be two of us, who had convictions about using medicine as a tool to bring about change, to improve the quality of life for those who lack access to fundamental care. There use to be two of us who just didn't seem to fit in as well with our peers. Somehow we aligned early in residency, and Gabby was the one person I could call at midnight in utter disgust at what I saw going on, and I could vent to her before going to bed. Gabby was the one who called me from Florida to ask what I was doing for one of her patients that I covered when she went on Christmas break. And that seemed normal. Last weekend I called the pedi intern to remind her about an order that needed to be done, and was chastised for doing work when I had physically left the building.

As I walk past the ICU doors on the way to the adolescent ward today, I feel a twinge of pain at knowing that the one person who would have never asked me the above question is no longer alive. I see a family huddled in the waiting room, and remember that 2 years ago we were in that room, hoping for a miracle, which never came.

But... I also see how much I've changed and learned in those two years. And somehow I know that her spirit is still very much alive.

And from now on, when people ask, I'm not going to justify or defend my plans. Instead, I'm going to smile and say "because I can."

At Risk

I am at Risk.

I am at risk of fucking away a perfectly good post-call Sunday afternoon...

It is now 1036 am, and I can't decide what to do. Paralyzed by guilt of the multitude of tasks that are piling up (emails, bill, phone calls, clinic notes, taxes, laundry-almost out of clothes, groceries-down to oatmeal ) that I could care less about completing, and the competing desire to get out a live a bit (go for a drive, a hike, find a new coffee place).

14 days of work in a row.. I haven't been out of a 5 mile range and I am going stir-crazy.

Trying to fall asleep last night in the call room I just kept envisioning going home to a nice mountain cabin, reading the NY Times on a wooden patio and drinking damn good coffee.

sleep, run, gym, play, work.
what to do
what to do

where have my fun friends gone?

Dr House

It doesn't matter that I got home 4 hours late from work today.

It was a great day. It was a bit of a mad house. Lots going on and I just kind of flew solo for a most of the day. Rounding on kids. Discharging kids.

I've learned a few lessons in the past few days.
-don't ignore my nagging gut feeling
-ask smart people when you're stuck

I've had 2 teens lately with unusual medical problems. While they have both been on my team, I haven't been rounding on them directly. For reasons that are not worth mentioning.

One of them went home, better.

One of them is still in the hospital, getting worse.

And it has just been pissing me off.

Part of it has been the pedi mentality, taking time, not being aggressive in work up and treatment. And I just wasn't going to be able to leave work until I felt like we were finally getting a clue as to what the hell is going on with this person. There are specialist on the team already, but things just weren't moving along. I decided this morning that I was going to cross a fine line and go to some of my adult medicine attendings for ideas. It's taboo to consult adult docs for pedi patients. But I'd reached my limit of being passive and waiting for badness to happen and decided I'd deal with the consequences later. My plan had been to pop into the Chair Of Medicine's office (who is likely smarter than Dr House) and bow my head in disgust that we'd done a sub-par work-up thus far. Her health is worth a lot more than my pride.

But at the last minute I decided to ask another adult specialist his opinion, and he had some ideas. We talked for a while. He was a bit concerned about our lack of progress, and asked if he could see the patient, as a formal consult. That's pretty unusual. Nobody looks for more work.

He saw the patient, and likely has figured out what's going on, and gave treatment plans as well. All of this starting at what should have been the end of his day.

I feel good tonight. I don't feel good because I think we finally have a clue. I feel good because this patient is finally getting the care they should have been getting.

And I'm a bit embarrassed. This medicine attending stay late today to help. Why haven't we-the resident taking care of her-worked as hard the past few days to figure out what's going on???

Updating..

yeah, lots going on.

Work: Love and Hate.
Love working in pedi land. Taking care of kids is great. Seeing kids getting better is great. Working with some great attendings.
Hate: Not going to mention it here.

I am taking care of some beautiful babies right now. Two who have infections and are going to turn out gorgeous after finishing IV antibiotics/antivirals. I also have one adorable infant who was abused beyond belief but amazing may still develop normally and who has an awesome foster mom lined up to care for her. I offered to take this kiddo home! (Well, not really, but I'd love to be a foster uncle).

Just got over food poisoning. It's a great way to drop 3 pounds really quick. Though sleeping for 18 hours on my only day off was not great. Being positively orthostatic and dizzy on standing was a fun cheap high though.

Have heard rumor that I'm getting a medical license for SA.

Bought a ticket to fly to South Africa-leaving June 21st.

Just really working a lot right now. Am trying to figure out what I like best about my job, and what I like least. I like my autonomy. I like that the attendings who know me and respect my opinion. I like that I usually have a good idea of what to do. I like that my skills have improved over the years. I don't like realizing how much I still don't know. I don't like supervising interns and medical students. I'm not really sure I'll seek an academic post after residency.

Time to go read up a bit..

Contra Dance & Pedi Wards

Well, I will confess that last night was... FUN!

Who knew that Contra Dancing could be fun. It's basically line-dancing, with live musicians and somebody calling out the moves. Thank god, there is a walk through of the moves and then the dance happens. Though, for the last dance there wasn't a practice session, and lets just say we didn't go out with a bang.

We probably did a dozen or so dances. And the other cool thing was that you change partners after each dance. Being the newbie last night, I got to dance with most of the guys. So, the dance part itself was fun (requiring constant concentration). It was also a really cool group. It was a GLBT-Gender Free group. I was the second-youngest guy! It was like a mini-pride.

I judged people based on how they did the twirl portion of the dance. Some were gentle and slow, and some liked to whip around. When you do the twirl portion (I forget the real dance term for it), if you don't watch your dance partner's eyes, you get wicked dizzy!

I may have to go again to the next one.

I'm call tomorrow on the Pedi Ward. It has been 18 months since I was last on the pediatric ward. EIGHTEEN months... I have floated in a day or two to round on kids, but 18 months is a bit of time to be away. Though, I am looking forward to it.

Anyway, going to try and make this a productive day.

Trouble #2

I can't even remember the last time I was up until sunrise. Well, at least the last time being up until sunrise when I wasn't in the hospital working...

DT and I had planned an early night. We were going to meet up after work (damn, I still have charts to finish from clinic), grab a bite and call it an early night since he's on call today. Well, we invited a few others, a bite turned into a lavish meal, then ES and I went to the sad gay bar and ended up chatting to this guy who I saw last time I was there (back in September? October?), and we swapped numbers so that he could come to Contra Dancing (more on that in a minute) tonight.

I *finally* got home. And then the bartender from the night before called so we met up and hung out-until sunrise. He's much younger, and so much fun. Really a breath of fresh air around here. I don't think many others would have even considered intentionally staying up until sunrise.

So, I am suppose to go to a Contra Dancing event tonight. I get visions of being back in elementary school, when it must have been gym or music class where they tried to make us square-dance. It didn't go so well. I wonder if I have one of those plaid shirts with the snap buttons... Looking for Trouble #3.

Time to get busy.

Trouble #1

Wow, very late.

Night #1 of trouble (not with the law). Just up to no good...

PS, if I were to get in *real* trouble (Brian in Seattle) you're going to be the first person I call...

"Stay Outta Trouble"

The secretaries at work know me way too well.

I went to work for lunch today. Yeah, it's true. I have money on my work ID for food, and didn't have money in my wallet and if you read yesterday, you know I have no food at home. So I went to work for lunch. (I did work this morning, at the other hospital).

I was sitting with our secretaries in the office, cause they are good fun. I don't recall much of the conversation, but I think I told them I wanted a tattoo, I want to have electrolysis on my chest (there was a demo at the gym yesterday), that I have the most gorgeous niece, nephews, and godchildren (and then showed them the most recent pictures), that I found a flight to San Francisco for the weekend-but it required me to call in sick to work tomorrow and I knew that would place me on their bad side, I also told them that this area is one of the many waste-lands of America and that there were many ideas floating in my head about how to spend the next few days..

"Brian, stay outta trouble."

We'll see.

Emergency ACLS

The emergency is that I am *gasp* OUT OF COFFEE. I'll let you in on a dirty little secret: I am also OUT OF INSTANT coffee. There you have it. Yes me, the coffee snob/purist/addict is out of the pure form (coffee beans) and the crack form (instant). Look, I have instant because I take instant backpacking... I can't muster up the energy to go buy coffee beans. I am beginning to HATE this time of year. It's been so damn cold out that the only traveling I want to do includes going to work (well, I don't want to go to work...), going to the gym, and getting back home. Argh!

ACLS: I recertified my ACLS today. I may have mentioned that after surviving a month in the CCU, that should qualify me as recertified for ACLS. (Advanced Cardiac Life Support). Well, as I got out of the Liberty this am, who did I see walking in to the class... My attending from the CCU! Who is such a great human being, that he made the first 2 weeks of CCU fun. (Fun?being in the CCU may not have really been fun, tolerable is probably a better term for it).

Me: "You teaching today?"
Him: "Nope, they are making us recertify."

Ok, this guy isn't just a cardiologist, he is an EP specialist-electrophysiologist.. when the heart doesn't conduct right, he fixes it.. Him taking ACLS is like an engineer playing with tinker toys...

Insomnia has its benefits

I don't know why I'm still up. Sometimes it just seems pointless to sleep...

LL is BUSTED!

I told KZ last night that I was going to join AA. For the wrong reasons. I don't think I have a drinking problem, and aside from New Years Eve, I can't even recall the last time I had too much to drink. Though, maybe the reason I can't recall the last time I had too much to drink is, because, I had too much.. But one tends to not forget the hang-overs. Anyway, I am well within my 14 drinks-a-week limit of acceptability. Oh, so I wanted to join AA to meet new friends. I have plenty of friends here, but most are work related. I've kind of lost contact with most the gays that I use to be friends with--though, the grapevine keeps me well informed of who is sleeping with whom, who is backstabbing whom, and I know who has which STDs! So, Friday night I thought long and hard about my fun days in Dublin, being out til the wee hours of the morning, doing crazy shit with HW (I called to make sure we actually DID the stuff I was thinking about), and decided that it was time to meet some fun people again. I'm sure people in AA must be FUN! Or at least have great senses of humor and good stories...

So, I'm trying to figure out if the whole 12 step process is going to be a tolerable cost to getting a new group of friends, when my pager goes off.

Ah-hah.
That's why I knew it was better to waste time on-line than go to bed. Had I gone to bed, I would have been annoyed by the page I received.

I'm the on-call doc for clinic right now. I just got paged about LL. The insult is that the page identifies who the patients primary care doc is, and LL's mom (he's 2) didn't know who his doc is. IT'S ME! Didn't know because they haven't been to the CLINIC in quite some time. He's missed multiple visits. It's like a sting operation! This is good stuff. He has a cold, and she pages me at 12:30 AM for a "fever" of 99.3. Perfect time to harass them to coming back to the clinic so LL can get his missed shots, and of course to make sure he is growing/developing normally.

And now back to searching for AA groups...

Ellis Paul

Last night, KZ and I went to see Ellis Paul perform..

It was the second time I have seen him in concert. Such an amazing experience. I sat there in awe that this guy is spending his days living his passion, doing what he wants, likely just barely getting by. Taking a risk to follow through on dreams. Living his life. That's amazing. His music is, at times, raw emotion about life, about love, about the damn inequities that fuck up the world. Pretty amazing stuff. And he's fucking great in person as well. He gets it. He wrote The Ballad of Chris McCandless, way before Into the Wild was made into a movie.

I'm turned on by people Who Get It. That life is an active process. It's about taking risks. It's about speaking out. It's about knowing what you want and going after it. It's about knowing that you may fall fucking flat on your face, but at least you tried.

Seriously, buy an Ellis Paul CD. Get a nice cup of tea (or wine) and dim the lights and just listen to the lyrics of this man. You won't be disappointed!

Normandy

A bottle of wine
Camembert cheese
Comfortable restaurant with ambiance
A bit of calvados.

That's where I'd rather be right now...

It's snowing out
I don't want to leave the cosy confines of my own apartment
I'm on jeopardy call for pediatrics
I'm not in Normandy.

Bummer.

5 Stars

Today is a 5 star day. (out of 5)

I had a great morning in clinic, seeing kids w/ juvenile arthritis. My attending harassed me for missing grand rounds yesterday. I guess she asked out to the audience yesterday where I was sitting, and of course I wasn't there (I was at the court house). Afterwards, she made a point of going to the Pedi program director and saying that she enjoyed having me in clinic (she is the type who would never admit it to me in person, the pedi program director told me the conversation this afternoon). But this woman is awesome. She -CARES- about her kids. And in fact we saw a kid today who came in for a second opinion, and my doc plans on taking over care of this kid because the other docs aren't doing such a great job...

Then, this afternoon I got pulled from clinic to fill in and teach second year medical students. I got to listen to pt presentations and then go to the bedside and teach physical exams. It was so fresh seeing second year med students who are eager to learn. And it was fun to be able to have dedicated time to teach.


Now I need to put away groceries and get ready for a presentation tomorrow..

Jury Duty

Yipee-

I get a day off of work to participate in Jury Duty. I have been waiting for this for a long time! I get to participate in my civil duty. I am hoping for at least a 3 week trial. I could use a mini-vacation from work.

Sunny days, sweeping the clouds away..

Stop what you are doing

and click on

THIS

(thanks to SYC for the clip)

Shriners

I'm about half way through this month. And this month I am at one of the Shriner's Hospitals. I'm working with the pediatric rhematologist (mostly) so am seeing kids with juvenile arthritis, lupus, and other assorted conditions. Also seeing kids with osteogenesis imperfecta (aka brittle bones). I spend a bit of time in the orthopedic clinics, and see kids with other bone anomalies.

It's been a great month thus far since we don't get a whole lot of exposure to these kids elsewhere in our training. It's also nice from a med-peds perspective because the will affect these kids when they are adults.

A Place to Live...

A small shot of reality.

Yesterday I wired money to South Africa, and paid 2 months rent. I won't go into all the lavish details of where I'll be living.. but it looks great.

I'll confess, that I did pass up the place that has 3 times a week maid service, who does not only the washes clothes, but also IRONS! But, went for the cheaper place, which looks a bit bigger, and a friend has stayed there and so it comes highly recommended.

The only major tasks are getting my visa and buying my ticket. (There's a huge list of minor tasks...)

Good stuff.

A few pics...

Home Sweet Home

Sorry Ryan, this pic will haunt you...

(click to advance pictures)

Not Figuring It Out...

Aquarius Horoscope for week of February 7, 2008
[Courtest of Free Will Astrology]

"To be young, really young, takes a very long time," said Picasso. I agree. It's not easy to hone your ability to see the world fresh over and over again. You've got to work for years to immunize yourself against the millions of people who think they're got everything figured out. To cultivate an ingenious and fully awakened innocence, you have to continually shed your temptation to rely on habitual responses, never ceasing from the effort to greet every experience with a beginner's mind. This playful approach to life goes against the grain of every religious teaching, every political system, and every ideology, which means that only the fiercest individualists with a highly developed sense of self can summon the courage to do it. It so happens, Aquarius, that you're now primed to make rapid progress in this noble undertaking."

Wwwow.

What a great quote, and great thought.

Kind of topical right now in life. Trying to figure things out less, or trying to spend less time figuring things out, trusting that somehow life works out, and just taking time to look at things anew. Seeing people in a new light. Seeing places in a new light. Seeing future plans in a new light. Even seeing work in a new light, well thanks largely to an amazing book I read the past few days (Better, by Atul Gawande).

I have found myself recently shedding thoughts, plans, ideas that I've had for a long time. I planned a life, back before leaving for medical school. I knew what I wanted to do when I finished residency, where I wanted to live, etc etc. I thought I had it figured out. But, life has changed a lot since 2000, and only for the better. And thankfully, I'm learning how to erase long-term plans, and being open to things I hadn't ever considered...

Enough said.
It's way too late to be up.

4 Day Retreat

More to come (with pics)...

I snuck away for a few day. Well, actually had to use 2 days of vacation, so can't say I snuck away, they knew I wasn't going to be at work.

I'll get some pics up here in a few days.

Progress.

Finally.

Got through to my contact at the South Africa Medical Board. After almost 2 months of trying to figure out the delay in getting my medical license, only 2 things are missing. One is a document that was emailed back in the fall. The other is a fee for the license.

One last hurdle-applying for the visit... And that should be done in April.

Woah... This crazy idea that started almost 8 months ago is really going to happen.

Randon Quote

"The man who sticks

to his plan

will become

what he used to

want to be."

-James Richardson

Ponder that over some nice coffee folks..

Worth It

This made my NICU month worth it

2 hours last night of just holding Baby O

She was delivered on my first call this month

And she's going home today

She's healthy

And has wonderful parents

I love the NICU, but this month I took a beating. I was the resident, who because of call and clinic schedules, worked alone most days from noon onwards, managing upwards of 18 kids at the busiest. The best part of this month was watching kids get better.

Sunday Call

It's my second to last call ever in the NICU. And I have mixed feelings.

I would rather be fast asleep in bed, and then go for coffee and read the Times and have brunch w/ friends... but weekends in the NICU (while they can be outta control) are often not too bad.

When I left on Friday, I had 15 babies. I know there have been a few more admissions since then. So, I'm sure the list it at 17 or so by now. It's going to be one of those busy days, I just have that feeling.

The Power of Lasagna

5:00 am- a feeling of total helplessness. A pH of 6.8 is almost not compatible with life. Holy shit this baby is about to die right in front of our eyes and our best efforts may not be enough. Work hard and fast and somehow this baby pulls though, at least as of this morning.

10:30-I'm a patient in my own clinic. More on this later. First visit to a primary care physician in years. Need a physical for my VISA application. I pick one of the clinic docs I work with. Role reversal....

1300-unwind in the gym.

1600-start prepping food for dinner tonight. Invited one friend over for dinner, and just kept inviting friends. People are tired. It's nice to just have some delicious lasagna and wine and relax. It's nice to just take a night off in the middle of the week, cook a nice meal and unwind with friends/colleagues. We all take joy in entertaining Karins 9 month old and 2 year old children.

It's one of those days which was set up with potential badness, but had ended with a group of friends taking a mid-week break and unwinding...

Maybe we should take a mid-week break more often. Maybe a Wednesday Lasagna night would go long way...

Filling up the House

Friday, 9:30 am

"Well Doctor..." (whenever the chief of neonatology wants to banter, he calls me Doctor-we banter very well back and forth, much to the puzzlement of many of my co-residents who terribly misunderstand his great sense of humor). "you're not that busy this morning."

He wants to give us a lecture/tutorial this morning. I have raised a protest. I'm on call. The second year resident and I are covering the team, and thankfully she is here all day today.

The Chief is giving me a hard time. It's 9:30 am, and we've already admitted 2 new babies to the NICU, and Sarah is headed out in the ambulance to go pick up a newborn at a nearby hospital.

I kick into smart ass mode. "Well, I'm going to do my best to admit 7-10 babies today!! I guesstimate that we only have about 7 or 8 beds open right now. And I'm kind of in that invincible mood. I've been here a week. I have a 600 gram baby on an oscillator and a couple of kids who have other various troubling issues, a few more aren't really going to hurt!

He grins...

Friday 9:15 pm.
I am in a nearby hospital picking up a baby. This is our second trip here today. This will be our 6th admission in 12 hours.

I am NOT popular in the NICU. I hear mutterings of my black cloud returning... I also have a slight adrenaline rush every time my pager goes off. Since this am, we have been expecting a woman to deliver who is 23 weeks and 4 days pregnant. The parents want full resuscitation. I'm on the fence as to whether this is the right thing to do...

We arrive back to our NICU, baby/admission #6 in tow. "What's the rumor I hear your goal was to admit 7-10 kids today?" I can only grin. I fucking deserve it. Being a smart ass always gets me in trouble, and today I'm paying the price. It's non-stop. I'm tired. We haven't even done evening rounds.

I ask about the 23 and 4/7 baby. No word yet. Well, I profess, that will be admission number 7, then I've hit my goal for the day, and then I'm done.

Midnight. Orders from rounds are done.

3:30 am I go and look at the kids I've admitted today, and look at the babies I've been taking care of all month. It's just soothing watching sleeping babies..

I'm satisfied. And I make my way to my call-room.

My pager goes off at 6am. I don't even think, I grab my glasses and step into my clogs and start thinking what size tube I'll use to intubate this 23 and 4/7 baby. Is a 2.5 going to be too big? I'm in the hallway and I look to see what room the NICU code has been called to..

My page reads: "HI BRIAN! We're meeting in the medicine resident room and going for omelets. YUMMY! Hope you got some sleep last night. Come Join Us!" It's a page from Karin.

I page her back. I can get 15 more minutes of sleep or I can eat breakfast...

I vote for sleep.

Admission #7 didn't happen. For once, not hitting my goal is a good thing.

Full House

 
It's almost 11pm, and for the first time today, I feel caught up in my work. No orders to enter. No results to follow up. It's a hectic day. There are 3 of us residents on the team, and one resident left post-call at 8am today (that'll be me tomorrow), one went to clinic, which left me here today to hold down the team by myself. We have 2 kids on oscillator vents. I'm a bit rusty on managing vents, so it's been a lot of work today. But there is a small sense of gratification knowing that kids are in pretty good shape for the night. 
 
Went to a delivery where a baby was born breach. Ended up having to almost intubate the kiddo, but he perked up nicely with lots of vigorous stimulation.
 
I met up with a friend and walked down to the medicine call room, and whoa, full house. 3 other med-peds residents, one of whom is on call for pediatrics. So, the admit residents for NICU, Medicine Wards, and Pediatrics are all med-peds residents tonight. Kind of nice knowing they are around. And our chief resident is there, finishing up late admissions as well. Medicine is behind 7 admission, Pediatrics is caught up, but I hear they are full, and the PICU is filling up as well. I offered to help, but being in NICU kind of tough to be that far away from the NICU for long.
 
Well, going to go follow up a few blood gas results, maybe make a fine-tune adjustment to a vent or two, and then get caught up on some reading.

BPB

Anticipation

It's 10am.

 

"Good morning, we're glad to see you back in the NICU." I am kind of glad to be back in the NICU. Well, at least at 10am I was, 17 hours later I was ready to be done. "So, you ready for the gastroschisis baby?"

 

Whoa!

 

"Um," I look around thinking I missed something "What gastroschisis baby?"

 

"Oh, she's being induced now."

 

Gastroschisis.. It dawns on me that about all I know about gastroschisis babies is what the defect is, I hadn't actually every really expected to have to manage taking care of a gastroschisis baby. Gastroschisis is a condition where the abdominal wall fails to fuse completely, so the abdominal contents are exposed. I think of the scene with Hannibal Lecture in Silence of the Lambs, when he says, "Guts in or Guts out." I've taken care of a NICU kiddo previously who had a gastroschisis repaired, they tend to be in the NICU for a few months. I can guess what needs to be done when they are born, wrap the bowel contents in some kind of moist gauze, decompress the stomach with a NG or OG tube, get generous IV fluids going, intubate, and call the surgeons.

 

We're in the middle of morning rounds, I make a mental note to look up a bit more when I get a chance.

 

12 noon.

 

Running behind. Rounds took for ages. There are 3 residents on our NICU team (me, a second year, and an intern, and we're all med-peds so it's kind of cool), and the second year resident needs to get to clinic, so I'm taking report on her kids. There is still no word on the gastroschisis baby.

 

3pm. I finally get somewhat caught up. Eat or look up gastroschisis?? I chow while finishing up a few small tasks.

 

630 pm. I get paged. All day when I get paged I'm expecting it to be the code page for the gastroschisis baby. And this page is about the gastroschisis baby. They will take her for a c-section in 2 hours if she doesn't progress. Are you kidding me? Why not just section her in the am. Makes no sense. I call the surgeon to update him.

 

9pm. Delivery Code pager goes off, and we make our way. Almost 12 hours later. Beautiful Baby O is delivered, and aside from some loops of small and large bowel (which should be nicely hidden by the abdominal wall-but are dangling about) she looks great. The attending neonatologist comes to the delivery and coordinates wrapping the bowel. I pay close attention, knowing full well that if I ever see another baby born with gastroschisis, I'll be expected to manage the baby, solo.

 

The anticipation of worse-case-scenario has ended. We take Baby O to the NICU, get an IV. The surgeon comes to evaluate her in the NICU. I intubate her in the NICU (it's a confidence booster to get a tube on the first day), and we take her to the OR. Amazingly, an 90 minutes later we pick her up in the OR, and she has a small gauze bandage on her abdomen, and what will be a belly button. Mom and Dad come to the NICU an hour later...

6 Months

6 months from now is July 1, and that is my start date at Baragwanath.

 

Wow, I have a lot of stuff to get done before then!

VACATION!

Day 1 of vacation! I've managed to get a few re-entry things done today. I have been able to do my laundry. Have been able to do some preliminary cleaning. Have made a few calls, and made a list of things to get done in the coming days.

I almost booked a flight back to Denver, to leave tomorrow. It would be great to get a few days to spend with people... but decided what I really need is a few days here to just relax, and to start getting stuff in order!

Here are some pics from Xmas dinner:

"I'm Going to Die."

This is what she told me.

And she said it with acceptance, almost in reflection.

I. Am. Going. To. Die.

Well, not tonight, but soon I guess. And I stood by her bedside, with lots of things to say. But I didn't need to say anything. She didn't need to hear me talk. She just just needed to think and say some things out loud. She knew. Those aches in her bones were due to the holes where bits of cancer are eating away. She thought maybe those aches were in her head. "Well maybe it is in my head," she points to her skull and grins, "I mean I thought the aches were things I imagined, but I guess the cancer's in my head too." She made a joke. I smiled, and thought it was funny. She tells me, "I have a dark humor." No wonder I like this woman.

She's known. She knew when her bone scan was done last week. Her biggest concern is not her dying. It's the pain and suffering her sister will endure when she dies. I wouldn't have asked before, but now I'm learning that my own discomfort in asking certain questions is really my issue. Why I ask.

Only in the past few years have these sisters become close. And now that close bond will be cut prematurely short. I think about how my own brothers were celebrating one of my nephews second birthday yesterday, and how through many twists and turns we've managed to become close, and I feel lucky.

"What do I do, I don't want chemo again." We talk about what's important to her. I'm not a specialist in palliative care. And I don't know much about cancer. And maybe that makes the conversation easier. It's important that she enjoys the quality of her remaining time, quantity is not the issue. We talk about pain control, no chemo, and other details, and I add, now it's ok to eat all the chocolate and ice-cream she wants. "Yeah," she grins, "you're absolutely right, chocolate and ice-cream."

Bad News

1) Tomorrow I have to tell one of my clinic patients that they have cancer. I haven't seen this person in a while. I would imagine that the clinic calling to schedule a test result would invoke a bit of panic, given that pts usually can't get in to see us.

2) We started our day, at 8:30 am with telling a mid-20s woman (who is a patient on our team) that her mother had been pronounced dead in the ICU. Her sister died yesterday as well. We then took her to her father's room (who is also a patient on our team) and she told him that his ex-wife was dead, and his daughter had died the day before. Not fun stuff.

3) I had to call a family member of another patient to tell them that it was possible we would be intubating her brother by the end of the day. As it turns out, he has been able to avoid the tube so far.

I'm tired.

Hanging out with Jameson

Just chilling.

Jameson is the emergency break for my mind. Pulling the handle, making the craziness of life grind to a stop.

I'm hanging out with Jameson, listening to Dar Williams wondering how the fuck I've gotten to be 32, single, living here, working in a great hospital, in a job I like most days, contemplating taking a year out of my life going to South Africa, wondering when I'm ever going to have time to see friends in Washington, Dublin, Geneva, California, Australia, New Zealand, Pittsburgh, Burlington, Hawaii, wondering when I'm ever going to have time to email/call those I'm on the verge of losing touch with, leaving dinner tonight wondering why I'm single, realizing that I'm tired now and should just go to bed, thinking about how HW and I had a pact to discuss at dinner what was fun and fabulous about our days and realizing that day go by now without any fun or fabulous events, thinking about a crush and why I never told him, thinking about last night and how my friend is such an amazing person and if I were straight I would marry her in a minute and then realizing that this applies to many women I know, but very few men, wishing I had a dog, realizing that all of the above is pointless because I'm going to work tomorrow and for the next 12 days in a row and will have no time to think about any of these issues again until I am on break, and wondering if life is simple or complex, and trying to remember a conversation I had this summer with KE in which the summary was that there will never be enough time to do everything, and just wishing that I had met up with JA who knows how to keep life simple and fun, and that is what I need in life, a partner who would make life simple and fun, and now the nip of Jameson is gone, and somehow there is no resolution on any of the above issues but it doesn't really matter because I have flannel sheets on my bed which await me, and I will wake alone tomorrow, and somehow will become comfortable knowing that I may wake solo for the rest of my life but in the big scheme of things, that's a minor detail, the major details are that I am lucky to be working in my chosen profession and somehow have amassed a beautiful collection of family and friends, and Jameson is a friend who slows things down so I can think about these things.

The above isn't open for conversation when you see me. It's random thoughts that Jameson had me write down so that I can go and sleep in peace.

24 hours

In the past 24 hours I have:

-slept 3 hours
-rounded on 11 patients
-attended one holiday party
-bailed 1 friend out of jail
-pronounced one patient dead
-gone to the gym
-told one man his wife of 52 years was dying, and should go to hospice on Monday
-made a list of all the people I should call tomorrow, doubting that I will manage to get in touch with half of them

Displaced Coloradoan

A foot of snow... Get out of here. One of the problems of not having a TV is not watching the news, and then not knowing that it is going to snow A FOOT.

This news made my day. It's so nice to get dumped on, and when I got off work tonight (an hour late because the night residents had problems getting in), I had damn ball cruising through the snow. The Liberty is a joy to drive in the snow.

I got the sense that I was the only one who was happy about the snow...

Xmas Party #1

Dave had his annual tacky christmas sweater part. A great time to get the group together and let loose a bit. Though, this year was by far the tamest year. I don't think I posted any pics from last year, and for good reason..

Beth and John
Christina, Kenny, Me, Todd
Ted and Sharon
The Med-Peds 3rd year photo (minus one resident)
Why do parties always gravitate toward the kitchen?

Eire

Friday night Mayu and I drove down to see Mason and Kim and their gorgeous daughter Eire.

Mayu and Eire
Kim and I

Dinner

"...must be nice to be able to stop for dinner."

It's 6pm, I'm in the cafeteria.

"Actually, this is breakfast, lunch, and dinner."

Aside from commando runs to the resident room to grab an apple, or banana, 6pm was the first break of the day. Just one of those days. But it was kind of fun.. I rounded on patients, and it was one of those days where I really felt like I was making good decisions, where my attending agreed with my plans. Kind of a nice feeling.

Ethics

This is one of the few nights were I can't seem to sleep. There is no logical reason to be awake at this hour.

This evening, right as I was getting ready to sign out (telling the covering resident about my patients), a nurse paged me about a patient who was a bit tachycardic. Made sense... she was febrile, and thinking about her course for the day figured she was likely a dehydrated as well. (I make a mental note to review appropriate IV fluids with the interns). But, she'd been getting more ill as the day went on, and for some reason I decided to go to the bedside and just see her myself.

She has an illness, which her family doesn't know about. It isn't something simple. It's causing her to be very unwell. And I worry that she will die. In my multiple family meetings today, I asked again and again her medical history, watching this woman's husband, her brothers, her sister for some kind of sign or even a flinch, which would tell me that they knew about her illness. But nothing. The husband re-affirmed that she was to be fully resuscitated.

Arriving at the bedside, I saw the monitor, and she was tachycardic, but it looked sinus to me. Fever to 103. Pulse strong. What the hell, might as well get the EKG to be complete. It was done, and as I walked back into the room to tell the nurse she could go to radiology, right before my eyes she coded, and right behind my back was her family, who I had just re-assured that the EKG was as expected, and that her heart rate would settle with tylenol and IV fluids. Family out. Code cart in. She's back in sinus rhythm. And then the decision to intubate.

Fuck.

Fuck.

Fuck.

Back to talk to the family.

They understand the seriousness.

And all I can think about is that if/when she dies, this illness will be listed on her death certificate and they will be shattered.

Next Chapter & Final Chapter

Next Chapter: as I was getting ready to leave from work last night, one of the pediatric residents paged me to let me know that PJ (Sept 07) was back in the emergency department. We haven't seen him since he was discharged to a specialist for further care of his brain tumor. Apparently, he has been receiving radiation treatment and a new experimental chemotherapy. It was nice to see him and his mom, and to get an update on the status of his condition. However, he looks remarkably different than when I saw him back in September. His long-term prognosis is still not very favorable.

Final Chapter: JP died this week. She was admitted to the pediatric intensive care unit with an infection, and her prognosis was extremely poor. Her family and the team made the decision to withdraw life support, and she died within a matter of minutes. Inside her small room in the PICU, just before she died, were all of her family members. And they had a birthday party. She would have turned two this coming Thursday. So her family gathered, had cake and ice cream at her bedside, and celebrated her short life. I will continue to be amazed by how incredible JP's mom is.

I am back on medicine wards this month, as the senior ward resident. In addition to covering my own patients yesterday, I was responsible for precepting all of the new admissions that the interns did.

Home

Where is home? What is home? Is it Home or home? Ever since moving to Ireland, this concept of home has been difficult to define. For the longest time, I told people that "H"ome was where my dog was, and "h"ome was where I was living. But what really is home?

Looking at Urban Dictionary Definitions:
1. What a house becomes after the person owning it has had sex in every room.
2. [skipped]
3. A word that means something different to each person who uses it. A person's home can be the place where they live, the place they grew up, or the place where the people they care about live. In the case of some people, home is a variable concept, changing dependant on the placement of another person or object, or a person may even consider his or her own body the only 'true' home.

I think I will finally admit that, for me, Denver is home. It just feels right. Knowing so many great people who live there makes it feel right. Watching the clouds coming over the mountains makes it feel right. Running in the foothills makes it feel right.

When I left Denver I didn't really think it would ever be home again, and that's been an idea which has been hard to part with. When I left, I never really imagined going back there to live. I didn't think so many friends would still be there, or have moved back. I never imagined that my family would grow as much as it has.

I don't know what will happen in the next 2 years... But, I'd say there is a good chance that Denver will be Home and home in the coming years... time will tell.

More Photos...

Piper and Bailey Decadent dessert with Mykel

Decadent Dessert with Ona (and Stacey) in Breckenridge

Awfully big bite...

Ryan and Jordan chillin with books

Am back home in MA. I had a great trip home.

Home..

Giving Haley a better view..
Jordan and Haley climbing on the Columbine Memorial
Jordan and Ryan playing
Seeing Julia (pregnany belly not shown) and Travis
Family Dinner at Tom and Irene's

Having a great time in Denver. Fresh snow today.

Have a great Thanksgiving.

36 Hours...

Until I see these cool kids..

Happy-ish Place

end of the changing colors

look, snow

I went to a lame lecture this week, well two of them, and both times thought how I'd never get those hours of my life back. Similar feeling this morning as I was surfing the web at home for useless crap. I was so disgusted with my recent foul mood and wasting time that I jumped out of my chair and grabbed my rucksack and hit the trails. Was so nice to be out and about. Nice and cold and crisp out. Very refreshing. Hence, the genuine smile.

This

blog

is

blank

until

i

have

something

nice

to

say.

Please

reread

old

posts

until

I

find

my

happy

place.

1

week

til

Denver.

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