Reading Time

I just want time to read. That's the thing that I crave the most these days. I have a huge stack of magazines, a new cook book, the new Mitch Albom book plus 3 other books that I've read a few pages of, all overflowing on my night stand and the side table by my reading table. I'm making time to read. That's a lie. I'm taking a vacation to read. All I'm going to pack for my trip to Ireland next week are things to read. "What are you going to do in Ireland?" people ask with regularity. Well, honest to god I plan to spend the days in cafes reading, and the nights in pubs socializing. It'll be nice to go back to a surrogate home where there's nothing touristy to do, but really it's forced relaxation, down time to read, to chill out. Giving my brain time to recoup. Take a break from the medical world, take a break from reading about patient conditions, about ICU management (not that I ever feel like I have read enough for work), and just relax with good books. I can't wait...

Low Point...

I hit the low point on-call last night.

Things just didn't go right. I had an hour-long family meeting with hyper-attentive adult children of a 70 year old lady (I don't want to go into details, ask me in person why I NEVER WANT TO WORK WITH WHITE UPPER CLASS FUCKERS), and then got nickled-and-dimed all night long 3 pain-in-the-ass nurses (the other 7 nurses were awesome as usual) . Sorry, I usually don't speak un-highly of nurses, but last night the surgery ICU resident and myself were starting to plot revenge on a couple of nurses who were the cause of misery.

The good part: while this was the low point of the month, my initial response was not to consider quitting residency, not to throw anything, not to punch, hit, spit, nor kick, but rather to realize that I am FUCKING exhausted. Mental Fatigue. Physical Fatigue. Emotional Fatigue. And the best part is that there is this one-week mentality. When you're down to the final stretch, it's all manageable. Had I hit the low point a week ago, you can bet I would have resorted to some less than mature coping mechanisms...

Know what I can't figure out. I work "80" hours a week. I know how residents in past worked 100+ hours a week (I did work 96 hours one week last year), what kind of quality of life was there back then. What kind of lack of balance was there... Jesus, I'd be a miserable SOB if I had to work those hours for more than a month, shit more than a week or two..

So, it's almost midnight. I came home this afternoon, slept about 2 hours, then went to see the Bare Naked Ladies concert with Patrick. What a great show. We had a good time.

Ok, getting up in less than 6 hours...
Cheers,
Brian

Random Thoughts

1-End of the Golden Weekend. Been relatively relaxing. Got very intoxicated Friday night. Was worth it. Thursday night on-call was somewhat painful, with only maybe 20-30 minutes of sleep, so going out and hitting it hard on Friday was a nice release. I'm sure there are plenty of red flags in there, but... Just chilled out most of yesterday. Had dinner with some friends. Spending today trying to stay on the low-down... Have been to the gym, and am going to get outside for a while this afternoon to enjoy the gorgeous New England fall colours, but then will plan on staying in my flat chilling out..

2-ICU Month. Coming to an end. Just over a week and a half to go, 3 more calls. It's been a really good month. I think I've learned quite a bit as well. If I were going to go into a fellowship, it would be a tough competition between infectious disease and critical care. Have been taking care of two very interesting patients for most of the past week. I've spent a lot of time thinking about how aggressive I'd want to be treated if I were critically unwell. It's kind of tough to know exactly what I'd want done. I'd encourage people to think about this.

3-JP. Back on the pedi ward. Saw her briefly before I left Friday. She didn't look as bad as I'd seen her before. Her mom has made her DNR/DNI (no resuscitation), which is a decision I agree with completely.

4-Patrick. It's been a bit tough this past week or two, I've certainly had a full plate, and work is keeping him busy. I'm not sure I've been the most pleasant person to be around. We're definitely looking forward to my schedule next month when things will resemble a bit of a more normal person's schedule. I certainly am learning that relationships require a fair amount of work as well. Thankfully, we're pretty good at communicating.

That's really the bulk of my life right now. Me. Work. Dating.
B

Motions...

Some days you just feel yourself going through the motions. Not really paying attention to the finer details. You're there, but not present. Running on autopilot. That's me lately. Running on autopilot. It's the second time I have been stuck on autopilot, the last time was back in March. March was way worse though. I remember so badly needing to get away from it all then, and that's the weekend I went away, found a nice B&B and spent my golden weekend enjoying solitude. Golden weekend is when you're post-call on Friday (meaning work ends around noonish), and then you're free Saturday and Sunday. A golden weekend is GOLD. A prized possession. GOLD. Fantasies about how to spend the golden weekend crop up weeks before it arrives. Am I going away again? I fantasize about driving away, and spending Friday night in a B&B in the mountains, or on the coast. Or flying somewhere. Escaping from my current over-worked life. But then, as the time draws nearer, the work required to find a place to go, to pack, to drive all seem almost insurmountable. It's also tough to justify the cost, given that I have a real vacation in 3 weeks..

Blah. That's the scoop. It's almost 8pm, and I may be going to bed in a few minutes. Not to mention that I dozed on and off all day today while we were in the car. I've even avoided caffeine to make sure I sleep soundly tonight.

That's my story.

FALL (pt 2)

I know I already gushed about fall.. but really, it's so beautiful out. I was post call yesterday so pick up Patrick and we went for a drive to some of the smaller towns around here, and enjoyed the changing colors. The weather was just wonderful. Able to just sit outside on benches, watching people, enjoying the cloudless skies. Then today, we met a few other residents for brekky, and then went hiking, and then went for ice-cream. It's not anything like "Grey's Anatomy." Don't let them fool you, our lives are MUCH MORE BORING than on the TV show. We talk more about sleep than we do about sex. We enjoy getting a free minute and getting outdoors. Don't get me wrong, we're happy to hang out in the pub too. Anyway, I do miss Colorado.. Something about seeing the Aspens change...

ICU is not too bad. Feel like there is so much to learn, and I'm not good at making time right now to sit down and read. For example, I really haven't been home since Friday night. Here I am, home, and am exhausted. Feel like there are a ton of things to do: email, phone calls, laundry, clean, READ READ READ. I've had a movie at my apartment from BLockbuster for a MONTH NOW and haven't read it. The stack of magazines are outdated as well. Blah blah blah....

I guess that's about it really. Thinking of all the things I want to get done, I all of a sudden feel motivated to get off the computer and get some work done.

Cheers. B

ICU & JP

ICU:
I had my first overnight call in the ICU last night. Similar to my first call in the CCU last year, there was no break, up for 30 hours. Although, it wasn't really that bad, and the only thing I didn't like was being so freaking tired.. I dare even say it was nice to be able to think for myself a bit, and then be able to page my senior resident when I needed help. I'm working with a resident in my med-peds class, and we're committed to having some fun at work. Yes, it is possible to have fun in the ICU.

JP:
Ready for some fucking depressing news? We have a diagnosis. It took 5 months for this horrible disease process to wreak enough damage in her brain to show some changes on MRI, and now the disease entity has a name, JP has a diagnosis to explain what's been going on. A disease which carries a fatal prognosis-in 2-5 years. And NO QUALITY OF LIFE til then. Dear god help this mom who will lose one child tomorrow and another one in the near future.

-B

FALL

Last night was the real first fall night. Driving back from looking at the changing colors, the air was crisp. It got dark early. There was just that fall feeling in the air. A day spent buying warm clothes at the factory outlets. Having soup for dinner. Seeing the pumpkins out for sale. It all screams fall. I think everybody should do a little happy fall dance, crunch some leaves, buy a pumpkin.

Out of the PICU now. JP ended up in the PICU a few nights before I left. Not good. Diagnosis, which seemed so close, is now elusive, again. I dunno. I just don't know.

Am starting in the adult ICU. Another month of every 4th night overnight call. I'm looking forward to the month cause I am hoping to really learn a lot, and it'll be nice to have this month over in the sense that I think it will help me be better at managing certain problems when I am back on medicine wards in December.

I am definitely looking forward to November 4th, when it's off to Ireland... Going to be great to be back and see people. It's forced vacation. No touristy stuff, just hanging out, reading for pleasure, evenings in the pub catching up. The pleasure of walking places, and not being in a car..

Ok, going to do something totally unheard of, and be in BED by 10 PM!
Cheers,
B

PICU & JP

PICU-SLAMMED yesterday. Crawled into bed at 330 am, out of bed at 4am, and never made it back. Had breakfast with Amy (The Pedi Ward Senior who got us dinner at 11pm!), and the Pedi Surgery resident, who kept rubbing it in that she had gone to bed at 9pm! So, it was really hectic, a few sick kids, but overall it was a great day for learning. At one point the PICU was closed to admission cause we FILLED IT UP! Kids with trachs with chronic respiratory problems, 2 head injury kids (one who kept me up all night), hemopericardium for unknown causes, aplastic anemia and sick, lupus nephritis and hypertension. Honestly, it doesn't get better. But know what was great, at about 5am, a sense of calm settled over the PICU. The guy with the really bad head injury started to settle down, the girl with the really bad fever started to look a bit better, the girl with really bad hypertension seemed to finally settle down, the kid who had the stroke was awake and talking (although he has lost his vision). And at 5am, there was a little joy, in knowing that kids were better. A few would be transferred out of the PICU, a few would go home. It was also good cause I got to finally think on my own, learned quite a bit as well..

JP... JP is a kid slightly less than a year old whom I have taken care of in July on the pedi ward and again earlier this month in the PICU. She is "my girl." I know this kid well, think about her regularly when she's not in the hospital, get updates regularly from her specialists. She is chronically unwell. If you saw her in the grocery store, you'd think she was maybe 3 months old. When I was in the ED last night I saw her down there , and my heart sunk. (She almost came to the PICU, but ended up on the floor where she was almost constantly observed by us neurotic residents and nurses who care about this precious girl). I can't even describe how shitty this situation is. Nobody knows why this kids is sick, some metabolic/genetic/endocrine disorder. Talking to mom last night (who just learned that her pregnancy is going to be terminated due to a non-viable fetus) she broke down and has finally realized that JP is not going to make it. My gut feeling changed yesterday too, and I don't think JP is going to make it. I'm convinced that we're slowly watching her die. And while I think it is horrible for me to watch her die, it breaks my fucking heart to watch her mom who knows that she's losing 2 kids. I can't even imagine...

PICU Part Two

2:30 am. just finished tucking in the kid I just admitted. interesting day. Like running a neurosurgical service. broken heads today. bleeds in the brains. two 20 y/o girls, and now a 2 year old boy. girls were preventable. bike helmets are a good thing. not driving drunk is a good thing. having a 2 year old with a brain mass is not a good thing. nice people today. great nurses. It's been a pretty decent month. I hate to complain cause on the one hand i know that next month is going to kick my ass (when I'm in the Adult ICU working more hours than any human should), whereas this month the work has been actually mellow, but I don't think I'm learning as much as I had hoped. partly my fully, of course, haven't really had the time/motivation to read much outside of work.

Anyway, life is really good right now. It's going to be a crazy few month (on-call 3 of the next 4 months), with a vacation to Ireland, and then home for New Years.

Ok, going to get some much needed precious sleep now. Oh, funny thing, we had a lecture on sleep deprivation earlier in the week, would have been nice had they allowed us to take a nap instead of going to a conference on sleep deprivation.

Neurotic Friends

First of all, I'm the neurotic friend. Well, that's a total lie, cause "birds of a feather..." yeah, you know the rest of the saying. However, as of late, I'd just like to thank my friends for putting up with my neurotic issues (life, love, and the pursuit of happiness), cause god love the people who I have called multiple times to hash out a few things going on in my life recently. You know who you are, and all I can say is thanks. And I might add that I listened, for once. This post won't make sense to many of you at this time. C'est La Vie.
-BPB

Mountains Beyond Mountains

I had the chance tonight to hear one of my heroes speak. Maybe "Mentor-By-Proxy" is a better term. If I've never tried to convince you to read the book Mountains Beyond Mountains about the work of Paul Farmer, have a look at THIS SITE on the group Partners in Health and find a copy of the book (or come visit me and read mine). It's a medically oriented book, but everybody I know who is non-medical has been inspired. So really, drop the smut novel, and read some real chicken soup for mankind kind of book. Really, trust me on this one... PICU is good. My favorite kiddo got transferred to the pedi ward today. Will miss seeing her, but will keep tabs on her.

g'night, it's very late.
B

PICU Part One

So, had my first overnight PICU call (they are all going to be overnight by the way) last night, and, um, I hate to admit it, but I wore the lucky socks, AND THEY WORKED! I actually didn't have a single admission, and went to bed and didn't get called til 0530! Amazing. Granted, I'm sure that means I'm going to get nailed on the next call, but that's ok.. It's certainly nice to be engaging my brain again.

I'm taking care of one of the kiddos I took care of in July. It's tough cause I was pretty worried about this kiddo in July, she's failing to grow, failing to reach milestones, has had a pretty thorough work up this far, and nothing is coming up. It's tough. And let me tell you, her mom is a Saint. It kills me each day when I have to tell her that we still don't know what's going on. FOR TWO MONTHS!

Ok, I need to get some reading done...

Cheers,
B

End of the Month

Tomorrow is switch day. I'll be starting in the Pediatric ICU in the morning. I will miss the slack pace of this month, but at the same time am looking forward to using my brain a bit more. Should be a good month for learning...

Roller coaster and forbidden fruit...

The past week has been a series of ups and downs, regarding one issue. Where I live. I am going to go on record and finally just plain admit that I do not love living here. It's not bad, well all that bad. In fact, many people are happy living here. The forbidden fruit was my trip to Seattle, where I spent the past four or five days for a friend's wedding, and also to visit another friend. Seattle, Ahhh. Coffee- everywhere! Healthy people running! CULTURE! Open and welcoming people! Fashion. Shopping. Everything that I seem to be missing from here, I was able to find in Seattle. It was heaven, but also painful cause I realized what I miss...

I'm not sure where I would be happy living right now. Maybe a big city. Maybe a smaller city with good mountains at my doorstep. Definitely somewhere with places to hang out-chilling having coffee.

I've come up with various strategies to keep me happy for the duration of my time here, or at least for the meantime. One strategy has been a bit of a make-over of the apartment. Bought some plants today, a few odds and ends (courtesy of a pottery barn gift certificate-thanks J&N), and some photo frames to mount on the wall. Part of this is philosophical, getting myself to believe that I will, in fact, be living here for 3 more years, and that actually coming to terms with the fact that my apartment is way more comfortable to hang out in than the lame-ass coffee places around hear, so am taking some time to make this a Home. Big "H" noted.

September and October are going to fly by, I start in the Pedi ICU on Friday, call on Sunday. It's going to be time to get back to the books, and I'm going to be ready for it.

Ok-time to hit the gym.
B

Tea Time & Driving

One of the things that I realized tonight that I miss about living in Dublin is having people over for tea. Pretty simple. Come over, brew some tea, and chat. It was easy in Dublin because people lived so close to one another. There was no need to spend half an hour driving to get to someone's flat. That brings up the other issue: Driving. I dropped off the liberty to the auto body shop this morning (to fix the dent that I made while four wheeling back in May). So, I've been without a car for the whole day, which has actually been kind of liberating. Liberating not having the liberty-pun kind of intended. I'm kind of sick a driving everywhere. Want to know what's gross, I have almost 21000 miles on the liberty, ALREADY. Where to feck have I driven? Sure, some long trips here and there, but most of that driving has been just driving around finding places to have coffee or to meet up with friends. When really,I am sure it would be more pleasurable to hang out in my own flat, drinking my own coffee with friends, and saving a few bob here and there... Just a passing thought.

Vacation starts Saturday morning. Thank God!

The Speed of Trees and Johnny K

The Speed of Trees: Ellis Paul is a musician that I have been recently listening to. I highly recommend that you check out his CD “The Speed of Trees .” It was suggested to me by a friend who lives in a small Colorado mountain in town. Johnny K is a through hiker on the Appalachian Trail (AT), That I met a little over a week ago during an overnight backpack trip.

How do these two things relate? I decided that I desperately needed to get into the mountains for a little down time. I was still trying to recover from the insanity of July. So I took a Friday afternoon off, packed up my backpack, and hit the AT. I hiked 9 miles (a fucking tough 9 miles I might add) and camped at a backcountry campground that was populated with AT through hikers. I was listening to Ellis Paul on the way to the trailhead and as I was hiking along I kept thinking of the title of the CD, “The Speed of Trees,” and how I have been so caught up in my daily resident life that I was missing out on the speed of the trees. Meaning, that in the blink of an eye, I realize that it was already mid August and I had yet to go backpacking/camping or even hiking. And that if I didn't make it a priority to spend some more time outdoors, before I know it, I would miss seeing the trees change colors in the fall. And let me tell you about Johnny K. 45, ex-Marine, decided he would hike the entire Appalachian trail this summer. Johnny K didn't just give me pieces of lightweight backpacking advice, but also suggested I slow down and spend more time hiking. Of course I gave him some advice to basically to take care of the healing wound on his ankle.

Daily Grind: it has taken me a bit of time to recover from July. Looking back, I think that July was much more difficult than I had anticipated it would be. The transition from intern to “senior” resident was a bit of a bigger jump than I thought it would be. So I was responsible for supervising both an intern and a medical student. It was pleasurable teaching for the first few weeks but when things were busy teaching was the first thing that was dropped, and it probably should not have it. Also, I realized that I am not good at delegating. I often found it easier to just to do the work myself than to delegate it to the intern or medical student. When my team was on call, I was also the pediatric admit resident which meant that all pediatric patients admitted to the wards came through me. Which means that more than once I found myself stuck on the phone for insane periods of time trying to coordinate admissions to the hospital. This month, I am doing pediatric outpatient surgery clinic. It is fairly relaxed. I have a week of vacation starting Saturday and am looking forward to my time off, as well as looking forward to seeing dad and Janice. September and October will be fairly busy as I am in the pediatric ICU in September and then the adult ICU in October.

My Home: I don't think that I am settling in here as well as I thought I would. I find that I really wish there were better (taller, more mountanous) mountains close by (part of why I don't go hiking as much as I could/should). At this point, I feel fairly certain that I will be leaving this area after residency.

After Residency… kind of the million-dollar question, or the future job du jour. Some days I see myself spending a year or two in the Indian health service, some days I see myself settling down in a bigger city (Denver, Chicago, New York, Seattle, San Francisco), some days I see myself doing three month locum tenems jobs. All I know at this point is that I am fairly certain I will be staying in primary care, providing care for both children and adults (and the occasional geriatric patients, ie, dad and Janice).

So, there you have it for now. I leave you with this quote to think about:

“Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place."-Susan Sontag-

Rocky Mountain High

I'm missing Colorado. More than I have previously, when I was even farther away. Perhaps it is because I had thought that once I was back in the US, it would be easy to make weekend trips back to Colorado. I mean really, Dublin to Denver was a long commute, so surely from where I am now to Denver should be quick. But sadly, there is no non-stop flight, and the length of travel (plus the outrageous ticket prices) has kept me from making a quick trip home. And it's killing me that when I get pictures from home I can't tell which nephew is which. I also really miss being able to make a quick day trip up to Georgetown, Breck, wherever. This morning I was surfing on the web looking at maybe trying to do a month elective in a small Colorado town ( I won't tell you which, but it is perhaps the most perfect place on earth), and it didn't look like there was a pediatrician in the town. A few fam pracs, but no pedi doc?? Outrageous!

So, I don't know what I'm going to do. I don't think I can wait til New Years to make it back. Anybody got a leer jet I can borrow?

On another note, I was on call Friday night. My first full call shift (there is an overnight float senior resident except for Friday and Saturday night). It was pretty decent, busy. 7 admission or so. Cool kids, cool parents. I didn't even seen the call room, but that didn't bother me.

In some ways, it has been a weird month. We've seen 2 incredibly rare cancers in kids, both kids should be ok. Both are likely to end up as published case reports, especially since one kiddo is the youngest patient ever to receive this certain chemo drug. Again, cool kids, cool parents.

Anyway, should be going to bed. Slept on and off yesterday post call, and took a nice nap this evening, so my sleep schedule is all off... c'est la vie.

By the Numbers

3-the number of e-mails I have received today from people I haven't heard from in years.

9-the number of admissions I had last Thursday to the pediatric team which I am managing.

2- the number on interns I was over-seeing last week.

8.5-the number of extra hours I worked due to the nine admissions

1-the number of brilliant diagnoses I was able to make the last week purely by accident

2-the number of naps I took on Saturday because I was so tired

0-the number of miles I hike last weekend, the weekend I was going to go for a two night backpack trip

3-the number of nieces and nephews I haven't seen in six months

635-the amount of money it would have cost me to fly to Denver last weekend had I booked my ticket on Tuesday

2-the number of discharge summaries I have not completed from this month

5-the number of cups of coffee I had today

2-the number of alcoholic drinks I had last week

5.5-the number of hours of sleep I would to get if I fell asleep right now until I need to get up for work in the morning

24-the rough estimate of the number of people I wish I could get around to e-mailing

7-the number of unscheduled vacation days that I have available

73-the number of times I was paged last Thursday

374-the number of days I have been a doctor

2-the number of times I seriously considered moving to a small mountain town and changing my identity

3-the number of hours worth of work I feel I would like to get done tonight

5-the number of conditions I listed that I wanted to read about

Fresh Coffee...

I had the freshest cup of coffee about an hour ago. Not fresh meaning that it was brewed this morning (which it was), but fresh meeting that I roasted the beans myself last night. It's like when speed addicts start making their own methamphetamines in their own kitchen... I roasted some Bolivian beans which were imported by a Bolivian company with offices in Bolivia and Massachusetts. (The beans are certified fair trade and organic). Good stuff. This is the start of a lovely new experiment in life.

The doc's advice: do something near and exciting this weekend.

Alive and Well & "What do I know now that I didn't know a year ago?"

Hey there, I am alive and well. I don't know what I have been up to recently but just haven't really felt motivated to jump on here to give any exciting updates...

I finished up my medicine ward month on June 3rd. It was nice to finish up on the wards, however, it is always bittersweet because when I left, I was giving up the right to continue taking care of three patients whom I greatly enjoyed. That doesn't mean that I have not poked in to say hi to them, and in fact, the one patient who I diagnosed with septic pulmonary emboli will actually be getting me as her primary care physician. It's exciting because she has done remarkably well. And by remarkably well, I mean being hospitalized has given her a chance to get off of heroin and to reconnect with some of her family. I am actually quite excited for her because she is doing so well. The other patient was one of my most favorite to patients so far. She was discharged to a rehab facility, and I have plans to go meet up with her and her husband for tea at some point. The last patient was discharged out of the hospital yesterday, and should have an uneventful course from here.

I have also just recently finished two weeks of geriatric medicine. (No, dad, not so that I can take care of you some day). It was pretty helpful, but, two weeks was not enough. It's kind of like pediatrics in a way. People fall and get hurt. People lose control of their bowels and bladder. Drugs which do well for adults cannot be used as easily in the elderly. It was also interesting going to a rehab facility for two afternoons, and to see the amazing work that is done on that end. My interest in the geriatric/rehab aspect is that I'm sure some day I will not have the luxury of having a geriatrician or rehab Doc to help me manage these patients.

I'm in clinic for the next two weeks. I have mixed feelings about clinic. I enjoy the patients we take care of, but the clinic itself can be a bit of a pain in the ass!

I have a few projects working at this point and was hoping to use this weekend to get caught up on them. I'm working on getting my international health track going at hospital, with the target date too start July 1st, 2007. I'm also trying to organize the immense amount of paperwork and articles and reading materials that I seem to have accumulated over the past year. I was half tempted to just throw the stack away and start all over.

Speaking of starting all over, I cannot believe that a year of residency is almost over!!!!!!!!!! HOLY SHIT! What do I know now that I didn't know a year ago? I'm sure I have learned a lot, but ask me to name one specific detail and my mind goes utterly blank. Utterly blank. Utterly blank! You see, when I try to think about what I have learned in the past year, all that comes to mind is how much I still need to learn. For example, this July 1, I find myself again on the pediatric ward. Last July 1, anytime I had a question, I was able to ask my senior resident and get the answer. This July 1, I am that senior resident. What is really different from a year ago? I guess what is really different days that this year I am more confident. I suspect I do know a hell of a lot more than I did a year ago...