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

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blank

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i

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something

nice

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say.

Please

reread

old

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until

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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.