Friday, August 31, 2007

Praise God for Small Mercies

Due a freakishly light day call yesterday (I only admitted ONE patient and I admitted her to another physician) this morning I started my day with only TWO patients. Upon my arrival at the hospital, I promptly discharged one of them - he's from a nursing home and if you want to get them back there you gotta get 'em out early and definitely before the weekend. He was actually doing quite well and ready to go, so I got him sent back. My second patient is pretty stable and MAYBE could have gone back today, but he sort of still had some issues, so I thought he should stay a little longer. (As another nursing home patient, he'll be here until Monday.) My very gracious upper level, when he realized I wasn't on call or in clinic, told me I could leave early! So I got to come home around 2:30!

And what did I do with my time off?? Promptly fell asleep on the couch.

Now I'm ready for some fun!

Thursday, August 30, 2007

Tuesday, August 28, 2007

Pre-call

I feel like many of my recent posts I've written after a call night, so I thought I should balance things out with a pre-call post.

Going into a call night is somewhat exciting as many questions run through my head:

Will I get any sleep?
Will someone code?
Will I have some interesting patients?
Is there going to be good dinner at the cafeteria?
Will I know enough?
Will my PDA run out of batteries?
Where did I leave my stethoscope?

Then come the answers:

I hope so.
I pray not.
Usually.
Occasionally. But there are always milkshakes.
Never. Absolutely never.
Only if there is information on it I absolutely need.
Who knows, but I hope all of you appreciate that even with becoming a doctor, deep down I am obviously still the same absent-minded person.

Saturday, August 25, 2007

4:45 am

I wanted to clear one thing up. Since the night I thought would never end, most of my call nights have been relatively painless. I don't want my entire readership to think that every call = no sleep and lots of work. I've had several where I got to sleep for more than 3-4 hours. :) It is best, I think, just to expect the worse so that when it happens you are not too disappointed. Last night, for instance, I was SO close to getting to lay down, but then got paged because one of our patients got very sick and had to be intubated.

One thing I am learning from the nights when I don't get to sleep: I can ALMOST fall asleep standing up if I'm still enough. This I discovered while scrubbed in to watch my upper level resident put a central line (large IV that goes into a vein that is close to the heart) into a sick patient.

I've also decided that between 4am and 6 am is the absolute WORST time for me to be awake. I do NOT do my best learning at that time. I've noticed I actually start to feel sick to my stomach. It makes me wonder if everyone feels that way, or if I'm just weak.

Friday, August 24, 2007

Me Use Tool.

This week it became obvious that we needed a new piece of furniture in the house. And since I always dread the many hours spent flipping through catalogs, deciding on colors, hiring interior decorators, feng shui analysts, and of course spending all the money, I decided that I would just go ahead and make the piece of furniture myself. Fortunately it was just a small bookshelf. And it was going to go in the closet, so asthetics were of low concern.

Unlike some of my more mechanically minded friends, I don't do a lot of woodworking, so this was somewhat of a big undertaking for me. I always get frustrated when I have to work on things, usually because I don't have the correct tools. After all, its hard to build things when your only tools are a 192-piece ratchet set and a tape measure. And lately I can't find my tape measure.

As part of my preparations before starting construction, I went to Lowe's to buy a saw. I found a few that caught my eye, like this one. But since it was about $664 above my saw budget I settled for a slightly scaled down model.


















Sure, its the smallest saw they sell at Lowe's, other than the ones they use to sharpen their pencils with, but still, I felt a wave of manliness as I bought my new saw. Saw's are dangerous. It feels good to have a sharp, dangerous tool in your hand, and to wield it well. With it, I am exercising my dominion over the creation. I can take a large piece of wood, and at a whim, make it into several smaller pieces of wood.

"...So they became cutters of wood..." -Joshua 9:21

All in all my shelving project was a success. The hand saw took some effort, but thankfully I had had almost all the wood precut at Lowe's with their enormous wall mounted saw. All I really had to saw was a 1x2 that I needed to cut into 8 inch sections. Yes, a 1x2. I was a little too embarrassed to ask them to cut that for me at Lowe's. But for this, my $15 saw was perfect.

The Outtakes from "Me Use Tool."

It turned out to be pretty difficult to get just the perfect "tough guy with saw" picture for this episode. Here's a few of the takes that ended up on the "cutting room floor," as they say in the biz.

This one just looked like I was angry with the saw...

















Aye, matey, look at me saw!

















Now I'm just depressed and bored by my saw.

















?

















Almost there...

Thursday, August 23, 2007

Does chocolate soy milk come from brown soy beans?

I came home from work two days ago to find to large, heavy boxes awaiting me from amazon. I was somewhat surprised since I hadn't ordered anything from amazon, but briefly wondered if they just decided, out of the kindness of their collective hearts, to supply me with one of the many items on my wish list. Upon opening the box, I was surprised to discover something much better and more useful for my current life, given that I don't have time to read, listen to music, or even watch very many movies, since sitting too still in the evenings leads to me rapidly falling asleep.

This is what awaited me:
Two whole cases of CHOCOLATE soy milk, in a very portable form for me to enjoy at work!!

I have been thinking for weeks about how I wanted to get some single-serving soymilk containers since the cafeteria of course doesn't have it, and I'm pretty sure that even ASKING for it would either elicit severe confusion (What? Ya mean they can milk a bean?) or get me run out of town (Milk is the official state beverage, and any replacement is probably considered either sacreligious or downright communist). Either way I'm suspect. But now, any time I want, I get to enjoy a nice, cold chocolate milk, and it's even one that will not induce any of the...err... digestive unpleasantness associated with regular milk!

A big, HUGE double-sized THANK YOU to Dave and Hannah for such a perfect and thoughtful gift!

In other exciting news...I just realized that since I'm not on call on Labor day, I get the day off!!!! It's a bonus day off! Woohooo!!!

It's somewhat amusing how a little chocolate and an extra and unexpected day off can make me this happy.

Tuesday, August 21, 2007

The Big Two-One!

There are celebrations going on at the Tell household this month. We have a big birthday that we are celebrating. Yes, every year around this time Aubrey and I are starting to gear up for birthday season. Aubrey closes out the season with her late October birthday, I'm right in the middle of things with my mid September birthday, and you know who kicks everything off with their August birthday........



Junior!!!

We don't know his exact birthday, but we traditionally celebrate in August because it was August, 1994 that Junior became a part of the Tell household. Yes, we adopted him when he was 8 years old, and this is now his thirteenth birthday with us.

Junior was the first truck I ever had. My dad and I went in together to buy him (Dad buying the lion's share) when I was 16 years old. Yup, its true, I'm one of those spoiled ones who got an awesome bright red truck when he was 16 years old! I think I was probably the envy of the school, although no one dared voice their admiration for Junior out loud. Probably a pride thing or something.

Much of Junior and I's story together can be told by his stickers. You can see some of them in the picture below. There are two stickers from The Navigators, since my parents and I were living at Glen Eyrie when we first got Junior. We had to live there for 6 months while my parents house was being built. My education can be traced through Junior as well. That green octagonal sticker on the front windshield is a parking pass for Point Loma Nazarene University in San Diego, the land of my undergraduate sojourn. The back window sports multiple parking stickers from Covenant Theological Seminary. And next weeks I will place on the bumper a sticker for Erskine Theological Seminary. These many travels are also reflected in multiple state inspection stickers, one from Colorado, one from Missouri, and, well, South Carolina doesn't do inspections. Of cars, or anything else.

Most uniquely, perhaps, if you look reeeeeeeeaaally closely at the picture below, you will see that above the rearview mirror is a pair of sunglasses that my friend Keith left in Junior when we were in college. I graduated in 1999. That's kinda weird if you think about it.

You will also notice in the picture that in honor of his big 21st, Junior is enjoying a cold one. (please comment if any of you have a car old enough to drink)



And I think in this picture below, that if you look just so, you can detect a faint smile. He's a happy truck.





(posted by Jeff, even though it says Aubrey)

Monday, August 20, 2007

Coincidence?

So today I undertook the much neglected task of organizing and labeling all of my seminary notebooks. I have some hope that they might actually be of use to me in the future, rather than just sitting in boxes in the closet.

I got a little extra ambitious and decided to rearrange a few of them so that they are color-coded by subject. All the Bible classes are in black notebooks, the systematic theology in blue, church history in red, etc... As it turns out, (unplanned, I remind you) I have three notebooks worth of Ethics notes, and they are in gray.

Seems vaguely appropriate.

Rub my belly? Please?


















Ohhh, pleeeeeeeeeeeeeeeeease???????

Sunday, August 19, 2007

A new definition of a good day.

Since I've been on medicine, I have a whole new definition of what it means to have a good day.

Yesterday, on my afternoon off, I got to swim, read some, AND sew (a little).

Today, on my day call, I've only had to see three patients so far, and I got to lay down and watch a little What Not to Wear on TV.

It's been a good weekend, and I'm counting down the hours until my wednesday off.

Saturday, August 18, 2007

Woohooo....

It's currently 10:45 in the morning. And I am at home. Done for the day!! Now let the fun begin. (we'll probably start with a nap.)

And in other news...
Yesterday, I became something I never expected....

a seminary wife.

Jeff had orientation to start his Th.M. at Erskine Seminary in a few weeks. So now I'm the seminary wife. Weird.

Thursday, August 16, 2007

How I know I'm in the right place.....

I realize that most of my posts these days seem to be about my job. Sorry. But here's another one.

One of my patients died this morning. This has happened a few times to people I was taking care of, but this patient is one whom I admitted to the hospital and have been taking care of for a few days now. She didn't even seem that sick when we brought her in- she'd been falling down more and having increasing trouble with confusion. She had many health problems, but we were trying to figure out why she was dizzy. We did various tests over the course of a few days, and nothing really came up, and we even started thinking about sending her home. But then, rather suddenly, her blood pressure dropped and stayed very low. We put her on medicine to keep it up, and started giving her lots of fluids. Still it didn't come up. She was obviously a beloved lady with lots of family who all began to come in to see her. We made her as comfortable as we could, and I felt like I got to know her family fairly well. They were believers, as was this patient.

This morning, she really looked sick and it was decided to stop the fluids since we could no longer help her. Within minutes, she was gone. I came into the room, listened for a heart beat, but heard nothing. I got to pray with her family, praising God for her life, and for his promise that we can live with him eternally through the death of his son, and know that she had loved him, too.

It sounds strange to write, but it was a good experience. For my whole life until this point, I have been dreaming about a time when I can DO something to heal and comfort others. Death is never happy, but this dear lady had suffered with poor health for so long, and passed away quickly and surrounded by those who loved her. I mourned with her family who will miss her and recognized that part of what I love about my job is that I am finally able to use the skills God has given me to comfort people in times of stress and sadness, in a way that was not possible before I was a doctor.

That, to me, is what medicine is all about.

Tuesday, August 14, 2007

My Husband.

Yesterday, I came home from a long day of work to find:

Laundry washed and folded
Kitchen Cleaned
Living room straightened
Onion Pasta cooked

and...

homemade focaccia in the oven.

That's right....my husband can make focaccia. From scratch. It was soft, warm, and delicious.

And he's (very) good looking, too. I'm not sure what I did to deserve him.....

Sunday, August 12, 2007

The On-call-ogist

For all you non-medical folk who read this blog (most of you, I'm assuming) I thought I'd give you a small sample of what it's like when you are on call.

0500 - Alarm goes off. Hit snooze.
0508 - Goes off again. Feel bad for husband, who doesn't have to get up, so drag yourself out of bed. Shower, pack a bag, and try to ignore the pitiful look the dog is giving you since you don't have time to walk her today.

0613 - Arrive at hospital. Begin seeing patients, starting with a sweet 97 year old, who you get to pray with as she is very open in her love for Jesus. Get a little teary when she prays for you and tells you she loves you.

0645 - Work your way down each floor, stopping and writing notes on all of your patients. Realize that none of them are going home, and since you are on call today, your patient list is going to get huge.

0745 - Meet Jeff for breakfast. ( french toast - yum)

0800 - Start rounds with the attending and the other team.

1000 - Still rounding. As you finish, revisit each floor to write orders on your patients and discharge some patients from the other team.

1100 - Finish morning work, and sit down in the lounge for a few minutes. Foolishly think that maybe today won't be too busy.

1104 - Beeper sounds. Look at number to call and inwardly groan when you realize it's the ER. Write down the information about the admission, and slowly make your way down there.

1108 - Beeper sounds. Return call to nurse who is confused about your orders, since you forgot to write down a vital piece of information (ie- how often to give medicine, what strength.)

1113 - Beeper sounds. A patient has a headache and wants some medicine for the headache.

1118 - Start reading about new patient in ER. While using computer, another ER doc walks over with another admission. Now the race begins to catch up.

1218 - Finish first admission. Start second. When almost finished with second admission and you are beginning to think you might get to relax for a few minutes this afternoon, the ER doc returns with these words: "Hey - I've got another one for you."

1240 - Beeper sounds - Nurse "Doctor, patient such and such is doing this. What should we do?"
Doctor "Uhh....mmmmm.....??" Silence. Nurse "Why don't you give them this medicine?"
Doctor "Yes. Let's give them that medicine." Nurse "What dose?"
Doctor (scrambling to look up answer on PDA) "How about this much?"

1335 - While looking over admission paperwork with upper level resident, realize you made three somewhat silly mistakes and didn't request two very logical studies. Rush to the cafeteria and grab some quick lunch to eat down in the ER, since there is yet another admission.

1500 - Beeper. Nurse calls to tell you a patient has died (very expectedly) and you need to fill out paperwork and pronounce the patient officially dead.

1502 - ER doc gives you another admission.

1545 - Discharge another patient from the other team and return to ER. Stay in ER until 6pm when you finally finish and sneak out to eat dinner with Jeff.

1645 - Second page about patient who is dead. Want to go, but realize that the situation up there can't really go downhill, and there is so much work to be done in ER.

1730- Third page about patient who is dead.

1800 - Grab quick dinner and return two pages. Give prayer of thanks that the ladies of the verandah let you use the kitchen phone.

1810 - Fourth page about patient who is dead. Mention you had to get some quick dinner.

1812 - Fifth page from Nurse Manager about patient who is dead. Learn to never mention that you had eat.

1830 - Go to dead patient's room. When you get there, realize this is a 33 yo woman who has been in persistent vegitative state after a tragic and unexpected head bleed, and in some ways death is probably a mercy to her. Try not to look at her 5 and 8 year old daughters who watch you and you listen for a heart beat or breath. Awkwardly stumble through what to say. Pray with family and cry a few tears with them as they mourn. Try to collect yourself before returning to the 2 admissions you already have in the ER.

1900 - 0600 Stay in ER and try to work your way through the list of admissions that keep growing longer and longer by the minute. Tense up every time and ER doctor walks by as you fear they are coming to tell you there is another one you have to add to your list. Around 0230, begin to lose all capacity for coherent thought and run to the lounge for some caloric and caffein-ific reinforcements. Feel guilty about eating a delicious little debbie brownie.

0600 - Start writing notes on all the patients you already had before this call, PLUS the patients you just admitted. This will take a while since your brain is working at about 10% of its usual capacity.

0625 - Deal with difficult patient family. Pray for patience.

0900 - Start rounding with attending.

0945 - Still rounding. Begin to get emotional since no breakfast has been eaten. Subtly suggest some breakfast. Want to cry with joy when the attending agrees. Get breakfast and enjoy a few minutes of non-medical conversation.

1030 - Deal with same difficult patient family. Still pray for patience.

1100 - Still rounding. Wonder if you will ever leave, and realize you have to come back tomorrow and that you are on DAY CALL tomorrow, which only means more patients.

1145 - Still rounding, but you can see the light at the end of the tunnel. Visit with another precious 93 yo lady who makes you smile.

0100 - Finish rounding. Check out to oncoming resident who can't believe you are still here.

0130 - Rejoice as you walk outside to your car. Drive home slowly, hoping you don't wreck.

0138 - Arrive at home.

0142 - fall into bed. Hurray the day is done!

Thursday, August 09, 2007

Two signs you might have a problem with alcohol:

1. You are admitted to the hospital because you are having symptoms of withdrawal (high BP, tremors, hallucinations) while your blood alcohol level is 0.450 - as in five times the legal limit for driving. As in still drunk. But withdrawing.

2. Your emergency contact number when you can't get in touch with your family is the owner of a liquor store. No kidding.

Wednesday, August 08, 2007

A few new codes...

Apparently, our hospital has a whole list of "codes" that get called in different situations. I guess I sort of knew this, but most of them are very rare compared to Code Blue. This weekend I learned a few more...

Code Red - This (logically) means fire or that a smoke alarm is going off. Over the weekend, as I was sitting in the ER finishing up some admission paperwork, there was actually a Code Red IN A PATIENT'S ROOM. Looking on my master list of all our patients, I realized it was one of OUR patients. I decided at that moment it is probably poor form if you know that something/someone is burning inside your patient's room not to respond and make sure they are ok. On arrival, I discovered that the reason for this was because the patient's wife, in spite of numerous posted signs and good common sense, decided she could light up a cigarette in the bathroom in a hospital where numerous people are on OXYGEN.

Code Silver - This one apparently means that there is violence somewhere in the hospital or someone feels threatened in such a way that security should respond. I was writing some patient notes on morning and heard them call one of these in the ICU. Inwardly I groaned, because at the time I had two different patients in the ICU - one a very sick Mother who was dying, the other a nice older gentleman whose fiancee had been unpleasant and threatening to our staff the night before, and I figured something could have happened in either of these situations where people could have reacted violently. I meandered down, and when I got there, my suspicions were confirmed. I was told that the fiancee of my gentleman patient had been having a heated discussion with his son, when the son's girlfriend (supposedly a stripper who like to play tennis - I'm not making that up) decided she'd had enough, and backhanded the woman (possibly one of her better strokes?) right in the face, and the fiancee responded somehow, at which point the son felt it was necessary also to throw a chair in her general direction. So basically, it was girl fight. In the ICU. At the bedside of a gentleman who was already in the ICU, and whose condition certainly wasn't helped by all the yelling.

I guess I can say that being a doctor is rarely dull.

Monday, August 06, 2007

Real Faith

Working in a hospital, I often see people at their very worst - sick, tired, anxious, and scared. They get angry with us doctors, or at the nurses, or at their family as they lash out in the midst of these emotions. But we also see heartbreaking examples of people at their best, the academic theology I studied in Seminary revealed in the lives of the saints, faith in Jesus played out in front of me.

I have been watching a 38 year old mother die for a few weeks now. She has been holding on with severe liver disease and lung disease for a long time. We, as physicians, haven't had much (or any, really) hope for her survival for a long time. Every day, though, when I came in, her sweet grandmother was by her bedside, praying over her. She had the kind of faith Jesus talks about when he uses the term "faith that can move mountains." This morning, though, this mother was no longer able to fight, and passed away. Her earthly body, eaten up by the fruit of her sins, betrayed her. At her bedside, I heard her Grandmother say,

"The Lord giveth, and the Lord taketh. Blessed be the name of the Lord." There was no questioning, no doubt in God's goodness, even in the midst of this tragedy.

Then I watched as her 11 year old son sweetly kissed her goodbye on her forehead.

As much as I love my new profession, without my hope that there is more to death than just the final shudder, the final heave of the chest, the last electric rhythms of a slowing heart, I'm not sure I could get through a day like today. I listened as this family prayed together with a chaplain, and praised God that their mother, daughter and granddaughter was finally in a place where she would suffer no more.

"I will ransom them from the power of the grave;
I will redeem them from death.
Where, O death, are your plagues?
Where, O grave, is your destruction?" - Hosea 13:14

Blessed be the name of the Lord.

Thursday, August 02, 2007

A new tradition.

I knew there were lots of reasons to love my family practice program at Self Regional.

Today I discovered one more: Milkshake Rounds

Apparently they have this tradition here every few weeks. Instead of our normal rounding in our conference room, we go down to the Veranda, order milkshakes, and discuss our plans for the day on the patio.

While eating milkshakes.

The only thing better than being a doctor is being a doctor while eating a chocolate milkshake.