The Longest Day

Somehow, it is Thursday.

Tuesday was the longest day in the world. Ever. It went from 5am until noon the next day. What's that? 32 hours? Something like that. But, oh, wow, was my bed comfortable. So comfortable, in fact, that once I laid down at 1:30 to 'nap' for a couple of hours, I didn't wake up until 9:30. (At which point I panicked, thinking I was over four hours late for work. It took me a full 2 minutes to realize that it was dark outside, and, therefore, still night) I got up in time to watch the Boardroom part of The Apprentice, finish reading book the thirteenth in A Series of Unfortunate Events, and brush my teeth. Then, I went back to bed, and got up this morning, refreshed, and awake.

Some things I discovered, after a full 31+ hours of straight working (except for rounds, I only got to sit for about two hours total during that time):
1. It is, indeed, possible to stay up for 30 hours and still make sense.

2. Around 20 hours, you get dizzy.

3. Somewhere around 23 hours, it is really hard to not burst into tears.

4. The hardest part of constant motion: feet and knees. My feet have never hurt so bad. Definitely contributed to the almost bursting into tears. I left the CT scanning room to sit for a minute, and the resident told me to go back in there to make sure the patient was okay. I wanted to slug him. After a good cry, of course.

5. The combination of sleep deprivation and caffeine overload can make you think you're in love. In other news: I've met the man I'm going to marry (not really, but I've always wanted to say that. And wouldn't it be cool if I do end up marrying this guy, and I can say "I said that I was going to marry you the day I met you," and we can put it in our wedding vows and people will cry, cause it's so romantic, and our children will make us tell them the story every night before they go to sleep, and we'll all live happily ever after. In Venice.)

6. It's at about 24 hours that you simply stop caring.


Completely outside the realm of call: On my last day on Vascular Surgery, my attending tried to convince me to go into surgery. He said I have "good hands." Today, one of the interns I worked with on surgery tried to convince me to go into surgery, saying that I have the "character" for it. WHO ARE THESE PEOPLE??? I am not a surgeon. Well, okay. I could really picture myself working with these people, and doing this kind of stuff. But I'm too lazy! Actually, I'm not lazy, but I value my free time way too much to give it all away. Surgeons, as a group, are the hardest working people that I have ever met. But as a result, they have no life. I have heard many of the males (from intern to fellow) say that they haven't seen their children awake for days. That is not cool. Which is why there are so few females in surgery, I think. If there wasn't that issue, I definitely would consider it. Scary, huh?

Snapshots of Forever

I started this on Tuesday night, but as I was RUNNING around the whole night, I never had a chance to finish it. Eh, thinks I, I'll post it anyway.

My first night on Trauma Call. It's an overnight call, which means there is the potential for me to be up all night. I don't think I've done that before... I've gone to bed exceptionally late (8am or so), but there was always the idea of bed. I do not know when I will be reunited with my oh-so-comfortable bed. But, I guess 26 years of age is a good time to pull my first all-nighter.

Things that have happened today:

- I walked past two Asian men in time to hear one say (in an accent): "he had to empty his testicles."
- I have finally become confident in throwing instrument ties.
- I got butt blood on my shoe.
-

Facing Fears

Day One of Trauma surgery. When I started med school - heck, when I was pre-med - I knew that the one thing I couldn't do was trauma. Surgery was a bit iffy at first, even. But during an internship in college, I came to grips with how everything in surgery was very contained and depersonalized. It was not a person we were cutting into, it was a yellowish blob that contained pretty neat things. Still, trauma lurked as this very scary, very uncontrolled...thing. A thing that I wanted to stay away from.

But here I am. On the trauma service. Partially because I had almost last pick out of my group. But partially because I know that I can't let there be something this major that scares me in medicine. If I'm going to be a good doctor, I need to be prepared to face things that I don't want to. Just look at what we ask patients to do: Sit still while we jam a needle in your arm; a tube in your chest; you have cancer, and we need to kill your body to kill the tumor, so deal; your father/mother/sister/brother is not going to survive this, do you want to withdraw care? How could we expect anything less from ourselves, than the willingness to boldly face the things we don't want to.

So, by chance or by choice, I found myself in my first trauma code this morning. A woman shot herself in the temple. In a park. A passer-by found her. She. Was. Not. Pretty. I won't go into details here...but this was not a depersonalized surgery patient. This was a person with a face and hands. Just not life.

Suicide patients are tough. What do you do with them? They are obviously trying to end things...why should we have the right to go against their wishes? Then again, less than 10% of people who try once go on to try again (I think...I need to verify that) - perhaps given the drive to go on living after their life was saved. Obviously, we must try to save everyone we can.

It's late, and I'm tired. And I committed a major faux pas today: I let my resident hear me complain. Grr. I NEVER complain. I try so hard - I barely even complain to my friends about being tired or feeling over-worked. I wasn't even really complaining today, I was just making a comment about the call schedule to my fellow student on the service, and she was listening, and jumped in to chide me. Arg. What a great first impression to make...

Rickin-Frackin.

I think a post I just wrote disappeared.

Man that chaps my hide.

Scrubs R' Us

I cannot express how frustrating it is being sent home 7 hours before morning rounds start. I still have to eat, shower and sleep. And pre-round. Ugh.

Keith Says:

My most recent comment:

keith said...
"If a spoonful of sugar helps the medicine go down, then your blog is choking me with my own dirty entrails. I can smell my appendix."

I must admit that I'm perplexed. Let's analyze:

"If a spoonful of sugar helps the medicine go down" Okay. Obvious reference to Mary Poppins, as portrayed by the lovely Julie Andrews. In the movie, the spoonful of sugar helps the poor, belabored rich kids complete the magical task of watching their room clean itself. If actually applied to real life, we're supposed to believe that something good, or sweet, will help a bad task be more bearable. If one accepts that making medicine go down is a bad thing, that is. (which I don't necessarily - hello!: cramps and Motrin)

"...then your blog is choking me with my own dirty entrails." I'm imagining at this point that this is not meant to be a compliment. The use of the word 'entrails' rarely suggests warm fuzzies. ('Oh, Linda, your entrails are so...sexy' is not a phrase heard often) Much less 'dirty entrails.'

This is where my confusion starts. Is the fact that he's choking meant to indicate that my blog lacks 'sugar,' or, taken to its extreme - anything good at all? OR - now, follow me here - is the fact that he's reached his entrails with his choking mean that there is, actually, TOO much sweetness, causing the 'medicine' to go down at much too rapid a pace? But, in this second case, what is the medicine in question? AND how did his entrails get dirty in the first place? Last time I checked, my entrails were still...well...in. The actual entrails themselves being, admittedly, slimy, are not actually dirty. Now, what's inside the entrail - the en-entrail, if you will - now, that is dirty.

Now, beyond this, my mind breaks off onto entirely disparate avenues. For instance, was the use of 'medicine' in the metaphor chosen specifically because of my professional aspirations, or was it merely coincidence? Did you intend to get the freaking song stuck in my head as some sort of revenge for forcing you to read my blog? How did you come to feel forced to read my blog in the first place? Where can I get an umbrella that makes me fly?

And, Keith, I have one last question for you: What does your appendix smell like?

Thanks for the laugh, and please do explain if you find yourself in such a torturous position as to be here, on my page (intended for me and my friends) again.

Show ME, Show YOU

Can ANYONE tell me what this is about????

Anniversary

It was six months ago today that all that junk happened. It feels like longer ago. So much has happened in 6 months... it doesn't even feel possible that it hasn't already been years and years. Yet, I'm still not completely back to normal after all of that either. I still question my behavior and people's interactions with me much more than I used to. At first, I was sure that everyone I knew was going to see that something had happened between me and those people, and that they'd take the other side. I was worried that people would start to think that I must be an awful person, to have caused my good friends to ditch me. When school started back up in April... let's just say that it was really bad. One of the hardest weeks I've faced.

Six months later, I can almost say that I'm glad it happened. Almost. I discovered (though I did already know...it was just confirmed) who my true friends are. My definition of true friend being 'one who doesn't tell you they don't want to see you any more, even when you are being annoying/mean/grumpy/etc.' It was only after the parking lot incident, and after my brain has had some time to settle down that I'm starting to see how stressed out I was having them as friends. I was never good enough - I spoke my mind too much, I was too concerned about things...I don't even know really how to pinpoint what I was doing wrong. I knew that I was in the wrong, and I had tried so hard to fix myself. But, really, I wasn't broken. No one can exist in a friendship where you're not allowed to be who you really are. So, good riddance. I still wish it had been a natural demise, instead of a brutal, final slash. Because, even though I know this is better, it still hurts. And I still spend way too much time trying to figure out what I could have done differently.

Hey! This also means that it has been 6 months since I got my hair cut! I shall set up an appointment soon...

Jet Lagged by Life

You know how you feel when you have to get up in the middle of the night to catch a plane and then travel all day without sleeping? That feeling of having lead in your limbs and cotton in your brain? That is how I feel today. And I haven't even traveled anywhere! Le sigh... Actually, le yawn.

I am so horrendously tired.

Bring on the Smelling Salts!

My attending had no cases today (surprise, surprise - I don't know what he does most of the time...), so I decided to go in on the case with the Chair of the Vascular Surgery department. The case was an ex vivo renal artery bypass to repair a renal artery aneurysm. The renal artery supplies blood to the kidney. An aneurysm is a big 'ol in an artery (like a balloon), where the artery is weak and can rupture. "Ex vivo" means that they dissect the kidney out, and pack it in ice and preservative material so that they have more time to work on the problem.

This was actually the first big, open abdomen case I've worked on. Most of the things I've seen with my attending have been endovascular - meaning, all I see is a TV screen showing x-ray images of what is going on inside the body. Good for the patient, boring for students to watch... Well, boring for me anyway.

Okay, before I start complaining (cause I'm gonna complain), let me just say: the abdomen - the inside guts part - is pretty! The colors are, I mean. Kind of like this color scheme (don't worry, Lindsay, this isn't a picture of actual intestines). Very pastel-y and pretty. I'd decorate my room in the colors of 'intestine.' Especially if you could add a little spleen for accent. (this one is, so don't click it Lulu)

Did everyone know that Lindsay's new nickname is Lulu? Well, it is. So say I.

ANYWAAAAY. On to the complaining. Well, maybe not so much complaining as...okay, really, it is just complaining.

The operation started at about 7:30 - the first incision, that is. I was helping to prep the patient by 7:10. Let me set the scene:

1. Head of the Vascular department.
2. Who liked asking me questions.
3. Whose answers I did not know. Gerota's fascia for future reference.
4. It was hot. At one point, Dr. Surgeon said: "The patient's temperature is under control, let's turn the thermostat down to 75." Down to 75.
5. I had a granola bar and some coffee for breakfast. At 5.
6. My 'monthly' started today.
7. I had taken four Advil. At 5.
8. The Advil wore off. Cramps. Ugh.
9. There was nothing for me to do but stand there.
10. Until they turned the heat back up, and wanted me to do something with stitches - I'm still not quite sure what...
11. My back hurt.

I lasted until 3. I started feeling bad around 1pm, and awful at about 2. I'm surprised I lasted as long as I did. I decided that I should break scrub when I started kinda blacking out... The annoying thing was that they were done 40 minutes later. I almost made it! Grrr. The anesthesiologist did tell me that the patient had more color than I did...generally not a good thing...

They say it happens to everyone. So far, 2 of the 3 of us on vascular have had to break scrub. We'll see if the other one holds out!

And, as a side note for the girls - if you're ever in a situation where you find yourself saying: "Well, it is only the first day of my period, and this pad is pretty absorbant; plus I'll be standing, not sitting, so less likely to get leaks; plus these scrub pants are enormous, so how could it leak thru to them anyway? And how long can an ex vivo renal artery bypass take? Surely not over 7 hours" Just say NO. And go find the nearest tampon dispenser.

Things That Make Me Grin...

...even on a Monday.

* :) *

Since I spent many hours over the past weekend doing the same thing (except not in Wisconsin. And with no guys), I can understand the obsession.

I am so tired. Maybe weekends are bad. I get lulled into a sense of 'having time to do stuff.' So I end up sitting around watching TV and reading, and don't realize that all that 'stuff' that I had time to do didn't get done. So I have to stay up late to do it. Then I'm tired.

My eyes were rolling back up into my skull today during a renal artery angioplasty/stenting. I had to move to make sure that if I just completely fell over, it wouldn't be all over the scrub nurse's clean stuff. Which really wouldn't matter too much, because for all these endovascular things, they don't actually use any of the stuff anyway. Ugh. How cool is it that putting a stent in your renal artery may cure hypertension, though? I think that's cool. Of course, it only works in about 20% of the patients...but who wants to crunch numbers on a Monday? I'd rather sleep.

Ahhh....sleep.....

This may have posted twice. I have no control over the whims of the internet. Wouldn't it be cool if I did, though?

Things I Swore I'd Never Do, part 2

So, remember when I did that horrible awful thing back in the days when I was a pseudo-psychiatrist? At that point I swore to myself that I would not let anything like that happen ever again. Well, I must admit that I have transgressed. This time it was not an article. This time it was (brace yourself here) staying after rounds to go to an operation that I didn't need to. I know! Isn't it horrible!!!?!! Especially since I was already hungry. AND I'm not on call Let me outline my reasoning, and you can be my jury of peers:

1. We were minorly chewed out yesterday for not doing enough.
2. It was my attending performing the procedure (IVC filter).
3. The Fellow assisting is the Fellow that chewed us out.
4. I'd been to the same type of procedure yesterday, and knew that it wasn't a terribly long one.
5. I was allowed to stick the femoral vein in yesterday's procedure, so knew that the opportunity was there to do it again today.

I think my reasoning was sound.

My presence was definitely taken as a positive thing. I was allowed to do more than I ever had before - including the femoral vein stick, AND deploying the filter. Doesn't that sound cool?? I got to 'deploy the filter.' It really just involved pulling a little blue handle, while they watched under fluoroscopy. But still cool.

So, I am satisfied with my decision, even though it marks my second heinous infarction, and moves me even closer to the Land of the Gunner.

Now I'm starving. Time to go home and eat, then promptly to bed. I'll do better tomorrow, I promise.

The Walrus Said

Okay. The time has come. I'm starting to get annoyed with people on my surgery team, which means several things: First (and probably most relevant): I'm PMS-y. Happens every month, I should be used to it by now. But not. Second: they should really let me move onto another team now, while I still think that vascular surgeons are worthy and interesting people. Because we all know where this is heading, don't we? That's right. The more annoyed I get, the more I will deny the existence of my patients' vasculature, just to annoy any future vascular surgeons I may happen upon. This is not a good thing.

Okay. I really can only think of two things that my new annoyance means, but I think two is a good starting point. I can expand from there. And, really, the annoyance has just started. It's like...noticing that you've got a quarter in your shoe (why do you have a quarter in your shoe, weirdo?) At first, you're like "Huh. There's something in my shoe. What could it be?" Then you concentrate on it, identify it as twenty-five one-hundredths of a dollar, and then try to put it out of your mind, because you happen to be in the middle of a marathon, and besides, phone calls cost 35 cents now, anyway. What good in dwelling on a mere quarter? Then, after a short period of time during which you delude yourself into thinking that you are SO beyond presence of said quarter, it starts to rub. On your toe. In a really annoying, won't-go-away type fashion. "That's okay." you assure yourself, "I am bigger - literally and figuratively - than any quarter" And you continue limping along, silently seething, yet smiling on the outside, because you signed up for this freaking marathon, and are paying a gajillion dollars, so gosh-darn-it, you are going to finish it, and have fun in the process, even if the freaking quarter is ripping your foot to shreds. Shortly thereafter you let go, and start yelling at the other people in the race with you, hoping to relieve some physical pain by inflicting emotional pain on the people around you. And just for good measure, you shove a few as well. And maybe spit on a bystander or two. Eventually you do finish the race, but you're practically crippled, and have made enemies all around you, so you move to an invalid home in Siberia, because it's cold there (which may make your foot feel better) and you don't speak the language, so no one can tell you to get off your lazy butt and start walking somewhere. Because don't they know you've got a freaking QUARTER embedded in your freaking CALCANEUS!!!!!!!!!!!!

SEE? This is just not a good thing. Which is why I should be allowed to Pass vascular surgery after just a week and a half. I'm only at the 'identifying it's a quarter' stage. There is so much more to come. Let me go now, and we'll all be winners.

I'm on call. But I got sent home before 8pm. Okay... so I like some people on my team. But he's going into urology, not vascular surgery.

This one is from "West Coast Tour" We had a really...creative lunch. That's my sis and Susan at Horse Tail Falls in the Columbia River Gorge. 

Disorganization

So, I got the pictures posted below, but they are in no specific order. And, they're mostly of Susan, because she's holding all the ones of me hostage. She hasn't named her price yet, though... Maybe that's the revenge for the Eeyore incident. Not that I'm obsessive about pictures of myself... Maybe I am. But c'mon, everyone's got to have some "Egoistic Days." Go ahead, give it a shot. I think you'll be pleasantly surprised. Just don't shoot anyone else down in the process. That's just mean.

Now I have to review a book, and as a result I get $75 of textbooks - of my choice! How exciting is that?

Also, on the exciting front - I am getting published this summer! In the Journal of Integrative Medicine, or some such. It's from research that I did last summer. I didn't actually write any part of the article (maybe I contributed to the "Methods" portion), but I'm the third author listed. I have the feeling this will be the only thing I publish in my medical career, so it's a big deal!

Ugh. I have to be back in surgery in 12 hours.

Tinkerbell! (Susan would not make a good blonde, we decided) 

Tim and Lou! These guys were great - they were our table companions at dinner. They're a couple from New York, and were a lot of fun to hang out with. 

Susan taking a picture of a rooster wandering the streets of Key West, Florida. Maybe later I'll get a picture of the rooster to add to the site... Susan takes a lot of pictures. 

Karaoke in New York.  

Disney World! I made her do this, and I don't think she's forgiven me yet... I'm awaiting revenge. 

Room service in Miami. She looks happy, but don't let that deceive you - this was just before a major 'credit card incident' that led us to believe that the Wyndham Hotels and Resorts are run by imbeciles. 

Our room steward aboard the Carnival Fascination (Empress deck room 189) left this little guy for us one night. Ain't he cute? 

Toys R' Us in New York. A caffeinated Susan is mesmerized by the smushable floor. It was pretty cool. But that didn't mean she should have shoved all those little kids out of the way to get to it. I've never heard so much wailing...  

Ack.

I'm trying to figure out this new-fangled picture thing here on Blogspot. It will work eventually. I hope. It is starting to frustrate me, though... The instructions are all like - do this and you're done! But, I can't even find the buttons to do the things that you're supposed to do. And it seems like I'm missing a step. Or ten. Grrr. Well, I do have a couple of cool pictures to add. And I still haven't written about the cruise. That may not happen today yet...

Noteworthy:

1. Hurricane Frances is going to kick the heck out of southern Florida. So much so, that cruise ships are staying away. Okay. I was ON one of those cruise ships a mere week ago. I am SO incredibly thankful that our timing was so good. I don't know what would have happened if we hadn't made it back for our rotations. Besides - what do they do with the ships? Just chill out on the ocean? Dock in... Cuba?

2. The Kobe Bryant case was dropped? Good grief. Make up your mind, or at least keep it out of my freaking newspaper if you're going to be all vacillating about it. Oscillating. Wassailing?

3. I am incredibly tired, and just learned that trauma surgery (what I do next) call is not just overnight. It is FOREVER. 36 hours at a time, baby. Every four days. That is just insane. I'm useless most of the time anyway. 36 hours with no sleep is not really gonna help.

4. I put in a Foley catheter today!

5. I have a really (really, really) hard time recognizing people once they put on surgical caps and masks. (or take them off, if I've only seen them in the OR) Really, all it takes is a cap, and I'm like..."where'd so-and-so go??" Yesterday, there was a conference, and I didn't know who this one youngish doctor was there. It took me 30 minutes to figure out that it was my attending with whom I'd spent a good 8 or so hours with in the OR in the past couple of days. Yeah.

6. Today, I was sitting in the lounge area reading up on the operation I was about to see. In comes one of the MMPWHM. Actually, all the mysteriously missing have returned. So now it's really just PWHM. Piwhim. Numbers 1, 2 and 3. Anyway. Piwhim #2 walked in, sat down by me and started chatting, all chummily. As if nothing had happened. As if the whole 'incident' was just some minor blip on the screen, and everything was all hunky dory again. This is the same person who practically hissed at me (calling me a manipulative liar) after we met with the school dean. Good grief. CONSISTENCY, PEOPLE! PLEASE! Show some consistency, that is all I ask. Feel free to go right on hating me, cause I ain't changing. I am not going back to the way things were. I do not want to sit and chat with you. No small talk. No how do you do today. Nope. Pure and utter hatred was what you showed me you were capable of, and I expect nothing less.

7. It's only 6:20, and I get to go home!!!

***!~!***100***!~!***

This is my hundredth post! For those of you who care... If you look at my little profile thing-y, it will also tell you how many words I've written. Why we need this information, I don't know.

Anyone remember when Microsoft Word did a spell/grammar/intelligence check? I guess it wasn't an 'intelligence' check, per se. .. It would tell you at what grade level the work was at, based on sentence and word length. I had so much fun with that. I entered some Shakespeare - I think he got in the 10-12 range. Hemingway was around 5-7. **Take a moment to enjoy the irony** (in other words: Hemingway is often as freaking hard to understand as Shakespeare; another reason that The Old Man and the Sea should be banned from ninth grade reading lists. And Romeo and Juliet, which has been done to death) I wrote at about an 8th grade level throughout high school. But I'm easier to understand than Will or Ernie.

Last night, I couldn't get to sleep. I actually yelled at my clock at one point. It went like this: Me, tossing and turning. I turn to look at my alarm clock, and whisper, exasperatedly, "Midnight!" Okay. So the story wasn't that exciting, after all. But don't you feel that your life is enhanced, nonetheless? At least a little?

This morning, I didn't feel all that tired. Then I started trying to actually function. Ha! I went down two flights of stairs before I realized that I had intended to actually go UP one. I'm transposing all my letters on anything I try to write. I'm spilling coffee, tripping, and have been hypnotized by the sound of my sneakers on linoleum floors. People. This is not normal. I believe now, after a mere 3 days and a few hours, that persons who go into surgery are actually ALIENS FROM ANOTHER PLANET!!!

Time for an aorto-bifemoral bypass. Cool, huh? Too bad my bloods not green, or I might enjoy it even more.

I apologized to my clock this morning. It wasn't its fault, after all.

Part Two

I must also send birthday greetings to my old friend, Elizabeth. Old as in made of gold, not as in chronilogically aged. I don't think she reads this blog, though. Unless she is secretly having me followed. Are you? Hmm.

Surgery call is different than psych call. That is my birthday message to you, Elizabeth. :)

The Birthday Tree

If your name is Susan, and you read this blog, then (most likely) today is your BIRTHDAY!!!

Let's all say it together: HAPPY BIRTHDAY SUSAN!!!!

For you: a birthday tree (or cerebral angiography...take your pick)