(Perhaps not so interesting) updates

• I realize that it has been over a week since I posted. I can't keep up with Kristen, though (props for all of the recent postings!)
• I guess my life is not that interesting.
• As for social outings: Amy, Shomir, Katherine, and I went to see "Bodies Revealed" (plastinated bodies) last week; not as good as "Body Worlds" which I saw at the St. Paul Science museum last year, but still good.
• "Tainted Love," an 80s band, played at Harlow's on Friday, where Amy, Kate, Shomir, and I jammed away. I wish I'd crimped my hair (some people went all out!). I love 80s music.
• I recently read House of God, which I wouldn't recommend. I hope to read some better books over break.
• I want to go see 'Kite Runner' but friends (ahem, Amy and Shomir [I realize that this is sounding a bit redundant, but no, we are not joined at the hip but do hang out a lot!!]) who said they would go w/ me want to "read the book first" but haven't been doing so much reading. I gave them a deadline of Saturday; otherwise, I'm going to go by myself or something on vacation!
• I realize I'm slacking w/ the pictures, but I've started to get made fun of...
• MICU (which, truthfully, has actually turned out to be pretty great with great attendings and fun other residents) continues. Three weeks down, one week left.
• I successfully, on one poke, placed a central (internal jugular) line last week and did not drop a lung or puncture the carotid (this may not be a big deal for some people, ahem anesthesiologists like Hansie, but it [placing it; don't worry, I haven't injured any structures on anyone before either] was really nerve-wracking for me b/c I'm not confident at all).
• Sadly, I learned (when checking up) that another one of my patients who we transferred to the floor died 2 days later. I have yet to learn the details but this shook me again. One thing I will NOT miss about the ICU is the frequent deaths. I don't think I will be transferring any more people to the floor.
• Luckily no one died my last night (Saturday) on call in comparison to one of the early ones when two did and when I had to pronounce one.
• I got called about 150 times to Tower 7 on my last night of overnight call. I kid you not.
• I started hanging out on Tower 7 so they wouldn't page me every 5 minutes.
• I slept near-continuously for about 19 (yes, that is nineteen!) hours after call.
• I don't think I'm made for q4 overnight call.
• I was a white cloud, though-- only 2 total (instead of 10!) admits.
• Today was my day off which I luckily got FREE from clinic (had to have clinic one of my days off on week 1) or testing responsibilities (had to take the CREOG, or ob/gyn inservice exam last Friday on my day off)
• I got a haircut today! No pics, though. You'll have to wonder what it looks like. Maybe I won't post any until I figure out the Kits' May baby's name (you realize, however, that they could significantly expedite this).
• This is the first haircut since May, before graduation!
• There are no costcutters or Haircutteries in Sacramento! (I went to SuperCuts).
• My fridge went on the fritz again. This time the temp was 56 degrees.
• My landlord is as frustrated as I am and... drumroll...now I have a new fridge!
• I can officially feel okay about grocery shopping for less risk of things going bad; however, I still hate grocery shopping and do not enjoy cooking.
• Shomir introduced me to gummy vites today. OH MY GOSH. If I had only known about gummy vites (chewable, gummy-bear-like vitamins!) when I was a child, I would have been much more vitamin-replete! Those Flinstones vitamins my parents forced on us were nasty (remind me to tell you about my sister's love and history with Flinstones vitamins sometime...). Maybe I will never have to go shopping... I could survive on these things...
• I promptly went to Target and bought gummy vites, among other miscellaneous things.
• I realize that I'm on call on Superbowl Sunday :(. Not that I'm a *real* football fan, anyway (Phi gives us a hard time about this), but I do like to watch the 'big game.' :)
• I love days off.
• I am very inefficient on days off.
• The hours in my day off are passing too quickly.
• I should go for a run.
• This post is nearly as random as Ebby Ray's.
• In one week, I will be post-call, DONE with the MICU and PACKING to prepare to head to Destin and then to McLean!! (Yay, vacation!!!)
• I like vacation.
• That's all I got.
  

q4 call, q7 posts

Sorry for the mini-absence. It's been kind of busy! I do have to say, however, that MICU time does pass quickly with the q4 call schedule! Two weeks (well, and one day) and I am OFF for vacation!!

Last Monday, the first call night where I had to carry the pager, was about as busy as a call night could be with 10 (!!!!) ICU admits, a near-record. Although it was quite tricky to answer all the cross-cover calls on what ballooned to a 46-patient or something service, I (on the "team that has it easy") was blessed to have both another intern to split them with (no, Hans, I, unlike you, am not superhuman and could not physically do that all!) as well as a great senior who took one of them himself. Some firsts for the night: anoscopy to evaluate for a source of GI bleeding (this little bedside funnel-thingie.... I'd never used one until then!) and pronouncing death in a patient who I had never seen before... very difficult and moving. Similarly sad was learning, this past Friday (our next call, where I again took the pager but which was just BORING in comparison), that one of the patients I'd recently transferred to the floor died the next day in the hallway in his second (this hospitalization) cardiac arrest. I was really shaken. Despite feeling more comfortable with the ICU setting, this is one of the many reasons I don't particularly enjoy ICU medicine. I cannot handle deaths.

On a lighter note, are some pics from some recent fun outings.

Shomir and me at Second Saturday last weekend

Bowling (which I still suck at):

Anika and Din Hai

Shomir, Alvin, me and Din Hai

Crocker Art Museum in Sac, where we went on Thursday-- I was trying very hard to take an arsty picture of this mirror exhibit

Then, today, as I had it off, Amy and I took off for a mini day trip to Berkeley (East Bay- around 75 min. from here) and a movie in SF. Berkeley was cool! I'd never been there, but it is home to CAL and has a very hippie feel... Amy and I walked around a bunch, visiting some quirky shops and then going to eat at Cafe Gratitude, a restaurant that specializes in Raw food which, from what I understand, proposes that the best food for you is that which has not been cooked over a certain temperature... The menu was interesting (all items had names like "I am triumphant" or "I am peaceful"-- very "granola,") but the food-- the sushi bowl I had and the enchilada Amy had (which I definitely tried)-- was great! I also tried some almond milk with my organic tea and we did break down and split some raw carrot cake, which was yummy and quite healthy, too!

The Spirit of Berkeley

"I am grateful"

I am grateful for dessert

Amy and I then headed just a bit further west to hit San Francisco to see The Business of Being Born, a documentary (only playing in select cities) recommended to me by my advisor, which discussed many aspects of the birth process and which really raised great points about doing it the "natural" way with midwives and home-births. Although that may put me out of a job, I really took many points home and think I'm going to try to seek out some exposure to labor in these settings, as I think we truly are too aggressive and interventionalistic in our hospital setting and in medicalizing something which is truly, most times, very uncomplicated.

In any case, we are back in Sac now (I still can't get over how close SF is!) but, as there is no MLK day off for me, I should head to bed. Good night! Until next time...

Why I am alive

I will be with thee: I will not fail thee, or forsake thee. - Joshua 1:5

I thought I was a big believer before. After this week, it is more evident that ever that God's presence abounds in my life.

These things I have spoken unto you, that in me ye might have peace. In the world ye shall have tribulation: but be of good cheer; I have overcome the world. - John 16:33.

Just in case it wasn't BLATANTLY evident from that last post, I was utterly terrified of this MICU business. Thank you all for your words of support- I think I kind of freaked a few people out. I was, truly, kind of in the dumps and depressed about this rotation. However, it has actually been tolerable.

The Lord shall be thy confidence, and shall keep thy foot from being taken. - Proverbs 3:26.

It is obvious that the Lord only gives you as much as you can handle. Some people might whine that I am having the "easiest" time ever on this rotation. First of all, I didn't have to take overnight call until the 4th day of the rotation (Thursday), whereas one lucky intern got to be on call the first night on, when the MICU is overwhelming enough.

Second of all, there are two interns on my team, meaning that we share the patients and so each have fewer than each of the other teams; in addition, we get to alternate having the cross-cover pager when on q4 call (Mika took it on Thursday-- I have it tomorrow).

Thirdly, we are somewhat of a white cloud and only admitted two patients our night on call (I don't believe there's a cap and the team on today already had 4 pts by 1 p.m.!), both of whom we wrapped up and transferred to the floor within 1-2 days post-admit. We may be having some "redistribution" going on tomorrow but, in any case, it has been a blessing to have it kind of slow to be able to "ease" in and get more familiar w/ the whole system, esp. data-gathering, which really is the hardest part (Other than OB, I haven't done an inpatient medicine rotation at UCDavis and didn't know where everything is reported or really how to get things done in the hospital).

Fourthly, we have an AWESOME attending this week and next, and another great one coming on after him. This can really make things go smoothly. Rounds are efficient, but also infused with teaching pearls which really enhances our experience.

Fifthly (is that a word??), q4 off is wonderful.

God is our refuge and strength, a very present help in times of trouble. - Ps. 46:1

Anyway, believe me, I needed to have it a bit easier than the others, for sanity's sake. I really think that God designed it this way because he knew how fearful and anxious I was and only gave me as much as I could take without sending me into a nervous breakdown. I have no problem admitting that I feel like the wimpiest, weakest intern on :) Today I started to feel a bit better and think I might be starting to get the hang of things. After rounds, I brought myself up to speed on the hospital course of one "rock" patient who may get transferred to a different floor if a bed opens up (I will be the lucky author of the transfer summary). Ventilators and arterial blood gases are also much less of a mystery to me and I might be better at doing math (i.e. anion gap calculations) on the fly, in my head, which is a blessing in itself.

When thou passest through the waters, I will be with thee; and through the rivers, they shall not overflow thee: when thou walkest through the fire, though shall not be burned; neither shall the flame kindle upon thee. Fear not: for I am with thee. - Isaiah 43:2,5.

So, in a nutshell, things are looking up (but, although things are better, I still ask that you pray for me on Monday the 14th when I will have the cross-cover MICU pager trying not to let down the 30 or something patients on the various teams!). God also let the sun come out yesterday and today, which does wonders for the mood (can you imagine if I lived in Portland?!!).

I also wanted to wish VERY HAPPY BIRTHDAYS to some very important people in my life as it's unlikely I'll post again until the end of this call-starting and -ending week.


First of all, MOM (without whom I definitely would not be alive!) :) - Jan 14th

Also on the 14th is AMY (far left; I don't have an excuse to ever forget her birthday now!)
On the 16th are the birthdays of my "other Mom" Inara...

...and my dear friend and California neighbor ERIN (here at her Bachelorette party last March!)And last, but certainly not least, is the birthday of my awesome mountain-climbing friend, Mindy (Friday the 18th).

Happy birthday to these wonderful women! I will be thinking of you and wishing I could celebrate with you rather than hanging out amidst the beeping ventilators on Tower 6 at UCD. Blessings and love to you all!

Slightly losing it

So to follow up my flat car tire Friday, I somehow punctured the front tire of my bike around 5:40 a.m. on the way to start the MICU rotation Monday. The metal prong-thing I found when I reached the bike cage behind the ER didn't get wedged in there was close to the hospital, so I made it there before the tire became fully flat, but I was not very pleased. A harbinger of the excitement to come this week/(month)?

Our team was post-call yesterday so I really had minimal duties at the MICU-- the leaving team took care of the couple of transfer summaries and presentations of new patients; however, I just walked around with this really ill feeling in my stomach. The ICU is very foreign to me, and while some people thrive in that environment (I remember Lesley telling me one time "I LOVE the ICU! You don't have to talk to those patients, you just do your exam and get out to write about the plan, which doesn't change much..."), it just makes me feel ill. I like taking care of mostly well, young, healthy people that can walk into my office (or pop out a baby). Anyway, I walked around all day feeling as though I was going to puke or burst into tears and I sort of feel the same way today (my "day off" even though I have clinic this afternoon), as I have to go back tomorrow. Ugh. Even the fact that it is technically q4 "off" doesn't make me feel better, as the terror of the "on" (q4 call) part wins. I am "ON" call on Thursday. I think I need to start both an antacid and an anti-anxiety medication. I hope this improves over the course of the month.

Anyway, I pretty much just slept all Monday night and then this morning. And I know that I'm really losing it because I thought I had clinic at 1:00. In fact, I don't. It's at 1:30. I really am usually on top of stuff like this. And I don't know what kind of a clock I was using at home, because I left my house in time to make it here.... by 12. Yes, a whole hour early. So much for that (half) day off which really should be a FULL day off (not coinciding with the clinic half- day), but the resident didn't have much sympathy for me when I brought this up.

As much as I tried, I could not get my bike tire back ON my bike, once the tube was replaced, when I tried last night. Anyone wanna lend a hand? :)
It is also raining a heck of a lot.

I wish things would change around here :).

I think I will go to grand rounds and try to learn a little something. I'm here, after all.

The good and bad of 2008 (so far)!

2008 started out wonderfully! I was lucky enough to get New Year's Day off b/c we worked out a "holiday-type" schedule w/ the other admitting medicine team at Mather, and so when work finally ended Monday night, I was freeeeeeeeee until Wednesday.

Shomir's friend Rachel has a house up in Tahoe so we, spontaneously, just went. It took us about an hour and a half to find the place... and rolled in around 11:56 p.m., just in time to get a glass of champagne handed to us to bring in the New Year! It was weird seeing snow up there, just less than 2 hours from (warm) Sacramento, but it was pretty! We joined Arash, his wife, and a friend and checked out a couple of the casinos in town-- no gambling for me, though.

Wednesday afternoon, we tried to go out to Sierra for some skiing, but, due to heavy traffic leaving the Tahoe area, ended up at Heavenly, another resort in town. Now, some of the day had me wondering why it is legal, much less a good idea, to let extremely klutzy/uncoordinated people like me get on two little planks and try to make it down mountains (I will stick to the greens only next time, I think)-- I was kind of paralyzed in fear as I got stuck falling multiple times on a Blue, but I suppose it was good to try. I've been skiing 2 times before, the last time about 4 years ago. I hope to make it up there more times this season to get better and some more confidence with it! I can see how skiing, if you're good, is awesome; the terror, however, is still too much for me.

This would be my level of skiing :)

But even when I was on my butt (Shomir was so patient with me!!), it was lovely because of the awesome views of Lake Tahoe from the hills.. They really took my breath away. What a gorgeous area! Here are some pics from the ski lift.

Well, it was back at work on Wednesday, with clinic in the afternoon. I had my first continuity patient come in for a 1-week OB check and, as she was uncomfortable and was worried about her baby's movement, I sent her over to triage to be checked out with a nonstress test. The admitting resident called me around 7:30 p.m. and said that she appeared to be ruptured and was contracting every 5 minutes! Wow! At the time I got the news, I was at an FP/OB applicant dinner, however, I could not concentrate worth a cent and had to take off for the hospital.

The patient wanted to VBAC (have a vag delivery after a prior C-section, which was in Mexico with an unknown incision), so it was a bit higher risk, but it was cool! I got to AROM her forebag, place an IUPC, and really manage the entire labor! I didn't start her on pitocin for augmentation until she stalled out a bit around 2 a.m. (I really wanted to be there for the delivery so had to be a bit more aggressive than ordinary), but everything went beautifully! I got about 2 hour-long naps in during the night, but I was just so nervous! She started pushing around 4:40 or so a.m., and by 5:11, we had ourselves a gorgeous little baby boy and an easy delivery without lacerations or anything!

Although I was exhausted and had to go straight back to work at the VA for my next day shift, it was really worth it to be there. That continuity is what I love about family medicine-- and the OB part is just plain fun. It was actually strange being back on L and D, as it's been a couple of months, as well as in this different "role" (I've been doing a whole lot of prostate exams on wheezy men this last month!), but it was great to see the nurses and residents again while I was hanging out all night:)

So the bad?

Work this week has been really rough. It's been a lot busier than last week, and the turnaround is getting me exhausted. We are admitting every day and so every morning we come in, there are overnight admits we pick up after having "capped" with other admits the previous day. Our attending is very good, but very aggressive with getting things done and people moving, so our hospital stays tend to be quite brief. I am churning out discharge summaries like there's no tomorrow. Honestly. And then, since we are constantly diuresing our census and have, on average, fewer people than the other team, the overnight admits and more of the transfers tend to come to us, which makes for hectic and quite stressful mornings.

Although I really do like internal medicine and am liking finally feeling comfortable and everything at the VA, all that, combined with extreme sleep deprivation, made me really crabby yesterday. That, and a really difficult patient with some sort of personality disorder that I had to discharge. And constantly being a little short-staffed due to clinic/days off/people showing up late/being sick/etc.

Today, we are having what appears to be a hurricane-equivalent in Sacramento (the mountains are probably getting TONS of snow!). The power went out at the VA, which was running on its emergency generator. I was supposed to give a case presentation over the noon hour today, on which I kind of slaved away last night despite being near comatose with fatigue, but it was so busy today that we didn't get to have lunch/noon conference. The only good? Today was my "half" day which meant that I could get out early, after my work was done (except that we had MORE discharges!! So exhausting!) I went over to the hospital to see my patient, but she had already been discharged!

I was going to go to the gym but it was closed secondary to the storm. Hmmph.

And then my "tire" light came on in my car. When I checked, my left rear tire was hissing and definitely going flat, and I found a piece of wood with a nail in the back groove of my tire space. Excellent way to end the (for normal people-- it's Friday!!!) week. Luckily, 2 blocks from the gas station where I initially stopped to rescue-inflate the tire, was a tire place where they helped me plug it up (I would be near-useless in tire-changing-situations). Also very luckily this was after I'd made it home on my half day and actually had time to take care of this.

I also have that sore throat and fatigue prodrome of a cold coming on. Grr.

At least I only have TWO MORE days of VA medicine to make it through.
Then a month to make it through MICU alive.

Oofda.

Christmas snaps and stats

Okay, so the first picture is of Amy and me in Old Sac last week. Very festive, huh?

Christmas eve was a day off for me! In some ways, I was a bit sad to "use up" my day off so early in the week (has to last me until next Tuesday or something!) but it was very relaxing.
I actually went out to Lodi, CA (about 40 min. south of here) to visit the Skogstads, friends of my Dad's from his tap dancing years in Fisher, MN. They've been asking me to come visit for months and months and it's kind of sad that I am only just now getting out to see them, but it was a fun afternoon getting to know them! Although I didn't get to see it, they also are the new owner's of my grandpa's old Thunderbird retractable car. Sorry for no pictures!

I then somehow invited myself along to Sarah and Matt's Christmas dinner at their Methodist church for a candlelight service on Christmas eve. :)

I only had to work a 1/2 day on Christmas, which was also a blessing!

Amy and I then went out to Folsom to do some hiking at Salmon Falls. I still think it's amazing that you can frolick around outside in December in this state!

Christmas night, a few of us had a dinner potluck at a medicine resident's house, with great wine, holiday (gingerbread, egg nog, and peppermint) ice cream, and other goodies.

I am quite embarrassed that I don't have pictures to share, but I've been a slacker. I know it. Go to Wendi's blog for your fill of pictures :)

So now onto the stats and other interesting facts:

• Number of patients our team discharged today: 5 (Curt says his record is 7)
• Number of patients Anika has at this very moment: 0 (yes; that is zero !!!!!!!!!! WOW!!!!!!!!!!! Strong work, Anika!)
• Number of transfers that haven't arrived: 3
• Number of bouncebacks to our team this week: 2
• Admission heart rate of one of them: 46
• Admission heart rate of the other: 140
• Number of days Mr. B has been here in our hospital: approx. 86
• Number of progress notes I've written on him: approx. 15
• The length of his toenails: very long
• The bad news: nurses at Mather don't cut toenails; podiatry consults are needed
• The reality: podiatry care is not an urgent issue at the VA
• The gross part: what I was doing at 8:50 a.m., trying not to shoot my eye out, with clippers I brought from home
• The world's longest discharge summary secondary to a near-3-month hospitalization: Mr. B's
• The lucky author: yours truly
• The worst news: He didn't even get discharged to the rehab facility because the physical therapists want to "further review" his notes
• What makes me hopeless (/crazy): I will have to round on him tomorrow
• Hemoglobin A1C of a patient I admitted this afternoon: 16.0 (goal is less than 7% in our diabetic patients)
• Highest Hgb AIC I have ever seen: 16.0
• Number of medications I was requested to refill by one very high maintenance, chronic pain FP patient of mine: 6
• Number of minutes it took me to sort out when/how/where I'd last refilled her prescriptions to make sure I wasn't getting the run-around: 20
• Number of days until I see her back in the office where she could easily discuss her concerns instead of making EMR havoc for me amidst a VA rotation: 6
• Days left on this VA medicine rotation: 10 (one of those should be a day off!)
• Months until I have to return to the VA for cardiology/CCU: 3
• Hours left of work today (thankfully): 1
• Number of rotations left until VACATION #2 starts: 1.3
• Number of months of those that will be spent in the MICU: 1 (ick)
• Months too many in the MICU: 1
• Days left until 2008: 5!!!!

Happy end-of-2007!

Peace on Earth (and at the VA)

Get this... it is actually SLOW here at the VA, from where I start to write this blog. We thought it might start to slow down over the holidays and, in fact, we are having people want to jet left and right (hmmm... you think that people would want to be home and not in the hospital over Christmas??! I had a fairly whiny patient ask me if he could have a "pass" to be out of the hospital for Christmas and just come back whenever he felt like it afterwards to the same room. I said "I'll see what I can do" although I thought about saying, "WHY CAN'T I HAVE A PASS ?!") with few admissions to replace them. I am down to 3 (yes, THREE, which is the fewest I have had this month!) patients, which, let me tell you, is much more manageable than 7+ sick ones (LOTS fewer notes to write)!

I had been doing quite well (i.e. no breakdowns!) until yesterday, when I had a very difficult case to deal with, a wonderful elderly man with terminal prostate and bladder cancer with bleeding from his urine, but also with a cardiac stent less than a year old with risk of clotting and large pulmonary emboli that could kill him any minute. We all had to decide to anticoagulate him and risk bleeding him to death or leaving him as is, to die from either his cancer or clots in his lungs. There was no right answer in the situation, I was getting opposing opinions from cardiology and urology and felt totally incapacitated by the situation, as well as entirely moved by his condition, his attitude, and the grace of both him and his wife. I don't think the wife was too comforted by my bawling in the room as we talked about prognosis and code status, but I finally got it together. Will try to make it through the rest of the month w/o the waterworks. (What was quite funny, though, was that earlier in the morning, Dr. E., an attending I had during my first very stressful month at Mather but who was now with the other internal medicine team said to me, in apparent all seriousness, "Wow, Tara, you look so much happier this time around. Are you medicated??" :) Of course, this was before the breakdown). In any case, we hope the patient be able to go home tomorrow to spend Christmas with his family, at peace at the end of his life.

I found out today that I have tomorrow (Christmas eve) off. I'm still trying to get into the holiday spirit. Shomir and I saw Messiah at the Mondavi Center last night, which was great. But it is still weirding me out that it's like 50 degrees out! I busted out my collection of Christmas ornaments and some blue lights just last night, so my apt. is kind of festive, but it's just a bizarre kind of holiday season. Anika will take Tuesday off, so I'll be here, but I'm hoping to go to a Christmas eve service tomorrow night (anyone free?) and could potentially get out early on Christmas for my "half-day" off this week if it's slow. On Wednesday, the 26th, it's back to a regular workday, with clinic in the afternoon-- the hospital will probably be slammed with post-Christmas CHF exacerbations and whatnot. Who knows what is happening over New Year's. I'll probably find out the day before or something.

We were trying to figure out how to get some Christmas tunes playing on the computers in the resident work room here at Mather, but apparently the internet browsers are blocked from all kinds of audio-visual sites. Bummer! Otherwise, if I had my way, we'd all be singing aloud to carols here :).

Talked to my parents yesterday and apparently my sister is "home" (i.e. packed her bags to head home from Arlington across town to McLean!) for the holidays. It's weird not being there. Despite schlepping all over the place the last 8 years or so, I think I've been with my family (albeit not at "home"-- last year Mexico, the year before Egypt, etc.) for Christmas every year since college. Maybe I can call them from the VA on Tuesday :)

Anyway, it's quite peaceful here and I hope it stays that way until circa 7 p.m. when I'm off :) I may actually try to go lie down for a few minutes until I get paged, inevitably for having filled out something incorrectly :)

MERRY CHRISTMAS! PEACE ON EARTH!!!!