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!!!!

Holiday cheer-stealing (if you like a cappella and Christmas music)

From Joia, via Wendi... some Christmas music for you. Isn't blog sharing great?! (Thank you, Joia!) :)

I tried my best to embed, but, alas, I am still a techno-retard. By Feburary, I will have figured out how to get the actual movies on here.

Here's Joia's post or, if that doesn't work, go to the actual You Tube site.

Lil' bits o' life

So I guess it's about time that I write about something of substance. Sometimes I am more into blogging than others. This is one of those not-so-into-it periods :) I wish I had some pictures to share, of applicant dinners and things, but I have sort of been slacking in that department. I'll have to try to get some from Brenden who's been on the ball. For now, here are some bullets.

• Most importantly: my fridge is fixed! I have an awesome landlord who, one day last week while I was at work, came over, removed my food items from my fridge, defrosted it, replaced some part I don't know the name of, cleaned my fridge and then replaced, in uber-organized fashion, my food items in the fridge and freezer. How nice is that??! Now I just have to go grocery shopping to populate it. But one thing at a time.
• This rotation at Mather VA is much less painful than round 1. It is partly because of efficiency, but also partly because the schedule has been changed... again. In addition to your one (week) day off per week, and the "good" weekend day when your team is not admitting and when you can go home once your rounding/work is done (i.e. 3 p.m. for me today), we interns were given another half-day off per week! This is amazing and goes to show how important UCD (at least the medicine, and FP depts) take the work-hour rules and resident quality of life! Now, this makes things difficult for your resident (this week it was Shomir) who, for each intern (Anika and I are on together), has to completely round/write notes (the notes are the worst part!) on your pts on your day off as well as cover the admits on your half day, but this is wonderful for intern mental health and preventing burnout. I was able to nap today, go to the gym, do some errands, watch some movies, relax in general.... still haven't made it to the store, but we're working on it :)
• I like my patients and what I'm doing, for the most part. We have some funny patients... i.e. a super friendly bipolar guy sharing a room with a schizophrenic who swallowed razor blades and who we couldn't discharge until they had cleared his bowel without perforating... I got to do (with Shomir's help!) a paracentesis yesterday to remove ascitic fluid from the abdomen of the bipolar guy with hepC. I like sticking needles in people! :) I feel really bad about some pts... i.e. one young guy of 56 who has end-stage renal disease and will likely start dialysis tomorrow...
• But on a more positive note, I like Guitar Hero! Alvin rounded us up to try this at Phi's house on Thursday for the applicant dinner, and I can see how I could easily get addicted... I didn't try the drums (looks hard!) or singing (still have anxiety about singing in public) but had a fun time with the guitar :)
• My parents made me very jealous by telling me yesterday that they plan to go on a trip to the Amazon Jungle in March! I have no idea when the next time will be I'll get to travel to somewhere exotic, but I'm working on trying to get my sis to be "into" going to Japan sometime. Still want to go to Alaska (where, if you recall, Mom and Pops went over the summer months).
• My dear friends Laura and Tony have started a blog (yes! More people's lives to stalk!!). You can check it out at right or Here. They also have bought tickets to come visit me at the end of March-April, which I'm thrilled about!
• Similarly, I have bought tickets to make a little E. coast trip during my next vacation, which (believe it or not) is at the beginning of February (intern year will be more-than-half-over!!!). I'm not super thrilled about taking terminal Sunday call (meaning I'll be rounding until noon on the Monday the first day of my vacation), much less being in the MICU, but I have to look forward to a visit to the Kitsteiner B and B in and around the resort vicinity of Destin, Fla., as well as seeing my parents, sis, godparents and (I hope!) other friends in northern VA following the trip to the sunshine state.
• Sushi, anyone?? I still cannot get over how many sushi places there are around here. I checked out Nishiki Sushi downtown on Friday with Charmian and Alex, two of my OB co-interns, who I hadn't seen in a while, and it continues to amaze me. Wendi, you'd love it (:)).
• The Kite Runner, one of the best books I've read (if you haven't read it [ahem, Molly], GO get it and read it right now), is (as of 12/14) out in theaters. Apparently I can't find it playing in Sac yet, but I will stalk the moviefone sites until I see that it is playing.
• My first continuity OB patient is due on January 16th. I have followed her this whole pregnancy and am really hoping that I am able to make the delivery; however, being at Mather and in the MICU might make this difficult. In any case, I have spread the word to the night float and maternal-infant care resident to be sure to page/call me if she comes into labor!
• For my dog fix, I get to dog-sit Kate's dog Lefty for the next couple of nights while she's in Denver. It will be nice to have some warm-and-fuzzy company :)
• It doesn't really feel like the Christmas season! Maybe it's because there's no built in "break" this year (and I'll probably be on on Christmas. We don't really decide about our "days off" until around the week of, but I'm pretty sure Anika was going to take Christmas. Maybe I'll have the 24th off. Not sure). Maybe it's because it's like 50 degrees out (but it does get nippy, i.e. 30s in the a.m.s!). In any case, I can't believe it's already the 16th of Dec.! If it weren't for the holiday music, I might have missed the holiday altogether :) Anyway, there's a Messiah concert at the Davis Mondavi Center next weekend I have to look forward to. And I'm trying to get someone to go with me to drive around and see the holiday lights in Sac, which (I've heard) are impressive! Trying to get into the season here :)
• That's enough bullets for one day! :)

Hablas español?

Ok, so I lied.

If you have ever studied Spanish, you will get a kick out of this, also courtesy "de la mamá" (my techie accomplishment for the day is getting the tilde and accent in this blog post). I won't even try to get the video right in here (Wendi, can you show me sometime how to do this??!) :)

http://www.youtube.com/watch?v=ngRq82c8Baw

Why we need FP/Psych residents

(Mom sent me this... I promise I will come up with an original post sometime soon :))

Hello and thank you for calling The State Mental Hospital!
Please select from the following options menu:

If you are obsessive-compulsive, press 1 repeatedly.

If you are co-dependent, please ask someone to press 2 for you.

If you have multiple personalities, press 3, 4, 5 and 6 .

If you are paranoid, we know who you are and what you want, stay on the line so we can trace your call.

If you are delusional, press 7 and your call will be forwarded to the Mother Ship.

If you are schizophrenic, listen carefully and a little voice will tell you which number to press.

If you are manic-depressive, it doesn't matter which number you press, nothing will make you happy anyway.

If you are dyslexic, press 9696969696969696.

If you are bipolar, please leave a message after the beep or before the beep or after the beep. Please wait for the beep.

If you have short-term memory loss, press 9. If you have short-term memory loss, press 9. If you have short-term memory loss, press 9.

If you have low self-esteem, please hang up our operators are too busy to talk with you.

If you are menopausal, put the gun down! Hang up, turn on the fan, lie down and cry. You won't be crazy forever.

If you are blonde, don't press any buttons, you'll just mess it up.

This coming week is National Mental Health Care Week (I'm not sure that it is, but whatever).

You can do your part by remembering to contact at least one unstable person (other than me! :)) to show you care...

'Cause I need a pick-me-up (a.k.a. "Walmart Cake")

(and maybe you do, too) :)

I'm back at Mather VA for my second month of internal medicine. So don't be expectin' to hear too much of me this month :) I'm trying to save the world from hypertensive men with renal failure and coronary artery disease.

Also trying to convince applicants (and Molly) that UC Davis is the right program for them all :0

In any case,

From my cousin Amy:in the text:
<
This is someone who was moving from an insurance claims office. So this is how I imagine this conversation went:

Walmart Employee: "Hello 'dis Walmarts, how can I help you?"

Customer: " I would like to order a cake for a going away party this week."

Walmart Employee: "What you want on the cake?"

Customer: "Best Wishes Suzanne" and underneath that "We will miss you". >>

Even I avoid Walmart.