You are a Sock

Time

2011-12-04T18:41:00.001-08:00

Rush, rush, rush. My life as a medical student hoping to go into emergency medicine meant I must see more patients per hour! Churn , churn, churn them through the ER. Which was why I was in agony at first, in what felt like the longest patient interview. I found myself impatient at my partner, at the world, at the clock for faltering so long with each step.

“I don’t know when I am going to die. I don’t care. I am just here.” Suddenly time stood still as everything clicked together. My hilarious patient who used humor as a coping mechanism was imprisoned at the VA. Although he was my father’s age, a hard life had worn down his exterior while a liver cancer was bubbling away his interior. An unusual familial breakdown as well as a bitter casting away of his treatment team led to this sad situation. There was literally no one left who cared about this patient except for the palliative care team. My fellow medical student and I took in his joking and his life story, and tried our best to be there for him.

It is interesting that I was scheduled to come back to the VA for my palliative care assignment. My first patient at the VA as a student died before he could be transferred into the hospice unit here. Etiology, diagnosis, prognosis, treatment, follow up. Everything about that particular disease I learned in basic sciences twisted into grotesque reality as my first patient with intractable cancer passed away before my eyes before we could even place a consult. Time passed too quickly.

Then, while on the psychiatry consult service, I met every patient who entered the hospice unit for their final days. Time passed too slowly then, as I tried to pry reason into my hours-long interview with demented patients trying to die in peace.

Fast forward to 1 week before my palliative care visit. The pinnacle of surgical technique rested in my trembling hands as I held a donor liver while transplant surgeon/gods quickly sealed it into a recipient. A once incurable cancer, stopped dead in its tracks with new life. Fast forward to my current patient- one who refused such a transplant. I tried to make sense of this decision. “They want me to be this perfect patient, to stop drinking and smoking, to take all these drugs. I don’t have time man! I want to do things my way, on my own clock. I want to live my own life.”

At the end of the interview, we thanked him for his time.

Time

2011-12-04T18:40:00.003-08:00

Rush, rush, rush. My life as a medical student hoping to go into emergency medicine meant I must see more patients per hour! Churn , churn, churn them through the ER. Which was why I was in agony at first, in what felt like the longest patient interview. I found myself impatient at my partner, at the world, at the clock for faltering so long with each step. “I don’t know when I am going to die. I don’t care. I am just here.” Suddenly time stood still as everything clicked together. My hilarious patient who used humor as a coping mechanism was imprisoned at the VA. Although he was my father’s age, a hard life had worn down his exterior while a liver cancer was bubbling away his interior. An unusual familial breakdown as well as a bitter casting away of his treatment team led to this sad situation. There was literally no one left who cared about this patient except for the palliative care team. My fellow medical student and I took in his joking and his life story, and tried our best to be there for him. It is interesting that I was scheduled to come back to the VA for my palliative care assignment. My first patient at the VA as a student died before he could be transferred into the hospice unit here. Etiology, diagnosis, prognosis, treatment, follow up. Everything about that particular disease I learned in basic sciences twisted into grotesque reality as my first patient with intractable cancer passed away before my eyes before we could even place a consult. Time passed too quickly. Then, while on the psychiatry consult service, I met every patient who entered the hospice unit for their final days. Time passed too slowly then, as I tried to pry reason into my hours-long interview with demented patients trying to die in peace.Fast forward to 1 week before my palliative care visit. The pinnacle of surgical technique rested in my trembling hands as I held a donor liver while transplant surgeon/gods quickly sealed it into a recipient. A once incurable cancer, stopped dead in its tracks with new life. Fast forward to my current patient- one who refused such a transplant. I tried to make sense of this decision. “They want me to be this perfect patient, to stop drinking and smoking, to take all these drugs. I don’t have time man! I want to do things my way, on my own clock. I want to live my own life.” At the end of the interview, we thanked him for his time.

Time

2011-12-04T18:40:00.001-08:00

Rush, rush, rush. My life as a medical student hoping to go into emergency medicine meant I must see more patients per hour! Churn , churn, churn them through the ER. Which was why I was in agony at first, in what felt like the longest patient interview. I found myself impatient at my partner, at the world, at the clock for faltering so long with each step. “I don’t know when I am going to die. I don’t care. I am just here.” Suddenly time stood still as everything clicked together. My hilarious patient who used humor as a coping mechanism was imprisoned at the VA. Although he was my father’s age, a hard life had worn down his exterior while a liver cancer was bubbling away his interior. An unusual familial breakdown as well as a bitter casting away of his treatment team led to this sad situation. There was literally no one left who cared about this patient except for the palliative care team. My fellow medical student and I took in his joking and his life story, and tried our best to be there for him. It is interesting that I was scheduled to come back to the VA for my palliative care assignment. My first patient at the VA as a student died before he could be transferred into the hospice unit here. Etiology, diagnosis, prognosis, treatment, follow up. Everything about that particular disease I learned in basic sciences twisted into grotesque reality as my first patient with intractable cancer passed away before my eyes before we could even place a consult. Time passed too quickly. Then, while on the psychiatry consult service, I met every patient who entered the hospice unit for their final days. Time passed too slowly then, as I tried to pry reason into my hours-long interview with demented patients trying to die in peace.Fast forward to 1 week before my palliative care visit. The pinnacle of surgical technique rested in my trembling hands as I held a donor liver while transplant surgeon/gods quickly sealed it into a recipient. A once incurable cancer, stopped dead in its tracks with new life. Fast forward to my current patient- one who refused such a transplant. I tried to make sense of this decision. “They want me to be this perfect patient, to stop drinking and smoking, to take all these drugs. I don’t have time man! I want to do things my way, on my own clock. I want to live my own life.” At the end of the interview, we thanked him for his time.

Interesting patients from the psych locked unit

2011-04-04T18:17:00.000-07:00

"Well sir, if I were you I would not call the police on your brother just because he would not let you smoke crack in his house."

"Ma'am I must confess when I heard you were caught running naked in the grocery store with a bag of fry sticks, I thought 'yes fries are indeed delicious.'" (Fry sticks= actually joints dipped in formaldehyde aka embalming fluid with some PCP sprinkled in)

"Yes ma'am, I understand that you think you are Jesus." x2 with women and x1 with a dude.

"Is it me, or is it me?" (Every day for the first week I had patients "terminate the interview" with me either by running away from me, refusing to talk, or getting so agitated I needed to leave before things got out of hand.)

"Why are you afraid of the police?" Insert reasonable answer here. Then insert comment about FBI tapping his phone lines.

Apparently bath salts are the big new drug. That is all. I'm not even halfway through the rotation. More fun later.

Done. Libyan refugees are happy.

2011-02-26T19:10:00.000-08:00

Done. Done done done! Done with pediatrics. And there goes my first clinical rotation.

The national shelf exam at the end of the rotation destroyed me and left nothing behind. I needed to go home, attend a massive birthday party for my niece, and then take a 7 hour nap just to recover from it.

Thankfully that test was the only bad part of the rotation. I loved playing with kids for 2 months. They come to you without any baggage. No drug dealers or depression- my patients were still...pure and ready to take on the world. Some were really sick, others were just fine and dandy for their well child check ups. Universally, it just feels so good to make a kid feel better.

Now I've still had my fair share of crazy stories. My very last patient for the rotation was a Libyan refugee. Her parents had gotten out a day or so after the protests had started, just in time before the government had started to knock off civilians. The parents were amazing and coping well for what was going on. Skype was their main line back home- but it was hard to work around the communications blackout.

They were also doing well with their daughter, who had a rare genetic condition that I had never encountered before. The moment I looked over her charts and saw what condition she had, I could think back to the very lecture that was supposed to cover it. Our professor was notoriously slow and his last words for that class: "Sorry for not getting to this condition. Please cover it on your own, but I'll be nice and not put it on the test." So of course I never studied it then. And of course I mastered that material at home later that day. But guess what. It never showed up on the exam. Not a single genetic condition showed up on the exam. Gosh I love medical school right now.

Onward to psychiatry! Two months total, with my first at the Veterans Affairs Medical Center, and the next at the local county hospital. Should be interesting. I am ready for the war stories.

A wall.

2011-01-30T17:22:00.000-08:00

My intern was calm, always calm.

The patient's mother on the other hand was unsettlingly still, watching her daughter with distant eyes. Moving her pediatric stethoscope across our patient's heaving chest, my intern closed her eyes in order to focus. Feeling uneasy about what was happening, I stared at my watch and started to count. Twenty shallow yet labored breaths in 15 seconds. Shit.

"She always goes straight to the ICU when I bring her to the hospital," the mother commented. This scene was unfolding about 11 floors too far from the ICU I thought, and tried to mentally urge my intern to pull the alarm. "Come ON Tina! She's in respiratory failure! I do NOT want to do CPR on my last day here..."

We excused ourselves as the respiratory tech came in to administer a scheduled breathing treatment. Outside the room at the nursing station our upper level resident raced over while my intern was on the phone with our attending. She opened the vitals sheet and cursed silently, then dialed in the Rapid Response Team.

If someone's heart stops, a team descends upon the "code" in order to perform CPR. At the children's hospital I was rotation at, a Rapid Response Team could be called whenever a patient is at the brink of disaster. Hopefully the RRT could avert the disaster and prevent patients from coding via timely intervention.

Timely indeed was the intervention. First 3 upper level residents arrived immediately, then a couple of cardiac fellows swung by because we were on the cardiac floor. My intern's calm presence was replaced by a orchestrated chaos, dancing around our patient with the heaving chest.

In the frenetic activity swirling around the patient, the mother was strangely calm, sitting still while observing the action. What kind of emotions were bottled up inside? Was she now simply used to the idea of death's hand constantly on her daughter's shoulder?

My attending was the last to arrive, and avoided everyone in order to walk to then squat next to the mother. He made sure to be at her level, and spoke in a slow and reassuring manner, an anchor while waves rocked the patient's bed. Soon the wires and tubing was disconnected from the walls, and the bed carrying our patient was wheeled out of the room, and to the direct elevators to the ICU. My attending remained by the mother's side, and continued his conversation with her.

When it was time to go, the mother simply squeezed my attending's hand, then shifted her gaze back to the empty space where her daughter's bed had been.

Open your mouth and say ahhhhhh- oh crap!

2011-01-11T18:06:00.000-08:00

I can make kids vomit on cue.

That is all.

Intensity

2011-01-10T16:29:00.000-08:00

I think I've figured out why my posts dried up this past year. I like to tell stories, of people I've met and of the strange or crazy situations we've been in. For the past year and a half my routine steadily became sleep-shower-study in isolation as I grudgingly converted to the cult of lecture streamers. Why bother spending 5-6 hours at school everyday when I can speed through all of my lectures at 2.5x fast-forward in just three hours in my pj's? Nothing blog-worthy there.

If this is my last post, then you will know it was because I caught some bug from the scores of kids coughing into my face as I try to listen to their breath sounds. I've started my clinical rotations with pediatrics, and I absolutely love it. Today was my first day in the pediatric ER at the local children's hospital. I have been thinking of going into emergency medicine (just skim through some of my previous posts), but now that I am on pediatrics I'm not so sure I could go back into the adult world. Perhaps pediatric emergency medicine?

Lumbar punctures.

The pediatric ER attending delicately unwrapped a sterile tray that held the needle as wide as my clipboard. I looked at the pudgy preteen boy curled up into a soccer ball on the stretcher, then back to the needle. There was no way this was going to end well, I thought.

Instead of finding the landmarks for the needle, the attending started to screw together a strange contraption that resembled a chemistry set. The entire time the attending gave a steady running commentary of everything he was doing to keep the patient relaxed as possible. He promised to notify the patient every time any needles were involved- and to his credit he did so- all except when the humongous one finally went in. Kinda like ripping off the Bandaid at 2 instead of 3 I suppose. Anything to minimize the agony of having the contents of your spinal canal poked around.

Now I am not squeamish but I found myself holding my breath as the needle went in all directions in search of the elusive cerebral spinal fluid. Seconds slipped by and still nothing. What started as a low moan steadily grew as the poor kid's pain tolerance slowly broke down. The attending moved the needle in and out faster and faster as he checked for the clear drop of liquid that would indicate success.

Nothing. For now. Later that afternoon:

"I want you to burn this picture into your head, and never forget it." The strange wailing cry, the mottled purple of the tiny infant, and the sheer rigidness of her back was nothing like what a normal healthy baby should look or sound like. "She's getting the full sepsis work up," another attending explained to the gaggle of medical students in short white coats.

Do you remember the first time you saw an ultra-violent movie in the theaters? For me it was Saving Private Ryan. You aren't the same afterwards. Sure it is fake, but the constant exposure wears you down little by little almost imperceptibly.

I've already seen too much out on my ambulance, so for this little infant girl to give me chills, I knew something was extremely wrong. Microscopic invaders had so thoroughly conquered this tiny body that her organs were starting to give up. Starting to was the key word. If this lumbar puncture could work, our team could speed drugs through her system to combat this deadly intrusion. We were at a critical window however, and this stick needed to work.

A experienced nurse held the tiny baby in a firm motherly grip that forced the tiny torso to lean forward. She put a towel over the infant's head, then put her chin over the baby's head while holding the rest of the extremities with her hands. This must have caused explosions of pain as the diseased spinal cord and brain covering stretched out so that the attending could take a sample of the fluid that bathed the tiny brain. If I had cried as hard as the infant did I would have blown out my eyes.

Seconds turned into minutes as the needle poked around the spine, searching for an entrance into the spinal canal. Suddenly blood appeared and the doctor scrambled to hold a test tube to the open needle as precious drops of clear cerebral spinal fluid reluctantly left the body. I found myself exhaling slowly finally, and my train of thoughts picked up speed again. Okay little kids. Time to show me what you are made of. Cough all you want all over me, but I'm going to figure out how to fix you up right.

So close I can taste the double rainbow.

2010-11-15T19:13:00.001-08:00

Hi there.

No, I'm not dead. Just learning stuff.

Lots of stuff. You know, so I can be a doctor.

Sometimes my brain wants to take a vacation, but I won't let it.

Not for another month at least. Then I will be done with basic sciences.

That means I probably know all of medicine, right? Right.

Movie Trailer life

2010-10-24T14:02:00.001-07:00

If my life were to be made into a quick montage for a movie trailer, this would be the background music to it:

Mentor tip of the week

2010-08-25T19:34:00.000-07:00

Mentor tip of the week: keep your sleep schedule CONSTANT, even on the weekends. If it is off by 1 hour, it's no good. This is from someone who has scheduled residents for 20 years, and would know something about sleep deprivation...

Two big tests coming up soon. Time to know cardiology and heme/onc COLD.

What my roommate left me

2010-08-14T22:21:00.000-07:00

I am typing this out in my brand new bed! My roommate moved out today, and left his bed for me. It's one of those fancy Tempurpedic ones. Me likey so far.

But you know what else he left me? A friggin half of a skull. (More specifically, the foramina at the base. The top and the mandible are gone. There. Happy, Ali? haha) I was helping my roommate's girlfriend pack the last of the his stuff while he was busy setting up his new place back on campus. While she was cleaning out the fridge, I flung open his closet hoping to find it empty. It was, mostly. Some books on the floor, but near the ceiling...sat a brownish remnant of a human skull.

Any hope of the skull being fake evaporated when I picked it up; wisps of memories of anatomy lab floated back into view. I remember when our tank received our own human skull to study every nook and cranny. It was a precious gift, but the shuttle driver did not think so later that day. I had to walk home instead of taking the air conditioned shuttle since I was carrying "biological goods without departmental consent." Bureaucratic speak for "get that f'ing skull off of my bus." Of the dozens of skulls dispersing from my medical school that day into the homes of my fellow classmates that day, mine had the pleasure of bobbing up and down to the beat of Daft Punk as I slowly froze on the cold walk back to my apartment.

I put this older, more fractured yet pristine skull gently on my roommate's table. Should I call the police? Or maybe I should first wipe my fingerprints and blame it all on the girlfriend? One thing was for sure though. I poked around EVERYWHERE in the apartment and could not find drugs, cash, or diamonds. Only then did my roommate's girlfriend walk into the closet and see the skull.

Instead of screaming, she just said "oh, so you found it."

Was there something she should have told me a long time ago?

"Yeah...kind of creepy, no? I think it's Cliff's dad's, back when he was in med school. We just kinda put it up there because...well...yeah..."

Faaantastic.

Other news- I helped out with our med school's White Coat Ceremony yesterday. The speeches were inspirational, and luckily the ceremony went pretty smoothly. I think the dean of admissions and the guest speaker have some kind of 30 year grudge/rivalry going on though, because they keep making fun of each other every time they are in front of hundreds of medical students.

On a final note, it was my friend's birthday yesterday as well! She is a recovering Diet Dr. Pepper addict, so naturally I had to make this for her in case of emergency:

I even threw in a set of gloves, but I made sure not to put in a line kit. Didn't want to make it TOO easy...

Lost in translation

2010-07-27T17:02:00.000-07:00

1. The patient has no previous history of suicides
2. Patient has left her white blood cells at another hospital.
3. Patient’s medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is tearful and crying constantly. She also appears to be depressed.
8. The patient has been depressed since she began seeing me in 1993.
9. Discharge status:- Alive, but without my permission.
10. Healthy appearing decrepit 69-year old male, mentally alert, but forgetful.
11. Patient had waffles for breakfast and anorexia for lunch.
12. She is numb from her toes down.
13. While in ER, she was examined, x-rated and sent home.
14. The skin was moist and dry.
15. Occasional, constant infrequent headaches.
16. Patient was alert and unresponsive.
17. Rectal examination revealed a normal size thyroid.
18. She stated that she had been constipated for most of her life until she got a divorce.
19. I saw your patient today, who is still under our care for physical therapy.
20. Both breasts are equal and reactive to light and accommodation.
21. Examination of genitalia reveals that he is circus sized.
22. The lab test indicated abnormal lover function.
23. Skin: somewhat pale, but present.
24. The pelvic exam will be done later on the floor.
25. Large brown stool ambulating in the hall.
26. Patient has two teenage children, but no other abnormalities
27. When she fainted, her eyes rolled around the room.
28. The patient was in his usual state of good health until his airplane ran out of fuel and crashed.
29. Between you and me, we ought to be able to get this lady pregnant.
30. She slipped on the ice and apparently her legs went in separate directions in early December.
31. Patient was seen in consultation by Dr. Smith, who felt we should sit on the abdomen and I agree.
32. The patient was to have a bowel resection. However, he took a job as a stock broker instead.
33. By the time he was admitted, his rapid heart had stopped, and he was feeling better.

First seen here.

Last week of summer break! Aieee!

Status post deadly race.

2010-07-24T22:10:00.001-07:00

I nearly died yesterday. 3 different times. It is surprising how stupid yet lucky I was, looking back with my 20/20 hindsight. I'm writing the following down as a record to learn from, so I never repeat those mistakes, and so that others may benefit as well.

That said, yesterday's events was a wonderful relapse of my adrenaline addiction. After a year of semi-serious running, I entered my first organized race: Los Chupacabras de la Noches 10k. A hard 6.3 miles through wooded trails from 9pm to 11pm. Yes, at night in near perfect moonless darkness. After the sharp crack of the starting gun over a thousand headlamps activated and lit up the trails like drunken fireflies on our sweaty heads. In addition, the trail was marked with flour and glowsticks so that we would not head down the wrong trails and fall to our deaths.

1. The Fall

There were 3 starting waves because for the majority of the race we were literally tearing through the woods in single file lines. If you started in the first wave but run pretty slow you would bog down the hundreds of runners behind you. If you run at a fast pace but start too far down the line you would end up trying to pass runners in front of you. This was my was case, and how I almost died the first time around.

I put myself at the end of the 2nd wave because hell, it is my first race and I did not want to bog down anyone. Or so I thought. For the first half mile it was a press of sweat humanity simply walking up and down trails because of the many bottlenecks as the starting parking lot turned into a road and then into a single trail. Interesting start to my first race, with interesting conversations along the way. Most revolved around my use of Vibram Five Finger running shoes. It was the one thing right thing I did that night because there was no earthly way I could get rocks stuck in my shoe since it was essentially a second skin. I had mastered how to use them after a year of use, and it was freaking amazing. I nimbly dodged grasping branches, dashed up and down gullies, and leaped over rocks with ease.

A little overconfident, I started to pass runners in front of me. I really should have started in the first wave because I stopped counting the runners I passed at 25. My brief hubris blinded me to the first disaster of the night- I nearly fell to my death. I was just passing another runner when several things happened simultaneously: my light briefly went out leaving me in the dark, a root hid the fact that the trail had started to dip, and most importantly the sides of the trail fell away suddenly.

There is no way for me to describe the wave of terror/adrenaline that slammed into me as I realized I was going crack my head open on a rock on the way down. In a split second, I somehow threw a leg out and threw my weight forward while moving down to lower my center of gravity; the rest of that second found me sprawled out on the trail. With the rest of my diminishing wave of adrenaline I peeled myself off the trail before I was trampled to death, or at the very least prevented a domino effect of runners crashing into each other in the dimly lit forest.

For the rest of the race I spent every other second repeating to myself don’t die don’t die don’t die. Lets see. I ran for another hour after that, and there are 3600 seconds in an hour.

I also started to call out roots, rocks, dips, and branches as soon as I encountered them since I was leading my own little pack for most of that hour. We were the 2nd wave people who really should have been in the first wave, just blasting our way through the slower runners in front of us. It is a little weird developing a protective relationship with total strangers that you have just met but never really see. I recognized their voices once they started to pass down my shouts of "rock! Dip ahead!" but that's all I have, because by the fifth mile I was seriously overheated, and told them to pass me up. "Good luck, good luck," I mutter as the alpha wolf loses his pack, quite the emotionally wrenching moment I tell you.

2. The world was ending, according to my brain

I trudged through the last mile in desperation because I really did not train that well for this race. Since I am on summer break, any discipline from the year is long gone, including my usual running regimen. I also conveniently forgot that the water stations were NOT at the end of the race, and thus did not bring my water bottle. This is crucial, because of how the Vibrams work. Normal runners strike the ground with the heel of the foot, which means a lot of the energy is absorbed by bone, ligament, and tendon. When compared to the muscles of your foot, they seem like supermodels on a diet in terms of how much energy they consume. Now with the Vibrams, my entire gait changes, beginning with what part of the foot hits the ground. I run like a cat or a dog, with the balls of my feet touching down on the ground first, with the energy dissipated through the muscles of my foot, and especially my calves (they are humongous now). The upside is I am indestructible- no injuries, no aches or pains anymore. This is how humans evolved to run- and how they caught dinner: endurance running until their prey dropped from exhaustion. But this also means that I need to down swimming pools' worth of water to keep them running each time I run.

By the time I crossed the finish line, the world was ending. I was so dehydrated parts of my brain was shutting down. I wobbled over to the ice chest in search of Gatorade but only found water. Fuck it, I thought and downed cups. Things continued to get worse. I was like a prisoner strapped down for a lethal injection- I knew what was coming and could not stop it. Earlier this year I had taken a sports medicine elective and helped out with the Big City Marathon, and learned about how dehydration and hyponatremia could mess you up.

They were out of Gatorade! Fuck! I thrashed my arms around in the ice chest searching to no avail. I met my immediate need for water, but the disorientation and wobbling got worse. Physiologically, the water was getting into the system, but without electrolytes to keep it in the blood, it floods into the organs, especially the brain. I had just taken neurology so I knew I could not feel my brain swell. But it was because things were horribly wrong. I was going to collapse from lack of motor control, but that I was not worried about. What was scary was the loss of inhibition. For the first time, the primal drive for survival reared its ugly head, in the midst of stormy waves of neurotransmitters and hormones rocking my nervous system. I was exhausted, and human decency did not exist anymore.

I swiftly stole a gallon of water for myself when I knew it I should share it, and that it would only worsen my condition if I drank it all. I almost turned hostile in search of the Gatorade, so I forced myself to dodge the crowd and stumble back to my car. Panicking, I wanted to call my friend in San Antonio to drag me out, but I focused on getting my electrolytes. I slammed back a can of Dr. Pepper and 2 bananas that I scavenged, and then put myself through excruciating stretches to ward off cramps. Like a druggie going through withdrawal, I weathered the physiological storm muttering to myself and walking around in circles.

Looking back it's almost funny how unprepared for this race I was. Should have done a lot of things, planned better. Could have been a lot worse though. There was already one ambulance out for a runner, could have been another one for me if my focus on survival had flinched one bit.

3. Psychopath

Half way home out on the road, I really needed to pee. Thankfully, my fluids and mental status were back to normal, but I was still worried about cramping. Best case scenario my foot cramped and I swerved and crashed. Worse case scenario I swerved and crashed into another car, killing a whole family. However, I never anticipated the situation where I get brutally murdered by a psychopath though.

My bladder instructed that pull over into this decrepit and deserted rest stop. I found my way to the restroom, but what the hell all the men's rooms were locked. In desperation I found my way around to the other side but they were locked as well. Well I could try the women's room.

Before I could try the door, a slowly squeaking wheel announced the arrival of…someone from the far end. From the darkened far end of the stop a strangely muscular man in a janitorial jumpsuit strolled towards me, pushing a mop in a yellow bucket. He was balding, but greasy strings of shoulder length hair waved around in the air. Just like Harold and Kumar.

I took a step towards the door to the outside, just in case.

The guy walks right up to me, stares me down, then points to where he came from. Neither of us say anything but I find the an unlocked urinal and pee in record time. I look around as I head out but there is no sign of the guy. No wet floors or anything. Weird.

The whole way back I'm checking my rear view mirror and keep seeing dirty white vans the entire way home.

_________________________________________________________________

I'm writing this the day after, where I was working as an EMT for the Opera again tonight. I got a chance to do my stuff in the middle of the opera hall, with hundreds of people watching. I even had 2-3 physicians offer to help, but I did not want to get their tux's dirty so I handled it on my own until my backup arrived. And the good karma I earned by saving a lady's life resulted in straight green lights THE ENTIRE WAY HOME. Made a 20 minute trip in 10 without speeding!

You probably do not want to know

2010-07-14T21:23:00.000-07:00

From an awesome new find

You call the shots, but I'll make them

2010-07-11T16:27:00.000-07:00

So I'm starting bartending school on Monday...and I'll be like this dude a month later.

The only problem is that I want to run a 10k race through a forest at night in a couple of weeks. A problem if I have classes from 9 am to 7 pm every day for a week. When will I get a chance to run? I'm going to try to do it in the morning. 6 am might be good. I'm going to try to reproduce a Harvard study on circadian rhythm.

You just have to fast for 12-16 hours before when you want to reset your sleep-wake cycles to, then have a meal when you want to wake up. Easier said than done, considering I'm visiting my parents-who-love-to-cook right now.

NPO means NPO!

2010-07-09T14:31:00.000-07:00

NPO- "nil per os," Latin for nothing by mouth, meaning the patient is not allowed to eat or drink anything by mouth. -wikipedia or something close.

You will usually see this as an order given by a surgeon to a patient a bit before surgery, so that when they cut open your guts, nothing flies out.

I somehow conveniently forgot what NPO meant today, and as a result, a cardiology fellow felt up my femoral pulse a dozen times unnecessarily. (You can find your own femoral pulse in the shower by putting your fingers the bony point of your hip, then following the crease of your groin towards your privates. Should be around halfway)

It all started when my friend called me up last night, trying to see if I could swing by the cardiac cath lab in the morning to help out with some research. "How much are you paying me?" His reply? A milkshake.

Sold.

The idea was to take some ultrasound and infrared scans of my major arteries, have me drink the fattiest/most creamy shake they could find, and then scan me all over again. You would be able to see my arteries clog up with McDonald's milkshakes in real time!

The only problem was that we had to meet the residents and fellows at 7 am. So my friend and I got some tea to put a little spring in our steps, and soon we were in those hospital gowns that exposure your butt to the world.

The resident casually asked me if I had any breakfast. Not really, I replied. When was the last time you had any food, they asked. I thought hard. Mmmm probably dinner last night. Okay cool, she said, and started to feel for my femoral pulse to scan.

It didn't help I was really ticklish. And that she was moderately attractive.

Hours later during the repeat scan, after the ultrasound showed some cloudy wisps of ah-damn-it there goes the whip cream. Right in my cartoids. I'm never going to McDonald's again.

But during the infrared, she noticed that I my heart beat was a little fast. Huh. That looks like a caffeinated heart, she mused. Then she kind of hit me on my leg, and asked me- did you have coffee this morning? Uhh...crap.

They had to throw everything out. But at least I am an expert in where my femoral pulse is now.

I'm writing this post in the lobby of Rich-Hospital, where a young white collar dad was walking around with his baby girl in his arms for the past half hour. Now they are both exhausted, sitting in the couches in front of me. Dozing off. Cute.

Yaaay summmmerrrrrr!

I'm kind of in awe

2010-07-07T11:01:00.001-07:00

"If I have seen a little further it is by standing on the shoulders of Giants"

-Issac Newton

I'm sitting in a room with the chief of surgery of our medical school. Who was there with Dr. Michael DeBakey when President LBJ signed the papers that created Medicare. In the front of the room, the president of ACEP- American College of Emergency Physicians is giving a talk on the history of emergency medicine. My med school just started a brand new emergency medicine residency this year, and I was lucky enough to be at the Inaugural Grand Rounds.

What are rounds? Well this ritual began when doctors started to see patients in hospitals, going around to see all of his/her patients. With new apprentice doctors (medical students) in tow, physicians would present a case with the help of a patient in order to further treatment as well as education. Now grand rounds have evolved away into lecture series, even online these days with medical blogs.

The intellectual and political firepower in the room was mind-boggling! There were easily 4-5 residency directors- doctors who are in charge of creating attending physicians, the people on the top of the healthcare totem pole. In the row behind them were the 12 new residents in our program. Finally in the back were my fellow medical students. Scattered around us were other dignitaries. A couple of deans. The chief of medicine. The public health authority of the city.

All there to celebrate the creation of what will be an amazing emergency medicine program. 40 years ago, one of the founders of emergency medicine traveled back to his medical school. He had earned his MD sitting in the seat right in front of me. He was thinking about setting up shop here, but ultimately choose Chicago instead. For a second everyone in the room thought about what life would have been had he stayed.

I have a month off from school. It was great going home for the holiday weekend, but I am left with a burning question that I needed to answer for awhile. What am I going to do with my life? I feel like today's grand rounds are those once-in-a-lifetime events that I should not ignore. But who knows.

It is finally sinking in that I have just finished the longest year of my life, an 11 month first year of medical school. Post about that coming up soon. Stay safe until then.

Friday Flashback #2

2010-06-18T19:16:00.000-07:00

THIS was my kind of week, chock full of flashbacks back to my fire department days. I mean, here were some of the classes I had this week:

Trauma (neurological)
Personality Disorders
Alcohol/Nicotine/Drug Abuse x2
Toxicology
Legal Issues

I easily saw all of these issues during a single shift. In particular, I saw all of these during one crazy call out to a MVC (motor vehicle collision).

It was really bad. Officers had marked off the scene by the time our bouncy box of flashing lights and sirens had painfully navigated past lines of jammed up traffic. I jumped out with my bags ready to go at the end of the scene closest to me ready to go, but instead of a car all I saw were tire tracks. They kept going for a while, then I saw a row of orange road medians destroyed as if Autobots and Decepticons had a big fight here. Finally off in the distance I saw the car with the wheels in the air, and realized what had happened.

Brakes slammed on at first, then one side of the car used the highway medians as a ramp, and rolled over in the air like a dolphin spiraling through the water as if doing tricks at Seaworld.

Coup, then contra-coup injury, when her car finally crashed into the pavement. It's French, and describes what happens to the soft squishy brain when it gets smacked around in a hard box. Coup- the front gets bashed as the body slams into the steering wheel. Contra-coup- when the BACK of the head rebounds just like a basketball off the edge of the hoop, but into more skull.

Trauma. Check.

I won't bother you too much with the boring stuff. Firefighters using Jaws of Life. Making sure the car would not blow up on us into a nice fireball. Carefully extracted a lady. Maintained c-spine. Quick trauma assessment. Load and go. Lined her up.

What was interesting was what happened in the back of the ambulance, just the two of us, flying towards the nearest trauma center. First, nothing my patient said made any sense at all. She looked like an intelligent, attractive professional, so I thought maybe it was another language. A little slurred. Leaned in and took a sniff. Yep, alcohol.

Alcohol/ Toxicology? Check. (To my med school peeps- brief Wernicke's area disruption too?)

So for the rest of the call, I did my medical thing, and kept checking in on my patient. Slowly, she seemed to come back, through the mist of all the chaos that had just happened. Then it got really strange.

Thank-you-thank-you-thank-you-thank-you-AH WHAT THE F@#$# is HAPPENING TO ME? She kept sobbing in gratitude, but then completely spaz out and open a can of whoop-ass all over me.

The only thing I can think of now that describes that is if she had a borderline personality disorder. I'm still not sure. Maybe it was the stress of, oh I don't know, launching her car into the air, seeing the world spin around her as phone flew through the air.

Personality Disorder? Maybe check.

Anyway, sorry this flashback did not end with a bang like the last post. I've got finals coming up, and I think I'm forgetting old memories to make way for all the stuff I am learning now. I assume we all made it to the hospital okay.

Oh almost forgot, as I was doing the rapid pat-down that is the focused trauma assessment earlier, I peeked into her ear and some plastic fell out. Huh. What's left of a bluetooth set. Too bad a cop was right next to me, and checked her phone. Yep. Texting right around when the crash happened.

Legal. Check.

(Some fictionalization. HIPPA. Duh.)

Friday Flashback

2010-06-10T19:49:00.000-07:00

I need something to keep me sane. Whenever exam week comes around, my brain does this weird paradoxical dump. The more information I shove in, the grey matter poops out weird things. Sometimes it's notes to a song, other times it is material for this blog. If it gets really bad, I start thinking of ideas for our school's-annual tradition-that-shall-not-be-named. But for now, here is what happened when I stay up past midnight reading about street drugs. I start taking some. I'm kidding. But I write as if I did:

We had a nice lecture on street drugs this week. Our professor talked about Narcan- a drug that basically brings you back to reality if you have overdosed on certain drugs. The trick is that you have to give it slowly, or else it reverses the high way too fast. Fast enough that the patient becomes a little...well annoyed is a nice word.

Three years ago...

I was scared out of my mind honestly. My patient was sitting up on the stretcher eyes wide open as if I was the devil. I had just finished my training as an EMT-I and was alone in the back of the ambulance while my paramedic partner sped our ambulance down the highway. First day on the job. What do I get? A suspected drug dealer who was probably doing some of her own goods. We found her responsive only to pain, loaded her up, and started some IV's. Without thinking I prepped the Narcan, and just popped it in. Bam. As my partner turned on the lights and sirens and started to head to the hospital, my patient started to stir.

Cool I thought. Pharmacology at work. The nerd inside me was kind of excited. Well it was excited until the patient sat up and stared at me as if she was possessed. Then she started to panic. I had no idea what I was doing by that point. "Um...you should probably relax..." I mumbled while my brain froze. Froze some more while the patient started to yell and take off all of her restraints.

"Umm...ma'am...let's not do that..." I can't remember why but I stood up in an ambulance zooming down the highway at 80 mph, and tried to push her back into the stretcher. Not a good idea to tango in the box at that speed.

Then it really went down hill. "LEMME GO YOU MUTHAFUCKAGETMEOUTTATHISSHIT-"

And that's when she actually opened up the backlatch of the ambulance, and suddenly I saw the surprised look on the driver behind us. I don't know about you, but I totally see the insides of an ambulance while it is flying down the highway everyday.

"JESUS CHRIST. What the fuck is going down back there?"

Luckily years of experience told my partner NOT to slam on the brakes. Or else I would be posting this post from a hospital bed. (But now I realize ambulances really don't have emergency lights- you know the the red triangle you push that flashes all of your blinkers. Kind of redundant, no?)

Anyway, after I nearly tackled the patient to keep her inside of the moving vehicle, we finally rolled to a stop on the side of the highway. Let's just say I learned some interesting knots that night.

Later in the hospital break room, my partner THOROUGHLY educated me. Life lesson of the day: Narcan needs to be giving SLOWLY, or else you have one pissed off druggie.

(standard fictionalization applied to protect privacy)

Today, I was a doctor

2010-04-09T21:35:00.001-07:00

For an hour, I had an MD behind my name.

I slipped on a long white coat, became a real doctor, and saw a patient.

This all started when our awesome ethics facilitator realized we had no idea what an ECMO (extra-corporal membrane oxygenation) machine was. We had been debating end of life care, agreeing that it was best to pull life support for our hypothetical patient.

"Do you guys know what ECMO is?"

Did we actually know what it would mean to take away the only thing keeping a fellow human alive? Would we be able to pull life support when it was time?

"No? Let's go see!"

We were dressed in jeans and sandals. Great for the weather outside. Not exactly professional.

"Oh wait...none of you have white coats. Okay, we can fix that."

So she leads us to the ICU floor, finds this restricted area and punches in a code, and accesses all the spare white coats of all the ICU attendings. I remember we were all looking furtively around in case someone walks in on us.

After she made sure we all got coats of attendings that weren't on...she waltz us onto the floor, and shows us what real medicine looks like.

It looks like a precious little infant sprawled on a gurney with tubes as wide as her neck attached directly to her heart that did not beat. It looks like two young parents looking apprehensively at the 9 "doctors" in long coats crowded around a bank of monitors that a dedicated nurse must attend to 24/7. It looks like hope, shaped like tiny spikes of a heart the size of your nose finding the will to beat.

I just hope she didn't look down and see all of our toes peeking out under shorts, jeans, and flip flops...

From a dinner party to holding a severed ear

2010-03-13T00:30:00.000-08:00

It seems like my life is boring unless I am in the emergency room. I finally came back after months away to end up holding a nearly severed ear while the ENT surgeon tried to reattach it. This is why I don't go chasing after large animals at night.

It was really fun holding up the ear the entire time. The ENT resident was really nice and quizzed us on relevant stuff, and taught me a lot about suturing material. There were 4 of us hanging out in the shock room, so I had a good time chatting it up with some good friends while druggies were dragged in and out in various stages of lucidity.

Highlight of the night was when I just walked in and started a line. Wow am I rusty, but I got in on the first try. Wooooo!

Hard to imagine a hour ago I was munching on hor d'ourves celebrating a friend's recent engagement. Now if I only had a motorcycle...

Anatomy is craazy! Immunology is dramatic!

2010-01-22T22:20:00.000-08:00

I'm on Head and Neck anatomy right now. It is all we have left to do, but I feel like I just started because it is so complicated! This block is 6 weeks long, but it is going at double-triple the rate of the whole fall semester.

Thank goodness for Visiblebody.com

That site is crazy. I LOVE IT.

Immunology has always had a special place in my heart. It was one of the big reasons why I am so in awe of the human body. I get the feeling military physicians might find immunology very familiar, because that is all it is. In a nutshell, our body is in an epic battle for survival. The high tech tools, strategies, and dirty tricks we use is mind blowing.

Your blood is strewn with mines, your skin is crawling with spies, sentries, and snipers. The calvary gets called in, mobile command centers migrate to field locations, and oh dear god the complex signaling involved is CRAZY! Things get cleaved, imploded, and exploded. Things gang up on each other, others commit suicide. Sometimes your body wins, lots of times it loses. Badly. Mothers will try to kill their babies, and men destroy their own sperm.

And I am less than half way through the course. And after that...there are two blocks of Infectious Disease. I can't wait!

Sweet Dreams

2010-01-17T19:34:00.001-08:00

Good stuff coming soon, I promise. Lots of ideas just bubbling around. Amazing what you can do when you start to have regular sleep.

Before: lived in a dorm for the past five years. Last three, on the corner of the medical center on one of the busiest streets in town. Last year, on first floor, woken up by ambulances every night.

-Last 2 years, drove an ambulance all hours of the night, roughly every 3rd night. For. Two. Years.

-Essentially, I have never had regular sleep since high school. Oh wait. That didn't count. Perhaps not since my days of recess thanks to a teenager's messed up hormones?

Now: 7-8 hours a night. Undisturbed, thanks to a nice cushy place with a great non-nocturnal roommate. My brain is aliiive again! I am even off of caffeine ever since I went cold-turkey this break.

It also really helps that I am on a nice workout/run schedule again. The link is definitely there: the better sleep you get, the more energy you have during the day to have fun and play; the more exercise you get, you enjoy better quality sleep. Win win! Yay.

Endocrinology rocks.

2009-12-07T15:24:00.000-08:00

One advantage about the way my preclinical curriculum is set up is that it is very similar to college.

Most med schools will put you in a bulimic state of learning: you spend a solid month in one class, learning all of human body's anatomy for example. You spend days memorizing every aspect of every piece of tissue until you start dreaming about it. Then come test time you have to vomit it all up. Repeat for every class, and it is a wonder we remember anything at all.

However, my days are spent learning all of the subjects at once by systems. Right now I am looking at butts and genitalia. I get to know everything about it: histology, anatomy, physiology, etc. I should know everything doctors know about how the body is when nothing is broken. I think it is great because everything is skillfully woven together, and I do not have to learn all about the hand in one day, then revisit it months later. The best part is that we get to keep the same professor for the whole subject, instead of the usual parade of PhD's needed to sustain a solid month scheduling for one subject.

I particularly love the endocrinology. The professor is pretty popular for several reasons, a great approach to teaching and a light British accent that all makes us swoon in particular.

Today, he proved he is also a gift to mankind by serving as the right hand of GOD, destroying rare diseases left and right. How so, you ask? Well we had a special session in class today, where he brought in two patients affected with diabetes. I won't go into too much detail, but basically one patient was recently afflicted with diabetes. That was the easy part, bread and butter cases for endocrinologist such as our professor.

The hard part was that the patient was had a extremely extremely rare form of diabetes. For months the patient was confined in the ICU while her blood sugar levels raced between record breaking highs, then record breaking lows. After her clinicians exhausted all options, including injecting ungodly levels of insulin to fight off the wave of sugar in her blood, our professor tried a specific anti-inflammatory drug.

It worked. In fact, it worked so well the patient was completely off any diabetes medicine when she spoke to our class. It turned out the patient had type 1 diabetes that attacked late in life when it really only shows up in kids. That kind of diabetes happens when your own body utterly renders the cells that makes insulin dead to the world, leaving none that can help you keep your blood sugar down. It is as if you want to go through a door that you have a key for, but someone stuffed gum into hole, so in frustration you keep jamming your key into the hole trying to get in. Our professor simply took out the gum, in one smooth stroke, with just one drug.

Now that is thinking outside of the box.

Thanksgiving is. So. Close.

2009-11-24T16:37:00.000-08:00

Something going around that really struck me...

I am thankful for the teenagers who are complaining about doing chores -- that means they are home and safe.

... for homework. It means we live in a country where education is valued and encouraged for all.

... for the taxes I pay; it means I have income.

... for the mess that I have to clean up after parties, because it means I am surrounded by friends.

... for the clothes that fit a little 'too snug' because it means I have enough to eat.

... for the lawn to mow, windows to wash and gutters to clean; it means I have a home.

... for the parking spot I found at the far end of the parking lot, because it means I am capable of walking and am blessed with transportation.

... for my huge heating bill, because it means I am warm.

... for the person behind me in church that sings off key, because it means I can hear.

... for the pile of laundry and ironing, because it means I have clothes to wear.

... for all the complaining I hear about the government; it means we have freedom of speech.

... for the alarm that goes off early in the morning because it means that I am alive!

Author unknown

Tankmate!

2009-11-20T21:34:00.000-08:00

Check out this post from my tankmate about our very first day in anatomy lab.

This is sort to make up for my dearth of posts during that critical time of my life. Let me know if you want to hear more about anything!

PS - This is what you've been missing out on:

http://streetanatomy.com/2009/10/26/hello-anatomical-kitty/

Quitting

2009-11-18T17:36:00.001-08:00

Quitting. I thought about it today.

A big soft-skills final exam is coming up, and I feel totally unprepared. I mean yes, I know how to do a brief history/physical exam already, but not the "full" one that allows physicians to explore the full spectrum of disease a patient might have. My exam consisted of the ABC's - is your Airway open? Good. Can you Breath? Even better. Do you have a Circulation? Dandy. That's the big idea for medics out in the field.

But now, I actually need to be able to feel for splenomegaly, and listen for heart murmurs. What? My preceptorship is in the highest socio-economic strata of this part of the state. Before I even started my preceptor visits, he warned me on the phone that I might not be able to do as much as I could.

At the time, I brushed it off, thinking my previous experience would be fine. So up until today, I half-assed my visits. I played along, and thus became complacent. I didn't get any chance to practice skills that will enable me to detect diseases and tease out differential diagnoses.

As test time got closer and closer, I started to panic. My classmates started to catch up to me, and I realized I had gotten rusty. Some of them had preceptors that let them loose, and as a result they learned and learned about the most fundamental skills a physician should be perfect at. Soon, jealousy took hold, and I wanted to defect to perhaps another preceptor site. It was rare to do so, but it is possible. For example, one of my classmates was assigned to a gastroenterologist. When she needed to learn how to take vital signs, all of her patients just needed to get scoped.

I walked into the pediatrics clinic today, I mentally took a deep breath. It was the last visit of the year. Maybe forever. So let's make the most of it, I thought. If I piss off some anxious parent fussing over their trust fund kid...screw it. I need to learn, so that I can help scores of future patients.

I just kept jumping in all day, and surprisingly, no one stopped me. It reminded me of when I first realized what I could do as a supervisor EMT, leading a team at a major rollover accident. I just did it.

At the end of the day, my preceptor had a simple visit, but had grown up with the patient's grandfather. After almost six decades of friendship, my preceptor's friend passed away the same year as his wife, only a couple years ago. Everyone in the room teared up except for me when this was brought up. My preceptor had such a enduring bond with the families of his patients. It just took me a semester to realize it. My biggest lesson yet.

I'm not going to quit. I can still get a lot of learning experiences here, and my preceptor isn't some concierge physician catering to the rich and famous. He has taken care of many PARENTS of the patients here, and is a pillar of the local community here. I can learn so much from him, and I am going to stay.

Rectal Intercourse

2009-11-17T19:08:00.000-08:00

We learned in histology today why rectal intercourse is not as great as it was made out to be.

Your anal canal is what meets the outside, and has nice thick layers of cells that prevent HIV and other bugs from invading your body. Now, one inch into the colon...you get to the rectum. Now, that is only one cell layer thick. I would imagine it is easier for HIV to cross that than...let's say through regular vaginal intercourse. So that's a no-go fellas.

The whole time, the professor kept interchanging "rectal intercourse" with "butt @#$(."

Oh he knows what he is doing. Every time he uses the colloquial, he immediately follows with, "that's not funny!" You can imagine how hard it was for the class today to maintain composure.

Haunting

2009-11-15T20:28:00.000-08:00

Beautiful, beautiful prose. I hope what happened to her never happens to me, but I bet it will, over and over.

That said, Critical Care sounds more appealing every day...

Frustrated

2009-11-08T21:16:00.000-08:00

I am frustrated. Once a week I go to a clinical skills class to learn how to perform a history, physical exam, etc. For a long long time, the course consisted of a group of students getting together with a faculty preceptor to talk about mushy stuff such as empathy and the importance of a "patient centered" interview. Yeah, yeah.

The EMT in me was thinking well that is nice, but what if you have a mentally unstable patient or a lovely GSW (gun shot wound) and blood is everywhere and you NEED a quick, effective report YESTERDAY?

For a month I was either bored out of my mind, or teaching my classmates how to draw blood, take vital signs, etc. However, the game changed recently, and caught me unaware. New territory began to pop up, such as cardio-pulmonary examinations. The material suddenly exploded, and I have pretty done a 180. Now it is REAL DOCTOR stuff, and all of the sudden I am struggling to keep up.

I got my wish. I am still frustrated. Now for completely opposite reasons.

David Watts

2009-11-07T20:10:00.000-08:00

Dr. David Watts is incredible. He wears many hats: professor of medicine at UCSF, gastroenterologist, writer, and frequent contributor to NPR. I will remember him as the first person to completely captivate me for almost two hours straight. Dr. Watts delivered a talk on humanism in medicine as the featured speaker for an annual tradition honoring a tragically murdered student at my med school. Faithful follower(s) of this blog- I now have no excuse to let this little window into my life as a med student fall into disrepair.

Keeping one foot in the world of scientific medicine while another foot firmly rooted in literature, he is an example that not only is it possible to achieve balance, but that honest reflection indeed is essential for sanity. I am sorry for taking a year off from this blog- at the very least I need to scribble down more than just my anatomy journal. Dr. Watts is completely correct- no other time in my life will ever compare to the journey I am on now.

Dr. Watts read out powerful vignettes with a quiet eloquence that gave an understanding strength to his message. The patient physician bond does not have to be destructive for either party. Third year medical students do not have to become proficient at emotional wall-building. The unique patient-physician relationship is actually enriching, even rejuvenating. The road I am on is already such a lonely process, I don’t need to wall myself up or tend to the just the science of medicine. This is a human process full of messy human relationships. To sum it all up- “Without science, we are quacks. Sometimes with it, we are still quacks.” –David Watts, MD

Gossip

2009-10-07T20:29:00.000-07:00

So as a reminder, I'm a first year medical student.

I was sitting in study area reading one day when one of our faculty mentors comes in to replace our snack cabinet. After she leaves, I email out to the group of mentees under her wing that we had vittles again to munch while pondering the positively elegant musculature of the arms and legs.

Roughly 5 minutes after I send out that email, I see several second years poke around the cabinet like a raccoon in a dumpster.

I love how fast info/rumors/gossip spreads in med school.

Hi there

2009-09-18T23:29:00.001-07:00

Yep it's been awhile.

I'm starting up blogging again, because the sheer weight of ideas and posts I've written up makes my computer want to go on a diet. I'll be nice and publish them slowly in bite sized bits.

I've also decided to shift the direction of this blog. Back during undergrad, I was a feisty and angsty little EMT, unsure about life and what was going to happen to me.

Well I got into medical school. Yeah, no kidding. Crazy, huh?

It is a fantastic med school, where I am having a TON of fun. Of course I study all day now and that's all I do, but boy do I have random tidbits to share. (Someday I will gather enough of this tidbits to be a useful doctor. Perhaps.)

For example, did you know kittens can cause acute carpal tunnel syndrome? Yeah! So there are these things called tendon sheaths, that surround the connections between your hand muscles and your hand bones. When you play with kittens, they will inadvertently poke your with their sharp sharp claws, creating microscopic holes in your hand. Germs can get into your tendon sheaths from those holes, and spread back all the way to the carpal tunnel of your hand near your wrist.

The thing is you won't notice these kitten inflicted microscopic holes at all!

Crazy huh?

journal entry from my interview days 11-3/5-08

2008-11-05T18:05:00.000-08:00

He was one of my hosts when I was on the interview trail. Well, I wish. But my host looked exactly like him. After I landed in Seattle...the elevation unsettled me a little bit. I am used to completely flat land, no surprises anywhere. However, I really like how it rains/drizzles a lot- it reminds me of Scotland, one of my favorite places in the world. Also, the lights dotting the mountains and the soothing expanse of lake surrounding the school is breathtaking.

So Mr. Krasinski, we'll call him, had the coolest apartment I've seen so far. He and his down-to-earth girlfriend shared a lofted space; again I grew up in one place my whole life and only recently started to travel, so the little things are wondrous to me.

After some small talk about the school, my host presented to me a flyer about the I-1000 proposition up for vote election day tomorrow, and gave me a key to his house and told me to make myself at home. Wow. I could only hope to be as hospitable as these people were if I could become a med student.

The next morning, we took the bus to school. COLORS! The fall here is so beautiful!

The bus is actually really really good. We arrived at school, the 2nd largest federal building after the pentagon. I didn’t believe it at first until I was actually inside. It’s a maze. Seriously.

So the admissions office has a freaking lounge just for applicants. This touch blew me away at first, but when I realized UWSOM didn’t interview batches of 60 once a week like some other schools, it made more sense. There was only 7 of us total that day. I loved it! I got to know all the other applicants who were just really fun, and our tour guide was great and showed us some great views and was pretty chatty as well.

The presentation was alright, so was lunch, and the med students as usual were great. The staff were superb, and walked us around themselves. Now the interview sucked. Role playing? Three interviewers on one interviewee? What the heck? They even played good cop, bad cop, and pissed off cop. Let’s say I have had better interviews. I left the room feeling like the whole trip had been fun so far but was a waste of money. The second interview was so much better. It was just one on one and we had a great time chatting in her office. Good thing my host let me look at the proposition up for the vote.

After that I had time to burn, so I sat in a neuro-ethics class. It was alright, big lecture of second years reminded me of my high school all over again. Next I just wandered around the undergrad campus. It is gorgeous, and I would have a ton of fun running these trails.

Near the end, I met a couple of retired professors, of dentistry and forestry. They actually gave me some good tips on photography, and we walked the trails, talking. I am so lucky. From the slums nearly dealing drugs to the hallowed halls of academia…it is a dream come true. Here I was in a suit, strolling with men who had risen to the top of their fields about photography composition and healthcare, when some of my childhood friends are in jail. This election day so many dreams are coming true.

The above pic was from a house party that my next host brought me to. It was possible to most fun I’ve had all semester. She drives a transformer:

Seriously! She wrecked her car, but her husband who was a surgery resident welded a new back end on. It’s hilarious! Anyway, we showed up at the house full of med students and just had a great time relaxing. Homemade brownies, pizza, drinks. I had to add that the yes, the rumor is true. The hotter the med student, the more likely they are married already. Hahahaha.

So my second host actually had an entire bed and room ready for me. Wow. This is just amazing! A huge window overlooking the lights of Seattle, chocolate on my pillow, what more could I ask for? All too soon it’s time to fly back home.

Ethics is fun

2008-10-20T13:18:00.000-07:00

Hands down. I have a great prof who is energetic and funny enough to make the 3 hour lecture come completely alive. He jokes about insurance companies, makes great analogies, and doesn't create a stressful class environment at all.

We were talking about euthanasia and assisted suicide today. Oh boy. It was a nice break from the madness of midterms though. I have to dive back into my intensive paper writing now. 12 pages down, 38 left to go!

On a unrelated note, I was doing another special event the other day, and our contact was this jolly tia. Anyway, she showed me some great music- Piano Vines is the band. They aren't signed, but wow it is a breath of fresh air whenever I listen in.

Sigh. Time to pick classes soon. I really want to take a year off, and just have fun learning about photography, economics, guitar. I don't know if I will be able to. This is essentially my 5th year. Do I want to take another? If I can take more classes with my ethics prof, that may be a deciding factor.

2008-10-10T14:50:00.000-07:00

Well today has been the most amusing interview yet. I was at UT-Houston today, walking into the building at 7:30 am. Aghhh. But it was a really early start because they reserve 3+ hours for their tour. It easily blows every other interview tour out of the water.

The Texas Medical Center. Biggest in the world, so big we were jumping on charter buses to get to all of our destinations. I had three hilarious tour guides - at the children's center they were jumping on the seesaws and playing with the toys. We saw open heart surgery- through an observation dome at St Luke's that was very similar to the one in Grey's Anatomy. Memorial Hermann is just so...nice compared to everywhere else in Texas. The new rec center, apartments, ANATOMY labs...wow. It's pretty impressive.

I love how there are McDonald's in the Heart Institute. Same at Parkland, above their path labs.

Songs stuck in my head all day:

The Rapture: No Sex for Ben
TI- Whatever you like
Nickelback- Gotta be somebody

You know, I've always wondered.

2008-09-28T16:27:00.000-07:00

This is such a good song for those living the life of a medic.

Human- The Killers

I did my best to notice
when the call came down the line
up to the platform of surrender
I was brought but I was kind
and sometimes I get nervous
when I see an open door

close your eyes, clear your heart

cut the cord
are we human or are we denser
my sign is vital, my hands are cold
and I'm on my knees looking for the answer
are we human or are we denser

pay my respects to grace and virtue
send my condolences to good
give my regards to soul and romance
they always did the best they could
and so long to devotion, you taught me everything I know
wave good bye, wish me well

you gotta let me go
are we human or are we denser
my sign is vital, my hands are cold
and I'm on my knees looking for the answer
are we human or are we denser

will your system be alright
when you dream of home tonight
there is no message we're receiving
let me know is your heart still beating

are we human or are we denser
my sign is vital, my hands are cold
and I'm on my knees looking for the answer

you've gotta let me know
are we human or are we denser
my sign is vital, my hands are cold
and I'm on my knees looking for the answer
are we human
or are we denser

are we human or are we denser

are we human or are we denser

2008-09-15T23:12:00.000-07:00

Interview

2008-09-02T21:06:00.000-07:00

I had my first med school interview last Friday! I drove down to the beach, through the traffic, to just barely make it in time for the social. Heh. That totally did not happen.

I met up with a MSII that I was bumming a place to sleep with, and he introduced me to the joys of Geometry Wars II on Xbox live, and some horticulture on the side. It was fantastic.

We ended up watching Flight of the Conchords and assorted stuff on his amazing TV, in his amazing bachelor pad. Life was pretty sweet- his own place, miles of beach outside of his window, a drive up and down the coast to class...I could imagine myself studying away in this paradise.

Anyway, the next morning, I dressed up and walked down to my car. Huh. The battery is dead. I guess I shouldn't have ignored the insistent beeping the day before. The rest of the day was actually pretty pleasant. Three people from my school was there, and 3 more from my highschool. Woahh trip down memory lane, while everyone else freaked out about the upcoming interviews.

Fastforward past the engaging conversations, past the presentations and tours. I can't believe I am at this point, an interview down, several more to go. When did life become this...weird adventure? It is the only I can really describe it. I have gotten to the point where many people from where I grew up would call me a workaholic, but what I see is a mini-quest. How much homework can I churn through in a hour, how much cell bio can I pick up, how many patients can I transport this shift, how much inventorying can I do in a day, how much life can I really live in this lifetime? I had gotten to the point where I would motivate myself to breeze through unpleasant tasks by warping my own perception of what was fun. Where was the real fun? It became a guilty pleasure, hidden away in a schedule that was in need of 25 hour days. My Meg Cabot books, sitting in a library just plowing through all of the teenage fiction books that I skipped when I was actually a teenager because I was too busy with the "regular" fiction.

I drove back, and watched some live football, then went out to dinner with some good friends from highschool. We snuck into Yao Ming's restaurant's restroom, purely because we were curious about the amazing faucets. They were indeed amazing. Then back to another friend from high school who was now a MSI. Sweet sweet stuff, watching Obama give his acceptance speech.

Here's to a brighter future.

Happiness

2008-08-24T22:30:00.001-07:00

For a couple minutes today, I was very happy.

My friend has a cute white VW convertible Rabbit. While it...converted, I felt like I was on the set of Transformers, with all the awesome German engineering at work.

We cruised back home from our dinner meeting, the warm breeze playing with my friend's blonde hair as she drove. Another friend was in the passenger seat, intently reading an article in Cell. Hahaha I felt at peace, and just enjoyed the tree lined drive shading us from the setting sun.

Classes start in half a day. It's time to rock n' roll.

2008-08-19T18:17:00.001-07:00

Okay, I admit it, the names and the circumstances have been modified to protect. And something called HIPPA. But this place is a great way for me to vent, for me to play around with the English language, and for me to have a punching bag whenever life gets too out of hand.

Well it starts at midnight. Again. If I had traveled back in time a year ago, I would not have recognized myself.

"Ambulance One, Paramedic One, Engine One, respond to a gun shot wound, ************* address, SO (Sheriff's Officers) on scene, Map page ***."

Minutes later, "Ambulance Three, Paramedic Three, respond to same address, possible fatality, LifeFlight on hold."

I was so pumped on adrenaline everything seemed to happen in slow motion. I sprinted past the officers lifting up the yellow crime scene tape to an horrific scene. One guy my age curled up lifelessly in front of a door. Blood formed a surreal backdrop to everything, spraying the doors, pooling on the floor, soon all over our hands.

A mother empty of tears held on to her son in the middle of all of the carnage. After I made sure the other kid truly had no pulse, everyone focused their efforts on the surviving kid. Hands clamping down to stop the bleeding, shears cutting off clothing, soft grunts as we lifted him on our backboard into the ambulance.

A soft whir in the distance signaled the helicopter's arrival. Inside the ambulance, things were getting worse. The paramedic had trouble intubating because of all the blood spewing from his lungs. I slapped my hands against the open holes but blood kept coming out, getting all over my uniform, my hands. He started to fight us as his brain lost his last oxygen reserves, but the flight paramedic arrived to knock him out with a cocktail, and soon the helicopter began to start up.

The copter lifted off from the street blocked off by our fire engines, and blew dust all over the blood caked all over me. Great. I ripped off my gloves only to notice the tear. Shit. I tried to clean off the blood on my bare hands, but just as I closed the door, the latch cut into my palm.

For a moment, I looked at the cut, imagining capilaries releasing blood, flowing blood that bubbled out onto my palm.

No time to think about it, because another unit called over the radio, warning all units about the 4-5 gangsters walking down the road towards our location, murderous and vengeful.

The night doesn't stop there. Hours later, we were called back. After multiple police units had secured the scene again, a crowd of neighbors had surrounded the mother of the fallen gangster, trying to calm her down. It was chaotic, with the entire extended family sobbing, trying to dab away the blood that covered the mother.

I don't even know where I am going with this. There isn't a meaningful way for me to express what I am feeling, but with each sentence I am trying to clean myself. With my previous codes, I could build a wall, separate myself from the patient in front of me.

There was no way I could now. I gave too much of myself, plugging bullet holes with my hands, the same hands that held hands with a mother who should never have to survive her sons, the same hands that a cheerful nurse drew blood from to test for possible exposure to HIV.

I drove home in the morning, and parked in spot under a shady tree. I got out of the car, and could not take it anymore. I crumpled the coffee cup that kept me from falling asleep on the road, and pounded it against the door frame of my car. I...let the emotions wash over me, a catharsis under waving branches, until I ran out and stumbled back home.

Beginings and endings

2008-08-02T21:20:00.000-07:00

Sometimes it is hard to tell when something starts or stops. Sometimes it is painfully clear.

During shift change, you hand off patients by rounding on each on, updating their status to the new shift of nurses, docs, etc. The old shift is dead tired, ready to leave; the new shift still sleepy- waking up. At the end of one nursing home shift, the head nurse discovered one of her patients did not have a pulse, nor any breaths.

I arrived on scene with the firefighters and medics. The Nigerian nurses at the under-performing nursing home did not know how to perform CPR. The beginning of the end for the patient that was coding. After awhile, we called it there. Time of death- exactly midnight. Beginning of a new day, the end of another.

2008-07-30T10:18:00.001-07:00

Our team that responded to the campus disaster met with the President of the University a couple days ago. Although it was a formality, it was good to have official recognition of our efforts. This is the exception, because the 24/7/365 coverage firemen/officers/EMTs provide go unnoticed in the background. It is perfectly fine because those of us who expect external gratification burn out and leave the field in droves.

The Dark Knight was an excellent movie. I am up for seeing it again.

People are unreasonable, illogical, and self-centered,
LOVE THEM ANYWAY

If you do good, people will accuse you of selfish, ulterior motives,
DO GOOD ANYWAY

If you are successful, you win false and true enemies,
SUCCEED ANYWAY

The good you do will be forgotten tomorrow,
DO GOOD ANYWAY

Honesty and frankness make you vulnerable,
BE HONEST AND FRANK ANYWAY

What you spent years building may be destroyed overnight,
BUILD ANYWAY

People really need help but may attack you if you help them,
HELP PEOPLE ANYWAY

Give the world the best you have and you'll get kicked in the teeth,
GIVE THE WORLD THE BEST YOU'VE GOT ANYWAY

- From a sign on Mother Theresa's Children's Home in Calcutta

Homecoming

2008-07-22T11:51:00.000-07:00

Last night, the last In-Charge returned. Cue dramatic music, Fellowship of the Ring-esque.

We four recruits finished training several months ago, and was joined by a current In-Charge. The five of us held the fort all summer, waiting for the mysterious sixth In-Charge to return. I had only met him once two years ago. He actually mentored my mentors, then left for Spain for a year.

The welcome back gathering was interesting. We had three from the original team from two years ago. Then another three from last year. And finally all four of us newest recruits were there as well. We had a ton of fun talking, but flowing underneath the entertaining banter was a unspoken bond.

This feels a little trite to type out, but everyone in the room was in the business of saving lives. It was both an honor and a joy for everyone to relax in our room, and without a doubt the campus was as safe as it would ever be.

Surprise!

2008-07-20T22:28:00.000-07:00

Today I worked an EMT contract job. The city opera society worked out a deal with us that I am perfectly happy with. I waltz in, and essentially get paid to watch an opera, tend to patients (only one patient the entire time last year), and could bring a date for free.

Nice, huh?

I was supposed to meet my contact at the box office. I found him, and he seemed like a nice cashier, showing me where to go and handing me my tickets. I brought a friend this first time, and we had a good time exploring the absolutely gorgeous building. The pre-show lecture was spectacular, ranking with some of the best lectures from the school year.

After we finished up the show, my contact walked up in a snazzy suit and asked if we enjoyed the show. It was indeed cute, entertaining, and just a great Gilbert & Sullivan show in general. As I flipped through the program waiting for everyone to file out, on the first page was a welcome letter from the President of the opera society, with a nice photo of my contact included. Yup.

Guardian

2008-07-06T21:58:00.000-07:00

Your Keirsey Temperament Sorter Results indicates that your personality type is that of the Guardian.

All Guardians (SJs) share the following core characteristics:

* Guardians pride themselves on being dependable, helpful, and hard-working.
* Guardians are concerned citizens who trust authority, join groups, seek security, prize
gratitude, and dream of meting out justice.
* Guardians tend to be dutiful, cautious, humble, and focused on credentials and traditions.
* Guardians make loyal mates, responsible parents, and stabilizing leaders.

Guardians are the cornerstone of society, for they are the temperament given to serving and preserving our most important social institutions. Guardians have natural talent in managing goods and services--from supervision to maintenance and supply -- and they use all their skills to keep things running smoothly in their families, communities, schools, churches, hospitals, and businesses.

Guardians can have a lot of fun with their friends, but they are quite serious about their duties and responsibilities. Guardians take pride in being dependable and trustworthy; if there's a job to be done, they can be counted on to put their shoulder to the wheel. Guardians also believe in law and order, and sometimes worry that respect for authority, even a fundamental sense of right and wrong, is being lost. Perhaps this is why Guardians honor customs and traditions so strongly -- they are familiar patterns that help bring stability to our modern, fast-paced world.

Practical and down-to-earth, Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for in the long run loyalty, discipline, and teamwork get the job done right. Guardians are meticulous about schedules and have a sharp eye for proper procedures. They are cautious about change, even though they know that change can be healthy for an institution. Better to go slowly, they say, and look before you leap.

Guardians make up as much as 40 to 45 percent of the population, and a good thing, because they usually end up doing all the indispensable but thankless jobs everyone else takes for granted.

The four types of Guardians are:

Provider (ESFJ) | Protector (ISFJ) | Supervisor (ESTJ) | Inspector (ISTJ)

Which one are you?

Purchase your Comprehensive Advanced Keirsey Temperament Reports™ now!
Use the power of your personality to advance your career, become a better leader, or improve your relationships

2008-06-24T19:15:00.001-07:00

Just found out, one of my most serious patient's name was Jesus. Hah. I saved Jesus's life.

Jesus is alive. I repeat, Jesus is alive.

2008-06-24T19:15:00.000-07:00

Just found out, one of my most serious patient's name was Jesus. Hah. I saved Jesus's life.

I wonder what happens next.

I wish things had turned out better

2008-06-19T23:23:00.000-07:00

Where do I start?

A long day at lab was winding down. I took out the dialysis bags, reading to purify my samples.

Then the pager cried out angrily. Wall collapse.

For a brief second as my neurons organized a response, life was still, and simple. 50-70 mph winds blew rain horizontally into my face as I dashed to my car. A line of scared construction works frantically waved me into the construction site after I waved my EMS sign for clearance.

I haphazardly parked next to what looked like anti-tank mines from "Saving Private Ryan." (Later I would have to jack up my car to dig out the spikes that destroyed one side and almost punctured several wheels.) I joined an officer and we sprinted towards the collapsed walls. From the talk afterwards, it looked like the crazy hurricane speed horizontal winds collapsed one side, and the domino effect created this insane scene from a movie.

The officer and I dashed into the mess of bricks. I scooped a helmet off the floor, and dodged rebar waiting to stab me. I climbed up the ladder, and it really was like a scene from a movie.

Over 20 construction workers were frantically pulling rubble off their fallen coworkers while the rain and wind overpowered my feeble attempts at medical Spanish. Lighting flashed to illuminate the black afternoon sky, while a circular saw screamed in agony in order to free someone trapped under layers of cinder blocks.

I found the ranking officer on scene, and tried to work the worst patient.

I searched for a pulse, praying for even a weak rebound against my fingers.

None. I stepped back and searched for more patients while they continued CPR.

The rest of the day blended together. Fire/Rescue arrived, and they used the massive construction crane to gently float patients down to the ground. The city's finest pulled a sheet over the traumatic arrest. God help his family.

Sometime in that hour, the rain stopped and the sun creeped up and said "surprise!"

What was f'king messed up was when my mud caked shoes kissed the ground again, we had a page to my dorm, several individuals trapped under a stairwell collapse. Can you say Cluster F'k?

Turned out to be a false alarm. I don't know who to thank.

Crap loads of people kept calling me. When my mom called, I promptly dropped the phone into a pool of mud. She thought I was dead for an hour or so.

A psych came by the conference room, and we just talked about the call. We were all fine.

What a day.

2008-05-30T12:21:00.001-07:00

I've taken a two week hiatus from my main EMS job, to sit back and finish up med school apps. Worst decision ever.

I essentially fell into this slump, where I caught up on sleep, let my family know I'm still kickin', and became homeless for a week (interesting story there). However, I did not get any work done, other than surf a crap-ton of medblogs on a wild-goose chase for any advice on how to wrestle with my apps.

Only when I jumped a call this morning did I realize I've been floating along, only half awake. I will hopefully be back in action tomorrow. For now, I am running Incident Command for the C-USA baseball regionals. The cot I set up next to my laptop is starting to smell like burgers and fries. Mmm yum. No patients, please.

You are a Sock. A funky personally quiz declared my existence as 100% cotton-weave. I thought it was an appropriate name for this blog. Socks go in haphazardly into my drawer, which is also a place for me to stick stuff. Dr Au describes it best:

Because your your underwear drawer is where you stash all your demons. All the private stuff that you don't want your parents to find. All the embarassing stuff that you jam all the way to the bottom right before your new boyfriend comes to visit. All the private valuables from your adolescence that you might find years later (tucked away under that dingy pair of granny panties that you never wear but keep around for contingency), the significance of which, years later, you can barely remember.

"http://theunderweardrawer.homestead.com/files/00-10-27.html"

Agh. Do you see how I've fallen into the dark side?

Code Blue

2008-05-24T19:17:00.000-07:00

Well. Last post up until now, the volunteer ambulance service I ride with fielded fairly routine calls, more medical cases than anything. Nothing really exciting or crazy.

I was waiting for a chance to...do something crazy. Save someone's life. Work a code.

Earlier this morning, I got my wish. Damn it...I wish it never happened.

It was actually a light Friday night, with several refusals and nothing close to my usual weekend crap-fest of calls slammed right after each other. I had dinner with the rest of the firemen, and relaxed while the others moved the ambulance and fire engine out into the street in order to play street hockey in the bay.

A nice normal night.

At 0145, we had a call for respiratory distress. Again, still normal considering the change in humidity and weather lately. Wooweewoowee bright flashing lights, zooming down the narrow road dodging idiot drivers.

We get on scene to find a gentleman with a mouth and tongue swollen up to Jabba-the-Hut size. He could still talk, with a odd high pitched tone. None of the firemen or us EMT's did anything on scene; instead, we walked him over to the ambulance.

Mr W, my paramedic supervisor asked me if I could handle this call. (Usually the supervisor can jet in their Crown-Vic responder cars, in order to be ready for the next call if he felt the two EMT's could transport a non-emergent patient without any complication.) I thought about it for a second. For the last couple of shifts I had always asked the paramedic to ride in since I am normally very over caution about everything. I looked at the pt, who was settling into the stretcher, who didn't look too agitated. Maybe I can finally just own up and take care of patients myself instead of defaulting to a superior. Maybe I could grow some balls.

"I've got this one, W. Don't worry about it." Mr. W looked at me, then back to patient. Our student was hooking the gentleman up to reserve oxygen, while my partner jumped into the driver's seat.

"I don't know. He is having a bit of respiratory trouble. I'll ride in," Mr W decided. I hook our pt onto the cardiac monitor, and tried to help Mr W start a IV.

Everything started to go downhill.

Mr W. couldn't get a line going. Our gentleman started to flail about. It took me absolutely too long to realize what was going on.

I looked at the monitor to see our pt's oxygen saturation drop. Drop. Drop. 95-100% is great. 90-95% Means something is seriously wrong. Any thing less means I get to shove a tube down your throat to force air into you. Your fickle body will probably be unconscious as well.

82%

63%

Our patient was flailing because his throat had swelled shut with his tongue so huge it was choking him.

We didn't have a line in. No IV benadryl or epi to slow down the reaction. I threw a dose of benadryl to Mr W, who stabbed the patient with a IM needle to deliver the drug into the muscles in his shoulder. Piss poor absorption. This man is going to die soon if we didn't do anything.

Our patient went limp. Blood oxygen saturation at 20%. His heart threw in the towel and the monitor flatlined.

Our student looked at me, then at Mr. W, unsure of what to do.

"START CPR NOW. FORGET THE DIVERSION, MR G YOU ARE TURNING THIS AMBULANCE AROUND NOW." Instead of heading to a hospital across town because they had our patient's records, we now were ripping down a sleepy road to the nearest hospital that was already on diversion for critical ER saturation. Our patient's life was literally draining out of our hands with every second we wasted on the road and NOT in a ER.

I frantically tore open compartments, looking for a bag to force air into my patient's lungs. WHY WAS EVERY BAG-VALVE-MASK PEDIATRIC SIZED?!?! The flustered student was pumping down on the patient's chest entirely too fast and too shallow, while I finally slapped together an adult BVM. I threw an Epi-Pen at MR W, who struggled to cut open the pt's pants, then stabbed the Pen in.

My God.

Thank goodness we were only several minutes away from the closest hospital. Those minutes were the most agonizing of my entire life. I tried so hard to bag our patient with one hand, but the whole endeavor was like trying to drive 80 mph down a freeway with one foot on the pedal and the attached knee steering. I am not joking. You need at least four hands to successfully bag a patient, I only had myself.

I felt like an utter failure.

We flew into the ambulance bay, and of course, the stretcher just HAD TO RUN OUT OF POWER as we tried to unload the patient. God damn battery powered stretcher. It saves us from breaking our backs trying to carry a 600 pound patient, but tonight my student STOPPED CPR in order to unjam the stretcher. ARGHHHHH NOOOOOOOOOOOO.

We finally wheeled our patient into the hands of a waiting ER team, and the began to do real CPR and pump the gentleman full of drugs. Maxed out on Epi. Threw in bicarb and D50.

During the entire scene described above, I was not scared nor freaked out. A weird detached calm blanketed me, my body was in automatic mode. Well, at least until I saw the patient's brother, sitting in a chair around the corner. Scared, uncertain eyes locked mine, until I forced my self to look away. Suddenly a flood of emotion rocked my body, all the way through my sweat-filled gloves. If the ER doc running the code didn't succeed, this man was going to lose a family member.

With the ER team in controlled chaos trying to save the gentleman's life, we EMT's were suddenly useless, so I waited outside while Mr W transferred the last of our patient data to the scribe. I stood outside with Mr G (my partner and driver for this night) and our student. After a minute I couldn't take it, and peeked back into the room. Seconds later, the nurse pounding the CPR stopped, and everyone relaxed a notch. Spontaneous heartbeat. Soon the gentleman was breathing on his own again.

Everyone involved was credited with a CPR save. "We" all worked together to save his life.

I don't know any more.

2007-12-26T20:25:00.000-08:00

I am completely bored, the day after Christmas, stuck in my dorm room. I made the trek back on the hopes of getting some work done...but after watching a movie and aimless websurfing, I know that it is hopeless. I guess some rambling wouldn't hurt.

So on my last ambulance shift for the class, I had a good time with a long time preceptor. We were out in the country for one of the last calls of the night, and I actually saw STARS in the sky.

It was amazing. My preceptor stated that he regularly sees shooting stars. I had no idea they actually existed. We were called into the backwoods, almost exactly like the home of the poor but smart kid from October Sky. I mean even the lights and crumbling steps mirrored the movie.

Through out that day we transported to a hospital that had the coolest nurses. There was one I just instantly had a crush on for the day (don't worry I don't normally do this). She was so...spunky. Looked just like Liv Taylor, but a lot funnier. I normally take a while to get used to people and places, but man, with her it was hard not to flirt back...

Anyway. Okay calls that day. Pretty crazy calls with this new service I'm hoping to volunteer for permanently...a kid with o2 sats at 45%, a couple of seizures here and there, mvc's...

The only sucky part is the ever present call at 4 am, and the last call 5 minutes before your shift is over. Oh and last shift, just when I take that last call guaranteed to make me home late by an hour, a Code Blue call goes out. AHHHHHHHHHHHHHHH WHHHHHHHHHHYYYYYYYY...

2007-11-15T23:43:00.000-08:00

Finally, a decent call.

My supervisor, another emt, and I were watching a sweet musical (Jesus Christ Superstar) when our pagers went off. Good timing, right during the final song. It was a weird moment, when all of us jerk up when the vibrating pager went off.

"Head Injury. No detail."

Oh crap.

All three of us start jogging out to the truck parked in the driveway, then halfway there we sprinted for it.

Lights and some sirens, speeding down a lane in 5 seconds that normally takes me a minute to bike.

The guy looked fine, but had blacked out. Crap.

A car full of guys had driven up to him, rushed him, mugged him, and popped him on the head with....something....then drove away.

After awhile, we finally convinced the guy to go to the hospital. I was frozen by now, since my friend who wasn't on duty needed my official EMS hoodie...to look official...

Things are getting pretty nasty.

College isn't safe. Be careful guys and girls.

2007-11-09T22:16:00.000-08:00

Wow that was a hectic month. Combine living at the ER on the weekends with crazy biochemistry studying and epi lectures to give...

I am going to miss my ER rotations. A lot. The one particular hospital I spend every weekend at, a county hospital level one trauma center, has basically been my new home this semester.

I am going to miss:

The really nice pediatric trauma fellow who loved to let us do cool things like hold a screaming kid while he stitched up a 8 inch laceration while thoroughly explaining everything he was doing as he was doing it. First of all, pediatric trauma? Wow. Second, a really really nice guy/doctor in a super busy ER who obviously has better things to do than show EMT students cool random things on the xray scans? Now that's rare.
The smell of vomit, feces, urine, sweat, blood, rotting flesh, cleaning solution. Oh wait, never mind, I have a weak sense of smell =)
The helicopter pad. I swear if I find a really cool girlfriend, I am going to bring her to the top. On a clear night. Yes.
One word: nurses.

Quick reminders to myself for the future:

Please please keep extra gloves in your pocket.
DO NOT BE A WALLFLOWER. Seriously. That is the only thing separating our class from all of the normal paramedic students.
Stop with the AC IV's.

On a related note, I started an IV on myself the other night. Sweet. Now I just need to keep the ingredients for an banana bag in my room for those pesky hangovers =)

More on my first ambulance shifts later on.

Oh here we go

2007-10-12T23:49:00.001-07:00

I have no idea why I am doing this. It's not like I have anything in particular I need to tell/whine about.

Life is fine. I am happy, well fed, but sleep deprived.

I just got back from a clinical at a local trauma center earlier, and I immediately thought about this quote:

'True heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever the cost, but the urge to serve others, at whatever the cost.'

-Arthur Ashe

My last patient had been in and out with the law. She was reading one of those thick romance novels when I approached her, and I couldn't help blurting out "Oh Nora Roberts is SO much better."

She was one of my favorite patients. Rehab is so lonely, so we just had fun talking about...stuff. It's so weird how I barely know the people living on my floor, but I got to know her really well in a 5 minute conversation.

Emergency medicine is a oxymoron. Spinal taps hurt. Like Hell. Oh god.

I just love patients leaving Against Medical Advice. Just love it.

That is all. I would like some sleep this weekend.