DONE! DONE! DONE!!! I passed the board exam last Monday and have already applied for my medical license. HAAAAAALLELUJAH...!
Now its Christmas, vacation, time to relax.
Fa la la la la, la la la la... Merry Christmas, everybody!
Saturday, December 05, 2009
Sunday, November 15, 2009
Four Days Left
What jumps and turns red with joy all over when Thursday comes?
If you do not know the answer to that I don't think we have hung out in the last- ummm, two years. Wow! I cannot really believe that it is November 15th. And we have less than 96 hours until PA school is over FOREVER!!!!!!
True, there's a board exam to be taken on Nov. 30th. But, no more classes! No more rotations! No more new jobs, new places, new bosses, new nurses, mean nurses, dirty jobs, dirty looks like "you're just the student," no more bottom of the rung. I am moving on up, baby.
AND ONE MORE THING FOR ME: No more white coat. No more seasonal dressing while keeping in mind there will be a white, long sleeved, might-as-well-be-a-straight jacket wrapped around me. Ah, I have been wanting to get rid of that darn thing for so long. Now the time has almost come! Plus, now I can put pens in my pocket again and not worry about all the marks. Sigh. So much to look forward to.
Maybe we can have a White Coat Bonfire. Hmmm.. all the festivities have not yet been planned. It could be added.
I do know, ma soeur et moi are going to Cancun on December 9th!
*Ahhhhhhhhh* (angels sing)
To go from swimming in patients and paperwork to riding dolphins is, hmmmm let's see. Only my wildest dream come true! (Really, I did dream about riding dolphins all through PA school. On the darkest days, I mentally pictured my glory day in the hot sun, riding dolphins. It may have been the only thing that kept me going. Well besides the Lord.)
And heeeeeeeere it comes!!!!!!!!!!!!!!!!!!!! Oh, THANK YOU LORD!
If you do not know the answer to that I don't think we have hung out in the last- ummm, two years. Wow! I cannot really believe that it is November 15th. And we have less than 96 hours until PA school is over FOREVER!!!!!!
True, there's a board exam to be taken on Nov. 30th. But, no more classes! No more rotations! No more new jobs, new places, new bosses, new nurses, mean nurses, dirty jobs, dirty looks like "you're just the student," no more bottom of the rung. I am moving on up, baby.
AND ONE MORE THING FOR ME: No more white coat. No more seasonal dressing while keeping in mind there will be a white, long sleeved, might-as-well-be-a-straight jacket wrapped around me. Ah, I have been wanting to get rid of that darn thing for so long. Now the time has almost come! Plus, now I can put pens in my pocket again and not worry about all the marks. Sigh. So much to look forward to.
Maybe we can have a White Coat Bonfire. Hmmm.. all the festivities have not yet been planned. It could be added.
I do know, ma soeur et moi are going to Cancun on December 9th!
*Ahhhhhhhhh* (angels sing)
To go from swimming in patients and paperwork to riding dolphins is, hmmmm let's see. Only my wildest dream come true! (Really, I did dream about riding dolphins all through PA school. On the darkest days, I mentally pictured my glory day in the hot sun, riding dolphins. It may have been the only thing that kept me going. Well besides the Lord.)
And heeeeeeeere it comes!!!!!!!!!!!!!!!!!!!! Oh, THANK YOU LORD!
Tuesday, October 27, 2009
Humanity and Heme/Onc
Due to an unexpected and very unusual twist in end of rotation plans last week, it turns out I am doing the very last rotation, the last 28 days, the LAST TINY LITTLE PIECE OF SCHOOL OF MY WHOLE ENTIRE LIFE with...
Kids with cancer. And blood diseases. (Also known to us as, hematology and onocology or- as everyone prefers to skip most of that- heme/onc.)
It is kind of sad.
I don't like any of the stories these patients have. All of their stories, so far, are very sad. These children are the living examples of the weakness of humanity. They are so innocent and sick.
My two patients are:
Sweet little M, 2 years old, with a big hard tumor in her belly and metastases to both her lungs. She hasn't been in the hospital long enough to know that not everything we do hurts so she has a raging case of White Coat syndrome. Take the white coat off and she is one sweet little pea. Approach her in the white coat and you will wish for a fate worse than death!
Today we heavily sedated her and punched holes in her hip bones to get some bone marrow. Ouch. Luckily, there was no cancer there so most likely she'll never have to have that done again- unlike kiddos with leukemia, who get it done weekly.
And little Mr. R... is an 11 month old baby who has a recently resected very rare brain tumor. Actually, they haven't even been able to diagnose it exactly yet. So, he's going home tomorrow while things get figured out. He has an 8cm scar across the top of his skull and a lop-sided little smile that would outcharm Elvis Presley. This little man may have to have chemo that would irreversibly scar his kidneys and he may not and end up leading a perfectly normal life.
Its this dichotomy of good and awful that seems to follow us around our whole lives... we can hardly enjoy the one without the other popping up and looming over our heads, threatening to destroy everything.
Or maybe that's a lie, and there are some things that cannot be destroyed... even by death. Give us peace in our hearts Lord. Let it be a long, long road with a good, good end.
Kids with cancer. And blood diseases. (Also known to us as, hematology and onocology or- as everyone prefers to skip most of that- heme/onc.)
It is kind of sad.
I don't like any of the stories these patients have. All of their stories, so far, are very sad. These children are the living examples of the weakness of humanity. They are so innocent and sick.
My two patients are:
Sweet little M, 2 years old, with a big hard tumor in her belly and metastases to both her lungs. She hasn't been in the hospital long enough to know that not everything we do hurts so she has a raging case of White Coat syndrome. Take the white coat off and she is one sweet little pea. Approach her in the white coat and you will wish for a fate worse than death!
Today we heavily sedated her and punched holes in her hip bones to get some bone marrow. Ouch. Luckily, there was no cancer there so most likely she'll never have to have that done again- unlike kiddos with leukemia, who get it done weekly.
And little Mr. R... is an 11 month old baby who has a recently resected very rare brain tumor. Actually, they haven't even been able to diagnose it exactly yet. So, he's going home tomorrow while things get figured out. He has an 8cm scar across the top of his skull and a lop-sided little smile that would outcharm Elvis Presley. This little man may have to have chemo that would irreversibly scar his kidneys and he may not and end up leading a perfectly normal life.
Its this dichotomy of good and awful that seems to follow us around our whole lives... we can hardly enjoy the one without the other popping up and looming over our heads, threatening to destroy everything.
Or maybe that's a lie, and there are some things that cannot be destroyed... even by death. Give us peace in our hearts Lord. Let it be a long, long road with a good, good end.
Thursday, October 01, 2009
A Transplanted Heart
My cardiology rotation really started off with a bang.
On Monday, we were chilling in the cath lab, and had just finished a right heart cath that showed a woman had a pulmonary capillary wedge pressure of 47. That, my friend, is heart failure. Dr. H is the only heart failure cardiologist in Oklahoma and he is pretty darn amazing. I had no idea when I was assigned this rotation just how freaking cool it was really going to be. When an organ donor in Oklahoma dies, Dr. H is the main person who decides who will receive the heart. And that is a pretty gigantic responsibility. He is a pretty amazing man and I am lucky to get to learn from him this month.
Keep in mind, there are only between 9 and 13 heart transplants a year in Oklahoma and the surrounding areas including western Arkansas and southern Kansas. So when Dr. H told me that a donor heart was available on Monday morning, and that I could go watch the transplant, I had no idea how special of an experience it actually was.
One common myth about organ transplants, including hearts, goes something like this: "I don't want to be an organ donor because if I'm injured in a car wreck, they might see and then not try as hard to save my life." In reality, organs are never harvested "on the scene" of accidents. If the person dies in an accident, their organs don't receive blood and the tissue dies- and you can't put dead organs in a living person.
Organs are almost entirely harvested from people who receive brain injuries and later become brain dead on respirators. In the hospital, after it becomes apparent that the person is completely brain dead and never coming back, doctors talk to families about wishes- and that is the time when organ donation becomes an option. Usually, organs are harvested while the person is still on the respirator. That way, the organs receive a maximal amount of blood before being removed.
Circling back... so on Monday, I got to watch a heart transplant. This was definitely the most amazing thing I have seen all year, maybe ever. The doctor who performed the transplant was a little grouchy that day because he had already opened up the chest of the person receiving the heart when they found out the heart was coming by ambulance, not by plane. So basically, the man laid in the OR for and hour and a half with his chest wide open, just waiting for his new heart. I watched his old heart beat for about 30 minutes of that.
Kind of strange, just watching a heart beat. It looked sick and worn out, and you could tell it really needed to be replaced. How lucky he was. Although so incredibly sad that someone else- an 18 year old in Tulsa- was so unfortunate.
About 30 minutes after I arrived, Dr. Elkins received a call that the heart was only 10 minutes away. So, he proceeded to cut out the man's heart. Cutting a heart out takes about ten minutes, and isn't as complicated as you would think; I mean, there are only four vessels to sever.
Right after he finished, the OR door opened and simultaneously, a man yelled, "Heart's here" and a blue cooler flew across the threshold and slid about 10 feet before slowing to a stop at the foot of the operating table. It literally looked like it had just been taken camping. One of the nurses grabbed the cooler, and dragged it over to a big bucket of ice. I made my way closer and saw that the cooler said in big letters, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT COORDINATOR OR THERE WILL BE NO HOSPITAL PICNIC THIS SUMMER."
No- just kidding. It said, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT UNIT." The nurse opened it up and grabbed what, in comparison to the big ugly broken heart just removed, was a most beautiful heart, completely unblemished. After dunking it in ice a few more times, Dr. Elkins sewed the new heart in.
For a few seconds after it was reanastamosed, the blood pump was still on- meaning that blood was being diverted away from the heart. No blood was actually flowing through the heart yet. And yet, the oddest thing ever... the heart started to quiver. (Or, in fancy medical terms, fibrillate.) Like, somehow it actually realized it had been reattached to a person. Crazy.
The heart quivered on and off for a few seconds and then the blood pump was turned off and the heart began receiving blood. At this, it really started fibrillating. Then, the surgeon took two tiny paddles and shocked it with just 10 joules. Also crazy- normally you shock someone with 300 just to get through their chest wall! The heart would probably explode right there on the table if you shocked it directly with that much electricity. However, the tiny paddles did their job and the heart started beating. Beautifully beating.
Eventually, the sternum was wired back together. (Watch that from two feet away and nothing that happens to you will ever seem that bad.) And with that the surgery was over.
Three days later, in the clinic, Dr. H looked sternly at a pretty 23 year old girl, his intense gaze nearly boring holes through her skull.
"There are certain things you are going to have to do to show me," Dr Horstmanshof paused-
"...to prove to me that you can take care of the incredible gift of a transplanted heart."
The girl just sat there, speechless. Incredible gift indeed.
On Monday, we were chilling in the cath lab, and had just finished a right heart cath that showed a woman had a pulmonary capillary wedge pressure of 47. That, my friend, is heart failure. Dr. H is the only heart failure cardiologist in Oklahoma and he is pretty darn amazing. I had no idea when I was assigned this rotation just how freaking cool it was really going to be. When an organ donor in Oklahoma dies, Dr. H is the main person who decides who will receive the heart. And that is a pretty gigantic responsibility. He is a pretty amazing man and I am lucky to get to learn from him this month.
Keep in mind, there are only between 9 and 13 heart transplants a year in Oklahoma and the surrounding areas including western Arkansas and southern Kansas. So when Dr. H told me that a donor heart was available on Monday morning, and that I could go watch the transplant, I had no idea how special of an experience it actually was.
One common myth about organ transplants, including hearts, goes something like this: "I don't want to be an organ donor because if I'm injured in a car wreck, they might see and then not try as hard to save my life." In reality, organs are never harvested "on the scene" of accidents. If the person dies in an accident, their organs don't receive blood and the tissue dies- and you can't put dead organs in a living person.
Organs are almost entirely harvested from people who receive brain injuries and later become brain dead on respirators. In the hospital, after it becomes apparent that the person is completely brain dead and never coming back, doctors talk to families about wishes- and that is the time when organ donation becomes an option. Usually, organs are harvested while the person is still on the respirator. That way, the organs receive a maximal amount of blood before being removed.
Circling back... so on Monday, I got to watch a heart transplant. This was definitely the most amazing thing I have seen all year, maybe ever. The doctor who performed the transplant was a little grouchy that day because he had already opened up the chest of the person receiving the heart when they found out the heart was coming by ambulance, not by plane. So basically, the man laid in the OR for and hour and a half with his chest wide open, just waiting for his new heart. I watched his old heart beat for about 30 minutes of that.
Kind of strange, just watching a heart beat. It looked sick and worn out, and you could tell it really needed to be replaced. How lucky he was. Although so incredibly sad that someone else- an 18 year old in Tulsa- was so unfortunate.
About 30 minutes after I arrived, Dr. Elkins received a call that the heart was only 10 minutes away. So, he proceeded to cut out the man's heart. Cutting a heart out takes about ten minutes, and isn't as complicated as you would think; I mean, there are only four vessels to sever.
Right after he finished, the OR door opened and simultaneously, a man yelled, "Heart's here" and a blue cooler flew across the threshold and slid about 10 feet before slowing to a stop at the foot of the operating table. It literally looked like it had just been taken camping. One of the nurses grabbed the cooler, and dragged it over to a big bucket of ice. I made my way closer and saw that the cooler said in big letters, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT COORDINATOR OR THERE WILL BE NO HOSPITAL PICNIC THIS SUMMER."
No- just kidding. It said, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT UNIT." The nurse opened it up and grabbed what, in comparison to the big ugly broken heart just removed, was a most beautiful heart, completely unblemished. After dunking it in ice a few more times, Dr. Elkins sewed the new heart in.
For a few seconds after it was reanastamosed, the blood pump was still on- meaning that blood was being diverted away from the heart. No blood was actually flowing through the heart yet. And yet, the oddest thing ever... the heart started to quiver. (Or, in fancy medical terms, fibrillate.) Like, somehow it actually realized it had been reattached to a person. Crazy.
The heart quivered on and off for a few seconds and then the blood pump was turned off and the heart began receiving blood. At this, it really started fibrillating. Then, the surgeon took two tiny paddles and shocked it with just 10 joules. Also crazy- normally you shock someone with 300 just to get through their chest wall! The heart would probably explode right there on the table if you shocked it directly with that much electricity. However, the tiny paddles did their job and the heart started beating. Beautifully beating.
Eventually, the sternum was wired back together. (Watch that from two feet away and nothing that happens to you will ever seem that bad.) And with that the surgery was over.
Three days later, in the clinic, Dr. H looked sternly at a pretty 23 year old girl, his intense gaze nearly boring holes through her skull.
"There are certain things you are going to have to do to show me," Dr Horstmanshof paused-
"...to prove to me that you can take care of the incredible gift of a transplanted heart."
The girl just sat there, speechless. Incredible gift indeed.
Sunday, September 13, 2009
Ob-la-di, ob-la-da, life goes on, brah...Lala how the life goes on.
I've been thinking a lot lately how life flows on and on. Whether you want it to or not... Sometimes it seems like its not the decisions we make that decide where life takes us, but rather that we're being carried along in its current-
"In his heart a man plans his course, but the Lord determines his steps." -Proverbs 16:9
I went to Lifechurch tonight after feeling deeply sad. While there a song played with the refrain, "Its all because of Jesus I'm alive- its all because the blood of Jesus Christ." I'm reminded that my life doesn't have anything to do with graduating from school or getting a job or making decisions about the future. The Lord has a plan and he knows what it is. The important thing is that because of Jesus my heart is alive. And I don't need all those other things- He is enough.
A few nights ago, Ashlie and I went for a run at Mitch Park. About a mile along, it started to downpour. And as we ran in the rain, drenched to the bone, I looked over at her and knew,
An alive heart is what life is all about.
"In his heart a man plans his course, but the Lord determines his steps." -Proverbs 16:9
I went to Lifechurch tonight after feeling deeply sad. While there a song played with the refrain, "Its all because of Jesus I'm alive- its all because the blood of Jesus Christ." I'm reminded that my life doesn't have anything to do with graduating from school or getting a job or making decisions about the future. The Lord has a plan and he knows what it is. The important thing is that because of Jesus my heart is alive. And I don't need all those other things- He is enough.
A few nights ago, Ashlie and I went for a run at Mitch Park. About a mile along, it started to downpour. And as we ran in the rain, drenched to the bone, I looked over at her and knew,
An alive heart is what life is all about.
Saturday, August 08, 2009
118 Days
Th July rotation was great. Dr. Wiens was awesome... I liked him a lot. The drive to Shawneee was not so great. He offered me a job at the end of the rotation- no call, mostly closing operations and doing central lines; not too shabby. I'm thinking about it.
Now I am with a kidney specialist, Dr. Carter, at Baptist in OKC. He is awesome. I love internal med docs cause they don't expect anyone to do their work, they just expect you to learn. That's no cause for complaint on my part.
In other news, there was a sailing birthday party for Meagan last night and my cat cuddles with me every morning. Tao milktea and tapioca are abundant and there are flowers on the porch. Sally is not coming back from California. I've been exhausted lately and worried but trying to remember life is good. Please be praying that the Lord will help me finish the last three and a half months of school well and show me what to do after that. Love & miss you all...
Now I am with a kidney specialist, Dr. Carter, at Baptist in OKC. He is awesome. I love internal med docs cause they don't expect anyone to do their work, they just expect you to learn. That's no cause for complaint on my part.
In other news, there was a sailing birthday party for Meagan last night and my cat cuddles with me every morning. Tao milktea and tapioca are abundant and there are flowers on the porch. Sally is not coming back from California. I've been exhausted lately and worried but trying to remember life is good. Please be praying that the Lord will help me finish the last three and a half months of school well and show me what to do after that. Love & miss you all...
Nighttime Rambling
Last night I dreamed about Afghanistan again. A mob gathered outside our house and the Afghan National Army had surrounded us to keep them from getting in. Jirah, Julie and Kate were there and a US helicopter came to rescue us. I'm only worried because its the one time I brought my violin to that darn country and this female officer made me leave it in the house because there was no room in the helicopter. Somehow we always end up in an armored car with the windows rolled down on the Kandahar highway, headed to Kabul. Jirah is crying. I'm thinking about how the violin would have fit in the car. And it ends stopping at a little buffet-style restaurant in Ghazni to eat.. I've had that dream before.
Why was the crowd mad? Why weren't we on the helicopter? Why were the windows in the armored car rolled down? Why was there an Afghan version of Furr's in Ghazni? Most importantly, why did I ever bring my violin to Afghanistan?? I'll never make any sense of it.
Why was the crowd mad? Why weren't we on the helicopter? Why were the windows in the armored car rolled down? Why was there an Afghan version of Furr's in Ghazni? Most importantly, why did I ever bring my violin to Afghanistan?? I'll never make any sense of it.
Friday, July 10, 2009
Turn, Turn, Turn...
Seems like there has been a lot going on this year and a lot of change taking place in many of our lives. God knows there is a time for everything, and a season for every activity under heaven.
A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep
A time to build up, a time to break down
A time to dance, a time to mourn
A time to cast away stones, a time to gather stones together
A time of love, a time of hate
A time of war, a time of peace
A time you may embrace, a time to refrain from embracing
A time to gain, a time to lose
A time to rend, a time to sew
To everything, turn turn turn
there is a season, turn turn turn
and a time for every purpose under heaven
A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep
A time to build up, a time to break down
A time to dance, a time to mourn
A time to cast away stones, a time to gather stones together
A time of love, a time of hate
A time of war, a time of peace
A time you may embrace, a time to refrain from embracing
A time to gain, a time to lose
A time to rend, a time to sew
To everything, turn turn turn
there is a season, turn turn turn
and a time for every purpose under heaven
Tuesday, June 23, 2009
WANTED
Have you seen this man?
He was seen last Saturday afternoon with daisies in hand, ringing a woman's doorbell in Oklahoma City.
Then later he was spotted taking her to dinner and dancing.
He has been known to frequent wooded areas where young PA students may be found.
You might also catch him hanging off the side of one of these.
Warning: THIS MAN MAY APPEAR HARMLESS.
He is wanted in Marlow, Oklahoma. If you have any information concerning his whereabouts, please contact the proper authorities immediately.
He was seen last Saturday afternoon with daisies in hand, ringing a woman's doorbell in Oklahoma City.
Then later he was spotted taking her to dinner and dancing.
He has been known to frequent wooded areas where young PA students may be found.
You might also catch him hanging off the side of one of these.
Warning: THIS MAN MAY APPEAR HARMLESS.
He is wanted in Marlow, Oklahoma. If you have any information concerning his whereabouts, please contact the proper authorities immediately.
Sweet Baby Lovin'
My precious friend Keri's baby, Gracie. And below is Summer's little munchkin, Colton.
I'm thinking summer wedding. Lilac and olive tones. Something simple, without too many frills. Perhaps around, say... 2029.
Monday, June 15, 2009
Moving Back to Edmond
This rotation in Marlow is almost over. On July 2nd, I will move back to Edmond... until December! Yaaaay! I will be living with Ashlie and her other roommate, Jenny, in a little house just off Boulevard and Danforth.
I spent the night there last night before coming home to Marlow today and there were fireflies zigzagging all over our backyard at dusk. And we have a porch swing. AND it is just a 10 minute walk to the nearest sno cone stand.
I think my life is complete. And now, for a short rendition of "Ice, Ice, Baby" (lyrics modified by Meagan Labay):
Ice, ice baby
flavored ice makes me go crazy
fun in a cup and i don't mean maybe
Or, there is this version, sung to the tune of "Billy Jean":
Cold sno cones
are not my love
they're just a treat
without any vit-a-muns
so, i just eat them for fun
I spent the night there last night before coming home to Marlow today and there were fireflies zigzagging all over our backyard at dusk. And we have a porch swing. AND it is just a 10 minute walk to the nearest sno cone stand.
I think my life is complete. And now, for a short rendition of "Ice, Ice, Baby" (lyrics modified by Meagan Labay):
Ice, ice baby
flavored ice makes me go crazy
fun in a cup and i don't mean maybe
Or, there is this version, sung to the tune of "Billy Jean":
Cold sno cones
are not my love
they're just a treat
without any vit-a-muns
so, i just eat them for fun
Wednesday, June 10, 2009
Vitamin K and the Faux Hawk Baby
Last Sunday, a baby was delivered. Delivered by a very small PA student (who had gotten approximately 8 hours of sleep in the last 2-3 days) to a very large and umm.... unhygienic mother. That is all I will say about that. But imagine. Delivering. An. Unhygienic. Person. Vaginally.
Ahem.
The next morning, I could not have been more relieved to see the baby was cleaned up. And, best of all, he had quite bit of hair that one of the nurses had styled up into the most awesome faux hawk ever. So. Incredibly. Cute.
Then, Dr. King let me circumcise Little Mr. Faux Hawk. This was really such an interesting procedure. There are several different methods for circumcising babies- you can use Plastibells, the Mogan, or Gomco- I got to do a Mogan. Really, to me the most interesting thing about circumcision is that in today's world, we can do them the day after a baby is born.
Why is this, you ask? Well, have you ever wondered why we give babies a shot of Vitamin K after birth? Circumcision first appeared in the BIble when God told Abraham to circumcise Isaac on the 8th day after his birth. Seems weird that he told him to wait, eh? Unless you know that babies, left to themselves, do not begin producing Vitamin K- a clotting factor necessary to clot blood- until they are about a week old. So, cutting into a baby before then without giving them Vitamin K will most likely lead to them bleeding to death. (However, if you invented babies you may have been aware of this small fact.) The End.
Ahem.
The next morning, I could not have been more relieved to see the baby was cleaned up. And, best of all, he had quite bit of hair that one of the nurses had styled up into the most awesome faux hawk ever. So. Incredibly. Cute.
Then, Dr. King let me circumcise Little Mr. Faux Hawk. This was really such an interesting procedure. There are several different methods for circumcising babies- you can use Plastibells, the Mogan, or Gomco- I got to do a Mogan. Really, to me the most interesting thing about circumcision is that in today's world, we can do them the day after a baby is born.
Why is this, you ask? Well, have you ever wondered why we give babies a shot of Vitamin K after birth? Circumcision first appeared in the BIble when God told Abraham to circumcise Isaac on the 8th day after his birth. Seems weird that he told him to wait, eh? Unless you know that babies, left to themselves, do not begin producing Vitamin K- a clotting factor necessary to clot blood- until they are about a week old. So, cutting into a baby before then without giving them Vitamin K will most likely lead to them bleeding to death. (However, if you invented babies you may have been aware of this small fact.) The End.
136 Hours in 9 days
I just finished a hellish little run of 12 to 16 hour days... oh sweet holy mother of my goodness. One more tomorrow. Then- 3 DAY WEEKEND!!
Thursday, June 04, 2009
Endangered Love
"Endangered Love" is one of my favorite children's songs. Its a song about two manatees who are in love, however, one wants to go to a ball in her new manatee lipstick and the other wants to speak French, go into the world and do noble things. In the song, they even almost break up. However, luckily for them, love finds a way.
Barbara: "Bill, I've learned French."
Bill: "You have?"
Barbara: "Mais, oui. Je suis Manatee. See?"
Bill: "Oui, oui mon amie!
I always knew you could,
I really hoped you would.
Now can we go into the world and do noble things for the good of all?"
Barbara: "Yes, but first, will you take me to the ball?"
Lesson for today: Have your cake and eat it too!
Barbara: "Bill, I've learned French."
Bill: "You have?"
Barbara: "Mais, oui. Je suis Manatee. See?"
Bill: "Oui, oui mon amie!
I always knew you could,
I really hoped you would.
Now can we go into the world and do noble things for the good of all?"
Barbara: "Yes, but first, will you take me to the ball?"
Lesson for today: Have your cake and eat it too!
Friday, May 29, 2009
Come Live With Me, and Be My Sweet Fluffy Ball of Love
Every month in my life right now is a new beginning. Every month, I start over at a new job. Every month, I get a new boss, a new workplace, a new kind of work, a new population of patients, a new boyfriend. And usually, a new place to move.
Just kidding about the boyfriend.
However, not this month! This coming weekend is, truly, a free weekend! I continue my rural rotation for another month and have only one thing to study for... a drug list for Dr. King and I'm golden.
The main priority for today is to search for an apartment. One thing has been blatantly missing from my life these last few months: my cat. For the previous year she had been my constant loving companion; the last few months, she has been living with Ashlie and Lewis as I move all around. Which she loves.. :/ But I miss her and I'm ready to cohabitate with her sweet fluffy little ball of goodness once more. And, as it seems everyone I know has a pet-free lease, it appears I'm going to have to find something by myself for at least the next 6 months.
So, the apartment search begins. Once it is completed, the job search will begin. As the Indian man on the plane said with a smile... the world is my oyster. I hope cats like oysters.
Just kidding about the boyfriend.
However, not this month! This coming weekend is, truly, a free weekend! I continue my rural rotation for another month and have only one thing to study for... a drug list for Dr. King and I'm golden.
The main priority for today is to search for an apartment. One thing has been blatantly missing from my life these last few months: my cat. For the previous year she had been my constant loving companion; the last few months, she has been living with Ashlie and Lewis as I move all around. Which she loves.. :/ But I miss her and I'm ready to cohabitate with her sweet fluffy little ball of goodness once more. And, as it seems everyone I know has a pet-free lease, it appears I'm going to have to find something by myself for at least the next 6 months.
So, the apartment search begins. Once it is completed, the job search will begin. As the Indian man on the plane said with a smile... the world is my oyster. I hope cats like oysters.
Sunday, May 17, 2009
Marlow Is Busy
Apparently, Marlow isn't as slow as I'd thought it might be. All the old folks are getting sick in their nursing homes, high school girls are needing their sports physicals, everyone in the hospital has to be followed, oh then there's the free clinic; and did I forget to mention Dr. King's clinic where we work 40 hours every week?
Marlow is definitely where its at. It being the work.
Marlow is definitely where its at. It being the work.
Tuesday, May 05, 2009
Mr. Lucas Strikes Again
I'm always forgetting to put new pictures of us up. Here we are a few weekends ago at Quartz Mountain. He went for a climbing thing and I was there for a women's retreat. Here he is in action, making me breakfast. What a sweetheart!
Beautiful Marlow
Well, time is flying. The spring has come and spring in Marlow is one beautiful thing. Everything here is green and the trees lining Main Street are old. There are gorgeous multicolored wild flowers all along the drive from the hospital in Duncan to the clinic in Marlow. Bright little flowers and old, beautiful trees lining the street of your new town in the rain... I'd say its a treat.
I got here on Sunday night after a not-small detour which included me getting to visit the Wichita Mountains once again. They are beautiful at sunset if you are driving in from the north. I hope I can go out there a lot on this rotation, but we'll see. Supposedly the hours for this stint are somewhere in the 9:30am to 9:30pm area. It looks to be no lie, so far.
I think I like small towns. The people here seem almost the exact same to me as everywhere else that I have been so that's no different. The hospital I get to live at is nice. Dr. King, my preceptor for May and June, is a great person and a good doctor. More good news... there might be someplace to go horseback riding around here that lets you gallop on the horses. People in small towns seem like they might be more likely to let you gallop on their horses than just make you stick to boring old trail rides. I'm keeping my fingers crossed and looking into it.
On a more personal note: I need a break. I feel worn out.
I got here on Sunday night after a not-small detour which included me getting to visit the Wichita Mountains once again. They are beautiful at sunset if you are driving in from the north. I hope I can go out there a lot on this rotation, but we'll see. Supposedly the hours for this stint are somewhere in the 9:30am to 9:30pm area. It looks to be no lie, so far.
I think I like small towns. The people here seem almost the exact same to me as everywhere else that I have been so that's no different. The hospital I get to live at is nice. Dr. King, my preceptor for May and June, is a great person and a good doctor. More good news... there might be someplace to go horseback riding around here that lets you gallop on the horses. People in small towns seem like they might be more likely to let you gallop on their horses than just make you stick to boring old trail rides. I'm keeping my fingers crossed and looking into it.
On a more personal note: I need a break. I feel worn out.
Thursday, March 19, 2009
Creep, Creep, Creep...
There is something that has been creeping up on me like a sneaky little insect. Something I have been thinking about a lot lately but trying not to. Something that is much more difficult to be rid of than brushing a bug off your leg on the Fourth of July. And that thing is... graduation.
Supposedly, we are to start looking for jobs this summer. Supposedly, I am to fill out applications and ponder salaries and paid vacation. Now I grow up and start deciding what I actually want to do. In someone's mind, I am an adult, and have even the remotest idea where I want to live and settle down. (And in some far away fairy tale land, I am also studying for our board exams.)
Reality: I am laying on the couch eating an ice cream sandwich and watching Sahar take a little spit bath.
Its kind of like having two lives. One in which I go to the hospital every day, do histories and physicals and patient care plans with some traumas thrown in; the same one in which I graduate in 8 months, settle down with a great job and have a very good life surrounding by loving family and wonderful friends.
Then there's the other life, in which I continually think of being back in dusty Kandahar, riding camels in the desert and laughing with nomads under tar-colored tents. Or Ecuador, treating brown-faced little children in a medical clinic by day and riding rusty old bikes on the beach by night. Or Haiti, sleeping on roofs, delivering babies on the clinic's dirt floor and hiking to waterfalls; petting purple sea urchins then riding to islands on ancient, patchy-sailed boats.
Ahhh... I still have no idea what to do.
Supposedly, we are to start looking for jobs this summer. Supposedly, I am to fill out applications and ponder salaries and paid vacation. Now I grow up and start deciding what I actually want to do. In someone's mind, I am an adult, and have even the remotest idea where I want to live and settle down. (And in some far away fairy tale land, I am also studying for our board exams.)
Reality: I am laying on the couch eating an ice cream sandwich and watching Sahar take a little spit bath.
Its kind of like having two lives. One in which I go to the hospital every day, do histories and physicals and patient care plans with some traumas thrown in; the same one in which I graduate in 8 months, settle down with a great job and have a very good life surrounding by loving family and wonderful friends.
Then there's the other life, in which I continually think of being back in dusty Kandahar, riding camels in the desert and laughing with nomads under tar-colored tents. Or Ecuador, treating brown-faced little children in a medical clinic by day and riding rusty old bikes on the beach by night. Or Haiti, sleeping on roofs, delivering babies on the clinic's dirt floor and hiking to waterfalls; petting purple sea urchins then riding to islands on ancient, patchy-sailed boats.
Ahhh... I still have no idea what to do.
Tuesday, March 10, 2009
Happiness. Flowers. Mountains. Lederhosen.
This is Mr. Lucas. He was pumping water while calling himself Lars in a German accent and talking about lederhosen. And so you can see why Mr. Lucas brings my heart pure joy. :) When I'm with him, I'm just about as happy as I can ever remember being. He is a genuinely thoughtful man with a cheerfully contagious disposition. You would really enjoy meeting him.
We went to the Wichita Mountain Wildlife Refuge last weekend. We did a little trail run out to a tall thin rock with two large boulders balanced on top- aptly named Crab Eyes- and climbed up on top. Its one of the most beautiful views in the whole park, or so says Mr. Lucas. Then we grilled out shishkabobs and later hiked to a waterfall with a couple of his climbing buddies. Then watched the sunset on Mount Scott- which I have concluded is THE prettiest view in the whole park. If you live in Oklahoma, and you haven't been, you have no excuse- the mountains are only an hour and a half away from the city. It is worth it.
Our delicious lunch. Yummy sweet potatoes not pictured.
He even brings me flowers.
Thursday, March 05, 2009
A Lot Going On
Seems like there has been a lot going on recently. My brother had appendicitis again and a second surgery to take out his appendix again (strange, right). I went up there this past weekend to spend some time with them. Now he's still having some problems and laid up at the hospital in Des Moines so be praying for him.
The ER is still going great! I love it there so much. Its really a joy to get to go every week. This week I traded one day of ER for a clinic day Friday, so no four day weekend. That has been one of the huge blessings of this rotation- lots of free time! Which, I am finding, is very fun to spend with my architect friend. More on that later.
So, the schedule is going to be a little odd until August, so here it is one more time:
March- Oklahoma City
April- Edmond
May- Marlow, OK
June- Marlow, OK
July- Shawnee, OK
Marlow is in the middle of nowhere. About an hour and 45 minutes from the city. So, I will be a little nomad for the next four or so months. Ahh... its been nice to be settled for so long. Now its time to uproot and migrate again.
The ER is still going great! I love it there so much. Its really a joy to get to go every week. This week I traded one day of ER for a clinic day Friday, so no four day weekend. That has been one of the huge blessings of this rotation- lots of free time! Which, I am finding, is very fun to spend with my architect friend. More on that later.
So, the schedule is going to be a little odd until August, so here it is one more time:
March- Oklahoma City
April- Edmond
May- Marlow, OK
June- Marlow, OK
July- Shawnee, OK
Marlow is in the middle of nowhere. About an hour and 45 minutes from the city. So, I will be a little nomad for the next four or so months. Ahh... its been nice to be settled for so long. Now its time to uproot and migrate again.
Monday, February 23, 2009
Psalm 19
The law of the Lord is perfect,
reviving the soul.
The statutes of the Lord are trustworthy,
making wise the simple.
The precepts of the Lord are right,
giving joy to the heart.
The commands of the Lord are radiant,
giving light to the eyes.
The fear of the Lord is pure,
enduring forever.
The ordinances of the Lord are sure,
and altogether righteous.
'In his presence is fullness of joy, and at his right hand are pleasures forevermore.' -Ps 16
reviving the soul.
The statutes of the Lord are trustworthy,
making wise the simple.
The precepts of the Lord are right,
giving joy to the heart.
The commands of the Lord are radiant,
giving light to the eyes.
The fear of the Lord is pure,
enduring forever.
The ordinances of the Lord are sure,
and altogether righteous.
'In his presence is fullness of joy, and at his right hand are pleasures forevermore.' -Ps 16
Thursday, February 19, 2009
Awake Late
Sometimes it is hard to sleep at night.
Especially if you stay up until 7:30am roughly 42.857% of the week. I am not complaining though, because the Job is wonderful. I couldn't be happier at the ER. Tonight at our girl's group, someone had a word for me. And the word was, concerning the Job and the hospital and the patients:
"You have been tailor-made for this."
I know that it is true. I have often thought that myself.
Especially if you stay up until 7:30am roughly 42.857% of the week. I am not complaining though, because the Job is wonderful. I couldn't be happier at the ER. Tonight at our girl's group, someone had a word for me. And the word was, concerning the Job and the hospital and the patients:
"You have been tailor-made for this."
I know that it is true. I have often thought that myself.
Sunday, February 15, 2009
8 Years Is a Long Time
Yesterday, the sweetest guy in the world took me out. Its been a really long time since I went on a date on Valentine's Day... eight years to be precise. This person is just simply amazing. We went out to a place called Red Rock Canyon and he taught me to rappel. Being a mountaineer for the last 16 years he is pretty good at it; I can't believe how much fun we had.
If you have run out of ideas for dates, I suggest finding a strong, good-looking architect who loves to climb and ask him to take you to the mountains.
If you have run out of ideas for dates, I suggest finding a strong, good-looking architect who loves to climb and ask him to take you to the mountains.
Thursday, January 29, 2009
Saying Goodbye to Griffin
The cute Italian resident was nice enough to give me today off, so my psychiatry rotation at Griffin is officially over. I was surprised at how much fun and how enjoyable this rotation was. I'm a little sad (not because of the resident :) but because I really became attached to some of those patients. I'm going to miss them and all their crazy shenanigans which brought so many laughs over the last month!
I will miss Miss T, whose only criteria for discharge was that she take a shower. She thought there were demons in the 4th stall to the end so we were always trying to convince her to take a shower in the first stall. But, after weeks of antipsychotics and psychotherapy she told us, "Basically what I'm telling you is I'm never going to take a shower at Griffin Memorial Hospital." Okay, Miss T...
I will miss Mr. J, who left his nursing home because he was "going to follow the train tracks to Egypt."
I will miss "Wolfvy," who first thought he could predict and pinpoint anything happening anywhere, at any time, all over the world, and email the people involved to warn them. And that his wife had sextuplets that all died within 15 minutes of being born. And that he'd had hundreds of surgeries to replace all of his bones with titanium, which is the reason he now gets struck by lightening so gosh darned frequently!
One person I will not miss is Miss L, who was the most annoying patient on the face of the planet. When she came in, she saw the treatment team and we asked her if she knew why she was at Griffin. She gave us THE meanest look in the world and said, "You want me to tell you again? They... ripped... my... ARM... OFF!!" She also constantly hallucinated children and believed that her residential care facility was using them to hand out the medicines. So she definitely wasn't going to go back there until they instituted some safer distribution practices. And that the owners were castrating all the male residents and then throwing the remnants at all the other patients. And that was just completely unacceptable. She was a tortured woman... who will no longer be torturing me. :)
I will miss Miss T, whose only criteria for discharge was that she take a shower. She thought there were demons in the 4th stall to the end so we were always trying to convince her to take a shower in the first stall. But, after weeks of antipsychotics and psychotherapy she told us, "Basically what I'm telling you is I'm never going to take a shower at Griffin Memorial Hospital." Okay, Miss T...
I will miss Mr. J, who left his nursing home because he was "going to follow the train tracks to Egypt."
I will miss "Wolfvy," who first thought he could predict and pinpoint anything happening anywhere, at any time, all over the world, and email the people involved to warn them. And that his wife had sextuplets that all died within 15 minutes of being born. And that he'd had hundreds of surgeries to replace all of his bones with titanium, which is the reason he now gets struck by lightening so gosh darned frequently!
One person I will not miss is Miss L, who was the most annoying patient on the face of the planet. When she came in, she saw the treatment team and we asked her if she knew why she was at Griffin. She gave us THE meanest look in the world and said, "You want me to tell you again? They... ripped... my... ARM... OFF!!" She also constantly hallucinated children and believed that her residential care facility was using them to hand out the medicines. So she definitely wasn't going to go back there until they instituted some safer distribution practices. And that the owners were castrating all the male residents and then throwing the remnants at all the other patients. And that was just completely unacceptable. She was a tortured woman... who will no longer be torturing me. :)
Monday, January 26, 2009
One Year Later: A Tribute to Cyd
It was exactly one year ago today that our dear friend Cyd was abducted in Kandahar. One year, and we have still not had the opportunity to hold a formal memorial service or funeral for her. So I would like to take this opportunity to write out a memory of Cyd I have, that no one else ever knew.
My first trip to Kandahar was in 2005- I stayed with Cyd and her two roommates for about a week. We had great fun during that time and there are many memories impressed on my mind from that short period; however, one stands out.
Every night of the summer, Cyd slept on the roof, on a small cot, under a mosquito net. She loved to sleep under the stars. I loved that roof, because it had a view of one of Kandahar's strange mountain formations just off to one side. Most nights that week, we went up to the roof and looked at the mountains and the stars. So it wasn't unusual that my last night in Kandahar, we again found ourselves on the roof after sunset; but this time we sensed the time was precious. So we lingered there for hours, talking and praying and singing together into the early morning. Cyd had a beautiful, resonant voice that rang out like a bell. We cried and talked over so many things. Sometime after one she finally left me up on the roof and went downstairs to sleep, because the first chill of fall had just arrived. I knew I was leaving for Kabul in the morning, and didn't know if I would ever come back. I stayed up on the roof for a few more hours, singing softly and basking in the beauty of the Kandahari night, staring at its millions of stars. After drifting off sometime later, I was suddenly startled out of sleep; and freezing, went downstairs to bed.
I have never forgotten that night with Cyd. What an unusual woman! That she cherished and found beauty in such a place, and somehow instilled it in my heart too. I will always love you Cyd; I wish we could sing on your roof tonight.
My first trip to Kandahar was in 2005- I stayed with Cyd and her two roommates for about a week. We had great fun during that time and there are many memories impressed on my mind from that short period; however, one stands out.
Every night of the summer, Cyd slept on the roof, on a small cot, under a mosquito net. She loved to sleep under the stars. I loved that roof, because it had a view of one of Kandahar's strange mountain formations just off to one side. Most nights that week, we went up to the roof and looked at the mountains and the stars. So it wasn't unusual that my last night in Kandahar, we again found ourselves on the roof after sunset; but this time we sensed the time was precious. So we lingered there for hours, talking and praying and singing together into the early morning. Cyd had a beautiful, resonant voice that rang out like a bell. We cried and talked over so many things. Sometime after one she finally left me up on the roof and went downstairs to sleep, because the first chill of fall had just arrived. I knew I was leaving for Kabul in the morning, and didn't know if I would ever come back. I stayed up on the roof for a few more hours, singing softly and basking in the beauty of the Kandahari night, staring at its millions of stars. After drifting off sometime later, I was suddenly startled out of sleep; and freezing, went downstairs to bed.
I have never forgotten that night with Cyd. What an unusual woman! That she cherished and found beauty in such a place, and somehow instilled it in my heart too. I will always love you Cyd; I wish we could sing on your roof tonight.
Wednesday, January 14, 2009
The Cute Italian Resident
So... there's a certain very good-looking young Italian doctor that happened to have a PA student assigned to him for the month of January. He immediately intrigued this student with his kindness and dark head of curly brown hair. Which she stared at the back of most of last week. However, since she has absolutely no idea how to attract a person of the opposite gender, (and possibly due to some rule about preceptor relationships the program made up pointlessly, without single students in mind) she admired him quietly from approximately two feet away in her chair as he interviewed crazy patients. I know because she's a really close friend of mine.
Then this week, just before lunch she began texting someone. He immediately looked up and said with a grin, "Who are you texting, your boyfriend?" She just smiled and said no. And sort of blushed because those are exactly the types of questions savvy females are able to take advantage of without replying in monosyllables. Although, she felt a twinge of hope because that's one of the first questions someone asks when they are interested, right?
Then his phone rang, and after he hung up, she decided to make a joke and said, "Who are you calling, your girlfriend?" But then he said, "Yeah."
*Sigh* .... nevermind.
Then this week, just before lunch she began texting someone. He immediately looked up and said with a grin, "Who are you texting, your boyfriend?" She just smiled and said no. And sort of blushed because those are exactly the types of questions savvy females are able to take advantage of without replying in monosyllables. Although, she felt a twinge of hope because that's one of the first questions someone asks when they are interested, right?
Then his phone rang, and after he hung up, she decided to make a joke and said, "Who are you calling, your girlfriend?" But then he said, "Yeah."
*Sigh* .... nevermind.
Sunday, January 11, 2009
A New Roommate
It has been over 2 years since I last had a roommate. However, following a short hiatus in Edmond due to a flooding incident right before New Year's, I now again live in downtown OKC. The days of Deep Deuce are over; my lease was up on December 31st. I am now staying with a friend until my rural rotations start.
My new roommate is awesome! I just love this sweet girl. She is a pediatric resident I met on the PICU rotation. She's also from Pakistan. Because she basically works 90 or more hours a week, unfortunately there's a lot she has never done in Oklahoma. For example, while on the prowl for food tonight and she pointed at a store and said, "What is a Braum's?" Needless to say, she was soon eating some Oklahoma dairy cow produced ice cream. This is going to be fun. And also will be a good transition- since she isn't home too much and I am not used to having someone home.
In other news, two of a greatest people on earth got married last night. Congratulations Danae and Nao!
My new roommate is awesome! I just love this sweet girl. She is a pediatric resident I met on the PICU rotation. She's also from Pakistan. Because she basically works 90 or more hours a week, unfortunately there's a lot she has never done in Oklahoma. For example, while on the prowl for food tonight and she pointed at a store and said, "What is a Braum's?" Needless to say, she was soon eating some Oklahoma dairy cow produced ice cream. This is going to be fun. And also will be a good transition- since she isn't home too much and I am not used to having someone home.
In other news, two of a greatest people on earth got married last night. Congratulations Danae and Nao!
Thursday, January 08, 2009
Baby Jonah
Beware: a very long story follows.
Due to HIPPA, no one is allowed to share medical information together with a patient's name. So the following story is true but the sweet baby has an alias. This story is one I have been thinking about for the last month and one with which I am just now coming to terms.
I had been at Children's Hospital a little over two weeks when I showed up to work one Wednesday morning and was greeting by our sweet, smiling upper-level resident, Kim. I'd had two asthma patients the day before who had both been discharged, and so was coming in with nobody on my plate. Immediately upon entering the residents' office, Kim informed me that she had a baby for me to follow. He would be the only patient I saw that day, as his case was complicated. His brief history is as follows:
Jonah was born seven days previous to his admission to the PICU. When he was four days old, his mother took him to the doctor, because she was concerned about constipation. The doctor noticed that Jonah had a low oxygen level on room air. He admitted him to the hospital in Lawton where he was started on some antibiotics.
That afternoon, Jonah's mom noticed his eyes crossing, lips puckering, and legs stiffening while his oxygen levels continued to fall. That evening, he had an episode that the mother recognized as a seizure. One and a half hours later, he had a second seizure lasting approx 3 minutes. Medflight was called to transport the baby to our hospital in OKC. Upon arrival, the paramedics found that his heart was not beating. They proceeded to intubate him and gave him chest compressions. He had another seizure en route to the hospital.
Then Kim paused and she said, "This is the part of the story that is so sad."
Kim was the resident on call the night Jonah came. Upon arrival at the PICU, Kim examined him, wrote an admission note, and was about to leave the room when Jonah's mom mentioned to Kim that she had painful, vesicular lesions on her right breast. Kim examined the lesions and realized that they were a primary outbreak of herpes.
There are only a few reasons that a person should not give birth vaginally. One of them is if the mother has a vaginal infection, because as the baby goes through the birth canal, it will mostly likely contract the infection. If it is a bacterial infection, like gonorrhea or chlamydia, it can be treated. However, if it is a viral infection, there is very little that can be done. Tiny infants also have virtually no immunologic defense against infection, and therefore, when they contract viral infections, it is very easy for the infection to get into their blood and spread to all their organs (called sepsis). It is very serious and frequently ends in death.
So that is how it came to be that Jonah contracted herpes from his mother. The mother had no idea.
Kim immediately got cultures of eye, skin, nose, trach aspirate, blood, urine, and rectum. And also of the mother's lesions. We already had a pretty strong suspicion that Jonah had sepsis due to disseminated herpes; when the cultures came back a few days later, the suspicion was confirmed. Everything was positive.
I went in to see Jonah that first day and he didn't look too bad. He weighed almost seven pounds and had little tufts of blonde hair. He did have some bruising from where they'd put IVs and lines in him- mostly around his umbilicus and thighs. With a blanket on, you could almost think he looked normal. (Apart from the tube going down his throat.)
However, when I got to his chart... wow. This baby was complex. Most of my other patients had their vitals and other stats monitored every hour. Jonah had everything normal plus more monitored every fifteen minutes. His chart was blackened with tiny little numbers. This was going to be complicated.
He also had every lab known to man done every four hours. The main things that concerned us were his kidneys and his liver. Here is why:
If your liver stops producing certain proteins your body needs to make blood clots, you bleed easily. When you have a lot of IVs and lines, you need the your blood to clot quickly. If it doesn't, you receive a LOT of blood products. Cells, plasma, and all these clotting proteins. Your medicines can also only be concentrated so much. In other words, you get a LOT of fluid going IN.
If your kidneys stop making urine, its very hard to get rid of the fluid that you take in and that your body naturally makes. What do we do for people who have kidney failure? We give them dialysis. Dialysis, however, requires a big hole. And its pretty easy to bleed a lot out of big holes, so if you are going to have kidney failure, you need your liver in good working condition, making all the clotting proteins it is supposed to make.
So, either your liver or your kidneys can fail, but it is really bad news if both stop working. So basically, my job every day was to do all the math on Jonah's intake (all the fluids, medicines, etc going in) and his output (urine, blood, vomit, etc), as well as looking at all the labs every four hours and all the medicines he was on and figure out if his liver and kidneys were going to start working.
So initially, we knew he was in liver and kidney failure. He wasn't producing any liver proteins, and so we had to continually replace all of them, so that he wouldn't bleed out of his lines. However, this meant that that in the first 24 hours of his hospital admission, he was given almost a liter and a half of fluid. That was equal to half of his dry weight. However, his urine output was practically zero (hence the kidney failure). So, lots of fluid going in, nothing coming out: Jonah began getting puffier.
So although his liver was shot, we knew the one chance he had to live was if his kidneys began working again. Throughout his 9 day stay in the ICU, each day I went into work wondering whether the Jonah had peed at all overnight. If so, he was going to have a chance to get rid of all the fluid we were pumping into him, and have a chance to survive.
However, every day, when I got to Room 8236, the chart that awaited me had bad news. Each day, the first thing I raced to was the urine output column: 40 milliliters in 24 hours. Ouch. His daily input was hanging around 900 to 1,500 milliliters- he was gaining around a liter of fluid a day.
By the end of nine days, he was bigger than an overweight 9 month old.
The thing that killed me was that none of the doctors ever really told his parents how bad it was. One day, they were taking a much-needed break down in the lobby and saw me leaving. His dad pulled me aside and asked hopefully how he was doing. That particular day, he had been bleeding immensely out of his umbilical line and we almost could not stop the bleeding. I had no idea what to say. Shouldn't the doctors have let them know how close to the edge he was?
Each day, Jonah looked worse and worse. My second to last day of the rotation, one of the attendings told me that Jonah had the worst case of edema he had ever seen. Jonah's whole-body edema was so bad that he even had chemosis, a condition in which the water accumulates under the whites of your eyes and makes you look really freaky. Not that his eyes were open; his swollen lids spared his parents from seeing it.
The last day of my rotation, I showed up almost 30 minutes late due to the OU parking office accidentally shorting me one day of my permit, hence leaving me without a parking spot and scrambling to find one on our cramped campus. After I walked into the resident room, I grabbed an exam sheet and headed over to 8236. He had looked so ghastly and awful the night before. Did he pee??
As I approached the room, I saw a huge crowd of crying family members gathered around the doorway. I turned around, threw the sheet into the trash and walked back.
Over night, the attending had informed Jonah's parents that after 8 days of liver and kidney failure, the chances that he would recover were basically zero. Although he was on a lot of pain medication, he was probably still suffering. That kind of edema would be incredibly painful. And so, they took him off all his drips and the ventilator early that morning. He lasted on his own for almost five hours before my arrival. After I'd seen the family crying, I sat down in the resident room for a moment to think. Jonah died less than five minutes later.
I went in to hug his parents. After coming in to see him every morning of his stay, I had a lot of internal emotions toward the parents and had prayed for them a lot. They looked awful and were sobbing. Although Jonah was so swollen, I grabbed his little hand. You could still see the softness of his little tufts of golden hair. Oh...
And so my very last duty on that rotation was his death summary. And so, this is why I can never work in a children's ICU and also... why I continue to eagerly anticipate the day when there is no more suffering.
Due to HIPPA, no one is allowed to share medical information together with a patient's name. So the following story is true but the sweet baby has an alias. This story is one I have been thinking about for the last month and one with which I am just now coming to terms.
I had been at Children's Hospital a little over two weeks when I showed up to work one Wednesday morning and was greeting by our sweet, smiling upper-level resident, Kim. I'd had two asthma patients the day before who had both been discharged, and so was coming in with nobody on my plate. Immediately upon entering the residents' office, Kim informed me that she had a baby for me to follow. He would be the only patient I saw that day, as his case was complicated. His brief history is as follows:
Jonah was born seven days previous to his admission to the PICU. When he was four days old, his mother took him to the doctor, because she was concerned about constipation. The doctor noticed that Jonah had a low oxygen level on room air. He admitted him to the hospital in Lawton where he was started on some antibiotics.
That afternoon, Jonah's mom noticed his eyes crossing, lips puckering, and legs stiffening while his oxygen levels continued to fall. That evening, he had an episode that the mother recognized as a seizure. One and a half hours later, he had a second seizure lasting approx 3 minutes. Medflight was called to transport the baby to our hospital in OKC. Upon arrival, the paramedics found that his heart was not beating. They proceeded to intubate him and gave him chest compressions. He had another seizure en route to the hospital.
Then Kim paused and she said, "This is the part of the story that is so sad."
Kim was the resident on call the night Jonah came. Upon arrival at the PICU, Kim examined him, wrote an admission note, and was about to leave the room when Jonah's mom mentioned to Kim that she had painful, vesicular lesions on her right breast. Kim examined the lesions and realized that they were a primary outbreak of herpes.
There are only a few reasons that a person should not give birth vaginally. One of them is if the mother has a vaginal infection, because as the baby goes through the birth canal, it will mostly likely contract the infection. If it is a bacterial infection, like gonorrhea or chlamydia, it can be treated. However, if it is a viral infection, there is very little that can be done. Tiny infants also have virtually no immunologic defense against infection, and therefore, when they contract viral infections, it is very easy for the infection to get into their blood and spread to all their organs (called sepsis). It is very serious and frequently ends in death.
So that is how it came to be that Jonah contracted herpes from his mother. The mother had no idea.
Kim immediately got cultures of eye, skin, nose, trach aspirate, blood, urine, and rectum. And also of the mother's lesions. We already had a pretty strong suspicion that Jonah had sepsis due to disseminated herpes; when the cultures came back a few days later, the suspicion was confirmed. Everything was positive.
I went in to see Jonah that first day and he didn't look too bad. He weighed almost seven pounds and had little tufts of blonde hair. He did have some bruising from where they'd put IVs and lines in him- mostly around his umbilicus and thighs. With a blanket on, you could almost think he looked normal. (Apart from the tube going down his throat.)
However, when I got to his chart... wow. This baby was complex. Most of my other patients had their vitals and other stats monitored every hour. Jonah had everything normal plus more monitored every fifteen minutes. His chart was blackened with tiny little numbers. This was going to be complicated.
He also had every lab known to man done every four hours. The main things that concerned us were his kidneys and his liver. Here is why:
If your liver stops producing certain proteins your body needs to make blood clots, you bleed easily. When you have a lot of IVs and lines, you need the your blood to clot quickly. If it doesn't, you receive a LOT of blood products. Cells, plasma, and all these clotting proteins. Your medicines can also only be concentrated so much. In other words, you get a LOT of fluid going IN.
If your kidneys stop making urine, its very hard to get rid of the fluid that you take in and that your body naturally makes. What do we do for people who have kidney failure? We give them dialysis. Dialysis, however, requires a big hole. And its pretty easy to bleed a lot out of big holes, so if you are going to have kidney failure, you need your liver in good working condition, making all the clotting proteins it is supposed to make.
So, either your liver or your kidneys can fail, but it is really bad news if both stop working. So basically, my job every day was to do all the math on Jonah's intake (all the fluids, medicines, etc going in) and his output (urine, blood, vomit, etc), as well as looking at all the labs every four hours and all the medicines he was on and figure out if his liver and kidneys were going to start working.
So initially, we knew he was in liver and kidney failure. He wasn't producing any liver proteins, and so we had to continually replace all of them, so that he wouldn't bleed out of his lines. However, this meant that that in the first 24 hours of his hospital admission, he was given almost a liter and a half of fluid. That was equal to half of his dry weight. However, his urine output was practically zero (hence the kidney failure). So, lots of fluid going in, nothing coming out: Jonah began getting puffier.
So although his liver was shot, we knew the one chance he had to live was if his kidneys began working again. Throughout his 9 day stay in the ICU, each day I went into work wondering whether the Jonah had peed at all overnight. If so, he was going to have a chance to get rid of all the fluid we were pumping into him, and have a chance to survive.
However, every day, when I got to Room 8236, the chart that awaited me had bad news. Each day, the first thing I raced to was the urine output column: 40 milliliters in 24 hours. Ouch. His daily input was hanging around 900 to 1,500 milliliters- he was gaining around a liter of fluid a day.
By the end of nine days, he was bigger than an overweight 9 month old.
The thing that killed me was that none of the doctors ever really told his parents how bad it was. One day, they were taking a much-needed break down in the lobby and saw me leaving. His dad pulled me aside and asked hopefully how he was doing. That particular day, he had been bleeding immensely out of his umbilical line and we almost could not stop the bleeding. I had no idea what to say. Shouldn't the doctors have let them know how close to the edge he was?
Each day, Jonah looked worse and worse. My second to last day of the rotation, one of the attendings told me that Jonah had the worst case of edema he had ever seen. Jonah's whole-body edema was so bad that he even had chemosis, a condition in which the water accumulates under the whites of your eyes and makes you look really freaky. Not that his eyes were open; his swollen lids spared his parents from seeing it.
The last day of my rotation, I showed up almost 30 minutes late due to the OU parking office accidentally shorting me one day of my permit, hence leaving me without a parking spot and scrambling to find one on our cramped campus. After I walked into the resident room, I grabbed an exam sheet and headed over to 8236. He had looked so ghastly and awful the night before. Did he pee??
As I approached the room, I saw a huge crowd of crying family members gathered around the doorway. I turned around, threw the sheet into the trash and walked back.
Over night, the attending had informed Jonah's parents that after 8 days of liver and kidney failure, the chances that he would recover were basically zero. Although he was on a lot of pain medication, he was probably still suffering. That kind of edema would be incredibly painful. And so, they took him off all his drips and the ventilator early that morning. He lasted on his own for almost five hours before my arrival. After I'd seen the family crying, I sat down in the resident room for a moment to think. Jonah died less than five minutes later.
I went in to hug his parents. After coming in to see him every morning of his stay, I had a lot of internal emotions toward the parents and had prayed for them a lot. They looked awful and were sobbing. Although Jonah was so swollen, I grabbed his little hand. You could still see the softness of his little tufts of golden hair. Oh...
And so my very last duty on that rotation was his death summary. And so, this is why I can never work in a children's ICU and also... why I continue to eagerly anticipate the day when there is no more suffering.
Friday, January 02, 2009
A New Year, 2009!
Isn't a new year such a refreshing feeling? I have written 2008 at least a couple of times already. Stopped and realized.... it is 2009 now! Ahh... mostly, its a chance to start again. And who doesn't love that?
2008 was full of kindness and good things, but it was all mixed with a lot of sadness. I can't say I am sad that this year is over. I am so excited for the new!
I did some research on New Year's resolutions on the internet and I am now planning to stop smoking and lose 50 pounds. Anyone else with some New Year's Resolutions?
2008 was full of kindness and good things, but it was all mixed with a lot of sadness. I can't say I am sad that this year is over. I am so excited for the new!
I did some research on New Year's resolutions on the internet and I am now planning to stop smoking and lose 50 pounds. Anyone else with some New Year's Resolutions?
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