Friday, September 26, 2008

How about some tact...and a side of discretion?

I knew that once I made my "this is the last post before I go to India" post that something would happen and I'd have the urge to make one...last...post...again.

I sent this story to a friend this evening and then knew I wanted to put it up here. I mean really...what is a humiliating public experience good for if you don't use it as blog fodder??

---

So I got my friend Dr. A to write me a script for all the things I might possibly need for any variety of illness or accident that could occur. He's been to India so I just put it into his hands. But I didn't look at everything he wrote down on the script...

I go, drop it off at busy drug store midday...hum de hum...just killing time...waiting for my Rx...

When I return to pick it up the pharmacist tech inquires in a very loud voice,

"are you waiting for a Rx?"
"yes"
"what is the last name?"
"Blackbear."
"Albino?"
"yup"

There are several people milling about also waiting for their drugs. She says over their heads,

"Your doctor ordered something that is over the counter, do you want me to grab it for you?"

"Sure."

I get up thinking...what could that be? She walks through the line and grabs a tube of canesten (yeast infection cream) out of the aisle, holds it up and says in her not-so-sotto voice

"He ordered a waaaaay bigger amount than this...do you want me to grab you a few packs?"

"um...no...that is fine"

I assume the public humiliation is over but she's just getting started.

"So, this is an ANTI-FUNGAL cream and it is MEANT FOR THE VAG but you can put it anywhere"

I am torn between thinking, 'did she just yell out VAG?' and trying to form a response that might truncate this exchange.

As she steps behind the counter she turns the box over in her hands reading the side,

"Yep. For the VAG but if you have a FUNGAL INFECTION anywhere else it'll work there too"...

Thanks, I can read. Please don't trouble yourself by reading me the information off the box!!!

Also, please allow me to dig myself into the linoleum now as I note the fellow customers take a precautionary step backwards.

Its not like I can save face my announcing to the crowd,

"I don't actually have a VAG infection (really, I don't) it's just that I am going to be traveling in some remote areas and I wanted to bring some medications just in case...I mean, I don't even GET yeast infections but my friend ordered it for me because..." shit.

So I hold my head high and try to pay with some dignity.

I still can't believe she used the word VAG!!!!

Hello Himalaya!

The time is drawing near.

Right now the house has many Albinoblackbear-made piles around it. Clusters of electronic charging devices, stacks of medical supplies, collections of scrub tops and underwear, hordes of powerbars.

OK now it is starting to sink in! I am actually going to India!

Packing is a bit of a challenge as the weather will be changing drastically. I checked the temperature this morning and it is 31°C (about 88°F) in Delhi but in the first of the Himalayan cities we are going to the low is around 6°C (46°F) for today. So in go the flip flops and the down jacket I guess!

I finally realized one of the perks of working in health care when I showed up at my ER around midnight (knowing it'd be a bit quieter) and got one of my colleagues to give me a script for the little-old-lady-like shopping list of prophylactic meds I want to bring. Man I am going to have a tricked out first aid kit!

So I am not sure how much I will be blogging while I am gone (almost never) but I will be keeping a journal while on the road. I look forward to the emotional, physical, and mental shake up this trip is going to give me. It is most needed.

Until I post again!

ABB

Saturday, September 20, 2008

Ughhhh.

I've had this sinus cold for almost 2 weeks now. This is my first really bad one and now I see what all the fuss is about. I had a couple of days off between my sets of nights last week and spent most of it in bed, trying to sleep. I guess I did get out for an afternoon hike with Same Name which was great, but once the Advil Cold and Sinus wore off I turned back into a snotty troglodyte. I had a day off yesterday before starting this set of 12h shifts, and you guessed it...I was horizontal for most of that as well. Awesome. I am going to be in wicked shape for this trip. Maybe they will let my donkey carry O2 for me. (Yes there are going to be donkeys to carry the clinic supplies). Wait, maybe they will let the donkey carry me.

This morning I woke up and I swear the infection has moved into my right mandible and zygomatic arch. Either that or I was grinding my teeth last night something fierce.

I have a stash of moxifloxicin which one of the docs at work gave me for my trip...I am resisting the urge to start taking them. Step. Away. From. The. Moxi.

Speaking of my trip I just realized that I am leaving in 8 days. 8!!!

I am not finished any of my applications and am thinking I may pare the list down because at this point it is about quality applications not the quantity.

Thursday, September 18, 2008

Fine Motor Skills

I enjoyed myself immensely tonight at work.

Partly because it started off with a code. Yay! A real emergency!

Not just the usual "abdo-pain-NYD-and-bed-4-is-waiting-for-second-trop-then-they-can-go-give-this-guy-a-tetanus-shot-and-a-migraine-in-bed-5" start.

Then one of my favorite docs let me suture a stabbing victim's wounds up.

Double yay!

This is a unique opportunity for me because when I am suturing in the North there is no one around to look at my technique or results to give me feedback and suggestions. It's great to have someone else watch and tell me what I am doing right or wrong so the next time I am in the middle of nowhere Northern community suturing someone up at 2 am I'll feel slightly more confident.

The best part was the fact that the feedback was "You did a perfect job. Don't be so worried about your work, you're obviously a perfectionist. Very well done."

Woot!

One of the other nurses said, "I suppose you don't wake the doctor up for sutures when you're up North hey?"

"Uhh...there are usually no doctors in the places I work...sometimes the nearest doctor is 4h away by plane..."

"Oh! Really?"

"Yeah."

I guess when I say that I work in 'remote' places sometimes the logistics aren't totally conveyed.

Saturday, September 13, 2008

I Was There, In the Room

I was just having a conversation with a friend of mine a few days ago about when people cry out in true anguish, and how those cries remain carved into your memory.

I told her of the two cases which still make me shiver when I think of them.

The first was a 43 year old woman who miscarried 14 week old twins in the department. Her absolute desolation was heart wrenching as she sobbed and cried out for her babies, apologizing to her husband, and uttering, "this was my last chance..." It was enough to move several of the staff to tears that night. I can close my eyes, and I am standing in the hall between the patient bathroom and the gyne room. A small basin is in my hands, and there are two baby boys in it.

The second case which comes to me often, was a 13 year old girl who jumped out of her second story window to sneak out to a party. She landed on her back, crushing her lumbar spine. I knew it was bad when I looked in the report room where the MD's pull up imaging results. I saw the ER doc sitting with his head in his hands. He got up and walked into the patients room, and a few minutes later the scream of despair at her diagnosis of paralysis echoed through the department. For hours she screamed and screamed, "NOOOOOOOOOOO!"

I can still feel myself standing behind that nursing station desk, the desk lamp shining on the charts beneath it, the overhead lights dimmed. My heart pounding.

I know that last night will be one of those nights now too. One that will stay with me a long, long, while.

4 teens were in a car which lost control and rolled over down a rocky embankment. The front seat occupants were both killed and the two back seat occupants were brought into the department. Both were in mild shock but physically stable. While we waited for the urine test to come back on my patient I sat and talked with her. A gorgeous girl with long curly hair down to her waist, mascara lining the contours of her face. She kept telling me she was fine and wanted to know how her friends were doing. She'd start crying softly and apologize to me for doing so. She told me the driver was her best friend, that she tried to wake her up at the scene but couldn't. "Please try to find something out about her, why isn't she here? Can I see her?"

I'd been told that her friends were waiting outside and that they didn't want her to know until she was sent home. Her urine came back clear and she was discharged. I walked with her out to the parking lot just as the parents of one of the surviving friends showed up. The night air has a chill to it now and soon we were both shivering as we walked out to the cluster, she asked me, "is she out here?" Her friends put their arms around her. I walked back into the department to grab her a blanket. Just as the ambulance bay doors swooshed closed behind me I heard her cry out "NOOOOO!!! YOU HAVE GOT TO BE KIDDING! YOU'RE LYING!!!! LYINGGGGGG!!!"

I came back out and she was being supported but her friends, she was wretching, crying, knees buckling. Her white shorts and legs were spattered with blood and on her feet the blue OR booties I'd given her. We gathered around, tried our best to support her.

After some time myself and the other nurse returned inside. I went into the staff lounge and fell asleep. I know that sounds harsh but I was running on 4 hours of sleep and the high emotional intensity of the night had sucked the remaining drops of energy from my bones.

After my break I returned to a quiet department. When the shift was over I felt the beginnings of my cold getting worse and exhaustion seeping in. Stepping outside the sun and seeing the rising mist at the bases of the mountains, I was reminded that there were things to be celebrated, and things to be grateful for. I drove out of the city limits, pulled my bike out of the back of my car. I went for a long road ride to think about the evenings events, how the feelings were going to be shaped in my memory.

My job, which can be horrible (yesterday's post), can turn around on a dime and suddenly become a high honor. When Eve Ensler writes about birth she starts with a line, "I was there in the room..."

For birth, and death, and everything in between...we are there...in the room. And that is why, I love this work.

Friday, September 12, 2008

Code Brown

I was asked to come in early for my night shift yesterday and agreed---not for any altruistic reason---for the double overtime. I was supposed to start at 2330h but instead started at 1930h.

I arrived and my first task of the day proved to be helping a 75 year old woman out by disimpacting her. That's right, sticking my hand up inside her rectum and pulling out clumps of poo. (To my delight I only gagged once and didn't get the usual waterbrash and watery eyed reaction I get when dealing with #2. I also couldn't believe my luck that I had made it this far in my nursing career without doing a disimpaction. It is somewhat of a right of passage.) The best part was when I stepped out to grab some more gloves she decided to give it a go herself and when I re-entered the room grabbed my forearm with her poo-mitt to steady herself.

Um...can you say "clorahexadine shower"?

Unfortunately it appears that the baseball sized lump of badness was what was keeping in her G.I. bleed.

Yeah. If you've never smelled a G.I bleed you ought to crack a beer and toast the universe now because you've got something to celebrate.

My problem went from dealing with someone who couldn't let it out to someone who couldn't stop letting it out. Just as fast as we stripped her bed, changed her gown, rolled her back and forth about 7 times to put new sheets and pads down, the great tide of feces flowed forth. I resigned a couple of times within a half hour period but the site leader wouldn't accept said resignation. I started using the "I love my job" mantra to ensure I was mouth breathing.

After a few hours of this her repeat troponin came back elevated indicating that there was some cardiac cell death likely happening...oh and her lactate was high as well...oh and her WBC...shall I go on?

So she needed to be transferred from the sub-acute section of the department and into the cardiac monitoring area. I gave report to the other nurse, scrubbed every square section of exposed skin on my body until it was raw, and sat down for the first time since arrival to chart.

I looked at the time:

2337h.

Which goes to show, you should never do anything for the money.

Wednesday, September 10, 2008

Blog Award

In the dead heat of LBMCAT (Life Before MCAT) Rogue Medic gave me a Blog Award.

I was flattered for a couple of reasons.

1) He writes well researched, thoughtful, interesting, funny posts on things medical. I respect the amount of time and leg work he puts into his blog (unlike myself who pretty much uses this forum to whine and/or tell the odd quirky story about ED work). I don't know how he stumbled upon my site but he seems to think I write well and has given me many props and readers in the short time that Asystole has been up and running...er...'flat-lining' I guess.

2) I assumed that no one really read my long, drawn-out, gratuitous postings from start to finish...but evidently he does! And it appears there may be others out there...to quote the famous Oscar acceptance speech, "you like me! you really, really like me!!"

Not sure about the real reasons I even have a blog. Blogs.

I used to keep a journal pretty religiously but when I started blogging I stopped because I thought that OTB would be an on-line journal that no one else ever looked at. But my only-child-like-attention-seeking attributes made me want to be a popular blogger. ME! ME! ME! ME! LOOK! AT! ME!

But my journal was mostly random notes of self deprecation, resolutions regarding discipline, really bad poetry about love gone wrong, mandolin tabs, recipes, and more whingeing about my love life. Really...who would want to read that? But secondly, why would I want to put it out there to the world? Do we all have a little Jerry Springer guest living inside of us? (Wait. Has any guest on Springer ever been 'little'?)

*Shudder*

So now I have ohtanninbound for the "life" side of things and this blog for the "medical" side of things. But clearly the two overlap. And I find myself sugarcoating/downplaying/deleting a lot of my posts on OTB because now there are people who read it (careful what you wish for) and I don't know if I want folks knowing things are feeling pretty rough right now in many many ways. Okay. I guess I do.

Wait. I was talking about my blog award. And this is on Asystole. I am sleep deprived.

Back on track...this award thing has rules and they are as follows:

1.You have to pick five blogs that you consider deserve this award in terms of creativity, design, interesting material, and general contributions to the blogger community, no matter what language.

2. Each award has to have the name of the author and also a link to his or her blog to be visited by everyone.

3. Each winner has to show the award and give the name and link to the blog that has given him or her the award itself.

4. Each winner and each giver of the prize has to show the link of “Arte y pico” blog, so everyone will know the origin of this award.

5. To show these rules.

Well...I am not very good at following rules. Besides, there is no possible way I could pick 5 blogs to give this award to. I love all kinds of blogs for different reasons. And really, who am I to judge anyway?

My friends have brilliant blogs (L. Corn, Nature Nerd, JFS, Curmudgeon), but I have a context for them and it is a way for me to feel like I am 'in the loop'. They crack me up also. It's good to surround yourself with people who have razor wit...keeps one sharp.

I read a gaggle of medical related blogs. Some I find offensive yet hilarious, some just let me get my ER groove on while I have my cereal* (see Whitecoat and ERstories) but would likely leave non-medical people bored (or confused). Others have posts that chronicle the major and minor events in a med student's life which I enjoy, partly because they give me a constant reminder of what I am getting myself into. BINY, OMD, BB are my top three because I think they are all people I would enjoy working with based on their views of patient care, random pop culture references, dedication to athletics, and quirky humor. Really...what more could you wish for in a colleage? To add to that, I've recently started skulking around Dragonfly's site, her post on interpreting letters is nothing short of brilliant...check it.

To round out the "smile on your brother try and love one another" post I appear to be creating...I must confess to my guilty pleasure in the form of Cute Overload (seriously, don't knock it 'til you try it...I don't get my kicks out of the cuteness per se, but the banter attached is so unapologetically devoted to the cause and humourous I visit it almost daily).

Oh, and of course...Fail Blog. How I wish I'd had the comic genius to come up with that one.

Okay, that's enough for now. I started this post 12h ago before going to work....and now I've been up for >24h which means I am entitled to an eye mask and some shut-eye before I get back on the merry-go-round tonight.



*It really is the best cereal ever. The best. Try it. And no, I didn't get free samples for saying so.

Sunday, September 7, 2008

Space Shifting


My friend Nature Nerd was leaning on me pretty hard to go hiking last weekend. And though I had a million things to do (like pack my belongings and work on med school applications) I agreed. And it was good.
The decompression post-school and MCAT was very much needed.
Seems the best thing to do after a stressimus maximus year is hit the trail and enjoy the views.

We hiked in and set up camp the first day, which allowed some sweet rock scrambling with only day packs for the second day.


The snow stared to fly so we headed down and back to camp. It would have been a slippery descent. And since one member of our party was a little off balance due to her 24 week gestation state, it might have gotten ugly.

Check out the wicked avy paths on mountain in the distance.
Certainly helped to get me amped about my upcoming trip as well...and break in the new hiking boots.

Saturday, September 6, 2008

The List Continues

McGill
McMaster
Northern Ontario School of Medicine
Queens
Memorial
Dalhousie
Ottawa
Toronto

That brings the count up to 17 applications total so far. Not including the US and Australian schools.

If I don't get in to at least one I will have to re-evaluate my career choice...oh...and my self esteem...

Friday, September 5, 2008

Denouement

When my father died 6 years ago I was given an amazing gift. This gift was seeing people in my life emerge from the mists of the past to stand behind me, around me. It was like a great circle of arms holding me up. From junior high social studies teachers, to former roommates I'd lost touch with, to nearly unknown classmates--I received food, mix tapes, wine, money, hugs, cards, laughter. My childhood friend arrived on the next available flight. And even though this time was difficult, disorienting, and sad...it was also joyful. Joyful because I was able to see how many people cared about me in a time when loneliness would have been treachery. I was stunned and humbled by the love that came my way. And though after it was over many retreated to the background again, I am comforted to know they are there. A silent army of support.

These last few weeks have shown me that network still remains rooted in the soil beneath me. On the days leading up to and after the MCAT* I received many phone calls, emails, and visits. I was contacted by friends, strangers, bloggers, and family members, stretching from the western Arctic to the eastern Arctic, through the US, down to Australia.

People have busy lives, worries, and children...dogs, jobs, and stressors of their own yet many contacted me to say things like, "oh, on the day of your mcat I shut the door to my office at 2 o'clock and just sent you thoughts of peace and clarity for 10 minutes".

Truly amazing. It worked.

The exam was long, and challenging. And if you know me, you know I have terrible test anxiety. I used to get nose bleeds during physics exams and once completely blanked on a chem midterm (forcing me to hand in an empty exam). But on the day of the most important exam of my life (to date) I was calm, cool, and collected. No PVC's, no diaphoresis, no memory blackouts. I answered the questions I could, guessed on the ones that I couldn't. Smoked the essay component. And stayed calm.

So again in a very difficult, stressful time in my life I have been astounded by the thoughtfulness of the people near and far from me, even ones who don't know my name sending me well wishes. My little nephews keep asking, "Auntie, when do you find out your GPO?"--not sure where they get the "O" from but it is still cute. If I heard "I am SO proud of you" once, I heard it a dozen times.

It will still be weeks until I find out my grades and how my shot at medicine is starting to shape up. But honestly...no really, honestly if I flopped it, that will be okay...I was given something separate from grades and admission offers. At the end of this long and arduous road I've been on I was given the opportunity to see that though often these days I feel alone...I am not. And blessings...I have many.

It has been a difficult time, most definitely. The day after the exam I was on the couch staring at the wall for hours wondering where the last year and a half had gone and what I had to show for it. Has this all been worth it? Is medicine really what I want? What are the things I value in my life?

It's a work in progress. Hoping some of that fine Himalayan air will give me some insight.

*(There is one very non-incriminating photo of the post MCAT celebrations on ohtanninbound. Yes there was a wee celebration that night.)