Probably Not a DVT

Aww thanks for all of the comments and emails!

Ok, I am a freak for jumping to the ED nurse conclusion (med student-itis maybe?)

But that was some CRAZY muscle cramp. 

Leg is 100x better today, almost completely symptom free. I was told to "walk it off" by one of my classmates. 

*And yes, I think Cartoon Characters was right--dehydration makes the most sense. I was really good about hydrating on the plane, it was the 12h after that with moving and unpacking that I dropped the ball.  And yes, it was actually the *worst* pain I have ever felt in my life (not that I have undergone serious trauma but have had my share of sports related injuries to compare it to). 

That was Weird

So I arrived in Ireland on Friday afternoon. The entire journey was pretty uneventful. Seems that 3.5h is almost the perfect amount of time to go through customs, change terminals, check-in, window-shop for 20 mins, buy a coffee and find your gate in Heathrow. Luggage arrived intact (miracle compared to last year) and Tobie was there to greet me at the airport.  A nice change from the complete meltdown that occurred near the police kiosk in the airport last year as I tried to figure out how much of my belongings had been left on the tarmac in Philly after they drove over my suitcases.

This year, instead of having snot and tears all over my face at the arrivals gate I was getting giant hugs and kisses from a very sexy man in a cashmere sweater. Really, you can't top that. I think 2010/11 is going to be a good year.

Arrived to the new pad and was blown away by how much I love it. It has some beautiful views of the river (photos posted soon) to be enjoyed from our plastic (read: indestructible) furniture. Though I must say, this year it is brown instead of lego yellow and red. 
Tobie has spent the last week unpacking all of our stuff and making the place look cozy. He folded all of my clothes and stylishly  organized them in the closet (thanks to his training as a clerk in Simons) and even set up all my med books in the office. We had a most lovely dinner of smoked haddock (poached), salad, and potatoes.

Tobie really is a great cook. All I could think about from the moment that I stepped off the plane was what an incredibly lucky lady I am. 

It was during the night that things got weird. I went to bed feeling normal-ish. Well, as normal as one feels after being awake for 30+ hours, flying across the ocean, and moving into a new apartment. 

I awoke with a start and all I could think was PAIN!!!!!!!!!

I literally jumped up in a panic PAIN PAIN PAIN PAIN PAIN!! I was still in a sleepy haze but something was seriously wrong. I was trying to talk but all I could say was "this is the worst, this is the worst, this is the worst, this is the worst". I woke Tobie up with all the thrashing and remember him saying "the worst what? what is going on??"

I had this crazy cramp in my left calf muscle. I mean, C-R-A-Z-Y. Now I am no stranger to muscle cramps, I used to get them from years of highland dancing. You know, the ones in the arch of the foot or calf that are so intense you feel like you are going to vomit? This was different. 

Took some ibuprofen and tried to calm myself down. Eventually the intensity settled but it seemed to hover on the cusp of sliding back into agonizing pain. I suddenly thought...birth control pill + many hours of sitting in cars and airplanes= oh shit, I have a DVT!

The next day my leg felt really strange. Heavy and aching in a dull way in the calf area. I measured my calves and they seemed to be roughly the same size (within a cm), couldn't feel any heat or see any redness. Did have a HELLA positive Homans sign (yes I know, contentiously significant).  Frustrating being here in Ireland because if it were Canada I know I could have a d-dimer and doppler done within hours and know for sure. Here that would involve hassle and me shelling out a LOT of money.

Today I woke up with the pain/fullness/tightness slightly diminished. Now I am wondering, was that just the calf cramp to beat all calf cramps?? So bad that it actually created muscle PAIN for 2 days afterward? Or is it a DVT and should I be on the next unreliable bus to the A & E department? Gah. Thoughts?

At least I could administer my own SC injections...

Boo. This displeases and uneases me. At least everything else is wonderful!

I've Been Livin' Outta This Here Suitcase For Way Too Long*

Pretty much packed.

The last few days have not involved a lot of sleep, but have involved me wrestling with many bags and suitcases. My last shift as a nurse was a pretty quiet one, but a nice one.  It was one of those days where nothing really bad or sad happened, no one yelled profanities at me, I didn't end up sprayed in a bodily fluid.

Just another day in the ED, running with crash
carts and IV poles.

Returned back to the house, finished packing and organizing. The morning was hectic and I was tired as hell. The long and many hours of hospital work this summer seemed to really catch up with me the last few days. I went through the usual cycles of hating my belongings "how come I have so much stuff??" feeling nostalgic about the place I am leaving "why do I always seem to be leaving great people and places??", excited about where I am going "can't wait to see Tobie, can't WAIT to see Tobie", and then just pure limp exhaustion.

Left early for Alberta, but had a long delay in Vancouver so I treated myself to a 10 min neck massage (best airport store idea EVER) and bought Tobie's birthday present.
Arrived back in Edmonton and have basically been unpacking, repacking, organizing, doing last minute errands (buying new runners, internet cables, international drivers license, etc.) Last night a dinner and night out with some very very near and dear friends. Ate at one of my favorite restaurants (hello bison short ribs, where have you been all    my life??) and then pints at a casual pub. The girls are good, so good to see.

And finally getting to see my family. My beautiful nieces and nephews who really just continue to amaze me with their intelligence, humor, talents, and cuteness (naturally). We had a delicious feast which included some nice cuts of meat that ye olde student will not be enjoying again for some time, a seriously 5 star home made birthday cake, gnom, gnom, gnom, and bubbly.


Tomorrow some very very last minute purchases to make, one last great pack/re-pack and then it is off to the airport and direct to Heathrow. A painfully long 3.5h layover and then to Ireland.

Year 2. Bring it.

--

*A line from one of my favorite Ray LaMontagne songs, Jolene.

Last Shift as a Nurse

My last shift as an R.N is tomorrow.

I can tell already that I am not going to sleep tonight.

Hip Replacements and Baby Catching

This past week was amazing.

Some of the highlights.

I delivered my first baby! Yes. It turns out if you harass the maternity nurses and docs enough they will call you up to catch one. I had witnessed a few during the summer but it wasn't until the day before my birthday that I got to catch my first one (thanks Doc R!) Baby Jessica was 9 lbs 4 oz, slippery, pink, screaming and born with a head of dark curls.

I was so excited in those last few pushes I had to clasp my hands together in order to keep them from inadvertently just reaching in there and taking the babe out or patting the perineum with anticipation. Doc R and I had gone through the steps verbally ahead of time but I hadn't really thought of what I was meant to do once the slippery, heavy, squirming baby was actually in my arms! I think I was giggling and cheering and almost (sorta) tearing up and then thought-- "er...do I put her down or clamp the cord or...ack!" It was a crazy wonderful blur and flurry of activity, Doc R helped me from there, "yes...just set the baby down now", "oh, right".

Yes she did give me permission to post this photo of her.

That afternoon I got to scrub in for a great toe amputation. It actually amazed me at how simple and slick it is to remove a toe. The thing really didn't give up much of a fight at all, just a couple of swipes with the 'ol scalpel and, thunk! It's in the bin. For some reason I just assumed that everything in the body was really anchored down. Meshed together, tightly woven. I suppose that I've always thought that because in order to have survived the sabre toothed tigers, bears, falls, wars, famine, the body must be a very study structure. But as I am seeing more and more in the operating room, it really isn't.

The next day my colleagues kindly let me spend most of the day shift (which was supposed to be spent working in the  emergency department) scrubbed in on several orthopedic surgeries. Ok, let me just say now, I take back EVERYTHING I ever said about orthopedics.

How I could never do it. 

How I could never stand to watch such brutal surgeries. 

Oh how very off the mark I was. 

Let's just say, tendon harvesting for ACL repairs is a thing of beauty. I was actually operating the arthroscope for that one. Hello that is not an easy task. When you are staring at a large screen tv it is difficult to immediately appreciate that moving the scope 1mm actually turns your field of view to a completely different scene. I could feel the sweat running between my shoulder blades and down the backs of my knees, 

just don't screw up

don't lose what he's trying to look at

don't pull the scope out by accident. 

Yeah, I did all three. Considering the fits of rage that I'd seen come from Dr. S I was expecting him to wrap the scope around my neck and throttle me with it. But to my surprise he only called me a 'useless assistant' a couple of times and commented on how much I was slowing him down once! He also yelled pointed out that holding the scope for the first time was no excuse for not doing a good job. I was in bone-chip, bloody, tendon harvesting heaven so it didn't even bother me. He let me pull the finished graph through the hole to where it was anchored. Pretty amazing actually. 

Other thoughts from the day included, 

Wow! the plantar fascia is REALLY thick and white!

I can't believe that a hammer and chisel were just used to crack open that calcaneus! 

Exposed muscle really is a thing of beauty!

I think I might faint from hunger and sleep deprivation soon!

Hey. I didn't say they were deep thoughts. 

There was also a theme party--70's due to the decor in my living room. It was a combined triple birthday party/retirement from nursing for ABB party. 

Things really took off when both Karaoke and Dance Dance Revolution showed up. 

Yes I am wearing a giant peace sign bindi. Thanks for asking.

There was also a beautiful 15km hike one day, some c-sections, entertaining shifts in the emergency department, dinner on a cruise ship, the move into a new (wicked) house, a meteor shower, and possibly a hang-over somewhere in there as well.

Two shifts left as a nurse. So many memories rising to the surface. Almost exactly 7 years to the day that I graduated. 

My Favorite* Orthopod

Today was my last day scrubbing into the O.R before heading back to Ireland.

I've had so much fun this summer getting to assist with the orthopedic surgeon and the general surgeon. Here is a photo from today, Dr. S captured in a rare moment where he wasn't yelling at someone, swearing, making an inflammatory statement, or all of the above at the same time. In all seriousness though, I've learned a ton from this man. He really took a lot of extra time this summer to teach me with every opportunity and it is very much appreciated. Not to mention the fact that he is a KICK ASS surgeon. Too bad he'll probably be retired by the time I need a knee replacement.

Pre-game before a hip replacement. 

*I told him not to be too flattered....he's the only orthopod I know.  :)

Seriously

That was one helluva strange night. It was like the ED axis was spinning just slightly off kilter. Whatever the chief complaint was,  it had nothing to do with what was actually bothering them.

Chief complaint: shoulder pain
Actual problem: Baker cyst x 3 months causing leg stiffness which resulted in a fall which resulted in the shoulder pain which resulted in exasperation over Baker cyst, which resulted in ED visit despite impending surgical consult for removal of cyst very soon.

Chief complaint: shoulder dislocation (2 weeks ago)
Actual problem: scabies (and alcohol abuse)

Chief complaint: dizziness
Actual problem: desire for expedited nursing home placement

And it went on like that.

I had the husband of an IV ABX dental abscess refuse to look at me and just kept repeating over and over again, "I want to speak to the doctor". He wasn't quite getting the concept that there was NO doctor in the department at the time and at 0100h NO doctor is going to come in from a warm bed or give orders on a patient unless the NURSE makes it happen.


Then there was the completely obtunded teen that drank himself into a bedwetting stupor.  He awoke from the depths of a Silent Sam induced coma to drag himself to the ED patient washroom. He then pissed all over the floor, wall, sink and escaped out the other entrance to the bathroom. When mom arrived to pick him up a few minutes later I went to get him out of the bathroom only to find a trail of urine footprints out the other side. I did some frantic searching through the few unlocked doors on the main floor and into the basement, worried that I might find him head first down a stairwell or something. Then saw that the pissy-prints went out the front door. I offered to call the police to help find him but mom was fairly certain that he'd just wander to a friends house and pass out there for the night.

Needless to say I was more than relieved when she called to say that he'd stumbled home. Heart attack by me averted.

There was more, but I think I'll give those ones some time and space. It is a small town after all.

Allow Me To Introduce, Tobie

So some of you have been reading this blog for a while, and may have noticed the name "Tobie" popping up every now and again. Rather than wondering if he/she is my cat/turtle/lesbian lover/stuffed animal I thought I'd write a post about him.

He. Yes, Tobie is a human male (and quite a lovely specimen of that variety in my humble opinion).

We met on Canadian Thanksgiving last year.

This photo was taken about 10mins before we met.

I had just come in the party, with yet another turkey to add to the carving room. He walked up to me and said, "Hello, my name is Tobie and I am not in the medical program but I am a Canadian". I think he was justifying the fact that he had essentially crashed our party but I was more than happy about it. I gave him the 'welcome' greeting and then proceeded to ensure his plastic cup never became low on wine for the rest of the night. I'd seen him around campus because he lived in my building, and had even met him in passing on the day I moved in. I was very very sleep deprived that day and forgot his name and what instrument he played. Just knew that it was something that could be carried in a small-ish case.

He had been invited by Jack (his roommate, my classmate) to the dinner. I think Jack took pity on his French-Canadian roommate that Thanksgiving weekend and told him to come to our big med-student pot-luck-and-turkey extravaganza. Yes, that was the night we really met. If you enlarge the group shot there is Tobie to the far far left with a >0.5 filled plastic cup in his hand.

Apparently the man knew who I was though. He told me months later that I'd caught his eye at the international student day orientation. As proof he described in detail what I was wearing and the question I asked about scholarships in 3rd year. This stayed below 'creepy' on my radar though because by that time I was already in love and just found it amazing that he could remember so much about me before we even knew each other. The kicker to that story is that he also told me that he'd had a very long chat with another international student during the tea-break. Tobie says he would not know the girl if she walked up to him today, nor does he remember where she was from or what she was studying. Yet he remembers my raisin colored Arcteryx rain coat.

The first conversation he overheard me having with my friend Ryan that day was me dropping a list of expletives while conveying my disdain for the liquid sock-juice that Ireland calls "coffee". Yes,  I know, so classy. I was on one of my rants about the poorly constructed brown drink à-la-Emerald-Isle. He noted my hefty travel mug and knew that I took this beverage very seriously. Apparently this scored points with him though and didn't scare him off.

Six weeks later, a lot of turkey, and a discussion regarding random facts about Chip Taylor (that I thought no one else knew) I decided I wanted to get to know this Frenchman without 60 of my classmates around.

Tobie is an extremely dedicated and passionate musician. He is a violist, though he is also a crack mandolin and violin player. He is studying his masters in orchestral string performance in Ireland for one more year. He studies, he plays, he practices, he writes, he teaches, and then he practices some more.

We've had to spend most of the last 3 months apart and it has been really difficult. This time apart makes it onto the blog because it is part of the struggle and sacrifice that comes with me becoming a physician, i.e. the main thread that runs through my posts.  I write a post about him today because he is part of this journey with me now and where I go in medicine and in life will be with him. Also, I decided that if he was going to have his own label on the blog he deserved a proper introduction.

I should add that like me, he gave up almost everything to pursue his dreams so he gets it. He also prepares a mean BBQ trout, makes me laugh, likes shoe shopping, loves his family, and listens to great music (though he does have questionable taste in podcasts--has anyone ever heard of Fretboard Journal Podcast? Yeah, I lovingly refer to it as the Fretfully Bored Journal Podcast.)

So in a brief handful of paragraphs that is Tobie. When (if) he reads this he is either going to kill me or kiss me! hehehe

This photo was taken about 6 months after we met.

Needed That

Had a wonderful night with three hilarious nurse-friends from the hospital. We had planned to go to a movie tonight after dinner at Rae's but in the end we sat and ate a lovely feast of fresh summer salads, enjoyed delicious beverages, stared at the ocean, and told stories.

I thought about how our conversation rolled along the whole perspective of life--from defining when life starts to what it feels like to watch a prolonged death. We laughed so very very hard at stories about the quirky people that populate our lives in and out of the emergency department--from the overly energetic nurse that falls asleep watching Inception, to the practical jokes we play on some of the docs, to the names we've been called during the night shift by drunken patients.

In these exchanges I hear sadness, frustration, humor, humility, love--every raw emotion possible.  I think about how many times those emotions have washed over us in the hospital. When those stories start rolling one really develops an appreciation for what we see in those buffed MRSA coated corridors.

It was better than any movie we could have watched. It was just what I needed.

Kicked in the Face

This morning we got report about a woman who was in the trauma bay waiting to be sutured by the doctor of the day. She had come in during the night, a head injury with two facial lacerations. There was alcohol on board so she had no recollection of how she had received said injuries. She denied that it was her husband that had inflicted them. He was at the bedside, in faded blue jeans and a thick black sweatshirt. When I walked by I saw that he was holding her hand through the siderails of the stretcher.

I had a brief glimpse at half of her face as I proceeded into the ICU to say good morning to my cardiac patient. What I saw momentarily jarred me. Her head looked deformed from the swelling. I didn't want to stare but it seemed her skull was double the size it ought to be. Jagged streaks of dried blood still criss-crossed her face. I heard howling coming from the room later as she was being frozen for her sutures. I tried to block the sound out.

I busied myself with my ICU patient and then went back out to the floor to bring in emergency patients.

I went into her room to start a saline lock in order to give her some I.V antibiotics. The sutures were perfectly aligned and identical. A vertical line of knots traversed her face in two places, each about 8-10cm long. Her eyes were nearly swollen shut. Her mouth looked almost like a snarl due to the swollen, abnormal position of her lips. Her nose was broken, but not displaced. Sadly, I doubt it was the first time.

I asked her how she had received the wounds to her face. She said she'd been at a party and had gotten into a fight with some people. I asked if it was fists that had cut open her face. She said, "no, their boots".

I remember the first domestic abuse patient I had as a shiny new grad working in the emergency department. She came in because she was having a hard time breathing. Her story was that she had fallen down a flight of stairs. There was a perfect imprint of a boot tread on her neck, starting to turn bluish-purple.

A boot tread.

That image haunted me for years, though time caused it to fade into the background. I had forgotten that woman until today.

I worry a little about the shell I have developed in the past 7 years. Back then, the image would have been right behind my eyelids every time I closed them for a couple of weeks. This time, I felt a pang of sadness and despair for the patient, but was able to carry on my day without much more thought.

When I scrubbed away in the shower tonight I wondered how I had gotten so callous. The irony is I devote myself to this work because I believe that health care is a way to make a positive impact on humanity. Yet somehow it seems that through the years I've lost some of mine along the way.

Moving is Not

Watching the father-of-the-baby texting during the vacuum extraction of his child.

Really? Texting?

More proof that the end of civilization is near.

The Highlight of My Day

Tobie left for Canada on May 17th. He had to catch a 4am bus which was a decent hike from the residence, carrying all of his luggage. I was slightly worried that he'd miss the bus, wait at the wrong place, or encounter some highway construction that would thwart his continued efforts to get home (remember this was after his original flight was grounded due to the volcanic-ash-cloud-of-annoyance).

When he arrived he sent me a text to let me know he'd arrived in Dublin.

I sent him a response saying, "I'm glad you made it to Dublin safely, I love you."

But he'd already turned off his cell phone.

So today when he landed in Dublin, he turned on his phone for the first time since leaving in May and (can you see where this is going?) receives a text from me:

"I'm glad you made it to Dublin safely, I love you."

Ain't technology grand?

[Ok I know that some of you are probably rolling your eyes and making little charades of self-induced vomiting, however, there seems to be a hopeless romantic buried inside of me and I felt the need to share--forgive me!]

Failed Resus

So glad he called it early.

It was an unwitnessed arrest of grandpa, the 8 year old called 911 because mom was out on a run.

Seeing people quietly in shock is more disturbing than watching people grieve loudly and dramatically.

It wasn't a messy code, like they usually are. It was just very apparent from the start that our efforts were in vain. We tried but, as the name implies, asystole is a hard rhythm to come out of.

We had a medical student start with us today, I went in the resus room after we'd all cleared out and found him in there with the patients daughter, a hand on her shoulder. I was impressed. We worked most of the day together but I didn't tell him that I was a medical student as well. He's actually a legit student, where as I am kind of more like a hospital crashing renegade medical student.

On the other side of the equation I did get to witness a birth yesterday, and I was happy to feel tears in my eyes when the baby finally emerged. I like getting an unexpected jab of emotion at work, it makes me feel less like an ED-Bot who works unflappably at putting out tiny fires all day but gets no major satisfaction out of a lot of it.  The doc I was with said I can catch the next one. I have since been creeping the maternity admissions.

And now...I need to cook dinner and let my shoulders relax.