Introducing...

Dr. Albino Blackbear BSc. N., BM BS (Hons)

It actually happened!

Residency starts...er...in two days! 

I am a terrible blogger. Once the last box is unpacked and internet is hooked up, a proper post will follow. 

Finito Mosquito

It was a rush. It was not anticlimactic at all.

I had been warning myself not to build up in my mind the last moments of medical school and the thrill of being done. So many milestones have felt disappointingly bland once they were reached.

Well it turns out that finishing medical school is not one of those milestones.

After a week from absolute hell (which I will get into once my medical degree is firmly planted in my hand) I arrived on Thursday morning for the last set of OSCE's (clinical exams). It was 12 five minute stations of medical or surgical skills. My last station was giving discharge instructions to a patient and when the buzzer rang, the actor patient stood up and shook my hand to say, "Well done!! You're done!!" The examiner said "Congrats!" and I emerged from the cubicle to see my friend, JM standing there with a huge grin on his face.

JM was the very first person I met in our class. We met in Toronto while taking the elevator up to our interviews. He surmised that I was there for the same reason and asked me where I was from, what I did for a living etc. When I told him I was living in Whistler, working in the emergency department there he stopped me and said, "Wait, so you live in Whistler, you have a job you love, yet you're planning on giving it all up to move to a different country and become hundreds of thousands of dollars in debt to be a doctor? Why?"

Well, when you put it that way. I had thought about his comment many, many times during the last 4 years. Why, indeed.

So when I saw his face as I stepped out of my last station I had to chuckle at the perfect end to medical school. We gave each other a rib-crushing hug and he said in my ear, "You know why this is a perfect finish don't you?"

I laughed and cried a little and said "YES! You were the first person I met on this journey!"

Then I randomly hugged a few other bewildered, exhausted, adrenaline frazzled classmates...I may have pounced on a few invigilator bystanders as well. It is all a bit of a blur.

We were then put in a 'holding tank' room in the hotel for over an hour as the other groups of students hadn't gone in for their exams yet. We weren't allowed to use our phones so as not to text anyone what cases were in the OSCE. I came prepared though. One little bottle of Champagne in my handbag which was quietly popped and then poured into the coffee cups they had provided for tea. A "CHEERS!" and few gulps to my pals that were also in the group. Shortly after the Prof of Medicine arrived and was asking us how it went. We were gathered in little groups chatting away, so when he approached we had just finished our Champagne. He said, "Are you having drinks soon?"

"Er.....well yes! In fact we've already had a little Champagne!"

You could see him mulling over this fact...hmmm are they allowed to have alcohol? This is an exam...hmmm...it's only 1030h...

Then he said, "Of COURSE you've already had Champagne! You're DONE! Good thinking on packing some in advance!!"

Phew.

We were set free.

I went and had an Indian head massage (best idea ever) at the spa, and spent the afternoon in the steam rooms and saunas with my dear friend, Emma.

The evening contained all the predictable events. Champagne. Great dinner out. Drinks at pub. Eventually going to Nancy's (the bar I LOVE to HATE). Having a drunk Irishman spill an entire pint of Guinness on me. Heading home with soaking wet jeans and a blister from my high heels.

And then it was over.

But I know it isn't the end. As a friend of mine on FB said, it isn't even the beginning of the end! 

WOW!

I am totally blown away by how many people commented on my match post!

I have been soaking in the sweet sunshine of many lovely, kind, thoughtful, generous comments from so many readers (many of whom I didn't know existed!) I actually didn't want to make another post because I wanted that one to stay front and centre for a few more days.

Honestly, people. Thank you so much for taking the time to comment and send on such wonderful encouragement. I am truly humbled by this.

Note to self: have mega life accomplishment more often!

I MATCHED!!!

Into what specialty do you match the girl who loves everything?

RURAL FAMILY MEDICINE!!!

I felt that this post needed to be written today. So despite the fact that I am running on 1.5 hrs of sleep and am still trying to grasp the outcome of yesterday's events, I wanted to update the blogosphere. 

The last few weeks seemed to drag on with painful anticipation. I spent many sleepless nights trying to sort out how to rank, and trying to decide what I truly wanted to be. After I submitted my list to CaRMS I started really doubting my list order. I mean, really started doubting. I had what can only be described as pseudo-panic attacks where I would go around and around in my head all the possible outcomes of the match. What would make me happy now? In 5 years? In 10 years? What was going to be able to give me the life that I wanted outside of work? What could provide me with the chance to write, maybe do some more work for CBC, travel, have flexibility, allow me to keep my athletic pursuits up, and also just enjoy big and small adventures with Duncan (I know, I know...I am introducing this character late in the game but he deserves his own post later). I've been wrestling with my first love (emergency medicine) and my new love (obstetrics) and trying to decide which of the two I wanted to do. Then I would be in clinic and see a few kids and think, "But...peds! I LOVE PEDS TOO!" or I'd meet the most fly 87 y.o lady who'd reinforce my hope for aging awesomely and I would mourn the loss of elderly patients. Also? It turns out I really enjoy continuity of care in my life. It just brings a whole other layer to job satisfaction for me.

I know, could the writing on the wall have been any more obvious?! I love getting off the beaten track, away from throbbing mega-hospitals and being somewhere that I know the radiographer's names as well as the name of the woman who serves the casseroles in the cafeteria. I don't want to live somewhere that people look at your handbag, not your face when they see you in the street. I don't want to take a subway to work or require reservations every time I go out. I am a country girl who loves country medicine. I don't know why it took me so long to come back to that, and accept it! 

So when I saw that I matched in rural family medicine, I thought..."Of course!!!" But I've forgiven myself for not knowing this a long time ago. I allowed myself to contemplate other areas of medical specialization to the furthest degree. When I said that I was going to just experience medical school and see what I liked, without preconceived ideas, I DID that. And this is where I ended up. It feels very full circle-ish to me. Now I get to do everything! Peds, obs, emerg, women's health, sports medicine, chronic disease management, surgical assist, palliative, hospitalist and down home family medicine. 

Some weird and wonderful things that have crossed my mind in the last day. 

I matched in the first program that I interviewed at. I adored the program, the people, the location. But I was guarded and wondered if part of my swoon was attributable to the fact that I was fresh and excited about interviews. I mean, initially I was so delighted with the place that I thought about not going to any other interviews. But then realised that would be a ridiculously bad idea for someone like me (a lowly IMG). I kept going back and comparing each subsequent program with that first one. Wondering.

When I was driving into the town (where I ended up matching) I came to a bridge and had a very strong sense that I would end up crossing this bridge a thousand times. I loved the look of it, I think partly because it reminded me of a bridge near my house where I grew up in Alberta. It was one of the few photos that I took during those two weeks of interviews, but it is my favorite. Looking at it, I can remember exactly that sense of predicted familiarity and how my heart had already started to feel tied to the place. It was strangely powerful and most unexpected.

Then last week, I had a dream that I matched to my program. In my dream I was shrieking and celebrating and telling myself that this was the perfect thing, and that I was so happy with the way things worked out. Of course when I woke up I felt the stress and worry creep back in as consciousness returned. The dream had been so vivid. That was where I wanted to go. What if I matched somewhere else?

I recently started on a new rotation with a congenial, fiercely intelligent, slightly quirky, banjo-playing dermatologist. When we met he asked what specialties I had interviewed for while I was in Canada. I told him, but I didn't say where in Canada any of these programs were. I told him about my previous life as a nurse in Nunavut and the NWT. A little while later he was introducing me to a patient and said, "This is ABB, she is going to be a family doctor in northern Saskatchewan". Now, again I will say that I hadn't told him where I was interviewing, and I have yet to find many Irish people who can even pronounce "Saskatchewan" let alone use it in a sentence. I mean, most Irish people know Ontario because their cousins always live in Toronto, and they've all been to Niagara Falls. Funny because it is true. So the comment from Dr. R threw me a little, but I didn't say anything to him about it, I just made a mental note. Innnterrrrresting. 

And now I am here. A little like a dog spinning around before he lies down. I still haven't fully grasped that the uncertainty, that has been hanging over me since I started on this journey over 5 years ago, has lifted.

I have a job as a doctor in Canada.

Let me just say that again on the off-chance that it sinks in.

I have a job as a doctor in Canada.

And it is a bloody good thing (as I am ~$250 000 in debt!) And an exciting thing. I am beyond grateful and excited to start on July 1st. I feel like I've been in the starting blocks for years. As a nurse I hoped some day I would become a doctor, and then as a medical student I had to deal with being slightly taken away from direct patient care. Mostly watching others do the nursing and doctoring. I've been striving, waiting, chomping at the bit for this responsibility.

This past week especially I've had a most distractible mind. My normal regime of night-before ironed work clothes, packed lunches and leisurely breakfasts has disintegrated to eating dry cereal and turning my underwear inside out instead of finding time for laundry...

But tonight I eased myself back into life. I cooked a delicious pot of veggie chilli, did loads of laundry, and sat down to write this post. The lack of sleep last night is catching up with me but I am happy.

It seems I've gradually started living my way into the answers. I cannot believe that I can actually say,

"I am going to be a rural GP!"

At the risk of extending this stream-of-ramblingness any more I just want to also say that over the years this blog has given me a great outlet and a wonderful connection to people all over the world. Even when I've felt like a tiny medical student, hidden away in a dark study room for weeks at a time, I felt connected to the people that read and commented, or took the time to write. I have made great friends and kept in touch with old ones through Asystole and I feel like it has given me many gifts on this wild ride.

And so writing this post for those of you that have been following along, gives me so much pleasure! Thank you all for the words of encouragement, advice, offer of cars, couches, lifts from the airport...for mailing forgotten bathing suits, buying me giant soup pots, sending mugs, meeting me at airports, buying me lunch and even the odd train ticket.

Expect the unexpected. Or maybe what was right in front of you the whole time.

FIRST INTERVIEW!!!

Nope! I am not afraid to use the oldest meme on the internet to display exactly how I feel!

Yes, I do believe I have the right to put that title in all caps.

Of course, I've been compulsively hitting 'refresh' on my emails since Thursday which is when some of the IMG programs were rumored to start sending offers/rejection letters out. Last night my mom and I were babysitting my brother's three little ones so I was distracted with the chaos until after their swimming lesson. As soon as they all fell into an "Ice Age" induced trance and I was able to check my email again.

Et voila!! My first offer!!

I screeched, jumped up and down, did some clapping, fist pumping, and then ran into the living room to 4 stunned sets of eyes. Of course my mom was over the moon, but the little-ies just looked up at me from their warm milk like I had completely lost the plot. My niece asking me, "are you a doctor yet?" Um, no....but it looks like I might actually get to be one soon!!

It's 1723h and I am Still in My Pajamas

The main thing I am currently trying to do is decide if I should or should not have a hot chocolate right now. I am still in my pajamas, and unshowered. All I've done today is clear the dining room table of stacked medical books. And I've eaten some snacks. And stared at the wall, in the typical now what? post-exam flat lined brain.

The exam was, a marathon of concentration but not too bad (except that I accidentally brought a mint chocolate flavored nakd bar with me as a snack---ahh I HATE MINT CHOCOLATE!) I am sure the prometric center lady thought I was a loon when she saw me pulling out the reams of food I had to declare prior to the exam. I just never know what I am going to crave or need to eat during times of extreme panic/stress but what I do know is that if I get hangry then I might throw the computer through the window. Yogurt, coconut water, almonds, apples, nakd bars, granola bars, water, more yogurt...I had a little tower of food placed atop the filing cabinet. I ended up chucking the bar in the bin after one bite, drinking a yogurt at race pace, and slamming the coconut water. I used almost all my time, just finishing the last few questions at the 3h 54 minute mark. I blame this on being ridiculously fastidious for the first 80 questions and then realizing I had 100 questions left and just over 100 mins left. It's been a while since I ran an exam marathon, cut me some slack.

After finishing I sped back to the hotel to shower, and check out. Then I zoomed over to the Operation Smile Dublin office to meet some of the staff involved in organizing my upcoming mission. While sitting in my car outside of the office, about 1hr after leaving the exam, I felt my pulse and noted that it was still >100 bpm. I tried to tell my adrenals to cool it. The saber toothed tiger was gone, I no longer needed 180 degree vision. I probably looked like a feral insurance saleswoman when I clunked in, suddenly very hungry and slightly wild eyed with a twitch to the right side of my mouth.

It was a very relaxed meeting and after chatting for a while the two of them stated that due to my arctic experience they should send me on one of their "really remote missions". Yes!! Well maybe they also were thinking that based on how I presented myself to them: better to tuck me far far away from any promotional material photo opportunities.

After that I was able to kick off my heels and head for the hills. (Well, shortly after a trip to my favorite deli in Dublin to stock up on essentials like Chile Hot Chocolate, truffle oil, and nice cheeses!) Drove out to the wild west coast and spent the weekend by the sea eating fantastic food, drinking Champagne, climbing up mountains, sleeping in, strolling around manicured gardens, sipping coffee, and just generally remembering how it felt to be human.

So thanks a million for all the lovely comments and emails of encouragement. It really means a lot coming up to an event like that.

Of course there are things already tugging at my sleeve to get started, like CaRMS, writing up my Grand Rounds presentation, school work...but not today. Or at least, not until after that hot chocolate.

She Be Chillin'

 

She's goin' in the fridge, folks. The end is in sight! 

End of An Era

So Thursday marked the end of an era in our lives.

Tobie had his final lesson with his master's supervisor. I am not sure if I am allowed to say who he is, on the blog, so let me just point out that the guy is kinda a big deal in the viola world. And he knows it. And he is very, very demanding and hard on his students. And not in an inspiring Dead Poets Society kind of way but more in a Scarface fear for your life kind of way.

So naturally we had to celebrate Tobie's final lesson, though it was a bittersweet celebration as it also makes us realise that Tobie is getting closer to moving back to Canada, and I am merely getting closer to spending another two years (minimum) here.

But hell, we had the Champagne. And if nothing else, having good Champagne is a reason to celebrate. The last time I tasted those particular bubbles was the night of my MCAT, and oh they were sweet that night as well. I discovered these particular (very hard to find) bottles in Galway a few months back and excitedly bought two, one for Tobie's last lesson and one for my end of exams.


Step one: change into a relaxing suit. If you can't drink fine alcohol together in your pajamas, something is not right.  

Step two: note the not-so-smiling face of Veuve Clicquot. She should have been smiling. After her husband died she took over the business and made it a raging success...and this was in the days when it wasn't proper for women to be involved in man work. Go Veuve Clicquot!!

Step three: pop your first bottle of Champagne off the deck, have your girlfriend catch the moment, by
chance, in the sweetest cork-popping action shot ever.

Step four: find a water glass and the one remaining wine glass that you still own, and get down to business. C'mon, give us a break, we are still students, after all...

Step five: Sláinte! (And spend the rest of the evening trying not think about a final performance that is still looming, or exams, or the fact that you will soon be living very far away from your beloved).

Happy Match / St.Patty's Day

I really need to take my headache to bed but I thought I'd be remiss if I didn't post a wee something on such an auspicious day.

To my fellow meddies, CONGRATS on the match! I can't even imagine what emotions I'll be going though in two years time on match day. It gives me chills just thinking about it.

And to everyone else, happy St. Patrick's day!

And yes, I rang it in with style, and with friends. There was hiking, jigging, pint drinking, green cowboy hat wearing, and laughing throughout the day. Photos to follow, but for now I leave you with an Irish toast:

Whiskey, drink divine!
Why should drivellers bore us
With the praise of wine
When we've three before us.

Take THAT, All Work and No Play

I am getting oh so very excited. Cathy and her husband Nate are arriving from Wisconsin tomorrow!!!

Cathy and I met on our Himalayan Health Exchange volunteer trip in 2008. You know when you meet someone and instantly know they will always be a part of your life from that point on? I have to say I was lucky enough to have that feeling about several of the folks on that trip, Cathy was no exception. There is also something about seeing your colleague's underwear drying on the line day after day, for a month, that really causes all pretense to fall.  It is pretty hard to put-on-airs and be aloof when no one has had access to running water for 3 weeks. Ok, one girl was aloof but we won't go there (who brings a white felt pea-coat as their jacket on a backpacking trip??) Bottom line, you bond with people when you are living and working together in the midst of controlled chaos and pit toilets.

Just chillin' (literally) at 14 000ft.

On the trip, Cathy was a 4th year medical student waiting to find out about residencies, and I was a nurse waiting to find out about medical school interviews.

Needless to say our lives have changed a little since then! She's now an old married woman and 2nd year peds resident.

I haven't actually seen her since our goodbye in Delhi, but we've kept in touch via email and random gift packages.

I've worked like a mad-woman all week in the hopes of taking next week off. I even managed to finish my paper early, and most of my homework for the next case is done. Now it is time to enjoy some Irish adventures and shenanigans. I don't feel a lick of guilt for my planned truancy. Besides, Cathy is like some kind of brilliantly-hilarious-Asian-American-Halley's-Comet that only comes around a few times in one's lifetime. I've got to enjoy the downtime when I can get it, after all, the hospital will be making me it's bi*ch soon enough.

Speaking of which, I GOT MED/SURG for the summer! STOKED!! Too many people wanted to do med/surg as their first placement (instead of GP) so the school had to do a lottery. The big issue is many of my Canadian classmates (myself included) are trying to arrange electives in North America in the hopes of getting some residency connections and local letters of recommendation. As you can imagine, the hoops to get back into a North American residency are many--but one step that many people have advised is DO AS MUCH IN CANADA AND THE US AS POSSIBLE* when you are a medical student. Many of these electives require that you have completed your 3rd year med/surg rotation. Needless to say there are quite a few unhappy Canadians right now in my class. I am hoping it will work out for them, the school has said they will try very hard to give them the preparation and skills required. Still, it's a gamble. Anyway, I am so excited as I cannot wait to get back into the O.R and back in the hospital in general. The small flickering light at the end of the basic science years is starting to show itself!

But now I must get cracking and get ready for the arrival of my esteemed guests. It's going to be so great to re-connect with this formidable woman!

*Any of you want to provide the ultimate clerkship experience for me in years 3 and 4? G'head and email me!

Retail Therapy

So I bought a car today!!!

Cue "Walkin' on Sunshine". It actually feels like my 16th birthday. My parents bought me a 1976 Grand Marquis Mercury as a gift, and surprised me with it at the licensing office. There are photos of me jumping up and down and my dad grinning from ear to ear. I wish I had a copy of that photo here.

The sweet ride of yesteryear...

Yes, I could fit my entire volleyball team in the car, including 6'5" coach and obese water boy.

Today's purchase was a wild adventure which I will dish on soon. Let's just say, when you answer a private ad for a car sale, you never know what you are getting into. Don't worry, it's nothing bad, in fact it was better than I could have ever anticipated. Just very, very, surreal.

Sadly, I have PBL in 12h and a metric tonne of work that needs to be done regarding the spine before that, so we'll have to save the post for tomorrow. Until then, I leave you with a photo of her beauty. I think I'm going to call her, Belle Bleu.

Little. Blue. Better. 

I can fit my lip gloss and macbook in this one.

One Down

Three to go!

Me and most of my favorite peeps in Ireland. Our post exam jump in the river.

Fun in the OR

Got to scrub in today for three neck surgeries and one ortho repair of a fractured ankle.

The Albinoblackbear tastes surgery and LIKES it!!

Oh dear.

More on that later. Right now I am heading back (after a quick meal and 20min nap) to work a 12h night shift. Gonna be a long long night.

And... *drum roll please*

I PASSED FIRST YEAR! Woooohhoooooo!

(It is pass/fail so I am assuming "P" is for "passed").

This Is Why We Do It

She was a beautiful woman in her late 40's. I was a disheveled and sweaty triage nurse. Our waiting room was overrun with people holding their bellies, foreheads, children's hands, and cell phones. There were no beds in the department. There was a large stack of charts waiting to be brought in, and still another chart buzzed through the printer.

I looked at the chief complaint: "food poisoning".

I called her to the triage station from the waiting room but she simply lifted her head, brown hair covering most of her face.

"Do you need a wheelchair?"

"Yeah."

I wheeled her in and looked at her flushed cheeks. She didn't look well, but then again, if she had food poisoning she probably had high velocity liquids coming out of her from all angles. I asked her what she had eaten, a hamburger and caesar salad. Ooooh. Hamburger. Not good. She had vomited once in the parking lot. No diarrhea. Her heart rate and oxygen were normal. Afebrile.

No meds, no allergies. She told me she had a history of hypertension but her doctor had recently taken her off her meds because she "needed to lose 10 lbs and then be reassessed". She only looked about 10 lbs overweight, if that. Her BP was 208/110. Umm...

"Do you have a headache?"

"Yeah a little bit."

"Visual disturbances? Double vision? Spots? Stars?"

"No."

"Chest pain?"

"No."

"Do you feel lightheaded? Dizzy?"

"Yeah."

Ok. Symptomatic HTN. No beds. Except for trauma bay. I asked the acute side nurse if she'd mind me popping this food poisoned lady into the trauma bay, just for a few minutes so I could get her on a monitor, get an EKG, and do a more thorough assessment. Her pressure was high and I was just not sure what was going on with her. "Do what you have to do" was the reply from the harried nurse who already had her hands full with a query stroke and 2 cardiac patients.

I wheeled the patient into the trauma bay, her repeat pressure was 168/78, HR 97, O2 98%. Now I was feeling sheepish for using our hallowed trauma bay for yet another puker and pooper. I asked her to turn from her side onto her back so I could hook the oxygen tubing behind her ears. I pulled the dark hair from her face. Her head turned in my direction, clear blue eyes stared up at me as she murmured, "I need to lay on my side for a minute". Her eyes rolled back in her head and she began to seize. Her face began to turned blue, first just around the mouth, then spreading up her cheeks, an unnatural mauve. Her husband used his body to keep her from rolling off the other side of the bed.

"I need some help in here!" as I pulled up the side rails and grabbed the bag valve mask for oxygen.

Within minutes two other nurses were at the bedside with a doctor in tow. Instantly we set about our duties.

An I.V is placed in her arm, valium goes in. No pulse. The OPA is inserted and we are bagging her. Her rhythm shows v.fib. The skin of her arms begins to mottle, and as I cut off her shirt I see that her chest is also mottled, no demarcation line though. I stick the quick look pads to her chest and charge the defibrillator.

When was the last time I hit the shock button? Why is this lady dying on us?

I see her husband standing with his eyes fixed on the head of the bed, mouth slack but eyes attentive, seeking. Just then another nurse offers to walk him outside, he agrees.

"I'm clear, everyone is clear. Shocking!"

And thus began the long hour of CPR. 13 shock deliveries, 8 doses of epi, a dose of magnesium sulphate (during a brief Toursades episode) and one dose of atropine.

We would get a rhythm, then a pulse, then back into v.fib. It was a roller coaster. We had no idea why this was happening--she could be a bleed--but was it hemorrhagic or ischemic? Was she an acute M.I? We had no labs so couldn't determine if it was her electrolytes. Pulmonary embolus?

We had intubated her successfully on 2nd attempt with a 6.5 after the 7.0 was a no go. With the intubation and bagging her sats remained 100% and we kept CPR going throughout. The numbers were running through my head...she'd been down now for over 60 minutes, she was getting 25% circulation of oxygenated blood thanks to the CPR, we'd given her enough joules of energy and epinephrine to power a leg of the Boston marathon and we still didn't know what was happening to her. What were we saving now? Would she be on a vent with severe brain damage the rest of her life? Would she even take to a vent? When do we call it? With enough epi on board I've seen PEA last for ages. After such a long time the heart is just twitching, it has no intention of ever beating again.

The lab attempted to do an EKG but due to mechanical interferance from the monitors and defib pads (which I was not about to remove any time soon) the print out was basically unreadable.

Her pupils were fixed and dilated. She is frighteningly cyanotic despite what our monitors were telling us.

She went into sinus rhythm. Tachycardic but sinus. We prayed that this time it would continue for longer than a few seconds.

It did.

The paramedics had arrived to take her to the Big Hospital. Her color began to improve, her cheeks no longer dusky. The mottling on her arms faded as they returned to a pale pink color. She was taking the odd breath against the tube.

We packed her into the ambulance, the doc and I at her side. We pulled out of the parking lot just as the respiratory tech pulled into the lot. Gotta love rural emerg. I attempted to fill in the gaping holes in the charting as the ambulance careened along the rainy streets. The paramedic student bagging her.

We arrived at Big Hospital and went through the usual song and dance with the dragon-lady triage nurse:

"Who is this patient? Where are you guys coming from?"

"We're from Small Hospital down the road, we talked to your ED doc who accepted her, this is the cardiac arrest we're bringing in..."

"I have never heard anything about this woman."

"Well, as you can see, she is intubated and unconscious. We've been working on her for over an hour. She needs a STAT CT among other things and time is of the essence, she could crash again at any moment before we know what is going on with her..."

*Large audible sigh from Dragon Lady.*

"Fine, roll her into trauma bay 1".

'Thanks."

We get her into the trauma bay, give report to the nice accepting ER doc in shorts and the cranky ER nurse with green streaks in her hair. The RT saunters in in his scrubs and PUMA's, looks at the tube and remarks, "the tube is too small". I stifle a remark about his genitals and point out that it has provided her with adequate oxygenation thankyouverymuch pointing out her color and sats. Asshole. I am so not in the mood.

Doc and I walk down the hall where our paramedics are anxious to get us back to our hospital before they go on another call. We see her husband and young son walk into the waiting room. Both Doc and I say goodbye to him. I shake his hand and say something about hoping for the best outcome for his wife. He walks in a daze to the quiet room with the teary eyed boy trailing behind.

We return to the department.

I call the CV-ICU everyday.

Day 1: She had been to the cath lab, showed a 30% occlusion in her LAD artery. She had had two stents put in, and was still in an induced hypothermic coma so neurological status was unknown. Outcome did not look good.

Day 2: Still intubated and in coma. Body temp not rising despite cooling protocol cessation.

Day 3: Still intubated but some periods of wakefulness, responding to voice.

Day 4: The nurse comes on the phone and I ask again how Mrs. D is doing. I explain that I was one of the nurses involved with her code at Small Hospital.


"Oh I am looking at her right now, sitting up and having coffee with her husband."

A sputter from my end of the phone comes as the reply.

"Yeah, none of her doctors can believe her recovery. She has no neurological deficits at all. Well, she has some amnesia from the night of the arrest. She remembers going to the movie but nothing about the dinner or afterward. But that is probably a blessing, who would want to remember any of that? You guys did great work on her out there at Small Hospital!"

I tell her she has no idea how much I needed that news this week, thank her and hang up. My eyes are filling with tears of joy and relief.

I am still stunned and thrilled at this outcome. I cannot remember the last time I was part of a successful resuscitation. Scenes from that night keep replaying in my head and all I can do is shake my head with gratitude that she is alive today.

This is why I love my job.

Lucky

I remember reading some Gary Zukav book years ago when I was in India. I was staying in this dingy 3$ per night hotel in Bangalore which had cockroaches crawling up through the sink and a single metal fan on the ceiling that rotated at a speed just fast enough to create noise but no breeze. I got to this section in the book where he said,

"If you had three minutes left to live who would you call? What would you say? And why aren't you on the phone right now?"

I know, it is nothing that profound at first glance perhaps. But I remember racing down the stairs and out into the dusty streets, finding an "STD" Booth (as they are called) and tracking my mother down for a strange, random, out-of-the-blue profession of admiration, love, and gratitude.

Working in the ED one gets reminded (too often sometimes) that many people never get to have those conversations before they unexpectedly leave this earth.

And so, that quote haunts me still from time to time. Who would I call today? And what would I say? What words are unspoken?

I am grateful for the phone calls and emails I've received lately regarding Jody, and grateful also for the conversations her death has inspired.

Today was Jody's funeral and thankfully the emotions and expressions were not too little, too late. Jody knew how much she was loved and respected, and in turn she made sure we knew the same.

It made today truly a celebration of her life, and not merely a declaration of our loss. I doesn't make her any less missed, but it does make all of this just slightly easier to bear.

Goodbye Beautiful Friend

Todd told me that Jody might not make it through the night. The indolent DIC had caused her to have multiple pulmonary emboli and her respirations had become labored, O2 sats dropping to the 40-60% range. I found this out in the back of an ambulance as I was returning from a spiral femur fracture transfer.

Earlier, I had received a message from my ED asking me to go on the transfer. I had no time to listen to the other 2 voicemails as I raced home from hot yoga, showered, changed, and headed back to the ED for the trip. It wasn’t until 4h later that I finally listened to the remaining messages and heard the one from Todd.

Too late to catch the last ferry to the island I went home and packed. I caught a few fitful hours of sleep, got up at 4am and drove to catch the first ferry of the morning. The whole time I prayed my phone wouldn’t ring with another call from Todd.

Jody was diagnosed in October 2007 with breast, lung, brain, and retinal cancer. She had just turned 39. In the ensuing months it spread throughout her bones and internal organs but she kept her sharp wit and smile. She somehow continued to glow even as the cancer raged inside her. She’d turn to you and say, “Look at me! Look at my skin! Does this look like the skin of someone who has the cancer?” And you couldn’t deny it--she was gorgeous.

When she was raising money for lung cancer research she told me—“lung cancer is the dirty cancer. There is much less funding and fund raising for lung cancer because society thinks it is only deserving smokers that get it. Well, it isn’t.” It made me take a look at my own buried biases about obesity and heart disease, diabetes, and yeah…cancer. She never smoked a day in her life, was athletic, and a veritable fireball of positive energy. She didn’t do anything to deserve this, but really—does anyone? I am still unable to stifle a bolt of anger when I see a 60 year old obese chain smoker and think—Jody will never get to that age.

In this world you will come upon a select few people who have a spark, a light in their eyes. People who draw you into their orbit simply because they take such joy in the dance of life. Jody was one of those people. I have always been in awe of her ability to act on, seek out, and attain all of the experiences she wanted to have in this life.

Our first night shift together in the ED I knew she was my kind of woman when she told me she was learning to grapple—and was the only female in her class. Soon there were two females and our friendship grew from there.

I was able to make it back to the island on time and even had one last visit with Jody before she slipped into unconsciousness. Her breathing became wet and ragged. Several of us gathered around her with Champagne and cake, telling stories and laughing about our many adventures in Jody-land. We took turns holding her hand and rubbing her back as she continued to work to breathe.

One of the hospice nurses, Christina, set up a bed for me on a fold down chair in a common room and I curled up for some sleep after we had arranged Jody so that she and Todd could fit in the bed together. I dreamed of Madeline, my mentor and beloved nursing instructor who taught me so much about grieving and death.

Around 7 am this morning Jody took her last breath in Todd's arms as he wished her peace and love. Her nurse came and introduced herself to me as Madeline. I shook my head at the coincidence.

Jody's wedding ring from Todd depicted the symbol of the Hummingbird totem, a Haida symbol often associated with marriage. I found this excellent summary of Hummingbird symbolism, the words describe Jody with shiver-inspiring accuracy...

When we assume hummingbird consciousness, our life becomes a wonderland of sensuous delights. We live for beauty, delighting in flowers, aromas, fine mist, and delicate tastes.

When it becomes our totem, the hummingbird teaches us to laugh and enjoy the creation, to appreciate the magic of being alive, and the truth of beauty.

Hummingbirds awaken us to the beauty of the present moment. As they dance the four quarters of embodied existence, they bring us medicine to solve the riddle of duality....

Hummingbirds teach us fierce independence. They teach us to fight in a way where no one really gets hurt. They teach us simple courage....

In hospice, the tradition is to open the window when someone dies--this allows the spirit to fly free. Then someone will travel upstairs to the garden on the roof and ring the bell to notify the spirit world that a new arrival is on the way.

When Todd went upstairs to ring the bell a hummingbird appeared on the roof. He marveled at the birds proximity. As Randi and I joined him on the roof we hugged and cried for a few moments before we noticed the bird had returned and hovered close by, it's tiny wings a blur. The delicate creature stayed near and we couldn't help but feel a sense of wonder and reassurance.

Jody is free now, and though we are sad she only was a part of this earth for a short time, we rejoice that we were among the lucky ones who got to share it with her.

...Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance...

Kahlil Gibran