WOW!

Things have certainly changed in my career. I am no longer hating my job. In fact, I am appreciating what a cool and unique job that I have.
2 days ago, I was flying on Mercy Air (helicopter air medical transport service) and we landed on the freeway for a guy on a motorcycle who had his lower leg amputated. I feel slightly strange to say that it was SO AWESOME! A major interstate was stopped, we landed and there were a ton of people pulled over watching, taking pictures of the helicopter. The guy was hit by a car and dragged. His right leg was hanging on by a piece of skin. We stabilized him and flew to the hospital. Pretty freaking cool.
In the ER a few days before that, I had 2 thoracotomies in the same day. This is a big deal, at least around here. A thoracotomy is when you open up the chest with "rib spreaders" and directly do CPR on the heart and can shock the heart directly with paddles while trying to find source of bleeding--usually clamping off the aorta as a temporizing method until the patient can go to the OR. It was pretty freaking cool. The first guy was a gunshot wound, he made it to the OR and to the ICU. The second one was a sad case. 28 year old female stabbed in the back, came in with CPR in progress. Her x-husband stabbed her in the back and turns out he got the pulmonary artery. She was pregnant. We worked on her pretty hard--she made it to the OR but didn't survive. We were injecting epinephrine directly into the heart, along with calcium, atropine, shocking it, etc. basically anything to keep it going. It was such an adrenaline rush! At the same time, I do realize what a terribly sad case it was. She had 2 kids at home too. Very awful.
So I am now back to loving the emergency department. It can majorly suck at times, and I can feel absolutely crazy, but at the same time...WOW!

Do what you love!

I was just thinking the other day how people always say "Do what you love and the money will follow..." Is this really true? Or is it more realistic to say: "Do what you love and if you are very lucky or already have money then the money will follow." I mean, really, let's say you love to act but you aren't great. You can act all you want and will never make a living at it. Or let's say you are a fantastic painter, but you never get your big break and always just scrape by, eventually taking a job teaching somewhere. Then you are bitter, depressed and feel cheated. Life is not organized to be fair to everyone, and just having a love or passion for something does not guarantee success. People who think it does, are the dreamers (I used to be in this catagory) and the people who already had a "lucky" break.
So now, I am thinking about "luck" and "chance." I have thought about this for years that "there is no such thing as an accident", or "you make your own luck." I do think that there is such a thing as luck. Things do not "always happen for a reason." I hate these banal platitudes. They make me sick. I feel as humans we always want to look outside ourselves and assign a reason to something. There has to be an explanation to why the young woman who matched at Highland's Emergency Medicine program got hit and killed by a car last year as she was crossing the street. Is there really a reason for that? No. There isn't. It is just luck--bad luck.

I do suppose that there is some truth to making your own luck. This means, you set yourself up to be successful and then you are in the right place at the right time. That is true. But then there are quite simply situations where a person gets lucky--wins the lottery etc. Or maybe it means you "use the law of attraction" to attract good things to you. There is probably some truth in this.

This is quite the rambling post. What made me think of all of this is my own self doubt. Am I doing what I love? No, I am not. That is the truthful answer. If I wanted to get right down to it and really explore what I love, I probably should have stuck to my original career path and stayed in the arts. I love literature and art. I love to curl up on my couch and read a book. I love to write. I also love nature, the environment, animals--so I could have explored that side of life as well.
Do I find medicine interesting and challenging. Absolutely. Do I love it? No. That is the honest answer. I think I chose it because it was lofty, and worthwhile, and challenging, and safe. I will have an excellent job when I am done. I will not have the uncertainty of doing what I love, and never having the money follow. I suppose growing up without money made me want to have money. I suppose the tangibility of being a doctor was more appealing to me than the unknowns of other ways to be successful. And let me tell you, if you don't love being a doctor, the training can be excrutiating!

Hard Lesson

I have not found the time to write in my blog since I started over at UCSD emergency. It is kind of what I had expected, but about 10 times harder than I could ever have imagined. I am barely keeping my head above water. I am juggling so many patients and feel pulled in so many directions. I can understand how other services get frustrated with the emergency department because I honestly could work up patients much better if I could focus on one at a time, then move on to the next one. It doesn't work that way.
For example, I have 5 patients, I have been on for 1 hour so they are all at the beginning of getting worked up. A patient comes in with afib with rapid ventricular response hr 200s, tachypneic, short of breath. I am pushing drugs trying to get her HR down. Have just instituted diltiazem drip, when "stroke code 3 minutes" patient comes in with acute stroke, so I write hurried orders on my afib lady and rush over to stroke guy. Meanwhile, guy off the streets comes in short of breath, tachycardic, with diarrhea. I need to go evaluate him for COPD, CHF? Pneumonia?. Then there is my back pain guy in the back who needs discharged, and my anxiety lady who wants me to go calm her down. Not to mention the sore throat that who knows when I will see, and is getting progressively frustrated. So this is what I signed up for right? I am good at multi tasking right?
Damn. It is so hard. I feel like the emergency department is a set up for disaster. It is so easy for a mistake to be made.
Maybe I am just justifying the mistake that I made. I can't get it out of my head. I had a homeless guy who didn't look that sick when I signed him out to the next team. New onset CHF but BP 158/100, tachy 105, tachypneic 24, 02sat 100% room air. He did have white count though, and what looked like renal failure. No known infectious source. So the typical conundrum, heart failure vs sepsis? So I ordered antibiotics, cards was going to see him and do an echo.
The next day I hear he coded twice and is intubated in the ICU. Then the kicker. He is allergic to penicillin and I gave him an antibiotic with a type of penicillinin it. I haven' been able to get it out of my head since I found this out. Such a simple thing to look at allergies. I have a hard habit of asking allergies as my last question on all patients, but I don't rememer asking him, but on his chart it clearly says penicillin. I didn't catch it, pharmacy didn't catch it, the nurse didn't catch it, he now may have very well had a reaction. It is hard to say though, he was not doing great based on his labs so may have been heading down anyway, but I have felt sick since then. In fact, I have been seriously considering my decision to stay in emergency medicine. He is a sick patient, that I know how to take care of but being pulled and tired I just simply made the easist mistake.
I enjoy stabilizing critical patients, but wonder if I am ready to really go through this again and again. I think I will never again give a patient a medication he has known allergy to, but working with limited information, limited time, it seems a set up for disaster after disaster.
So I don't know how to go about looking for a different or new specialty, or trying to reinvigorate everything that I thought I loved about emergency medicine. Right now I feel so tired, defeated, and not sure I am up for this the rest of my life.

Choices

It's been a few days, but I have been meaning to write about the young girl who I saw die in the emergency department. I have been at Children's for almost 2 weeks now and I haven't seen any really sick or injured kids. I have seen a bunch of developmentally delayed kids or with cancer/chemo, but none acute.
This poor 7 year old was in a car accident. Her father was driving intoxicated and report was he ran into the back of a semi-truck. Another semi hit him from behind and sheered off the side of the car that the girl was in. THe mom, dad, and baby were without injuries. She arrived on Mercy Air. Since I can do what I want there, I went to the top to meet the helicopter as it landed. It didn't look good. She was intubated already, CPR in progress, and I looked at her eyes which were already fixed and dilated. We had lost her already. However we still tried to resuscitate her for about 25 more minutes. She was dead and I knew it before she was brought to the trauma bay.
The mom however, did not know. She had been taken away from the scene by the police. The dad was still in custody--vehicular manslaughter I'm sure. She was brought in, and was told of her daughter's death. It was terrible.
You would think that seeing something like that would make me cry or react emotionally, but I didn't. I suppose it was all so removed from me. I wasn't involved in telling the parents, and we never had a chance at getting her back... It does make me wonder. Am I already so callous or was it just the situation? Will I eventually see so much that none of it makes an impact?

Children's

Today rather sucked. Actually I am anticipating the entire month rather sucking. I started my first day at Children's hospital today, and it was one of my worst first day's... Not that I could explain it in any way that anyone would understand, but perhaps a few of my peers can commisurate.
I show up early. Noone gives a shit that I am there because I am just one in an endless stream of new people who don't know what the hell is going on. So all I have is a print out of my passwords. There are three different passwords to different computer systems. I try to log on and they don't work. I call the help desk who is no help and says I need to get approved from another department. It is 6:30 am, and the person who can help me is not in until 9. THe attending that I am working with is annoyed and tells me I can work under a medical student ID until then. Fine. Whatever. Here is my orientation: "Room's one through 9 are in this part, and around the corner is observation with another 6 rooms." Fine. I go see a patient.

I am clueless. I can take a history and physical, but I need to look up old records to see what I need to do. I can't figure out the computer system. The attending...annoyed that I don't understand the archaic dos operating system: "You have to use the over and down arrows, then right arrow, hit F3 scrolll down and hit F12." Oh, OK, why didn't I think of that, it is so intuitive. Now let me ask you my other million questions, like where do I write orders and how do I look up labs? THe questions in my mind pile up but I limit them to a very minimum.

Meanwhile, I am circling the floor trying to find things. Patient's are coming in. It is just me and the attending...it goes on like this for a few hours. Now I have to dictate a discharge summary. I have no dictation code, no access to the codes to punch in to get my ID and the dictation line....

I am getting weary just reliving this day. Somehow, someway, I managed to see 17 patients in 8 hrs.

Here's the clincher. I am clueless about kiddos. I don't even know how much tylenol to give. 1.5 teaspoons, 2 teaspoons? Who knows? HOw long do you treat an ear infection? I sure don't know!

I guess that is why I am there. To LEARN medicine, or is it to learn a messed up computer system? I always wonder if this technology is really simplifying things?

Can only go up from here!

Oh my gosh. I am so nervous. I had my first real shift in the emergency department and my assessment was that it was a disaster. I was a freaking idiot. The computer system was working against me all day. I didn't know where anything was. I was working with the head of the entire department. I was trying to make a good impression on the nurses while seeing a bunch of patients. I felt completely scattered. I feel that multitasking is one of my strengths but doing it while taking care of sick patients was just hard. I am not good enough with my medical knowledge to do it seamlessly and efficiently.

That being said...at the end of the shift the attending said I did a good job. Not sure if he was just being nice. I mean what else could he say? I wanted to scream! I felt like a medical student again and out of my element when I was supposed to be in my element.

In addition, everyone, and I mean everyone keeps saying that this will be the hardest year of my life. "If you don't feel like you are drowning you aren't seeing enough patients." So...here I go AGAIN! Every year is supposed to be the hardest year of my life. So, I guess we will see. Will this really be the hardest year or just another hard year that I am by now used to?

I still think I made the right decision with emergency medicine. This will be a wild ride!

13 things.

Today is the last year of my intern year, so I decided to write about what I learned in each of my rotations.

First: Special Care Nursery: i.e. Neonatal ICU

This was my first rotation as an intern. I was pretty nervous but not too bad. I was trying really hard to do everything right. Honestly, I didn't feel much like a doctor on this rotation. The little preemies were so foreign to me that I didn't know what to do for them. This month I did get used to being called "Dr. Gray" which was doubly weird because it was a new last name and I was being called doctor. Call nights were stressful at first because I thought I should have an answer immediately and not have to look things up. I wanted to be confident but I honestly didn' t even know how much fluid boluses to give these little guys.



2. Radiology

This rotation was a joke. I learned how to waste time and about the ins and outs of the hospital. I reinforced why I didn't want to go into radiology in the first place. BORING! The teaching was abyssmal. I would sit and stare at a computer screen while the radiologist dictated into a microphone. Every hour and a half or so, I would get up and take a break. I also learned that radiologists tend to have no curiosity. Whenever an interesting reading would come along, I was curious about how the patient presented and how he was doing etc. They tended not to care. It seemed like too routine and mundane for my taste. I know that everyone said to go into radiology but it was just not for me.


I got too bored to finish this, so will post as is, months later...

A year in review

I have been in academics so long, that my years do not follow the regular calender. Instead of thinking about Jan-Jan, I go from June-June. So this is my year in review, and what a year it has been! I am approaching the end of my intern year. Wow, it went by so fast...perhaps the fastest year of my life. So much has happened this year. In my personal life, I went on a couple fabulous vacations, including Cuba for Gary's 40th birthday, Alaska for my best friend's lovely wedding, Utah for some awesome skiing and climbing, and of course Portland and Durango to see family. I also bought a guitar with every intention of learning to play it. Of course, it is now making a lovely addition to my western theme den...with 2 strings broken... I took a Spanish class, and came a wee bit closer to making my desire to speak a foreign language a reality. I trained for a marathon during one of the hardest months of my intern year, and came oh so close to my goal of 4:20. (actual time 4:26--I bonked at mile 19). We bought the best dog in the world--and named him after our favorite place in the world. We moved into a fabulous house and actually bought some furniture that we have the intention to keep---dare I say...forever? I continue to have a very strong marriage and a true friendship with my wonderful and quirky husband. It is amazing to be in love more than ever after 11 years.

Some future goals for the next year...
Actually learn to play the guitar that I have.
Actually use more than one tense while speaking Spanish (well maybe two occasionally).
Don't give up on my "thing." My friend Shanna had a great way of explaining that everyone has or should have their "thing." This is something that you love to do and would spend your free time, vacations, travel around the country and world to do. My "thing" is definitely climbing, and unfortunately I have not been doing it. I feel part of me is missing and I want to get that part back--I'm not ready to give up on it yet.
Continue to be committed to putting healthy foods into my body. When I was purely vegetarian, I ate so much healthier. I thought I could eat meat occasionally but it has become way too frequent. Perhaps I can commit to vegetarianism again, because I believe in it.
Encourage more romance in our marriage, not get bogged down in the day to day grind.
Nurture the dreams of my husband.
Travel to 2 foreign countries and have amazing adventures.

Well, that is about it. I am saving my professional year in review for this weekend when I have more time to reflect.

If you could meet one person from history...

So things have a tendency to ruminate in my mind. For the one of you who have been keeping up with my blog (and I think that person is my Grandma!), you know that I have been trying to figure out who I would like to meet. And now, I think I have a working hypothesis. I think it would be immensely interesting to meet Leonardo Da Vinci!
Just check out this quote: "I love those who can smile in trouble, gather strength from distress, and grow brave by reflection, Tis the business of little minds to shrink, but they whose heart is firm, and whose conscience approves their conduct, will pursue their principles until death"
Some quick facts:
He is of course immensely famous for controversial paintings like The Last Supper, and Mona Lisa. I would love to sit down and figure out, who Mona Lisa really is and to truly crack why he painted The Last Supper the way he did. It took him 10 years to paint Mona Lisa's lips and he kept the painting with him until he died...
He is also the true "Renaissance Man" He was so eclectic having an intriguing mind and desire to explore--dissecting cadavers, inventing things. He is considered the father of modern science
He is the illigitamate child of a peasant!
He wrote most of his notes using mirror writing...some think to keep his ideas secret? Was he actually schizophrenic? Would be interesting to see why he needed to keep his ideas secret.
He invented the bicycle 300 years before it appeared on the road, and he sketched the first motorcar, helicopter, airplane.
He would wear pink to make his complexion look fresh.

Well those are a few of the things that I have learned about my new favorite historical person. So now, if I ever get that question again, I will sit back, ponder it for a moment, and then act like I just thought of him off the cuff and will extemporaneously recite a few facts that I just happen to know because I am so cultured...

Speaking of culture:
I am going to Europe for the first time in a few months. Gary and I got super cheap tickets to Spain from San Diego. We had actually wanted to go to either Asia or South America, but the tickets were so cheap that we couldn't pass it up!

Failure

I take failure so hard. I wonder if this is normal? Today I couldn't do a simple arterial line. Actually, I think arterial lines are the hardest procedure to do, but anyway, it is still rather simple. However, I missed. Plus I missed in front of 4 nursing students, my co-intern, 3 nurses, my resident, and my attending. Thank GOD, that the co-intern I was with, tried after me and didn't get it. Of course, the attending tried and got it in 2 seconds flat. Shit! I was so upset. I've done a bunch of them, and I've failed at quite a few too (which is frustrating), but it is still bothering me at 9:31 pm as I am writing this. AAAAAAAAAAAAAAHHHH! I try to just be chill and say, "Oh well, I'll get it next time," but it just feels so good to do something right. I want to feel good, not bad!!

Mowed the lawn today. Haven't done that since I was 12. Felt good to mow a lawn. Then I had grilled corn on the cob for dinner. I guess that was my high for the day.

My next entry will be: "What I've learned as an Intern." Then I am going to write a book called "How to be a bad doctor." I've got lots of examples of what not to do...stay tuned.

Just breathe...

I have been running myself ragged these last couple of months actually. First work was really stressful and I was working a ton. Then I moved, and that has been surprisingly more stressful than I anticipated. So now, I always feel like I am never quite caught up. I have no routine. My workouts have suffered. I barely cook. I am just tired! All that being said, I think I have made a turning point in my medical career in the last month or so. I am not sure if it is because I am almost done with my intern year, or if there comes a point in all physicians life where they feel like they are getting it. I am taking responsibility for my patients and not just doing what the Attending says. I make my own decisions, and feel the repercusions of those decisions. For example, I just discharged a 40 year old woman with congestive heart failure. Her heart was pumping 1/3 as well as a normal heart, so she was admitted and an automated internal cardio defibrillator was placed. She was doing well and was discharged a day following the procedure (yesterday, my day off). Today I came into work and was dictating her discharge summary when I looked in the computer and she had been readmitted! Turns out, she had a massive stroke about 12 hours after discharge! She was now in the ICU. Oh boy, I freaked. I ran through everything in my mind to see what I missed. I talked to the Cardiologist who was also concerned. I went to see her in the ICU. I felt terrible for this poor woman, and also a real fear in how easily something like that can happen. There were no mistakes so far as I could see, but still, it is so sad to see in a person so young. She had been putting off this procedure too because she was scared to do it. It really bummed me out. It made me realize the importance in what I do everyday.
Then, we were driving to the store and we saw a homeless man passed out in his wheelchair at the offramp from the freeway. My first reaction, was look at that guy passed out there. Then Gary said: "You going to go check him out?" Well, damn...I guess so. That's who I am isn't it? Just then an ambulance pulled up, turns out some other folks were concerned about him too.

I have a pretty cool job, but I'm scared. For real.

Advice for a young lady

I wrote this advice to my oldest niece. So I thought I would post it here, because it also serves as advice to myself.May 18, 2009

Hi Brianne—
I can’t believe you are turning 18! I was just a little younger than you when you first came into my life. You were the first child that I have ever loved and the one who taught me the joy of children, and how much more fun life was when sharing it with a small child who was experiencing the world for the first time. Now you are grown up and ready to start your life as an adult. You have a lot of great times ahead of you, and a lot of difficult but rewarding decisions to make. You are going to receive a lot of advice from a lot of people. Your job will be to decide which pieces of the advice resonate with you, and ultimately try to take a few words of wisdom to carry with you. However, your real task is to know who YOU are, which may be the most difficult task of all. You will need to experience life, try everything you are curious about, make mistakes and learn from them.

I have a life that I love for the most part. I have things that I would have done differently, and goals that I still want to do. For what it is worth, I am going to give you my top 10 pieces of advice that I hope can inspire or motivate you in some way. My hope is that you find at least one that you would like to remember. If not, keep this letter and maybe bring it out again in 5 years. It is amazing how time changes everything.
Here goes:
1. Don’t let anyone define who you are. I learned this one the hard way. You may be in love, have a great boyfriend, get married, have children but never, ever forget who you are. Do not lose yourself in the relationship or your role in your job or commitments. Remember your needs and desires. You are a wonderful woman with your own ideas. Remember this.
2. Nobody else is paying as much attention to your failures as you are. “You are the only one who is obsessed with the importance of your own life. To everyone else it is just a blip on the radar screen so move on.” John Travolta. This is something I am still learning. I get so upset when I don’t do well. I still worry about what other people think. You know what, they are busy and worried about their own lives. Brush yourself off and try again. It truly is not as bad as you think.
3. Read. Reading is active. Movies, TV, video are passive. Reading engages your imagination. Video substitutes for your imagination and distracts you from life. Reading also makes you well rounded, have a great vocabulary and incidentally do well on tests.
4. Respect your body. Think about what a great gift a healthy body is. Stick to this diet: “Eat food, not too much, mostly plants”. Work out, move your body, do sports, use your body now before age creeps up on you and then you can’t. Your body and your mind are two natural gifts that you are born with. Use them well.
5. Find people who you love and who love you. Remember that love is not a leisure activity, it requires work. Pick up the phone, send an email, write a letter. Kiss your mom, hug your dad. Be generous with your love but not careless. Respect that true friendships take time and commitment but the rewards are immesurable.
6. Push yourself to your limit. Do something challenging, physically or mentally. The reward of accomplishment is so worth the challenge. Climb a mountain, Run the extra mile, study extra hard for a test, cook a soufflé from scratch, then enjoy the rewards. You will be surprised how far both your mind and body can take you.
7. Never, never, never give up. If the front door is closed to you, go around the back door. If it is closed, go around to the side of the house to see if that window is open. Just keep trying. The only person that can stop you is you. If you have a dream, then go for it.
8. Find your “thing.” Find something that you love doing and make it a priority. Everyone needs a “thing” Mine is climbing, and since I have put it on a backburner for my job my life feels less rewarding, although it would appear that I am more“successful.” I miss doing my “thing.” Your dad’s thing is hiking, your mom’s nutrition. Find your “thing” your life will be so much richer.
9. Take detours. Metaphorically and physically. I have seen my peers have such a one track mind to accomplish becoming a doctor that they haven’ t experienced the richness of life. I say, if you want to backpack across Asia then go for it. If you want to live in the Caribbean for a summer than do it. If you want to stop along the side of the road to take a short hike or pop into an interesting coffee shop, then do it. Live life and keep your mind and experiences open.
10.Keep a journal (or a blog). Knowing you are going to write about your day or your week sharpens your attention to everything that happens around you. You really examine your own feelings about a situation and it causes you to live more deliberately. Plus it’s fun to go back and read your entries. Trust me, when you are 25, you will not remember what you were thinking or doing at 18.
11. one to grow on…Relax, Take a breath. Don’t be afraid. All you have to know is who YOU are. The rest is gravy.


Well kiddo, that is all that I will say for now, though I am sure I could ramble on more. Everyone loves giving advice.
I have enjoyed seeing you grow into such a charismatic, funny, beautiful, caring young woman. I am looking forward to finding out what wonderful things you will do with your life. I feel lucky to have been a part of your life, even from afar.

All my love,
Your Aunt Bonny
Siobhan

Moving Pains

Whew! I am tired and I still have no idea how to decorate my house! Gary and I moved into a house, and I am so excited about it. We have never lived in a house before! I love, love, love it! It is so nice to have privacy and not have to worry about playing your music too loud, and stomping too loudly (gary is a very loud walker--he sounds like he is 300 lbs when he is walking around the house).
Here's what I love about my house.
1. It's big. Three bedrooms and a den and a big yard.
2. The neighborhood is cute, and settled. There aren't a bunch of cookie cutter houses around.
3. The neighbors talk to you !
4. My house is old and personalized. Lots of built in shelves and wood work and secret compartments.
5. There are built in laundry hampers in the bathrooms.
6. The canyon behind my house goes on for 12 miles, and there are lots of people (but not too many)on it so I don't feel scared running alone. Lander can run off leash twice a day!
7. There is an awesome tennis/raquetball club literally just behind my yard. Trying to convince Gary to join (he's afraid it is too bourgeousie), but it has a huge pool, hot tub, 23 tennis courts, 3 gyms, classes like yoga and spinning, bar, restaurant. What more could you ask for?
8. Fiesta Island is a 3 minute drive away (off leash dog area for Lander) plus the bay for boating activities (if we buy a boat).
9. There is a big yard area, and a big garage.
10. You can see the nightly seaworld fireworks from my lawn (nightly in summer, weekends in winter).
11. There is a fireplace and lots of windows.

Now all you people don't get me wrong. If you aren't from California then you won't be so excited about a house. Plus this house is by no means a mansion, but in San Diego, things are quite expensive so this was a big deal to move to an actual house. It is so worth it! I feel so grown up!

Now for my next step in growing up...



Ha, you thought I was going to say, have a kid.
No, my next step: invest in the stock market! Wish me luck!

Meaning of Life

I have been meaning to write about my surgery rotation while it was still fresh in my mind, but somehow having a few moments of free time to go to my friend's wedding, drink excessively, pack, search for a new car, grocery shop, start a new rotation, exercise, reconnect with hubby and dog has taken up all of my time. Oh well, I am still going to write about it, because maybe if I can capture the horror of the rotation it will be something I can go back and read about when I am feeling sorry that I didn't do orthopedic surgery.
How do I put my finger on "the surgeon mentality." Is it unfair to catagorize a whole group of people in one way? Just as I believe that there is a little truth behind every joke (Gary hates it when I say this), I also believe that there is a truth behind every stereotype. So how and why do surgeons have this cold, abrupt, hard-driven, even malicious stereotype. What is it about their day to day interactions that causes this perception. Here are my observations for what it is worth:
1. In surgery, you dispense with all pleasantries with your co-workers. When you come into work in the morning, there are no "Hey Siobhan, how was your night? Have a good run? Any plans for the weekend?" No. Simply, come in the door and hit the ground running. If we have a free moment, mostly the surgeons just talk about their surgeries, or lack of sleep, or how much they still have to do. Occasionally, there is some disparaging comments regarding other services or the nurses.
2. Introductions? Forget about it. People come and go, and noone gives a shit who you are. You are your job. This is the Attending Dr. So and So. This is the Resident, This is the intern. You are there to do your job and know your role, and don't step over your role. Never in any situation, do you bypass your resident and ask the attending a question directly.
3. Surgeons pride themselves on their short notes. This bugged me. Why can't I have a note from a consulting service that actually says what the hell we are supposed to do? This seems incredibly important to me since when you page a surgeon they rarely answer (because in the OR I assume). This causes a lot of patient discharging problems. It is very hard for an intern to know the discharge plan on a neurosurgical patient's spinal fracture and herniation.
4. Surgeons avoid patient contact at all cost. It wastes valuable time. In their defense, they do have precious little time. They have to do surgeries all day, which I understand. So many times during my rotation, I am called to a bedside of a patient (that I don't know because I am cross-covering and on call), and the patient is being discharged and they have no idea what is going on. The conversation goes something like this. Patient: "I had no idea I was being discharged today, then the nurse brings in my discharge papers and I have never even seen a doctor." Me: "Oh, I'm sorry about that Mr. Smith, let me just go check in the chart and I will let you know what is going on." I go to the chart, which says nothing. I page the consulting physicians with no reply. I go back to the room "Bullshit, bullshit, bullshit, follow up in 1 week, blah, blah, blah, I have no real idea because I'm an intern, make up some more stuff, I apologize you have not seen a physician until now, reassure, reassure."
5. Surgeons have a sense of pride about how much they work. The more work they do, the longer they stay in the hospital, the better doctor and better person they are. They also brag about never sleeping and not needing sleep. They think "balance" is a 4 letter word.
6. Surgeons don't eat. At least, not sitting down. Somehow, their supreme intellect and capacity to save lives have rendered them impervious to malnutrition. This may account for their lack of need to urinate or defecate.
7. Surgeons like to say things like: "Why is this taking you so long, it should take 2 minutes." "End of discussion, there will be no debate about this." "That is why they are nurses and we are doctors" "Get someone over here who knows what they are doing."

Well, I was going to write 10 things, but now my little Lander is causing a commotion and I need to take him out. This should be enough to remind me, that though surgery is "cool", nothing is that cool.

Viper

We don't see many children at UCSD hospital. Occasionally in the emergency department someone will bring their kid in, but usually most parents take their kids to Children's hospital if they can. However, I just saw a 7 year old kid in trauma clinic. All of our patients have a follow up appointment 1 week after discharge. This kid was in a car accident on Easter. His father was driving home from the grandparents when he fell asleep at the wheel. He wasn't drinking. When a patient comes into the trauma bay, they are given a code name. A random word plus a #. For example: Apple, 16. The reason is that often you don't know their real name and you need to identify the patient somehow. This kid and his father were taken into UCSD hospital, he had 2 siblings in the car as well, sister and brother, who were much more injured and were taken to Children's. The kid was given a trauma name: Viper, 56, and he wasn't hurt. He had a tiny laceration on his forearm that we superglued. He was put into a cervical collar and admitted and observed overnight and received CT scans to make sure there were no other injuries. He was a very cute and brave kid and he loved his trauma name. When I saw him in the morning which was the first time I met him, I asked him his name, which he said, but then added "you can call me Viper if you want to." I had heard through the grapevine that his siblings were much worse off, but then after I discharged him in the care of his father (who was also admitted overnight with minimal injuries), I hadn't thought much about him until today. He was brought in by his grandmother, and was doing well. He still loved to be called Viper and said that it is his new nickname. I was glad to hear he was doing well, and asked about the welfare of his brother and sister. The news was terrible. His sister had broken her back and was paralyzed, and may not make it. His brother had multiple injuries and had broken his neck and other bones but it didn't sound like he was paralyzed. I didn't press for details. Since this visit, I havent been able to keep that poor family out of my mind. Viper's sister who will never grow up into the woman she could have been. Viper's father who will never forgive himself, Viper's mother who will always wish she would have been there to keep the dad awake. Treating children is very different than treating adults. The emotional factor is undeniable. While I feel very sad about the man who fell off the cliffs while drinking and broke his neck and is now paralyzed, I feel a real anguish for this family. I wanted to hug Viper and his grandmother. He is so young and doesn't realize yet that his life will be forever changed now after this one incident. The fragility of life was very tangible today, and yet it made me want to be a part of a child's life. In some way that I can't explain even to myself, it made me want to be a mother. I felt like I wanted to protect this child who wasn't even my own; I wanted to make everything OK for him. Maybe that is a true instinct. The desire to protect and care for a child. He doesn't know yet what a loss this will be for him, and his innocence about it all, made me want to weep.

home sweet home

Gary and I are taking a dramatic step...don't worry, not too dramatic. We are moving from condo living into a house. Slow down a second, you say? It has only been 11 years, why rush anything? Well, having our little Lander has made us grow up a bit, I think. Plus, it is just a pain in the ass to take Lander outside all the time while living in a condo. It is more than that though, we also just don't want to be living on top of people all the time. We need some SPACE! So I am pretty excited about it, although it is pretty crazy the amount of rent we are going to pay here in San Diego for a house. We found a cute one, with a lot of character, near the bay and also right on a canyon for running. Should be perfect! I can't wait to move. I have definitely outgrown this place, but i will miss the pool and hot tub and gym! That is all that is new in my world. I am still getting up at 4:30 am for my trauma rotation. It has gotten a little more sane as supervising physicians have changed, but I am simply exhausted all the time. I am also much more short tempered. Gary was surprised the other night when I honked at some people who were taking their sweet time to get out of a parking spot! Lack of sleep, exercise and socialization does something to a person. No wonder surgeons are how they are. I would be miserable too if I had to do it longer than a month.

simplicity of an apple

These last four days have been rough. I started trauma surgery rotation on Monday, and I have been warned by all my co-interns who came before me that it was tough, but you just can't prepare for this. I show up on my first day at quarter to six, everything is a mess because there are no medical students on the rotation to do all this necessary scut work. The result is, I don't know which patients I am supposed to see until nearly 7. I then have less than 1 hour to round on 7 patients that I don't know and 2 of them just transferred from the ICU. Blah, blah, blah. Then I meet the surgeons. Whoa! All I can say is that I am SO glad that I didn't choose to go into surgery. The personalities are so intense and dramatic and egomaniacal that all I can do is laugh. I am constantly exchanging glances with a co-resident of mine on the team right now (also an EM resident) while on rounds when something extremely absurd happens. The interaction is comical. The atmosphere is simply malicious. There is always a hierarchy in medicine, but nowhere is it so profound as in surgery. Ok, I could go on, but in reality I am just venting and I could never capture the misery of the rotation.
Sometimes when I want to reconnect with Gary, I ask him: What was your high today? What was your low? So my high today was an apple. I was walking back to my car, and I was lucky enough to be walking while there was still daylight. No sunshine, but still light outside. There was a slight breeze, and I had an apple. I left the hospital and bit into a little bit of heaven. I walked the 8 blocks back to my car, eating my perfectly crunchy apple. It was amazing!
oh wait, I just now hear a fire roaring from the living room. I may have to change my high for today.

tight shorts

I'm on call right now. There are no women delivering right now, nor have there been all day... so I'm bored. I've spent hours on line but decided to call it quits when I started googling myself and read info about other people who have the same name as me. There are more Siobhan Gray's than there are Siobhan Wilson's. There is even another Dr. Siobhan Gray.
I also read a book today: Thousand Splendid Suns. It was pretty good. It kept my interest. I was more involved with the Kite Runner though.
Then I decided to go work out. But since I didn't have any clothes with me, I went a couple blocks down the street to this second hand store and bought a t-shirt and shorts. Of course I didn't try them on--they are workout clothes right?
So I get to the gym, and my red shorts are SKIN TIGHT and barely cover my rear end. There may have been a day that I could have pulled that off, but that day is gone. To make matters worse, the lady checking me out did not remove the big huge security tag on the shorts. As I was already pushing it by leaving the hospital to buy clothes AND work out, I decided. What the hell, and just wore my red skin tight shorts with a big plastic security tag on the side! It did feel good to get a workout while on call though. I felt like I was cheating the system...

In other news...I finished my step 3, which is the last part of my medical boards. That felt awesome to complete! It was 2 days which sucked, but it was a big relief to get that off of my shoulders. I've also applied for my medical license so I can write my own prescriptions soon! Pretty cool. My nephew, Lucian, who is 4, asked me on the phone the other day: "Aunt Siobhan, why did you want to be a doctor?" So I answered the only thing I could "because I wanted to help people when they are sick." "oh, ok. I just wondered." It does feel pretty good to be a doctor. Definitely has changed my life.

Contentment

I recently came back from vacation a week ago, where Gary and I visited my mom and grandma and also met some of our Wyoming friends in Utah for a little camping and climbing reunion. As much as I want to tell you details about the terrible gastroenteritis Gary and I go on this trip, I will refrain. It wasn't the best vacation, which sucks because my vacation time is limited and I want to have all my time off to be a supremely good time. It was great seeing my family and reconnecting with old friends, even if I only did one climb!
The drive back was long, and I had some time to think when it was my turn to drive as I did not have an audio book to listen to. You know how it is, when you have time to think, your mind runs wild and lots of stuff comes up. I got to thinking about my life, dreams, goals, etc. as I normally do, and my mind kept returning to the subject of what I would like to have or attain to be truly happy. One simple concept kept replaying in my brain: "I would like to be content." I had never really put it into words before, but I realized then, that I am never satisfied. Never content. I don't know how or when I became so goal oriented, so focused on achieving. It is not only achievement that drives me however, I also want NEW and unique experiences. I don't want to get bored or complacent. For as long as I remember, I would not consider this desire for change or desire for success to be a negative personality trait, but now I am not so sure. I think a person can be pushed too far to one side.
Here are some examples that illustrate my lack of contentment:
1. I do like my hair, I consider it one of my favorite parts of my body, however, I always want to change it. When it is short, I see pictures of it long, and want it long, then I grow it and immediately want it short. I often wonder, how can so many women be happy having the same hairstyle year after year after year?
2. I don't know where I want to live. My adult life, has been a quest for the perfect place. Am I Mountain girl or Beach Girl? Do I want to live in the states or abroad? Should I live closer to my family? I see my friends who are completely comfortable that they will live the rest of their lives in San Diego or Wyoming, or whereever the place may be. Don't they wonder if they are missing someplace special? Something new?
3. My job. I chose Emergency Medicine partly because it allows me the flexibility to explore all the other avenues of life that are available to me.
4. My indecision about having children. Why can't I commit to having kids? I am scared that they will hinder my ability to grow and to explore the wonderful world. I am afraid I will miss something. How do people not feel scared about sacrificing such a big part of their lives raising children?
5. Meals. Gary will eat anything that is around. I always have to jazz it up with something special. You mean you are going to eat that burrito without cilantro! Don't you want parmesan on your pasta?
I am thinking, wouldn't my life be so much simpler If I could just cultivate the ability to be content? Part of me wants a simpler life. If I could just find fulfillment in the everyday things, wouldn't life be so much easier and fulfilling? There is a reason for the old axiom of "Ignorance isBliss." Is being content the same as being ignorant? Don't I want to be "worldly, intriguing, ambitious?" If I were more content, would I have a great husband, a job that I love, financial stability, countless opportunities?
Somehow, I have to meet in the middle. Maybe I need to go meditate for 10 days in yosemite valley and figure this all out!

too much to do...

I have not been satisfied with how my life is going lately. I have a great husband, a job that I love, live in a beautiful place, have an adorable little puppy, have great health, and yet I feel not quite right. I have so many things that I love to do, run, bike, climb, read, cook, hang out with friends, go to the beach, yet I do not have the time to do them, nor do I often have the energy. Only having one day off a week is really hard especially with Gary working so hard as well. My day off generally consists of trying to sleep in, working out, then doing errands, cleaning the house, taking care of online stuff and then hopefully having time to have a nice dinner or drinks with Gary when he gets home from work.
Everyone knows that being an intern is tough, but it is tough not only while you are at work, but also tough for how much you have to sacrifice. There is a reason why people go from undergrad directly to medical school then to residency. If you wait, you get old and feel more entitled and ready to settle! I feel very differently now then when I was 26. I feel ready to start my real life already.
I feel the dissatisfaction a little more acutely lately now that we have Lander. I think the reason is that adding one more element to our already stretched thin schedule has shown me just how worn out I really am. Lander has taken away what little relaxation time that I had. He has made me go from just coping to really not coping that well. I know, I know, he's just a dog! But he is like the straw that broke the camel's back.
So all of this has made me realize that I think they had it right in the 1950's when wives stayed home to take care of the household and the children, and the husband earned the salary. What an ingenious idea? Can you believe that is coming out of my keyboard! But, I guess I will update that sentiment to reflect the current age. I think people have it right when one spouse stays home and the other works. Don't get me wrong. I wound not be happy being a homemaker personally, but I would be extremely happy to come home every night from work with a fully stocked fridge, dinner made, house cleaned, laundry done, bills paid, dog walked, sheets washed, dry-cleaning picked up, and all I have to do is simply relax and enjoy life. I think in that situation, all the work stress could much more easily vanish.
I would LOVE it if Gary could stay home and take care of all the STUFF, and take care of me. If only he could still keep making his salaray. Ahhh. there's the rub...

ps

P.S. I've substituted wine for sweets. Is that wrong?

Generation boredom?

I was watching bits and pieces of Oprah today while riding my stationary bike. One show was about how to simplify your life. This idea has been intriguing to me lately, although I am not that great at it. I am thrifty and cost conscious in some ways. For instant, you may call it my pet peeve to throw away stuff from the refridgerator. It literally causes me anguish when something goes bad, or we don't eat the brussel sprouts in time. I may be a little obsessive about this at times. I remember when we were moving from Japan, I was force feeding Gary Udon (type of Japanese noodle) because we had bought too many and I didn't want to throw them out before we moved. One day, I opened the cupboard to prepare the Udon and we were out. "hmm, I said, I thought we had more?" "Nope," Gary said. "You made me eat them all!" Only later did I learn that he threw them out behind my back!! However, in contrast...I also just bought 1 dress, 2 shirts, 1 jacket, and 1 pair of jeans at Banana Republic that I didn't NEED. So the theoretical rule in our house is that we have to get rid of something for every item I purchase. I have yet to done so, but pretty good rule...in theory!

But what I found really intriguing today, was a small part of the show that they didn't really get into that much, this was the fact that children are growing up with constant sensory stimulation and without it, boredome ensues. They are always on line, on their cell phone, texting, watching TV, playing video games etc. This has got to have major consequences. For instance, I still keep in touch with my college physics teacher occasionally. He told me that teaching has changed for him in the last 8-10 years substantially. He is unable to get student's attention, "there is a lack of focus and a demand for more showmanship on my part. There has to be multi-media at all times to learn" he said. Am I just getting old to think that this is sad and maybe even tragic? Look at me, blogging right now, feeling like our technology has gotten out of hand. Every generation thinks that how they were brought up was the right way. When I have children (or child), do I allow them a personal computer, a cell phone, unlimited TV? I had none of those things and I think I turned out pretty good. Wouldn't we love to be able to enjoy simple time together, a quiet evening playing games, watching a fire, reading a great book, instead of all the NOISE? It is not a new sentiment to say that the technology we have created has made our lives more simple and efficient in so many ways, but at what cost? Are we raising our children without patience? without the ability to imagine? impeding personal communication while fostering sedentary behavior? Are we creating Generation Boredom?

this is beautiful?

Today is my first day of obgyn as an intern. I have delivered one baby today and went to one c-section. My reaction has not changed from the first time I have seen a birth. In one word: HORRIFIC! I know it may be funny that I say that. I know so many people who think: "Isn't it amazing," or "that is so great that you get to deliver babies all day." Hell no. I simply do not like it. It seems so wrong and so gruesome. I know, I know, it is part of life and that most women go through it but it is definitely not something I am looking forward to. I also wonder what the husbands think about that part of your anatomy after that huge head comes out, among other stuff. I feel like Gary would pass out. He cannot handle anything medically related.
Actually the whole process of having a child is pretty distressing to me, (besides the first part!). I know some people like pregnancy. In my short experience with it, it was awful. You get sick for no reason, have gastric reflux, get fat and swollen, can't drink and in return you get a "glow" Whatever.
So maybe people with kids will help me put this in perspective. It's all worth it in the end right? When you are holding your little baby in your arms...
While I am on the subject. Gary and I have proven to ourselves that we are not able to handle disruption in our lives so easily. Our little puppy, Lander, has proven to be a handful. Gary and I have shared our lives together for so long that we have our routine down. Now, we have this new little guy who we have to play with and walk all the time, and feed, and train that we are exhausted. We are grouchy towards each other and we aren't doing the things that we normally do. Gary said: "Well I guess I just don't work out anymore." and I have not been able to cook as much or go grocery shopping etc. Plus our end of the evening relaxation routine has not been happening. But, we do love the little guy. He is so great! So maybe it will be worth it in the end.

trust your guts

I was pretty sad today. I transferred a patient from the ICU to a SNF yesterday. He has been in the ICU for almost 2 months. He was very very sick, I'll spare the details. He was making improvements and didn't really need to stay in the ICU but a long term acute care hospital would have been more appropriate. However, his insurance did not cover that stay so he went to a SNF. I found out today that he decompensated en route to the SNF and was back in a different ER 6 hours after transfer. I feel like an irresponsible doctor. I know it wasn't ultimately my decision to transfer, and we had been hanging onto him longer than we should have. But it really sucks. I had been talking to his brother daily on the phone. This makes me really angry about the health care we can provide and the limitations to the care that is appropriate. I feel like I should have been a stronger advocate for my patient despite pressures to transfer from case management and my resident. hmmm. lesson learned for when I do have the final say. If I feel nervous about transferring someone, maybe best to keep him a little longer.

Influences of friends

I have a friend who will be moving away soon, and it got me thinking about the influences of friends and how they shape your experience in life and hopefully bring new adventures into it. I am blessed to have quite a few fabulous friends, but will highlight three as they have been on my mind recently.
First, I have a good friend who I met during medical school. She and I are not alike in many ways yet we seem to get a long and have a fun time together. She likes to shop, and, well, shop, and spend time with friends and family, NOT eat and drink, and likes sleek hair and doesn't like peeing in the woods. I on the other hand, don't shop all that much (hence still trying to find my style), eat and drink too much, work out avidly, and also spend time with friends and family but actually like kind of bed-head hair and love peeing in the woods. I like the feel of air on my rearend. Anyway, we are a funny match but we have great conversations and she always makes me laugh. Who knew that after medical school ended and she moved away that we would still stay in touch as often as we do. What I admire most about her is her fortitude to stick to a task and her commitment to her ideals and her love of friends and family. I was thinking about her a lot today because she got me to give something up for Lent. I am not catholic but I love giving things up, so since yesterday, I have not had any sugar. Turns out, I am quite addicted to sugar and this has been kind of hard for me. Maybe she and I can get together and have one of her homemade pan cakes after this whole Lent thing is over. How long is it again?
So, it is funny how someone can influence your life...If you will notice the title of my blog, LOVE, DEATH, and CHOCOLATE. This title originated actually, from one of my longest and greatest friends from Wyoming. She is such a character, and we are actually quite alike in many ways. We both love the outdoors, camping, climbing, boarding, whatever. We love to travel and have new adventures. We can party hard, but know when to call it quits...most of the time. We have wonderful men in our lives and have the capacity for a lot of love as we know what it can be like to have challenges in your family and still love unconditionally. I think we have both grew as women and have become more into our own, and I have just loved to see her find happiness. She is my inspiration for the title of the blog in a weird way. She had posted or emailed something about what 3 things would you like to have to make a perfect day. So, I was thinking about this, and my list would be: Love (in the form of romance), campfire with friends, and great chocolate. So where did this death thing come from? Well, I have been thinking a lot about death lately (being a doctor and all), and I am trying to come to terms with it as a part of life. I decided to name my blog, in part about what I love in life, but also in part, what I do with my life and how I spend much of my time. So my 3 things, aren't what I would like to have as a "perfect day," but rather what is a part of my everyday. I have love from my wonderful husband, great friends and family and hopefully from myself; daily I see illness, heartbreak and death which is usually surrounded by love of family, and finally the ol' chocolate, which represents my end of the day relaxation which usually takes the form of either wine/chocolate/hottub in various combinations, and sometimes all three, snuggling at the end with the hubby.
Finally, another great friend whom I have come to love over the past 5 years is someone who will most definitely be moving away very soon. I have been around the block, meaning, I have moved quite frequently, and I know what it is like to move from friends. For the most part, you eventually lose touch. There are few that you will remain friends with for a very long time, and I would be interested to see who I will still be friends with when I am old and in the hospital. This friend is inspiring to me because she is hands down the best listener I have ever had as a friend. She will honestly listen to what I am saying and give me feedback as well as alternative ways to looking at a problem. She is very well rounded. One day she will be the worlds biggest shop-a-holic, the next hiking a mountain, or traveling across the world. She and I get a long, I think because we are both quite eclectic and try glean the good parts out of life. She inspires me to be curious. She is the reason I have the NY times as my homepage, and the reason I try to read books that are nonfiction occasionally. I am sad to see her go because she is a friend that I would like to stick around and see where our friendship would take us. She inspires honesty and sincerity as well as capriciousness. Who knows, maybe she will be a friend that will last a lifetime. I know time will tell, but honestly, it will be up to us to commit the time. Life gets harder. I know that now. I don't have time for what I want to do in life and for the truly important things in life. Friends who are at a distance miss out on day to day life and sharing and that is the hardest part. I suppose I am lucky to have wonderful people in my life and should rejoice in what I have now, instead of what I may lose in the future. For now, it is bittersweet.

Life in the hospital

I'm on call, It is 1 am and I am walking to the doctor's lounge for a snack and water. A disheveled man, not in a hospital gown hurries up from behind me and states without prelude: "Every time I go to the bathroom, my colon falls out of my asshole, and I have to push it back in."
Me: "That sounds terrible, you should go to the ER and get it checked out."
Him: "That's what I thought too, thanks doc."
This is my life. I love it.

reflections of circumstances

It is funny where life takes you. I am at a point in my life where I see death almost daily. I see people literally at their worst moment. I see family coming into a scary ICU, which is an uninviting and terrifying place and sometimes I try to envision it from their eyes. What must it be like to see your husband, previously relatively healthy, and now in a sterile environment with a tube in his mouth, in his penis, in his neck, in his arms, in his chest. Monitors beeping, IV bags hanging. The sensory experience must be shocking. Yet, to me it has now become "normal." It is amazing what a human can accomodate to. The other day 3 patients died in the ICU. This was another day at work for me and the other health care professionals. It is no wonder that doctor's become callous. I feel like I am one that makes an effort to relate to both my patients and family, and yet, I think that so far I could do much better in that regards. I get so busy doing my "work" that I don't call family as often as I should, or walk into the room when I know they are there. However, in as much, as I think that I could do so much better with my "bedside manner," I would say that I would be in the top 95% compared to the attendings that I see. It is rare to see an attending that I admire in that regards. The care/comfort/humanity is often secondary. Don't get me wrong, I admire some of the attendings in so many other ways, but his one crucial aspect seems lost. It is this intangible aspect that I want to get right, yet I too get lost in the work, the fatigue, the stress of uncertainty, that I am not living up to my ideals.
Sometimes I think, what if this was Gary (since I can't say,what if this was me because my perspective is so warped at this point). What if Garys brother was in the ICU and Gary was seeing him for the first time, what would his reaction be? He would be confused, lost, uncertain, and hanging on the doctor's every word for hope. This is what I must remember when I see families. Death, although a part of life, is not "normal" for most people. I am learning this lesson that I already know...how to put humanity into my practice. Who would have thought that it would be challenging for me?

A Hard Days Night

It is 9 pm on my post call day, and I am sitting here with the familiar feeling that somehow I lost a day. It is now Thursday when it seemed like just a moment ago it was Wednesday morning and I was going to work. For those who have experienced a hard call night, they can relate to driving home the next day feeling a little unfocused, or not really caring about anything but just getting to your call room in hopes your pager won't go off too soon, or taking about 2 minutes to write a sentence in your note the next day because your mind won't focus. I hate call. Everyone hates call. It is not humane and doesn't make sense from a patient care standpoint or in simple terms of what we should do to our bodies. Yet, it persists and will likely continue. The theory is that if a resident is in the hospital all the time they can see the progression of the disease, and therefore learn more. What isn't explicitly stated is that after about 18 hours for me personally, I no longer care about the progresson of the disease. I am on autopilot trying to do my work and not harm anyone in the process. All I care about is sleep. However, I still have 12 more hours of work to do, and in those 12 hours, I am not my sharpest, do not care about having discussions to get a complete history, and may not necessarily make mistakes...but don't put as much effort into doing as thorough of a workup as I might otherwise. Plus it just sucks! You go home, and I am usually starving and smell. I have an aversion to going to sleep directly because I worry about MRSA and C.diff sheets, so usually take a shower. Then if I am very lucky, hit the bed by 1:30 or 2:00 the next day. Let me clarify, the day before my day would start at 5:30 or 6:00 am, and I will have been at the hospital sometimes (like last night) without a moments rest until I head home. Then I usually wake up around 5 ish, and then am in this sort-of daze. Kind of like how you feel after partying too hard the night before. I work out (because I have too, not out of desire), eat, then try to go to bed around 10:30. That is what works for me. Others try to stay up and then crash early and sleep hard. There is no good system. Of course there are good call days, and bad call days. The good days are not good in that you "learned a lot" The good days are good because you didn't admit many patients or the patients you were following weren't too sick so you didn't get called much. The good days are when you can sleep and pretend you are a normal person. The bad days such as I had last night, are actually the times when you are admitting really sick patients. I put in 7 central lines and 2 intubations last night. It was a terrible night.

The Red Bundle of...Love?

Wow, how am I ever going to have an actual child. Gary and I had been debating about a dog for oh...10 years. We finally decided on a breed, Vizsla, although if Lagotto Romagnolo weren't so rare and so darn expensive then we may have gone with them since they don't shed. In any case, we decided on a dog, but usually that doesn't mean anything for us since we change our minds hourly. So I was so surprised that on about 5 pm on V-day (which we decided was a lame holiday and to not exchange gifts) that Gary showed up with a new baby Vizsla. He is so precious and so much work! Wow! We have not done anything all day except watch the dog (and spend way too much money at Pet Smart).
Gary calls him a chick magnet: Quote "I'm going to have to start wearing my ring again." (He hates wearing his wedding ring and uses every excuse to not wear it..suspicious?).
We named him Lander after our favorite place on this planet...may not be the most beautiful or exotic but definitely the most nostalgic and where we have been happiest so far.
So now we are puppy parents. This may be to ward off my baby desires or pseudo-desires. Gary thinks he will take him hunting.
So at age 32, I have finally managed to commit to a dog...and I'm scared to death.

My Philosophy of Life

This is my first attempt at blogging. I have been trying to keep a journal for years. But it turns out that the only time I really write in it is when I am either depressed or angry. So when I look back at my old journals I seem exceptionally psycho. I am hoping they don't fall into my still unconceived children's hands when I am gone, and they will think that their mom really really was nuts. Therefore, I have decided that if I blog, it will give me a way to share my day whether I am sad or happy and may have a more complete view of how I view life.

The title of my first post is "Philosophy of Life." I chose this, because I was recently asked in an interview "What is your philosophy of life?" My answer was pretty lame if I recall. To give me some credit, I had been doing the interview for 2 hours by the time they got to this question so maybe I could have come up with something more eloquent than "Work hard, Play hard..." In any case, I suppose that is my pedantic way of saying my general philosophy, but I want a good way to say it. I am also a forever dreamer, always thinking up new options and angles to situations. I always am in the search of new adventures, so much in fact that I think I tend to live in the future too much instead of just living in the day. I would say I am forever an optimist, and strive for myself and people around me to make the most of their life. So maybe this blog will give me a way to think about how to put my philosophy of life into a nice Abraham Lincolnian type of phrase.

This paragraph made me think of another interview question that stumped me while I was interviewing for residency. At Utah, they asked me: "If you could meet anyone from History who would that be?" Now that may sound like a pretty easy and generic question and one that someone who had interviewed as much as I have, would be able to answer. But quite frankly, it threw me. First of all, I am ashamed to say that I know little history. I wish I did, but I need to find a fun way to learn it. I try to read books about the subject, but I end up reading the first few chapters then scrapping it for a fiction novel. Movies are okay, but honestly you cant learn history from a movie. I need to have my little bro school me on the subject. My honest answer to the question was : Madame Curie. To this day, I still haven't looked up what she actually is famous for. Something in science and she was a woman. I'm so glad they didn't ask me what she actually did. My thought process in my 10 seconds to think was: "Can't say Gandi because that's too overdone, can't say Jesus or Buddha because too divisive, can't say Oprah because she's alive, can't say Bob Marley because then they will think I smoke pot, can't say a president because I don't know shit about any of them, oh I know, I will pick this random woman's name out of thin air and say that." I think I was saved because maybe my interviewer didn't know who she was either.

Now onto my stationary bike, the food network, and then some wine...