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...