Thursday, August 25, 2005

Thank you notes

This may well be the area of my life that I STINK at the MOST!!! I've NEVER been good at writing them. It's not that I'm not thankful. It's not that my mother didn't teach me better. I am. She did. I'm eternally grateful for the kindness and thoughtfulness that has been shown to me in the past. I just can't (or won't, or DON'T) sit still long enough to write a simple thank you, put a stamp on an envelop, address it, and put it in the mail.

When I sent out graduation announcements I PROMISED myself that I wasn't going to revert to my old habits. That if people were going to take the time to congratulate me, that it was only RIGHT AND PROPER, that I take time to THANK them.

The first 10 gifts I received...thank you notes went out within a week! Then we moved, then I graduated, then I started residency.

You know where this story is headed.

LAST NIGHT...I finished the thank you notes for gifts received for graduation! Mind you, some of these notes have been DONE in their envelops since JUNE!!!!! I just never stuck them in the mail. Do you know how hard it is to find stamps these days??

I'm quite sure that I've forgotten SOMEONE and more than likely I've sent someone a thank you note TWICE for the SAME gift. But at least they're done and not sitting there staring at me. I am going to hand deliver the thank you notes from our friends at church who not only came to graduation, but came over our house that night and helped us celebrate. Billye brought GREAT ice cream, Lorinna made an AWESOME cake, Jenny brought cherries, Gerry and Mary brought pigs-in-a-blanket, Jo brought daisies to plant in the flower bed, and I know there are a few others that I'm forgetting.

I was so blessed to receive cards from friends and family. Some of whom I've known my whole life. Friends of my parents, parents of my friends, and friends I've made along life's journey. I am truly thankful they took the time to write. Thank you. Your continued friendship, love, and support mean the world to me.

Anyway, that task is done and next week I am going to start addressing our Christmas cards. Maybe you'll get your's by Valentine's Day!


Sunday, August 21, 2005


Is there NO shame?!? I have had to alter how comments are left on my blog b/c the wonderful world of spammers have decided to invide my blog. So STOP! This is a place for me to catalog my life as an intern and NOT a place for you to litter my website with your dribble. Does anyone know how to STOP this MADNESS. THOSE comments will be welcomed.

Saturday, August 20, 2005

"Primum Non Nocere"---"First, Do No Harm"

"First, Do No Harm" These words are not actually in the Hippocratic Oath, but that is a discussion for another time. I want to tell you about their application in my life.

EDIT: in the first edition of this post, I had a long story about a pt and surgery. Here's the 2 sentence version.

Chance finding on CT, pt to surgery, pt experienced a complication, different surgery. Now with colostomy (he had a bowel resection after a perforation) intubated and in serious condition with a good chance for a MAJOR infeciton that could lead to septic shock and his death.

I tell you this story because it reminded me that nothing we (I) do in the practice of medicine is without consequence. Pt. X's AAA was an INCIDENTAL finding. If we hadn't done a CT Abdomen, he might have lived the rest of his life (?30-40 years?) and never known he had this. And now, he's fighting for his life in th ICU because we "helped" him. I belive we did the right things for Pt. X and no malpractice has occured. But life is fragile and sometimes even feeding a patient after surgery can be dangerous and not without risks.

The morning of this second surgery, there was ALOT of confusion when he came back from surgery. He was dehydrated and evetually required 17 liters of fluid. His family was there asking questions that didn't have an answer. I had come to know X's wife, because he's been in the hosptial for several weeks. I noticed that no one had gone out to talk with her.

So I went.

I couldn't give her a prognosis, I could merely explain what had happened, what the surgeons had done, and that all we could do at this point was wait. We had hit a bump in the road and things were going to be rocky for several...?days? I felt completely inadequate, like ANYONE other than me should be the one talking to this family. But I was the one who had rapport with them and felt I should go.

So I went.

His wife started crying, which meant that I started crying. She hugged me and we cried a little more. It was good. I don't mind admitting to you that I cried. I was scared, she was scared, neither one of us knew what was going to happen in the coming days. I'm glad that I went. I believe that I made a small difference in this family coping with bad news. The day I can't cry at something tragic and sad, is the day I need to find a new line of work.

Saturday, August 06, 2005


I have managed to survive my second night of call as an intern. Let me explain. I am on a rotation in the CCU--the Cardiac Care Unit. The patients we admit either have a previous diagnosis of heart disease, or they are being admitted to our service because they have experienced "chest pain" and need to be "ruled out" for having a heart attack or MI (myocardial infarction--fancy way of saying heart muscle injury). Monday, Aug. 1st, was my first day in the CCU, we change rotations on the first day of each month. I was on call. My first night of call as an intern. Call means that we show up to the hospital at 6 a.m. one day, see our current patients, and admit any new patients to to the cardiology service to our team. We do that all day and all night until 7 a.m. the next morning. Then we round with our attending (see previous post for hierarchy of doctors) and go home (hopefully) by noon, 18 hours after we entered the hospital. We go home, sleep and show up at 6 a.m. and start all over. Call is q4, meaning that every 4th night this month I will spend the night (not that I get to sleep there, mind you) in hospital admitting new cardiology patients and taking care of small issues with our current patients.
Call #1: Aug 1st. Starting a new rotation was ALWAYS unnerving as a medical student. Your grade depended on how well you performed and how well the attending and residents liked you. As an intern...It's worse. You show up at 6 a.m. and have 4-8 patients that assume in 5 minutes you will know their entire medical history, what brought them to the hospital, and how best to take care of them and send them home...All before the first (of many) bottles of diet coke has had time to settle in your stomach. And to top it all off, Day #1, I'm on call and carrying the CODE PAGER!! That's right, if someone in the hospital codes (their heart stops beating or they stop breathing on their own, or both) and a code blue is called, the code pager (I'm carrying one of many such pagers) goes off and alerts me (and a whole bunch of other epople) to the patients room number, where it is expected that I will show up in a matter of seconds and begin resuscitation efforts on that patient.

In case there's any doubt in your mind, this is one of the scariest things about being an intern. We all have to take ACLS (Advanced Cardiac Life Support) and learn how to "run a code," but until you show up and see one in progress and have someone asking you (me) what drugs to give to get this person's heart beating again...You have no idea what to expect.

So, of course, at 2 a.m. my first night in the CCU, my first night of call, the code pager goes off. Thankfully, I was not the first doctor there and therefore did not have to make any decisions. I would like to tell you that I put on my Superman cape, ran into the room, and in a moment of brilliance saved a person's life. It didn't happen that way. This patient was being well attended to by the time I got to the room, but I might as well have been 3 years old...I had no idea what to say or do. I don't know if I've ever been more intimidated in my whole life. I never went to a code as a student and like anything you do for the first time, you don't know what's expected or what to do or how to handle the situation until you've been there. [This is the main reason people without children (myself included) are so STUPID (again, me included) when they start talking about how they could raise someone else's child better, or how they would NEVER let their child do this or that] (This attitude has probably ensured AT LEAST 2 or 3 temper tantrums in Wal-Mart or a museum from children that I hope to have someday...Sorry Mom and Laura, that's not today, or even this month, really, not even this year. The next code I go to, I will be a bit more prepared for and hopefully will handle the pressure better.

Call #2: As I type this, I am post-call. I went to the hospital yesterday at 6 a.m. and got home around 12:30 this afternoon. I would like to say that in a city of 4 million people, no one got sick, no one had chest pains, and that no one came to the hospital. ALAS! None of that happened! Was it a full moon last night? I went to the ER about 3:00 a.m. and it looked liked a rock concert gone bad. There were people EVERYWHERE! Thanks to the same ER last night, and the nurses of 3 Cullen (the main floor where the cardiac patients go) I got a grand total of 30 minutes of sleep last night, and fortunately, not all 30 minutes were at one time (insert sarcastic voice here).

There's so much more I could tell you about last night, but let's face it, I've had little sleep and rambled on enough, even for me. Regardless about what (or how) you read the above...I'm loving it! I am doing what I've been waiting my whole life to do. I have MUCH to learn, but man, this is good stuff.

p.s--As I went back and read the above verbage, I realized how vulnerable saying these things can make me. It's hard to admit your failures or weaknesses and there are some who would say that they would have handled the code much better than me. And they would be correct. But they've been there and done that before. My friend, Keith, from medical school, who is currently in Iraq serving his country, was a paramedic before medical school. He ran TONS of codes on the back of an ambulance. As a 3rd year student, Keith happened to be outside a patient's room as they coded. Keith stepped in (as a 3rd year STUDENT, mind you) and began to run the code in spite of his attending and others there who were "??more qualified??" than he was to run the code. I was not there, but the story goes that someone asked Keith's attending (as Keith was performing CPR and yelling at nurses to push drugs) if he was capable of "running a code". The attending very matter-of-factly said, "Yes. And probably better than you or me." I will be in a code situation again, and by the time I finish my intern year I may not be a good as Keith (this guy is amazing) but I will be better at handling codes.