It's official. I'm forever an Astros fan. They are currently 3 outs away from their first World Series. I went to bed sad Monday night after one of the greatest home runs ever hit. My hat's off to Albert Pujols. I may have been even more sad that my WIFE got to go to the game while I watched it on TV. That's for another blog. Even if something goes terribly wrong in the bottom of THIS 9th inning (Game 6), I will still forever be an Astros fan.
The last few years have been tough. I married a Cardinals fan. Her aunt, Becky, whom you could find on the Cardinals' website in a red wig recently, has weekend season tickets. She's been a Cardinals fan longer than I've been alive. Needless to say, my Christmas present last year was a little tough to swallow. It was an Cardinals National League Champions t-shirt.
If the shoe ends up on the other foot this year...I hope she's as good a sport, because that's what she's getting for Christmas. Love you, Aunt Becky.
I am going to sign off now and watch the last 3 outs of Game 6. I have more to say about the Texas Tech, u.t. game this weekend, but I will save it for later.
GO ASTOS!!!!!
Wednesday, October 19, 2005
Thursday, October 13, 2005
No time to post
I know it's been awhile since I've posted. Sorry. But I am in the Medical Intensive Care Unit (MICU) this month and I am on-call 11 nights. That translates into 308-330 HOURS that I am physically in the hospital when on call. 28-30 hrs per call * 11 calls = 308-330 hours. And that doesn't take into account the 6-8 hours a day that I am in the hospital the day before I go on call. For a bit of perspective, if you have a "normal" 8-5 job and work 40 hours a week, then in one month's time, you work 160 hours. Needless to say, Beth said to me 2 weeks ago, see you in November (which has TEN GLORIOUS DAYS OF VACATION!!!). I have not gone more than 2 days (and only twice have I gotten 2 days in a row) in a row without having to go to work.
I'm not complaining, I'm just telling you why I haven't blogged in awhile. This month is MUCH different from last month at LBJ. The MICU has patients who are REALLY REALLY sick. Sick enough, that at any moment they can take a drastic turn, either good or bad. It's too early to say if it's going to be a good month. There are several factors that will need to be blogged about when I am not here and the potential for people who need to be blogged about are not around. (I'm fairly certain the previous sentence is a run on, and those of you who have degrees in English will anguish at reading it).
I was on-call the first day, Oct. 1, and I was MISERABLE! I had NO IDEA what I was doing. Luckily for me, the nurses here in MICU are OUTSTANDING! I have learned quickly these past 13 days and my confidence level is leaps and bounds higher than it was when I left here on day 2 after a 30 hour stent on-call. As an intern, most of the medicine I've learned in medical school is theoretical. They teach us about insulin, where it's produced, what it does, and how the body can mess that up. What they DON'T teach us is the Mr. X is a brittle diabetic and even the smallest amount of insulin makes him hypoglycemic and unresponsive. Other patients, who give them MASSIVE amounts of insulin and their sugars are still SKY HIGH. That's what I mean by theoretical. We talk about mechanical ventilation and breathing for patients, but we don't talk about the machines and the 45 different ways you can accomplish the same task, inhilation and expiration. It's just not as simple as "in and out" when the vent is involved.
And so I learn. I try to read. And I learn some more. I ask TONS of questions. And I learn. I have had to tell a family that it's time to say good-bye to their loved one and then write the order to turn off the vent. I've seen lab values that are incompatible with life and have the patient tell me where they are. People are amazing. Medicine is amazing. I wouldn't have it any other way.
On a much different note. Beth and I had the pleasure of Rachel's (a link to her blog, "The Wonder Years" can be found to the right) company at our house last night. She was in town for work and came over for coffee and brownies. We had a GREAT time. I've know her since...6th? 7th? grade. Her husband, too. I have yet to meet Buddy, but hopefully that can happen in the near future. Rachel spent about 2 hours with us and we laughed and talked about work and high school (she's a college recruiter) and had a nice time. I'm glad she came and hopefully she will come again should work bring her back to our neck of the woods. Rachel and I decided that we need to have Becky come to D/FW and we can have a mini-reunion with Eric and Christina since neither Becky nor I got to attend Eric's wedding. There was this hurricane that kept me from getting to Eric's wedding. I'm still a little sad about that. I've known Eric since 1986. 19 YEARS and counting. I've been friends with him longer than anyone outside of family. I hated not being there. Sorry, Eric. Life happens.
Well, I better get back to work. There are labs to check and orders to write.
One more comment. Texas Tech beats u.t. and ends their hopes for a national title.
Sorry, Becky, you are still required to love me and call me your friend. But you heard it here first.
I'm not complaining, I'm just telling you why I haven't blogged in awhile. This month is MUCH different from last month at LBJ. The MICU has patients who are REALLY REALLY sick. Sick enough, that at any moment they can take a drastic turn, either good or bad. It's too early to say if it's going to be a good month. There are several factors that will need to be blogged about when I am not here and the potential for people who need to be blogged about are not around. (I'm fairly certain the previous sentence is a run on, and those of you who have degrees in English will anguish at reading it).
I was on-call the first day, Oct. 1, and I was MISERABLE! I had NO IDEA what I was doing. Luckily for me, the nurses here in MICU are OUTSTANDING! I have learned quickly these past 13 days and my confidence level is leaps and bounds higher than it was when I left here on day 2 after a 30 hour stent on-call. As an intern, most of the medicine I've learned in medical school is theoretical. They teach us about insulin, where it's produced, what it does, and how the body can mess that up. What they DON'T teach us is the Mr. X is a brittle diabetic and even the smallest amount of insulin makes him hypoglycemic and unresponsive. Other patients, who give them MASSIVE amounts of insulin and their sugars are still SKY HIGH. That's what I mean by theoretical. We talk about mechanical ventilation and breathing for patients, but we don't talk about the machines and the 45 different ways you can accomplish the same task, inhilation and expiration. It's just not as simple as "in and out" when the vent is involved.
And so I learn. I try to read. And I learn some more. I ask TONS of questions. And I learn. I have had to tell a family that it's time to say good-bye to their loved one and then write the order to turn off the vent. I've seen lab values that are incompatible with life and have the patient tell me where they are. People are amazing. Medicine is amazing. I wouldn't have it any other way.
On a much different note. Beth and I had the pleasure of Rachel's (a link to her blog, "The Wonder Years" can be found to the right) company at our house last night. She was in town for work and came over for coffee and brownies. We had a GREAT time. I've know her since...6th? 7th? grade. Her husband, too. I have yet to meet Buddy, but hopefully that can happen in the near future. Rachel spent about 2 hours with us and we laughed and talked about work and high school (she's a college recruiter) and had a nice time. I'm glad she came and hopefully she will come again should work bring her back to our neck of the woods. Rachel and I decided that we need to have Becky come to D/FW and we can have a mini-reunion with Eric and Christina since neither Becky nor I got to attend Eric's wedding. There was this hurricane that kept me from getting to Eric's wedding. I'm still a little sad about that. I've known Eric since 1986. 19 YEARS and counting. I've been friends with him longer than anyone outside of family. I hated not being there. Sorry, Eric. Life happens.
Well, I better get back to work. There are labs to check and orders to write.
One more comment. Texas Tech beats u.t. and ends their hopes for a national title.
Sorry, Becky, you are still required to love me and call me your friend. But you heard it here first.
Friday, September 23, 2005
Rita is Here
Time for an update.
So it's 2:00 p.m., Friday, September 23, 2005. My sister's birthday. Happy Birthday Sis! Remember in my last blog that I said it would probably take Beth 8 hours to get to Austin. It took her 28, yes, TWENTY-EIGHT hours to go less than 250 miles. For her it was a nightmare. I was too scared to sleep. Never in my life do I ever want to go through what I experienced in the past 36 hours. There are many, many thoughts and emotions associated with it and Beth and I will spend many hours trying to sort them all out.
For now, the important thing is that Beth is safe. Dante and Picasso (our 2 mini-dachshunds) are safe. I LOVE VOLKSWAGEN!!! and they will get a BIG letter of THANKS from me in the near future. Beth drives a Passat, and when she left our home her gas tank was full. When she got to Bastrop (30 miles outside of Austin) 26-27 hours later, she still had 1/4 of a tank of gas. The batttery in her car is dead due to the extreme heat, duration of the trip, and not being able to go faster than 10 miles an our for 28 hours, but she didn't get stuck on the side of the road without gas. I am eternally grateful.
I am going to be at LBJ County Hospital until the storm passes. We have some critically ill patients that will be our help should we lose power and backup generators.
Regardless of what you may hear on the TV and radio. IT WAS ABSOLUTELY IMPERATIVE THAT PEOPLE LEAVE WHEN THEY DID! If they had started the evacuation 24 hours later, many, many people would have needlessly lost their lives. They system worked. Maybe not 100%, but it worked. We wil lnever know how many people were
spared because they made the decision to leave, even if they did sit on I-10 for 16+ hours.
Time to get down to business. Take care, and I'll again when I can.
Because of His grace,
Jeremy
So it's 2:00 p.m., Friday, September 23, 2005. My sister's birthday. Happy Birthday Sis! Remember in my last blog that I said it would probably take Beth 8 hours to get to Austin. It took her 28, yes, TWENTY-EIGHT hours to go less than 250 miles. For her it was a nightmare. I was too scared to sleep. Never in my life do I ever want to go through what I experienced in the past 36 hours. There are many, many thoughts and emotions associated with it and Beth and I will spend many hours trying to sort them all out.
For now, the important thing is that Beth is safe. Dante and Picasso (our 2 mini-dachshunds) are safe. I LOVE VOLKSWAGEN!!! and they will get a BIG letter of THANKS from me in the near future. Beth drives a Passat, and when she left our home her gas tank was full. When she got to Bastrop (30 miles outside of Austin) 26-27 hours later, she still had 1/4 of a tank of gas. The batttery in her car is dead due to the extreme heat, duration of the trip, and not being able to go faster than 10 miles an our for 28 hours, but she didn't get stuck on the side of the road without gas. I am eternally grateful.
I am going to be at LBJ County Hospital until the storm passes. We have some critically ill patients that will be our help should we lose power and backup generators.
Regardless of what you may hear on the TV and radio. IT WAS ABSOLUTELY IMPERATIVE THAT PEOPLE LEAVE WHEN THEY DID! If they had started the evacuation 24 hours later, many, many people would have needlessly lost their lives. They system worked. Maybe not 100%, but it worked. We wil lnever know how many people were
spared because they made the decision to leave, even if they did sit on I-10 for 16+ hours.
Time to get down to business. Take care, and I'll again when I can.
Because of His grace,
Jeremy
Wednesday, September 21, 2005
Rita is coming...and she's not bringing Tequila
Gulf Hurricane, Take 2
It's Wednesday night and I felt the need to blog before Rita makes her presence known. Rest assured that the citizens of Galveston and Houston and the surrounding areas are taking Rita and her fury extremely seriously. It is taking 5 hours (normally a 1 hour trip) to drive from Galveston to downtown Houston.
Beth plans to leave for Austin tonight in the middle of the night. It will probably take her 8 hours to make a normal 3.5 hour trip. She is taking the dogs and a few keepsakes and heading for higher ground. This storm is so big that I'm sure Austin will get plenty of rain.
Me, you ask? Well, as an intern in the medical field, I am reporting for duty. My team is on-call (admitting patients for the night) starting Friday morning at 7:00 a.m., a few hours before we start to see effects of the hurricane. We have been told that we will stay in the hospital perhaps untilSunday or Monday depending on the storm, since the other residents won't be able to make it to the hospital. Even if I have the opportunity to leave Saturday morning, I won't. Beth and the dogs will be taken care of and I'm sure that they will need help in the hospital.
Say a prayer of us. That the casualties will be few and the damage minimal. Pray for patience as people spend many hours in the car trying to get out of harms way.
Time to batton down the hatches. See you on the other side.
Jeremy
It's Wednesday night and I felt the need to blog before Rita makes her presence known. Rest assured that the citizens of Galveston and Houston and the surrounding areas are taking Rita and her fury extremely seriously. It is taking 5 hours (normally a 1 hour trip) to drive from Galveston to downtown Houston.
Beth plans to leave for Austin tonight in the middle of the night. It will probably take her 8 hours to make a normal 3.5 hour trip. She is taking the dogs and a few keepsakes and heading for higher ground. This storm is so big that I'm sure Austin will get plenty of rain.
Me, you ask? Well, as an intern in the medical field, I am reporting for duty. My team is on-call (admitting patients for the night) starting Friday morning at 7:00 a.m., a few hours before we start to see effects of the hurricane. We have been told that we will stay in the hospital perhaps untilSunday or Monday depending on the storm, since the other residents won't be able to make it to the hospital. Even if I have the opportunity to leave Saturday morning, I won't. Beth and the dogs will be taken care of and I'm sure that they will need help in the hospital.
Say a prayer of us. That the casualties will be few and the damage minimal. Pray for patience as people spend many hours in the car trying to get out of harms way.
Time to batton down the hatches. See you on the other side.
Jeremy
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!
Ha!
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!
Ha!
Sunday, August 21, 2005
STOP SPAMMING MY BLOG
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.
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.
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