What happened?

Okay - what the heck happened to my Red Sox? I know, I know we won last year, which should make me feel good. And I did - I do. But we were on top of the AL East for so stinking long. Why did we have to blow it at the end of the season?

Now the whole shebang might well rest on the final three game series against the Yankees. I hope they (the Yanks) all stub their toes and break their hands in the next several days!

But the good news is that I'm discharging one of my babies - and he's mostly normal! He's a former extreme preemie with multiple complications who has somehow hung on to the greater part of his brain and neurologic function. He's so freaking cute, too. He has little black curls and a big 'ole grin.

So nice.

NICU goodness

The NICU is depressing. For every baby that leaves mostly healthy and mostly normal, there seems to be five babies that either die or leave with serious neurological devistation. Which is just freaking fabulous, if you know what I mean.

I just had to go tell a mother that the Pseudomonas ventriculitis is most likely gonna kill her kid. He's not hemodynamically unstable - he looks just like he did this morning prior to his ventriculotomy. But when the neurosurgeons went in to look around, all they saw was puss. Clearly, our antibiotics aren't worth crap for this kid.

So he's gonna die. The only questions remaining are when and how.

Remind me why I like my job?

The Aftermath... duh duh duuuuuuhhhh

First off, to all of my readers who are relatives or out of state friends: We're fine. No windows broke, no flooding, power is back on, the hubby and cats are fine.

Nothing much happened in my part of the world. Some branches were down, lots of us lost power, some yahoo got shot while trying to loot and nearly everyone ran out or nearly ran out of gas. Other than that, Rita was almost a non-event.

Which is very very cool.

I feel horrible that our neighbors to the east got hit so hard, but I have to say that I couldn't be happier that Houston was spared. Now, of course, many of those people who got stuck in traffic trying to evacuate are saying that they'll never leave town for a hurricane again. The doctor part of me is horrified - these people will put themselves at such huge risk. The bitchy Darwinian part of me thinks that these folks will just have to learn the hard way; furthermore, if they aren't fleeing like sensible people then there will be more room on the highway for my loved ones.

But life is pretty much back to normal. I've switched rotations, so now I'm in the community hospital NICU. Hmmmmmmmmmm... babies. Life is good, 'cause right now there aren't any fetuses. Just plenty of ventilator depended chronic lung babies, some feeders and growers and a couple of former fetus train wrecks. The really really super cool thing is that due to a scheduling fluke, I don't have to take call until this Sunday.

Rock on!

Another day, another dollar

Well, so far so good. I have no idea how the house is doing, but we're fine here in the community hospital. Apparently we picked the right community hospital to hang out in - its twin a little ways up north has lost power and is transfering all of the patients here. Whoo-hoo!

We'll be awright.

Much ado about nothing...

That is, if a category 3 hurricaine counts as nothing. So the whole trajectory of the storm changed this afternoon and that bitch is veering away from Houston to the east. Part of me is happy happy happy. (That would be the vastly larger part, by the way.) The other part of me is a little mad. We - and by we I mean my husband, my friends, my colleages, my colleages' spouses - did so much prep work. Everyone is exhausted. Most of us came into the community hospital packed for a 5-7 day stay. I know I did. I also brought enough food for myself for about four days and enough water for two. If it all turns out to be unneeded, a small part of me feels a little jilted.

I kinda wanted a 'I lived through Rita' t-shirt. Stupid, huh?

But really, I'm so fucking greatful that this thing has decided to chill out and calm down. I was convinced that Rita was going to blow our windows out. See, we have these tall single pane windows on both the west and east walls of our condo. To make matters worse our condo is supposed to resemble a loft, which means the entire place is just one huge oblong room. So if the window(s) shattered, our entire place would get drenched and we'd have a large, $200,000 wind tunnel. And we couldn't board up the windows 'cause the outside is stucco - there would be no place to attach the plywood to the wall.

But thankfully all of that looks less likely now. 60 MPH winds = possible damage. 150 MPH winds = total destruction. Therefore, 60 MPH winds = good.

When this is all over I'm taking a very long nap.

One Rita I wouldn't want to drink

So here we sit in the path of a category 5 hurricaine. I have to say, this is one of those experiences I had hoped to avoid while living down here on the Gulf.

I think my people will be fine. My husband, thank the powers that be, is leaving town. Last time we communicated, my husband agreed to go away to Dallas (Hi Lizard!) with the cats to stay with his brother. I'm wholeheartedly in favor of this plan, 'cause then I won't have to worry about him. I don't want him here if this sucker is going to be bad.

I have to stay. The pedi residents will be manning the floor at the Community Hospital and at the MSDQCH through the storm. All of us plan to stay for quite a long period - up to 96 hours if need be. The Chiefs currently plan to have my team on call tonight, so home tomorrow post call, work Friday for as long as needed, have a "day off" on Saturday (expected landfall that morning) and then come in to relieve the other MDs on Sunday. We've been explicitly asked to not show up on Saturday so that someone minimally fresh will be available to take on patient care Sunday.

I'm not sure how the current plan is going to work out. I mean, will I even be able to get back to work? I would rather not be home on Saturday. I really don't want to be home on Saturday, actually. I'll probably just come in on Saturday and not work.

Or something like that.

But anyway, I'll get a up-close and personal view of a wicked strong hurricaine. Oh, joy. Hear the excitement in my voice... NOT.

But Chris will get out, I'll be safe in the hospital and that is what is important.

Update:
So, the plan is for my team to be "off" on Saturday. However, the hospital is kindly giving us space to ride out the storm overnight Friday. My team and I figure that folks should get the hell out of Houston, but barring that, the safest place to be is inside one of the hospitals.

I can't say that I'm excited about 48+ hours in the hospital. But it could be fun in a twisted sort of way - kinda like a big pajama party.

We'll just have to see!

Things that don't suck

I haven't been having the greatest three months, so I've decided that tonight I'm going to create a list of things that don't suck. Just to make me feel better.

My husband
Our cats
Zoloft
Sex
Guinness
Sam Summer
Astros
BoSox
Live baseball - Major League or triple A
The resident crew - the uber-bachelor, the soon-to-be-married, the (mostly) happily single
The boyz (which, oddly enough, includes more than one girl!)
The Proletariat
My aunt
Ice hockey
Mythbusters!
Risotto
Epicurious.com
Blue Man Group
James Bond
Central Market
Weezer
NIN
Grey Goose Vodka
Helios
Ireland
Scotland
Paris
Vienna
Family Guy
DVR
The Internet
Action Flicks

Enough for now. If any of my three readers want to, start your own list!

Q4 Kicks My Ass

Or, A Lesson on Terminology.

In medicine, every drug or intervention order must include a frequency. Furthermore, doctors are lazy writers. Abbreviations? Hell yes! Acronyms are good too. So instead of writing "every 4 hours" or "every day" we write "q4h" or "qday". That's a reduction of nearly 73% or 57% respectively.

As a group, residents expand this system to quantify our call nights. Call runs on a repeating schedule - every third, fourth or fifth night. Hence, q3, q4 or q5. As an intern, I had a lot of q4 months. And I did okay.

I must be old, but now q4 really kicks my ass. I feel like I'm on call or post call all the time. I'm tired, I'm cranky and my undereye circles are expanding at an exponential rate. And let's not even talk about the party my acne is having on my chin. Yuck.

But repeat after me, I'm not an intern any more! This remains cause for celebration. I only have have two months of call this year. Sooooooooooo much better than ten months, and it is soooooooooo good to NOT be on the bottom of the totem pole.

So really, life ain't bad.

Goddamn it all to hell

JJ (the kiddo who died) not only herniated (ie pushed his brain out of his skull), not only had eye findings consistent with abuse but also had relatives who had fucking reported abuse to CPS days prior to the injuries leading to his death. Apparently, these relatives had seen him covered in bruises.

Goddamnitalltohell.

Not only did he die, his death was preventable.

Not that it helps any, but the step-Dad has been arrested for homicide. I hope he roasts.

Tagged again

Seven Things Meme

Seven things I plan to do before I die...
1. See Mt. Fuji
2. Start a clinic or foundation for under-insured children.
3. Get my MPH (masters in public health)
4. Have kids.
5. Retire in the mountains and ski all the time.
6. Go to cooking school.
7. Biuld a modern design, eco-friendly house with my husband.

Seven things I can do...
1. Belch louder than any other female I know.
2. Belch louder than most men I know.
3. Take care of asthma
4. Ski
5. Cook well.
6. Make my husband smile.
7. Keep aquarium fish alive.

Seven things I cannot do...
1. Sing
2. Understand why anyone would hit or shake a child.
3. Tolerate dogs.
4. Fake interest when I just don't care.
5. Waterski
6. Skydive - I'm very scared of heights.
7. Do much of anything with my left hand.

Seven things that I find really attractive about the opposite sex...
1. Penises
2. Laughter
3. Kisses with lots of tounge
4. Open-mindedness
5. Bums. Especially bums in a really nice pair of black pants or jeans.
6. Intellegence.
7. Blue eyes.

Seven things I say the most...
1. I love you. (To hubby)
2. My name is Dr. Doctawife, welcome to the hospital, sorry you're here. What brings you in today?
3. Thanks.
4. Did you remember to check on the ... (to my interns)
5. Whatever.
6. This is Dr. Doctawife, returning a page.
7. What do you mean, the patient is here (in the ICU)! No-one called to give me check out!

Seven Books I love...
1. Anything by Mercedes Lackey.
2. Most Nora Roberts books.
3. Alll of the Harry Potter books by J.K. Rowling
4. The Harriet Lane Handbook for general pediatric reference.
5. Most books by Christine Feehan.
6. Anything by Sherilynn Kenyon.
7. The Texas Childrens Hospital Formulary. I can't do my job without it.

Update

So the kid I talked about in my last entery died. His pupils became fixed and dilated yesterday at about 8:30 pm.

To fight child abuse, you can donate money here. If you suspect child abuse, you can call 1-800-252-5400 in the state of Texas. For more information on Texas Child Protective Services, you can check out their website.

Remember, some folks shouldn't have kids. It is up to the rest of us to make sure those kids eventually have someplace better to go.

Post call

This is an experiment. Life always seems skewed after a night on call, and I've talked about it a lot with my hubby. But I've never written about it. He says that I'm grumpy, impatient and somewhat moody post-call. I have no idea what I am. Other than damn tired, of course.

So I thought I'd write a post-call entry today and then read it tomorrow. Just to see how the 'normal' me views the post-call me.

First let me talk about call. "Being on call" does NOT mean that I'm at home, maybe answering one or two pages from anxious mothers, sleeping peacefully in my own bed. While a resident, being on call means getting to the hospital at about 7am on day one and leaving at about 1pm on day two. Yes - that's more than 24 hours straight in the hospital.

And no, one does not sleep in a nice dark room in a quiet portion of the hospital all night while maybe one or two nurses page you about anxious mothers. As an intern it meant dealing with 2/3rds bullshit, 1/6th social chaos and 1/6th true medical problems. ALL night. As a senior resident, it means dealing with 1/4rth bullshit, 1/2 intern problems (eg how to deal with social chaos) and 1/4rth real Sickness. Of course, as an upper level the Sick patients might, at any time, stage a coup and storm the other three quarters of my time. Don't shoot til you see the whites of her eyes! Needless to say, everyone is up all night long.

So last night was a gem. Three intubated kiddos, two of which were Sick, and three regular admits. The Sickest child is likely the victim of abuse. And guess what! He's most likely gonna die. At one point last night, his intracranial pressure hit 80 mmHg.

That's bad. The goal is less than 20. Intracranial pressures of 80 = intracranial badness/impending doom.

Motherfucker. Some people just shouldn't be allowed to procreate.

On a more positive note, leftovers are good. Mmmmmmmmmm... meatloaf.

Lines, tubes and protocols

On call again.

And apparently, my formerly stable white cloud, which served me well through two years of residency, has turned black. Every freaking time I'm on call I either get really high volume or really sick kids.

Even the chief resident noticed. As a matter of fact - he made it official. He looked at me tonight and said, "Well, you have a second PICU admission on the way. I should have known - it's your call night, after all."

But first I have to explain what a white or black cloud is. A resident with a 'white cloud' is someone who has easy call nights. Few admissions, no one too sick, no social disasters, no transfers from the PICU. A resident with a 'black cloud' (which would now be me) gets multiple admissions, Sick patients, folks on other people's teams going from sick to Sick, social nightmares and issues with miscommunication between consulting services.

Oh, the joy.

It didn't used to be this way. I sailed through most nights on call, at least here at the community hospital. I never cared for more than, oh, five patients. Luscious. Apparently, that is not to be my fate this time around.

I know I sound whiny. I'm sorry, I'll stop soon. I just needed to follow in Ween's footsteps and take a moment to bitch.

On a brighter note, friends will be coming over to dinner Sunday night. Yay!

Manipulation

Dealing with nursing at the community hospital (CH) can be very interesting. I feel like I'm trapped in a bizzare roll playing simulation, where the moderator is asking the students to act out various ways to motivate the un-motivatable employee.

For example, the second and third nursing shifts weren't recording the 'ins and outs' (aka I's/Os) for AH, a 21 day old patient with poor weight gain. Tracking how much a patient takes in and how much the patient puts out (in both stool and urine) can be critical when diagnosing the etiology of failure to thrive in a baby. Basically, without the I's/Os, we can't figure out what the hell is going on. And guess what, nursing has the primary responsibility for measuring the intake and weighing diapers for the output. It is kinda sorta part of the job description. And it isn't all that hard.

So why wan't it happening?

This was my question.

But if I said or did anything at all slightly accusatory, condescending or reproving, I would earn a bad rap with the RN's. Which would be a problem. If nursing don't like ya, and you ever want to get anything done ever again - you were screwed.

Needless to say, much ass-kissing ensued. Because, of course the nurse working today would never have made such an error, and could she please educate her co-workers about the correct and proper way to do things? And was there anything I could do to make her life easier?

So you see, when you see me and my nose is brown, you'll know why.

Responsibility

Right now I'm the senior resident on the children's ward at the Community Hospital (CH) affiliated with my program. I run the ICU when the staff (ie attendings) aren't around. So if someone is intubated and ventilator dependent, it's all me. Furthermore, CH has been designated as the destination for any sick kids from the Astrodome - which means I'm waiting for the other shoe to drop. So far, so good.

But man, I can't believe that there aren't sick kids out there, just waiting to be brought to light. Scary scary. Can't you picture it? A kiddo in status asthmaticus (a very long bad asthma attack) on the verge of ventilatory failure lingering on the floor of the Astrodome until (on my call night, of course) he's found by some astute volunteer or wandering MD - then brought to me in the PICU. I just hope I can take care of whatever rolls in.

I'm not without support. I can always call the Chief Resident to get advice, who can then call a Critical Care attending over at the MSDQCH if things get too sticky, who could then call me back. But that's a lot of calling, and sometimes kids don't have a lot of time. Granted, I spent one five week long hellish month over in the MSDQCH intensive care unit trying to learn what I needed to give the kiddos what support they need until help arrives, but damn, that was only five weeks and it was last November for Pete's sake!

So far I've done okay, let's just hope tonight goes as well.

Katrina

This is my chance to write something truly insightful about a horrible tragedy.

Not gonna happen. I haven't wrapped my brain around what happened last week. I can't wrap my brain around what is happening this week.

The scope of the disaster is really more than I fathom. My home is in Houston, I've treated patients from New Orleans and I've seen the Dome. None of that matters. I just can't picture it.

Which is weird.

When the Twin Towers fell, I could connect the images on TV to images in my reality. I can't pull the pictures from New Orleans or the pictures of thousands arriving at the Dome together with my worldview. Somehow, in my head, Lafite's is still underlit, leaning sideways and open for a beer. The Bourbon Orleans still presides with majestic splendor over Bourbon St. while offering some of the finest accomidations in the Crescent City. The trolley still trundles towards Tulane and drunken collegiates.

But my head is wrong. My intellect fully understands that thousands are displaced and an entire culture has been devastated.

My heart just won't believe.