Tuesday, June 29, 2010

Note to self...

When a VA patient tells you he drinks 1-2 glasses of wine a night...
times that by 6.

Seriously though, if there is anything I have learned when it comes to our veteran's....it's that they like their alcohol. Some are more obvious than others and most will never admit it outright, but 95% of the time you can safely guess that if a patient is coming to you from surgery... be prepared for alcohol withdrawal symptoms.

For example... right now I am taking care of a post-op CABG x1 with an AVR. Basically, he had a one vessel graft on a coronary artery and a prosthetic valve placed in his heart. He's a relatively healthy guy considering what we are used to here. No history of drug use, smokes a pipe, told his surgeon he drinks one shot of gin a week. Told the social worker he drinks a shot of gin a week AND 1-2 glasses of wine a night....

"Yup, that explains it." I said to myself.

When I came on shift, I noticed the patient had been having minimal signs of alcohol withdrawal, just some tiny tremors that I thought looked strange. I pulled the intern and resident to the bedside to have them take a look.

"You know when a dog is sleeping and they're dreaming about something and you see them do that funny twitch thing, or you see them start to move their legs like they're running."

I can't believe I'm actually explaining a patient's symptoms like this.

"Uh huh," the resident nods as the intern begins doing a neuro check on my patient. The docs are nice enough to humor me.

"Well, thats what he's been doing. He isn't doing it now but if I mess with him at all, like do a fingerstick or anything, he starts doing it." Luckily, just as I was about to touch him to see if it would happen...he began twitching on his own.

"SEE, like that!" I point at him, SO thankful that this time, when I actually get the doctors about something, it happens when they are at the bedside and not the second they leave instead...
I swear I'm not crazy.

We all came to the conclusion that we weren't quite sure what was going on, and since his pressures didn't drop too much when it happened and he was remaining stable... well we basically all shrugged our shoulders and decided to just hope it'd stop.

It didn't...

Around 2am, this patient who had been on enough fentanyl and versed to knock out an elephant and should have been zonked out of his mind, SAT UP, in bed, wide eyed and reaching for his ET tube. I jumped up, grabbed his hands and began explaining to him calmly that he was in the ICU and his surgery was over and he was fine...but that he had a breathing tube in his throat and IV lines everywhere and cannot grab them and needed to go back to sleep. Yes, the longest run on sentence ever. He looked at me for a while, nodded his head and then began to fight me like mad....at which point I decided I needed back up and yelled for my neighbor to come in and restrain him while I increased his sedation.

This is the classic case of the patient not admitting to the true amount of alcohol they drink on a daily basis. The amount of sedation this patient required was a sure fire sign that he had quite a tolerance built up. Anyone who can wake up on 5mg/hr versed and 500mcg/hr fentanyl has got to knock a few back pretty often.

All in all it ended up being fine. Thank goodness for dexmedetomidine... the wonderful drug that sedates you but doesn't depress your respiratory drive = we can extubate you and keep you calm at the same time. :)

And next time, I'll remember to pay a little more attention when someone says they drink "1-2 drinks" a day.

Sunday, June 27, 2010

First week back

1st day back from vacation and even though I've only been away from this place for 12 days, it feels like I have to re-learn everything. About an hour into work I look over to my good friend and neighbor for the night, MB and I say,

"Good Lord, I forgot how stressful our job is!"

"Welcome back!" she smiles.

My patient was a triple A repair (abdominal aortic aneurysm). I won't bore you with all the clinical details but basically the night got interesting and by 0330 I was banging on the on call room door to wake up the intern after 6 unreturned pages. I was not happy to say the least. My patient had signs and symptoms of internal bleeding. To make a long story short the problem was not managed well by our ICU team and when the vascular surgeons rounded in the AM they were not happy either. Especially when they came in and found out that their patient had a hematocrit of 16 (extremely low) and no one bothered to call them.

Sad thing is that I really liked the resident on call for that night and the intern himself isn't generally a nice guy but he's good... knows his stuff. I have a feeling that everyone's lack of response had something to do with it being their last night on the rotation. Everyone seemed to have an "I-don't-care-I'm-outta-here-soon" attitude.

Not fun.

2nd day back at work

I have a patient that I've had before... weeks ago. Unfortunately he took a turn for the worse and has been re-intubated (for the 4th time) and has been in a fierce battle with end-stage liver disease, as a result from years of drinking. Ended up eventually with esophageal varices and now, as I have him, has a severe lower GI bleed. We haven't been able to get his family here (whom he has been estranged with for the past decade) so he is still a full code, despite a very grim prognosis.

I ended up giving a total of 10 units FFP, 4 units RBC's, 2 of Cryo, and 3 of platelets. Practically cleared the blood bank out of everything they had. Came back from break at 5am and there is the GI attending scoping him and trying to find the source of his bleed.

"This must be punishment for taking vacation." I thought to myself as I step in the room and gown up to assist.

"Only 2 and a half hours left." MB reminds me as she passes my room, seeing the desperate look on my face.


3rd night back

His family arrives and he is placed on comfort care. He gets extubated and is put on a fentanyl drip. Now, here I am at 3am with a patient who has an O2 sat of 76% but for all intensive purposes is hanging on quite well. Trekking along at a HR of 80 and a blood pressure of 124/50... not bad for a man that is slowly bleeding to death.

Morbid? ... maybe, but its the reality of my job.

"Welcome back to the ICU dear"... vacation is definitely over.

Friday, June 25, 2010

Celebrating freedom

Your Quit Date is: Wednesday, May 05, 2010 at 11:30:00 PM
Time Smoke-Free: 48 days, 2 hours, 18 minutes and 29 seconds
Cigarettes NOT smoked: 577
Lifetime Saved: 4 days, 9 hours
Money Saved: $176.40

It has been a hard month and as I'm writing this at 4am on 6/23, I am amazed at the words written above here. For those of you who don't know or haven't been following me for long... I used to smoke.

As you can see from my wonderful quitnet.com reminder I have been free from smoking for almost 2 months, 48 days and some change (by the time this posts it will be a solid 50 days!). It has been hard! Let me tell you, I have been through some pretty terrible things in my life and quitting smoking has been undoubtedly one of the toughest personal battles I have ever fought.


So today, I'd like to take a moment to acknowledge the freedom I have fought for and gained these past 48 days. Yesterday, I found out that someone in my family might be very sick. Nothing set in stone yet... but it's not looking good. Needless to say it was one of those, "Oh Lord, I wish I was still a smoker" moments. I knew smoking wasn't an option... so what did I do?

I drove to the store and bought some nicorette gum. I poured myself a glass of wine when I got home and I sat. I sat on my porch, clutching the pack of nicorette gum. I sat there with my wine glass sitting beside me. I sat there and I sobbed to one of my best friends and told her that I was angry and sad and scared and hurt. I sat there... and I breathed, but I didn't smoke. I didn't even use the nicorette gum.

Today, I am celebrating the fact that I have survived some really tough moments these past few weeks and I survived them without the vice I had been using for almost 10 years. I survived it all without cigarettes.

I will always take it one day at a time, and I am thankful for every moment I remain smoke free, but for now... for today...

I am celebrating freedom.

Wednesday, June 23, 2010

Technical Difficulties

This week has been full of technical difficulties in my life. Literally... and figuratively speaking. I've been meaning to write a lot on here. I have a lot to say and a lot to update about. I also can't wait to share more about Seattle!

Unfortunately, I have been in the process of switching to a new laptop and it has been quite an effort to transfer over all of my old files to the new computer. This also means that photo editing and blog writing have fallen to the wayside as a result. Also... my glorious 12 day vacation is coming to a crashing end tonight and I'm back to the grind. Definitely not ready to go back to work but alas, duty calls.

Hopefully I will be able to update soon. In the meantime a gift from me to you.

Courtesy of AwkwardFamilyPhotos.com and Fail Blog.

Sunday, June 20, 2010

Day 1: Seattle!

Welcome to Pike's Place Market!

Our first stop after arriving in downtown...
Yup, you guessed it. The very first Starbucks in Pike's Place Market. I love Starbucks and since Seattle has over 400 in the city alone (literally one on every street corner) I was in pure heaven. My max espresso shot count for the day... 6!

Meet Helena, my partner in crime when it comes to traveling. She's the best at finding great travel deals (we snagged a trip to Hawaii for less than 500 each!) This is her reveling in the glory that is Starbucks! Also, Helena was lucky enough to have a college friend that lived near Seattle. He was so nice, he picked us up from the airport and him and his girlfriend chartered us around for the day. You'll meet them a little later. :)

The market itself was packed full of people. It was apparently the first no-rain, sunshine-filled day in a long while, so the masses were out to soak it in. One of my favorite parts of Pike's Place (other than the food) was the flowers they had. They were so gorgeous and really cheap!

Five dollars a bunch. Look at those colors!

There were all of these amazing cheeses and preserves. They had a ton of different vendors with everything from souvenir clothes to organic lotions and bath products.

I was sad that we didn't have a kitchenette in our hotel room because the food looked so good I wanted to buy a bunch and take it home with me. Although we did manage to bring home a good amount of fun market finds for our friends at home.

And of course the part of Pike's Place Market it is most well known for... Seafood!!

If you look closely you can see the fish guys throwing an order to each other. This was the famous spot where they throw the fish. Also I love all of the crab! As you will see in an upcoming post... I love the show Deadliest Catch... and Seattle is a crab boat mecca.

That fish you see is a Salmon and it was 40 lbs!! Seriously the picture does no justice to how big it was.
For lunch... pizza with mole sausage! yum

That was Pike's Place.... onto the second part of the day

Joel was Helena's college friend and Em was Joel's girlfriend. Hands down two of the absolute sweetest people I have ever met in my life. They were so nice to take us all around Seattle and even showed us to places outside of Seattle. One of which was Em's family's house. They lived on a beautiful little lake that we went canoeing around.

Joel, me and Helena paddling around the lake. I obviously had no idea a picture was being taken. I think at this point I had been up for 24 hours. Hence the need for multiple Starbucks coffees a day.

Our redneck version of a four person canoe. haha
The lake was beautiful... just the beginning of me falling in love with Washington. I kept saying, "If I grew up here, I'd never leave!"

We stopped by these beautiful falls outside of where Em's family lived. We were going to try and hike to them but the trail was closed. Aren't they pretty?

Last but not least we went to a place in West Seattle to get some really good fish and chips.
Alki, and again...since it was the first sunny day in ages.... everyone came out. My favorite? The cruisers with their crazy cars... see for yourself.

Haha, so much for the anti-cruising ordinance... The view of downtown Seattle from Alki was amazing.

Helena and Em, once again, enjoying starbucks. (catching a theme here?)

There you have it... our first day in Seattle.

Don't you just love summer traveling?

Wednesday, June 16, 2010

Home looks so different now

I'm back from Seattle and it was an absolutely amazing trip! Trees and mountains, water and green nature everywhere! I just loved it. I'm pretty exhausted and will probably sleep a good 14 hours tonight but it was all well worth the exhaustion. I woke up this morning to RAIN!

Sad now, cause I love rain and now I'm stuck back in 70-90 degree California weather. bleh. Oh Washington State, you stole my heart!

Now, it looks like someone threw up luggage all over my room and I'm just starting to catch up on the many blog posts and emails I have missed while I was away. Oh, and of course I will be uploading pictures galore to share with you all!

Happy Wednesday friends. Hope where you are it is much cooler than here!

Monday, June 14, 2010

3a.m. Oatmeal Crisp

This is what I do when I can't sleep ....

Fruit Filling
2 c. blueberries or 1 (10 oz.) pkg. frozen blueberries, thawed
2 c. strawberries
1/4 c. sugar
2 tsp. grated lemon rind
2 tsp. water
Oatmeal crisp
1/2 c. all-purpose flour
1 1/4 c. quick cooking oatmeal
1/2 c. brown sugar or 1/4 splenda brown sugar (which is what I used)
1/2 c. butter
1/2 tsp. cinnamon
1/4 tsp. nutmeg
1/4 tsp. salt

Preheat oven 375 degrees.

Prepare your choice of fruit mixture as indicated below. Cover bottom of buttered cake pan or pyrex dish with mixture.

Combine flour, oats, brown sugar, cinnamon, nutmeg and salt together in bowl. Cut butter in dry ingredients until mixture is crumbly or do what I did and just melt the butter in. Sprinkle topping over fruit and bake in a moderate oven. Serve warm, plain or with whipped cream, I used fat free cool whip. Top it off with a few dried oats and fresh blueberries.


Square pan: 8 inch or 6 cups. Cooking time: About 30 minutes.

Friday, June 11, 2010

Free at Last!

image credit

My 12 day vacation from work has officially begun and words cannot describe how needed this is. For some reason, this week at work has been incredibly long and hard. I have definitely had more horrendous assignments and wasn't extremely busy, I guess.... it was just exhausting.

I have a feeling, the lack of sleep and the fact that I did a 16 hour shift in the beginning of the week, is what did me in. I've also been trying really hard to go to the gym during my break. I try to run at least 2 miles everyday and sometimes I lift weights as well... in light of that, I left work today practically limping my feet hurt so badly.

Needless to say... the week is over and tomorrow morning I will be heading off to Seattle with one of my best friends! We'll be spending a few days in downtown and also heading up to Vancouver for a day!

I can't wait and doing nothing but bumming around a new city, eating, getting coffee, taking some pictures and maybe getting a chance to do some fun outdoors-y things sounds like the perfect dose of medicine right now... that and a nice foot massage, haha.

Some fun suggestions we've had for things to do and see:
The Fremont Troll
Jimi Hendrix museum
Oyster Bar
Deadliest Catch boats in the pier (I love that show!)
Pike's Place Market

hmm, anything else?

Most of the tips I've had from people have centered around food, of course... haha no complaints here. That always seems to be the best part of traveling. :)

When I get home I will have 6 whole days to do nothing but sleep, relax, hang out with friends and catch up on non-work stuff. One of which is going to include hosting a terrarium party at my house! (More on that to come later)

Yay, for summer vacations!

Wednesday, June 9, 2010

Strange Day

Today has been a strange day. Too many unexpected and unusual things for my liking.

It almost feels like I stepped into a Salvador Dali painting...

something akin to this...

Not to mention that this day started at 10am yesterday.

For a 48 hour span I will have gotten 5 hours sleep...
Who says residents and interns are the only ones who have crappy hours?

Almost forgot one of my best friend/ex-boyfriend/ex-roommate's birthday (thank you google calendar for saving me)... so not like me... especially for those that matter most

Last year his birthday involved a very large, homemade sponge bob cake.... you wouldn't believe me unless you saw it, so here you go.

Discovered another friend....also a previous roommate for a 6 year stint.... had decided to lose 40lbs and join the police academy.

huh?...who are you and what have you done with the person I lived with for 6 years?

Had no clue and realized that in just a few months things can really change a lot.

Have you ever had one of those days where it feels like everything is just a tiny bit off?

Or maybe a lot off?

Today was definitely one of those days.

I hate feeling like I am on the outside looking in... completely lost to my surroundings...

Feeling like I am always forgetting something, or doing something wrong, or missing the point...

well, today was one of those days.

And then... I come to work and I have a fresh, post-op, CABGx3 for a patient...

cardiac surgery, intubated, sedated, spaghetti factory of lines....

I stepped into my routine and suddenly... almost instantly

the world turned slightly back into place...

I took a deep breathe, smiled and thought..

Ahh... home.