I'm gonna be in pictures

They're gonna make me a star.

I was sitting around today, minding my own Team Failure business with my intern and med student, when a group of people with Vandy badges and a camera crew approached us, asking if we want to be in a recruitment video. What kind of recruitment video, you ask? Minority recruitment. Hmm. We are two blond women (coincidentally both dressed in pink) and a tall, skinny white guy. Minority recruitment? But sure, whatever. I'm stuck there waiting for admission labs to come back, so I might as well be entertained and entertaining.

This mostly involved filming us pointing at x-rays, , walking around the halls, and in general doing medical-ish things without looking at the camera. (How do reality TV people do that? It's so invasive! Talk about an elephant in the room.) But the best part was when they asked if we have a patient who would be willing to be filmed with us. Boy, do we ever. Mr. M is the cutest little old man ever. Ever. He was tickled pink to be in our video and obliged politely as the crew filled his room with cameras, lights, and sound equipment. Then, sweet soul that he is, he let them film him in his hospital gown talking to us. Cutie patootie! Unfortunately, we've been informed they weren't filming with sound. So it looks like this will not be my big break, and I will have to keep my day job as a medical resident. Se la vie.

I don't know where or when this video will be posted, but I will surely put up a link if I find it.

Doomed to Failure

I flatter myself to think you've noticed the paucity of posts lately. So for all of you out there in cyberland, I'm gonna play a little catch-up...

I made it out of the MICU by the hair of my chinny chin chin, but it's out of the frying pan and into the fire with me. I'll be spending two weeks on a little gem of a service called CHF (congestive heart failure), affectionately dubbed Team Failure. And by gem I mean punishment, and by affectionately I mean anything but. Cardiology falls just underneath MICU in the adrenaline junkie subspecialties of medicine, and we have previously established that I am adrenaline averse. But I am captain of this little ship for two weeks. And by captain I mean the scallywag who scrubs the decks.

Here's a brief re-cap of my first couple days: Show up at 5 am. Discharge 8 patients. Stay up all night and admitt 9 new patients. Drag through post-call rounds. Go home, eat, sleep. Show up at 4:30 am. Discharge 4 patients. Admit 5 patients. Leave at 6 pm. Go home, eat, sleep. Show up at 4:45 am. Discharge 3 patients (no, wait, just 1, the other 2 have issues and have to stay). Admit 2 patients. Leave at 6:30 pm. Are we sensing a trend? I'll bore you the gory details, but suffice it to say I'm not planning on having a lot of fun these next two weeks. I'll see you on the other side.

Light at the end of the tunnel: If I survive 3 more overnight calls, I will be on clinics. Translation... NO CALL for two months. Woohoo! Nick is gonna have to get his fast food fixes in fast before I'm home for dinner every night.

All you need is love

Nick and I had the pleasure of spending this weekend (well, 18 hours of it at least) in Arizona for my cousin Dawn's wedding. Everyone agrees that she and her fiance Matt make quite a perfect couple, and both sides of the family have been awaiting this day with baited breath for quite some time.
The whole day was beautiful, from the beaded gown to the daisy centerpieces to the ice cream sundae dessert bar. Dawn, too, was stunning not just with her hair all done up but with the schoolgirl giddiness the entire world permits a bride on her big day. This is even more entertaining to those of us who know that she is not given to frilliness, so I know it must be the real thing. While Dawn and Matt were of course the stars of the day, Matt's giant Italian family was not to be left out; their combined musical talents were quite impressive, even down to his uncle's ventriloquism.
I owe a debt of gratitude to a fellow resident who very kindly took my Saturday MICU call so I could fly out and arrive just in time for the ceremony. It's nice to work with people who care enough to help you out. I was sad to miss out on the shower, rehearsal dinner, and wedding brunch, but it was so good to be there at all. Now that we've all hung up our suits and party dresses, it's time to start planning the next wedding, for my sister Laurie and her fiance Seth. I can't wait!

The man behind the curtain

April finds me in the MICU yet again. This is my last stint in critical care for second year, and I'm spending this go-round in the new Vandy MICU. It's quite fancy with all sorts of new gadgets, including walkie-talkie phones for all the residents. But underneath the shiny newness of it all, everything is just the same.
I'm still terrified of being the code resident, although this, too, is ebbing with time. Last night I completed my initial evaluation of a non-responsive patient and was quite proud of myself to find my hands weren't even shaking a little bit. So I played my role as the Narcan* fairy and pranced back upstairs to the unit. But not everything here is so easy.
I cannot bring myself to face the first room on the left in the far hall. For days a remnant of a man has been living behind that sliding glass door, stumbling in the dusk of his life. A few family members come and go, more often than not tearful. In fact, his wife's gratitude to us physicians and nurses is almost embarrassing; we are most literally doing nothing, which is in accordance with his previously expressed wishes to be DNR/DNI (do not resuscitate or intubate). The real life translation of this is that we all tiptoe by his room, knowing that it is only a matter of days or weeks or hours until his condition overwhelms him and he passes.
Critical illness and even death are not new to me or any of us in the unit. However, this is more difficult than usual. The momentum of a snowballing tragedy in a patient's condition leaves little time for reflection, and we are rushing rushing rushing to try try try until the end, and then it is over. The chaplain leads the family away, and we turn our eyes to the next new gurney rolling down the hall to take his place.
Other times, death does come slowly, so that the patient and all of us see it sauntering over the hill, mocking us with its lackadaisical inevitability. Social workers and case managers appear from nowhere and whisk patients away to far-away loved ones or homey Hospice units where a patient can die in peace and comfort, away from the beep-beep-beep, beep-beep of the monitors and vents and telemetry boxes of the ICU. Then there is sometimes only family, and at other times only the Lord, to accompany him to the end. I am never there.
Then there is Mr. X. He is dying slowly, but he has nowhere to go. So here he stays, where we can all watch. Only none of us can bear to look, to pull back the curtain and think about the man lying in the bed, barely breathing. We are not used to seeing this part, to watching the hurt draw out like this over days. So I remind myself that the Lord works all things together for the good of those who love Him, followed swiftly by a prayer to help me overcome my unbelief. And I continue to hold my breath and tiptoe past that room, and I wait, not just for the unavoidable death of my patient but for the day when my faith shall indeed be sight.
The Lord has given, and the Lord has taken away. Blessed be the name of the Lord.

*Narcan is the reversal agent for narcotic analgesics, used in both intentional street overdoses as well as unintentional iatrogenic (ie, result of seemingly appropriate medical care) overdoses.

Ritualistic

Last night was a long one, as are most of my calls. But oh, the joy of coming home early post-call. Everyone has his or her post-call ritual, and we can spend hours debating the order and proportions of sleeping, eating, and showering. Here's my version.

1) Call Nick from the car so he knows I'm still alive and to come looking for me if I'm not home in 20 minutes. Stay between the white lines.

2) Drop my bag by the front door and hang up my coat, Mr. Rogers-style. Make a potty run when I realize I've been holding it all morning.

3) Eat. This almost always involves a large bowl of Special K with Red Berries. I can't even describe how rejuvenating the cold crunchiness can be for weary post-call bones.

4) I usually shower at work before rounds, but if for whatever reason this hasn't happened (like a 7am code), insert shower here.

5) Watch TV, usually the Food Network unless I have a "What Not to Wear" recorded on the DVR. There's just something so soothing about watching Paula Deen scoop sticks of butter into her bowls.

6a) If I slept some on call, I will pick a recipe for dinner or dessert and go to the grocery store. Then, like the living dead, I lean on my cart and scootch up and down the aisles. Incidentally, I think today will be pecan-crusted tilapia with beurre blanc sauce.

7a) Cook dinner, hang out with Nick, read, check email, etc.

8a) Go to bed at 8:00pm.

Alternate scenario:

6b) If I did not sleep on call, TV watching will continue. I will start sitting upright and then wrap a blanket around me. I will then proceed to prop my feet up. Danger, danger! The next step in my post-call degradation is lying on the couch, which 99.9% of the time leads to sleeping on the couch. This is occasionally interrupted by one of the dogs poking a cold, wet nose in my face.

7b) Wake up and tell Nick how hungry I am. Go out to dinner, usually Red Robin based on proximity.

8b) Go to bed at 8:00pm.