Tales from the land of Er, chapter 1

Today was my first ER shift for my two week rotation, otherwise affectionately known as the Er. Things got a little crazy when I picked up not one but TWO septic (disseminated infection) patients who both earned non-stop tickets to the MICU. This led me to break out into impromptu song while sitting beside a medicine intern also condemned assigned to the ER this week.

Me: (chanting) I got the sepsis, I got the sepsis, I got the sepsis. (now to the tune of "I Shot the Sheriff") I got the sepsissss... Intern! I can't think of any more words!
Intern: (humming, humming) Oh, ok! How about... I got the sepsissss, but I do not have an S-T-D. No, no, no, I got the sepsisss, but I do not have an S-T-D.

The remainder of our lyrics involved references to various body fluids implicated as the source of his sepsis, but I can't exactly remember them right now. Sorry. Good-night, all.

His, mine, and ours

Nick and I have never been good at compromising. Oftentimes, we both want what we want how we want it or nothing at all. So instead of meeting in the middle where neither one is satisfied, we just take turns. Movies, dinner, etc - we alternate whose vote wins. But occasionally the stars align, and we want the same thing. And vacations are no different.

His: The USS Midway
A decommissioned aircraft carrier converted into a museum. This was actually Nick's first time on an aircraft carrier, since he was an airman and not a seaman. Pitiful excuse for a sailor if you ask me.

Hers: The Flower Fields
Several acres of ranunculus blooms, kinda a historical remnant from the life's work of a California botanist. Oh, if only they let you walk out into the fields for pictures. Alas, this is the best we could do.

Ours: The World Famous San Diego Zoo
Yes, that is its actual name. And this was mostly a "hers," but Nick liked it enough that I'm categorizing it as "ours" for posterity. We got some fun pictures, and Nick even walked away with a modified farmer tan - ie, a redneck.

And there, in a high-resolution JPG nutshell, you have our San Diego vacation.

Love in my tummy

So I was going to tell you all about the zoo as the second installment of my San Diego series, but I couldn't think of a sufficiently catchy title. So instead, I'm going to talk about my favorite thing.

Food.

Oh, cyber-friends, I can't even tell you. Nashville is famous for a lot of things, but food isn't one of them. Then you go so long eating at mediocre restaurants that you start to think they're good. Then, a wonderful place like San Diego happens to you. Happy sigh.
Our favorite meal of the trip was dinner at the Indigo Grill. Yelp labelled it "New American." I have no idea what exactly that means, but it was delicioso nonetheless. We started with the brie plate, which was so far beyond the usual cheese and cracker plate that it requires a picture to do it justice.
Panko and sesame crusted brie, honey-roasted garlic, jalapeno jelly, cotija cheese, and mole sauce with creme fraiche swirls. Not to mention the super cool branded tortilla. Thankfully, our waitress warned us that the red pepper in the center of the plate is for garnish and way too hot for actual eating unless you're a fire swallower.



 Dinner was good, too, but check out dessert, a baked Alaska-style concoction with mint ice cream, chocolate cake, and swirled merengue. Not to mention the flaming ramekin of rum to complement the dragon chocolate mini-sculpture. Sorry, the flames don't show up well in photographs.

The same management company also owns a groovy little place called Corvette Diner, which was way fun, 50's diner style. Nick enjoyed his "Elvis" burger; apparently the king really liked peanut butter on his burgers. And my sandwich included a patriotic toothpick flag, which as you can tell by this picture really tickled me.



My last culinary recommendation should you ever find yourself in sunny San Diego is the Oceanaire Room. Hands down, the best seafood I've had. Ever. And the food is fancy with debonair waiters in their little white jackets, but the atmosphere is overall still casual, which befits the vacation mentality quite well.

War stories

My moonlighting shift last night was overall... disappointing. Almost no admissions, and LOTS of cross-cover. It was so painful. So, so painful. But it got me reminiscing about the good ol' days as an intern, when cross-cover was my seemingly permanent lot in life. I have a few doozies - here's one of them. This one is the truth, the whole truth, and nothing but the truth. I kinda feel like I've told it before but can't find it in the archives, so humor me.

It's just after midnight, and I'm typing away at my latest H&P. I've been getting hammered all night about this one guy in particular - definitely an HMP. So I decide to get on the offense rather than play defense all night. I'm gonna pre-emptively write an order for a prn (as needed) sleeping pill to go along with the constipation, pain, and anxiety meds he's already asked for. I open WizOrder. Am-bi-en. Click. 5mg. Click. Qhs prn. Click. Accept. And done. I sit there with a smug little grin on my face, so proud that I'm saving myself a page. Approximately 1 minute later...

Beep, beep, beep.
Me: Morgan [general medicine].
Nurse: Oh, hi. Did you just put that order in for Ambien on Mr. Smith?
Me: Yes.
Nurse: It's so weird. I was just in his room, and he asked me for something for sleep. And then I walked out of his room, and your order was on the printer! How did you know?! I was only in there for a minute!
Long, tension-filled pause.
Nurse: I mean, it was just such perfect timing.
Me: Well, he's needed everything else under the sun tonight.
Another long pause.
Me: Do you need anything else?
Nurse: No, I just wanted to ask you how you knew.
Me: OK. Bye.
Click.

You can't make this stuff up.

I left my heart in San Diego

My oh my. I'm fresh off the plane from Cali and strangely torn between glad to be back and wishing I were still there. I am sadly not tan at all; the sub-70 degree temps just didn't suffice for laying out. But Nick and I did cram in a lot of sight-seeing, eating, laughing, and sleeping. And oh yeah, that ACP poster competition thingie. There will be multiple picture-happy posts about my trip, but I am quite tired tonight. So we'll start with the reason for my trip. My poster.

Note the fish-belly white pastiness characteristic of medicine residents. And the uber-nerdy hang-around-the-neck name badge. I am pretty sure I didn't win since other people presented diseases so rare I'd never even heard of them. But I will have you know I personally awarded myself the prize for prettiest poster. :) I'll let ya know what bizarre-o diagnosis clinched the victory once the results are posted online.

Yeesh. It's nearly bedtime for me because someone (not naming names here) signed up to moonlight the night after getting back from vacation. More fun pictures and stories to come.

PS Yes, I know the song is technically about San Francisco, but that's what you call creative license.

Crunchy granola

I've been thinking about the ER lately since that's where I head after vacation. And thinking about the ER led me to remember this story.
A college kid came in with a leg injury after a bicycle accident. I don't remember what he hit or if it hit him or he hit it or what. Those details aren't important. The attending and I decided the wound needed irrigation, which means dumping several bottles of sterile saline over it while you dig around with sterile gloves, kinda like scrubbing dishes. By the way, this hurts. A lot. And no, I'm not just saying that so you'll expect worse than it is. It really, really hurts.

Attending: Nurse, bring me four of morphine.
Patient: Um... Is that natural?
Attending: What?
Patient: I mean, like, organic?
Me: Ha. I have no idea. But either way, you're getting it. You won't make it without.
Patient: But, like, I mean, I try to be organic and stuff.
Attending: In a few minutes, you aren't going to give a rip about organic.

So we went about our business, morphine and all. We found a little bleeder that required a stitch. I'm pretty sure we used an 1.0 silk (trust me that's a type of thread). At least he got himself natural fiber suture. :)

The night the lights went out in Nashville

Whew! Sorry about the posting drought, but this last week has been busy busy busy. Let's catch up, shall we? I'm on vacation, the first three days of which have been spent installing hardwoods.
Do I hear you say, "What? Hardwoods? But I thought you were done remodeling?!" We did, too. Then a little incident occurred involving bleach deck cleaner and our living room, dining room, and hallway carpet. No rug, potted plant, or furniture re-arranging could cover the shame. Our only option: replace the floor. I'll spare you the number-crunching, but suffice it to say that do-it-yourself hardwoods give us the most bang for our buck. Back to my story.
Saturday was a very dusty whirlwind of cutting, sawing, measuring, cutting, re-measuring, screaming, sawing, etc, etc. I had the very unglorious task of holding the wood whilst Nick sawed, which positioned me exactly where the dust blew since the saws are designed to blow dust where no one would ever conceivably stand. Lucky for me I had an N-95 in my white coat pocket from my "rule out TB" patient last week.
Progress was slow, and come Sunday night we still had a long, long way to go. And here's where the drama ensues. Monday's forecast called for rain, but we thought we'd just keep trucking with the saws plugged on the front porch. Ha. Joke's on us. This worked well for a while, but shortly after lunch a veritable tempest blew in. When the tree in the front yard started creaking threateningly, we scrambled to get all the stuff unplugged and indoors, just as the power went out. We scooped up the doggies and headed for the basement since weather.com told Nick's cell phone we had a tornado warning. Right then.
Well, I don't think a tornado hit us. We had no real damage, just tree branches everywhere. But needless to say, the ten subsequent electricity-less hours put a real damper on our hardwood project. Thank goodness for our gas stove; I whipped up broccoli beef stir fry by candelight. And the poor doggies spent all night freaking out. I think they were having PTSD flashbacks to last years' flood. At least the power came back on overnight, and we're all lined up to finish by this evening.
Moral of the story: Don't clean the deck.