It's Hard to Believe...

... that Easter was already nearly a week ago. Although we didn't have spectacular plans, it was a fun weekend. (Really, any weekend I have off is fun.) It was also the first Easter Owen has been old enough to do anything "Easter-y". And it didn't take him long to figure out that finding eggs in the backyard was more than a chore when he realized they were filled with his favorite treats: mini-M&Ms. What can I say the boy loves chocolate... just like his mama! He also looked handsome in his Easter outfit for church. But, as much fun as it is to dress up and eat candy, I hope that he grows up appreciating Easter for its true meaning.

... that my ICU month is down to one more weekend, and one last call. For nearly a year I stressed about this month, but looking back I am so thankful. I still feel like I have so much more to learn, but taking care of some of the sickest patients around has been an awesome experience. I have more respect for my patients. I have more appreciation for their families. I have more awe for unexplained outcomes. I have more confidence in my own instincts. And I have more love for what I do.

... my belly is this big already! In a little over 11 weeks (plus or minus a couple), we'll be meeting little Newman #2. Talk about "it's hard to believe!" We still don't have anything for his nursery, or a baby book, or an outfit to bring him home from the hospital. The one thing we do have is a name... But, no, we aren't sharing. Something has to be a surprise.

... our house is on the market and we are getting ever closer to the big move. Now that the sign is standing tall in our front yard, we just need that special buyer to walk in the front door and sign on the dotted line. Any day now, I hope.

... that I got sucked into the "Royal Wedding." For as little t.v. as I've watched lately, I spent way too much time this evening watching every carefully choreographed move of a couple I have absolutely no attachment to. As useless as my gawking was, I must say that she looked amazing and they way they looked at each other was terribly romantic. Okay, now I'm really getting pathetic.

... that I'm 27. I don't why I thought of that, but I'm getting old.

Post-call Treat for Me

Sleep deprivation can do a number on a person's ability to make good decisions. At work, we've been told that when we drive home after a 30-hour shift our abilities are equivalent to someone driving legally drunk. Makes you feel pretty safe, huh? They have even contemplated making us take mandatory naps before we leave the hospital. Can you imagine? Back to preschool we go.

In addition to our driving abilities, they have done studies about spending habits when residents are sleep deprived. Sure people buy junk food, clothes, shoes, etc... But, I've even known a resident who bought a car post-call.

Well, after a long, very long, call night (which included me breaking into hormonal tears at one point) I had my own impulse purchase. I finally bought a nice camera! Some impulse purchases people regret, but I'm not regretting this one yet. Although I still have a lot to learn, it has been a lot of fun so far.

Here are a few shots of my favorite subject from my post-call purchase:

Experience

As I settle into the ICU, I am amazed how much you can learn in twelve days. It is incredible what medicine and technology can do, and yet, what I am learning has less to do with medicine and technology and more to do with personal experience. I see people who are easily in the midst of the worst time of their life.

Obviously, the patient's experience is difficult, but it is surprising how different and unexpected their reactions can be. There are people who have gone 50 years without seeing a doctor who are suddenly dependent on us for their every breath. Some cling to the support with every ounce of strength they have left in an effort to fight the terrible illness that got them there. Others choose a different, yet equally difficult, path and leave our unit peacefully to a quieter room, their home, or their eternity. It truly has been my privilege to be allowed into these personal decisions and private moments. An honor.

What has also been fascinating is the experience of the people who aren't laying in the bed but who are going through an equal amount of pain. Family and friends diligently sit at the bedside. At 2:00AM, the waiting rooms are filled with plastic hospital pillows and cheap white blankets that cover exhausted spouses, parents, children, and friends. When I get the page that someone has taken a turn, it is not unusual to be beaten to the room by their loved ones. The bags under their eyes are darker than mine. Just like the patients themselves, the families reactions are as varied as the colors of the rainbow. Most, to my surprise, are calm, collected, and reasonable. I think my natural reaction would be hysteria and panic, but that is the minority. How do you watch your mom go through painful treatments? How do you come to terms that life will never be the life you and your husband had planned? How do you allow your son decide he wants to go home and rest while the cancer takes over? How do you respect your grandma's wishes when it means the end? How?

I don't have the answer to that question, but I've see it done. There is so much to learn about human experience, and so much more than cannot be understood. And that is endlessly more interesting than the wealth of information I've been learning about ventilators and shock.

Intensive

My anxiety level has never been higher for starting a monthly rotation than it was on March 31st. I have had a healthy fear of the intensive care unit forever, and an even greater fear for taking care of it's patients. When I volunteered at a hospital in college I would even get a little nervous if I was asked to help in the ICU waiting room just making coffee and cleaning up. Can you imagine how much more intense it is to be thinking about ventilator setting, pressors, and sedation? And while working on the general medicine hospital floors, the ICU seemed like a magical place where you send people you don't know how to, or can't, take care of anymore. Now, I'm it. My team is the one that gets called when doctors don't know how to, or can't, take care of the patients anymore. We're the end of the road. If we can't fix it, it's over. Talk about pressure!

Well, April first came around just like I knew it would. There was no avoiding it now. With lots of prayers for clarity I scanned my badge and entered "the unit". To my surprise, amidst the anxiety and nerves was a sense of calm and confidence. A God thing because I can think of a million reasons why not to feel calm or confident. Without too much trouble I made it through my first morning rounds. We all survived - me and my patients. Success! Normally, that is all that has been asked of my on my first day, but not only was this my first day, but I was also on call. I survived the normal day with my staff and my team to help me out, but what in the heck was I going to do when they all went home to their warm beds and left me alone with the pager all night long?

When the last resident said good-bye, my heart raced a little faster. It picked up tempo every time the pager went off. I was tachycardic when the page came from the ER letting me know they had an admission. Here we go. It's just me, my sweaty palms, and a patient that has just been intubated and put on a ventilator. As soon as I walked into the room the Respiratory Therapist looked at me, read off the most recent labs, and asked what I wanted to do with the ventilator settings. (What I really wanted to do, was run out of the room and let someone else make a decision so I don't kill this guy, but I don't think that was what she was hoping for.) Needless to say, I didn't run, and it all worked out fine. And, it was also good to get my first admission out of the way. Then came the second. Then a third. We all made it through the night - and it was a long night!

Now it's April 4th, and I'm a pro. Okay, not really, but definitely feeling better. Less overwhelmed. Less anxious. More confident. More knowledgeable.