New Month... and it's going to be a long 0ne

Wow, it's been a lot longer than I realized. There really aren't even any excuses for it being a month since there's been a new post. Seriously, wow! It is nearly mid-December!

To quickly get you back up to speed, it is a new month and a new rotation. November was wonderful!! The first two weeks were a crash course in Dermatology and it was awesome. There was so much I needed to learn, and it is good to finally have a decent grasp on the biggest organ in the human body - our skin. Then, the last two weeks of November was outpatient clinic, and some much needed vacation time. And can I just say: I love my clinic almost as much as I love my vacation!

But now... I'm not having so much fun. lub. dub. Cardiology. Known to be one of the busiest specialties at UNMC, it is living up to its reputation. What's worse is that our fellow who is running the service is terribly, I mean painfully, inefficient. My Type A, left brain is spinning. When we have a 2-page list of patients to see I don't think we need a meeting on the other side of the hospital to go over the same stinkin' thing three times a day. AHHH! My eyeballs hurt from rolling so much. And, by the way, I'm not the only one. The other residents on the service share my pain. The secretary that rounds with us said something. Even our attending made a comment. Yep, it is that bad. Oh boy... it is going to be a long month! We joked on day #3 that we needed to have end of the month margaritas. On day #4, we changed it to mid-month. By day #5, weekly. Say a little prayer for me and my sanity.

Dawn of a New Day

The day has come. The end is near. The fat lady has sung. Pigs are flying. The ship has sailed. The tide has come in. Extra, extra, read all about it. No matter how you say it, it is the dawn of a new era. At least a new era in the Newman house.

Years and years ago man invented fire. And then the wheel. And then an even more genius soul created coffee and chocolate. Yet, this moments sits far above these, on a baby blue throne that reigns in my soft mommy heart.

Months and months of training and preparing have brought us to this moment, and yet I was still not prepared for the vision before my eyes. Smile plastered across his face. Hazel eyes wide with pride. One hand with a tight grip on the plush basketball that just happens to be the exact size of his head and the other hand and arm straight out to his side creating that perfect 90-degree angle with his body. A little (okay, not so little) round belly out in front leading the way. Legs steady. Feet planted. Then...

wait for it...

wait for it...

One brave little foot leaves the ground. All of the muscles in his body spring into action as in that split second his frame is balanced on a single, size 3 foot. Just as quickly, that brave little foot hits the ground again. But this time it is the ground 4 inches ahead. Steady once again and the smile is bigger and the eyes are brighter. Mission accomplished. However, almost as if it's jealous, the other foot jumps off the ground, reaches in front of its partner, and leaves a teetering body on top. Plop! A gentle landing on a cushioned bottom. There is no break in the smile. And moments later we're going through it all again.

That's right folks. Step right up. It is the dawn of a new day. A new day in the Newman house.

Owen can walk!

Of course he wouldn't walk for the camera, but he did sneeze a noodle out of his nose. :) I'm a proud mama!

Derm

After months of busy hospital work, I finally have a much needed clinic month. Weekends off and no call! That's music to my exhausted ears. However, it isn't just time to relax, I still get to learn. Currently, I'm working with a Dermatologist at Offutt airforce base, and this is something I've really been needing. It may surprise you, but UNMC doesn't have a dermatologist. That's made it kind of difficult to get much derm experience in the last few years.

Now, after one week I'm feeling more comfortable with skin diseases than I ever have. Have acne, sun damage, a weird mole, eczema, or psoriasis? I'm your doc! Okay, I might not have learned everything yet... but I still have a week to go. ;)

Before you ask, if you're looking for some free advice here's what I have for ya':
1) Don't smoke.
2) Wear sunscreen. Seriously. Wear sunscreen!
3) Ask your doctor about Retin-A. It's great for acne and anti-aging.

Looking forward to next week already!

Happy HallOWEN!

Another first for our family... Owen's first Halloween! or as it is known at our house - Hall-OWEN. Our little lion took to the trick-or-treating streets like he had done this a thousand times. Instead of fussing and pulling at his mane all night long, to our surprise it stayed in place. He didn't even cry until the night was over and he was back in his jammies. It didn't take long for exhaustion take over and for him to fall fast asleep. (It also didn't take long for mom and dad to raid his candy bag.)

Whew!

My last call for internal medicine wards was NOT one to forget. It's hard to believe all of the things that went on could really happen within one 30-hour period. Being able to actually use this stuff is much better learning than reading it in books and taking tests. Without further adieu, here is the list of major events (in addition to all of the high blood pressures, low blood sugars, and need for sleeping/pain pills) that took place on my farewell to Medicine Wards...

1. Pathology came back from the mole I took off in clinic last week. Positive for melanoma - skin cancer in a 29 year old. Negative margins, but my excision was 2-mm short of the goal. Arg!

2. Went to evaluate a patient for chest pain. That is nothing special, but while I was standing outside the room writing orders and a short note, her oxygen saturations dropped to 40%'s (normal is >90%). Thankfully, she improved with some suctioning.

3. A few doors down a patient went from being pleasant to acutely agitated and aggressive. She rips out her own IV. Obviously, I can't get any labs or studies. We calm her down with some Vitamin H (aka Haldol) in time for the nurses to note that she now has unilateral weakness. After a stat head CT scan to look for stroke, we finally get the rest of the studies I wanted originally.

4. Speaking of stroke... All morning I worked on getting a different patient calm enough to have an MRI for her stroke symptoms. We finally got a partial study before she freaked out in the scanner and a short time later the Radiologist called me: definite stroke. Next step, call the neurologist.

5. Beep... Beep... Beep... Code pager! They end up coding the same patient four times for V Tach.

6. Nothing exciting, but we did still have to do the standard admissions from the ER. One renal failure. One probable undiagnosed cancer. One delirious pneumonia.

7. Geriatric patient has passed away and needs to be pronounced. Sure enough. Time of death: 14:02.

8. Once again, called for a acute mental status change. On arrival, realize "nonresponsive" would be a better description. Stat labs/glucose/EKG please. Nurses are busy with that so I check blood pressure myself and it goes from 120s to 70s. Seriously!! Fluids wide open. Temperature now 34 - ask for a rectal - 34.6. Not normal! Another stat head CT once his BP is stable, and off to the ICU.

Think that's all. Guess again...

9. Someone else is throwing up blood. NG lavage gets back a lot more blood and of course now he's wretching with the maroon stained fluid oozing out of the sides of his mouth. Vitals and hemoglobin are stable. Another stat imaging study on its way.

10. What now? Another nonresponsive patient. Before I order my third stat head CT of the night we give a little Narcan to reverse the effects of narcotics. His eyes pop open and he glares at me. No more morphine for you, sir.

And to end the night, just as we start our morning rounds...

Beep... Beep... Beep. Code blue! I'm just down the hall so of course I'm the first doc to arrive. No pulse. Chest compressions going. Here we go. Get some meds going. Finally get an airway cleared of bloody vomit. After 20 minutes we have a rhythm, pulse and ICU bed ready across the hospital. Hold up, not so fast. A nurse two doors down starts yelling for help. You guessed it Code blue down the hall. Do you want to know how many crash carts are on the floor... one! That's not a good scenario when two patients are coding. Everyone rushed down there and supplies arrived from the floor below. Remember, the first patient is far from being stable and also now far from the ICU. Sure enough he goes asystole with only me, his nurse, and a respiratory therapist in the room. I start chest compression while ordering a round of epi again. Respiratory is bagging. The nurse is pushing meds. Other people are flipping from one room to the next to help out. We've almost maxed out our drugs and decide this will be our last round when we get a pulse. A good pulse. It was our window so we rushed him the 1/8-mile trek to the ICU. Prognosis is terrible, but at least he'll have a heart beat when family arrives to likely say their final good-bye's.

After all of that adrenaline I didn't even need my post-call Starbuck's. It was a relief to hand off the code pager to the next intern later that morning, but I was also incredibly grateful for the experience. I guess that is the way to end Medicine wards. You can't really top that!

Therapy

What would you do with your first two-day weekend since Labor day? It didn't take long for me to decide what I was going to do. I was in desperate need of some retail therapy! Owen and I were two of the first people in the mall Saturday morning, and it didn't take long to have a bag with two new pairs of shoes. It was glorious!

On the Border

The goal for all of our patients is to get them healthy and out of the hospital as quickly and as safely as possible. Well, we currently have a patient who has been admitted since June. That's correct, they have not been out the walls of the hospital in nearly four months. No fresh air. No warm sunshine on their face other than what filters in through the windows. They came in very sick and unfortunately had one complication after another.

As rocky as the medical course has been, the social issues are even more touchy. Just imagine this: You hop on a plane from Canada for a nice visit to see your family in the States. As you share old memories and laughs you suddenly collapse. Thankfully, you can't remember the whirlwind of being rushed to the emergency department and then flown hours away for more medical care. When your mind finally begins to clear you are surrounded by white coats trying to explain your new circumstances. You can't make out their medical terminology, and in fact, you can't make out anything they are saying because you don't speak their language. For days and weeks you nod your head to be polite and treasure the few minutes a day that they take the time to use the interpreter phone. Some days are physically exhausting; other days are emotionally draining. Not only are you sick, you are lonely. Some days you wonder how this will all end. You are sure you've ruined your family's future as you wrack up hundreds of thousands if not millions of dollars of medical bills. And of course there is no health insurance to cover these expenses. You can no longer eat. You struggle to breath. You can't understand the doctors let alone the television. And your family is hundreds of miles away. Why are these people surprised that you are falling into a depression?

So here we are. What do we do now that they are almost "stable" yet still so medically fragile with a long road ahead? The standard answer would be to transfer to a skilled nursing facility or a rehab center for additional therapy. Unfortunately, the reality is that these places can't really afford to take uninsured, foreign patients. It is a limited resource after all.

Our thoughts wonder how different it would be for this patient if we could just get them home. All that medicine and therapy has too offer will be available from their socialized system. Now, how can we cross that border? Trust me, we've been working with who and what we can, but it's, of course, more complicated than I can begin to imagine. After exhausting our other alternatives, the best plan for now is to get the patient healthy enough to make a 14 hour drive with some family across the country and across border to the nearest Canadian hospital. Even as I type this I hesitate knowing all of the extraordinary things that would have to happen for this to be a safe journey. I know how wiped out I might feel after that road trip let alone all that they will have to deal with along the way. Feeding tubes. Medications. Dressing changes. Stools. The Foley. Suction devices. DVT prophylaxis. And on and on. This is going to require super-human strength.