ER Uck

Things change.  As a teen, premed, and medical student I thought I would love the ER.  Drama.  Adrenaline.  Gore.  Rescue.  Codes.  Excitement.  The stories from my trauma surgery rotation were awesome.  Real doctors saving lives.

Well, I changed my tune the first month of residency.  A few weeks after my hood and M.D. degree began to gather dust I found myself in the UNMC ER.  I hated it.  I wasn't prepared to handle complicated traumas.  I wasn't confident enough to send people home.  I was anxious without a scheduled list of patients I knew, or the time to get to know them.  And I was never so glad to start back to back months of inpatient hospital rotations.  Despite loving to suture, not minding the blood and unpredictability of delivering a baby, and enjoying solving a complicated medical case once in a while, ER was clearly not what I was cut out to do.

After that month I've avoided the ER.  I had to do two more weeks when I started in Grand Island, and thankfully, that wasn't so bad.  I had a little more experience, a little more confidence, and a little more support from the staff.  Still, you didn't find me signing up for extra shifts, and you couldn't pay me enough to lose years off my life while moonlighting in some small town all by myself.

Well, my avoidance couldn't last forever.  This month I've been working in the small town of St. Paul to fulfill a requirement for residency.  (Ironic, isn't it, that I picked the shortest month of the year?)  Part of the job for most small town doctors, including mine for the month, is covering the ER.  No ER doctors.  No trauma surgeons.  No orthopedists.  No stroke team.  No cath lab.  Eek!  With 5 of 6 ER call nights in the books, I'm glad it's almost over.

Yesterday was my busiest ER day so far.  Sure, I'd had 3 or 4 patients at once before, but most of those patients could have been taken care of in the clinic.  Nothing "emergent."  Nothing broken, bleeding, dying, infarcting or seizing.  Yesterday, was different.  As I was waiting for labs to come back on a woman with abdominal pain, a guy came in screaming with leg pain after falling off of a roof.  (What he was doing on the roof during a blizzard is beyond me.)  As X-ray was taking his picture, I overheard the scanner report that a 40 year old was coming in with a probable tibia fracture after an accident.  Then, before the nurse could get up from the desk the phone rang with another ambulance calling in with a kid who hit a tree sledding.  This all after we had just cleaned up after the seizing, questionable stroke, vomiting, supratherapeutic and bleeding, vasculopathic, elderly patient.  Is it time to go home yet?

Actually, it all went fine.  I felt a sense of accomplishment, and probably some unhealthy pride, when it was all over.  Still, I am happy that my days of covering the ER forever are numbered - one to be exact.

Not a Hotel

It's always been a pet peeve of mine when patients are rude in the hospital.  I know they are sick, in pain, and scared so they get away with a lot from sensitive me, but there is definitely a limit.  And, definitely, it sometimes crosses a line.  Here is some free advice for those rare few who think the hospital is a Hilton.

 

1.  You will not get a full night of sleep.  IV pumps beep.  Nurses take vitals.  Delirious patients next door scream.  Doctors make rounds before the sun comes up.  Your cozy bed is at home.  Oh yeah, and you are sick.  Why is it so surprising to people when they can't sleep?

 

2.  Hospitals are not substitutes for your home, nurses for your children, or doctors for your spouse.  This is maybe my biggest soap box, and maybe the one people will argue with the most.  I am amazed by the number of times it is the family member who request that their loved one be hospitalized, and often it isn't because of the extent of their illness.  It's usually because Daughter Donna doesn't have any more PTO, or it's the middle of the night and Sister Suzy has to work in the morning, or Local Pharmacy doesn't deliver meds until afternoon so Dad can't get his morning meds at home.  I'm thankful to not be one of the millions trapped in the sandwich generation, so I wholly admit to a lack of sympathy.  (Although empathy I have.)  Still, it is rare that the slow fade of health, memory, and strength sneak up on people.  It takes awareness, honesty, and difficult planning to prepare for it.  Fun - no.  Worth it - yes!  Ailing parents, consider what your stubborn independence does to your children when you hurt yourself.  Spouses, protect, don't cover for your loved one.  Busy children, get your priorities in line.  And everyone, accept help when it's offered so you don't have to demand it when it's too late.

 

3.  Stop complaining about the food.  First of all, it isn't that bad.  Secondly, it's usually your doctor who tells the cafeteria not to bring you salty french fries, or pure sugar syrup, or a 3000 calorie hamburger because that is what we've been telling you to eat (or not eat) at home for years.

 

4.  Therapy is for your benefit, so don't refuse it for lame reasons.  That goes for physical therapy (which is what I see refused most often), but also for lab draws, replacing blown IV's, and going down to the radiology department to get a better quality X-ray when you know they could wheel the portable unit up to your bed.  "I'm too tired," is the reason we ordered it in the first place.  Getting better isn't comfortable.

 

5.  When it's time to go - Go!  Maybe this echos some of #2.  Still, when you're in the ER at 2AM and don't know what to do because you aren't prepared, I can consent to the admission.  But, after three days of fighting with "utilization review" and explaining medical necessity to your insurance company, you have to go.  That's plenty of time to meet with social work, arrange home health care, pick a nursing home, get Betty Jo to fly in from California, learn how to give injections, or make arrangements with your employer.  The truth is, once we've done all we can to help you, sitting in a hospital can actually harm you - the risk of infection exposure, medication errors, anemia from repetitive blood draws, radiation exposure from repetitive imaging, falls, and not to mention draining your (or the government's) bank account.  Please, just go.

 

Thank you to the 95% of agreeable, pleasant patients.  And to the rest of you, I still really do like you and want you to get better even when you frustrate the crap out of me.

Day Off

After a busy month in January, it is nice to start February with a little break.  My next rotation starts on Monday, so I intend to take this day O-F-F.  (I debated turning off my pager completely, but I have a needy OB patient who is due, and I'd feel bad to spring her on any of my covering staff if she comes in today... again... but for real this time.)

 

I started the day by sleeping in.  Out of bed at 6:20AM.  That's pretty late, huh?  But, considering for the past four weeks I've been at the hospital by then, it felt pretty refreshing.  And, with my next rotation in St. Paul, there won't be much sleeping in for the next few weeks either.  Also, being the morning person I am, it also gave me an hour to myself as the boys slept in, too.  Three out of five days of Bible study were done before the first bedroom door creaked open and bare feet pattered toward me sitting at the dining room table.

 

The goals for the day are intentionally few.  Breakfast.  Bible study.  Blog.  Run an errand to the bank, and Owen requested we go to the library which sounds good to me as I'm in need of another book on tape for my month of commuting.  Maybe a shower.  Maybe plan meals for next month.  And if I'm really bored maybe some cleaning or studying during nap time.

 

The things I won't be doing today include: clinic notes, t.v., Facebook, or this stupid "BubbleGame" I've been addicted to lately.  I'm not about to waste this perfect this day.

 

It's going to be a great day off!

 

(I was going to include a photo of the three of us with our bedheads this morning, but I can't find the SD card for the camera.  You'll have to use your imagination of what a little boy with long dark hair, another little boy with thin light hair, and me look like in the morning.  And, add "find SD card" on the goals for today.)

Oh, My Purse

If you know me, then you probably also know the big red bag that is always by my side. As a woman, as a mom, and as a physician, there are always things I need. In the past I carried a cute little purse, a diaper bag, and a white lab coat (and add a breast pump when I was breastfeeding).  That wasn't very efficient or practical.  Honestly, it was down right terrible to go anywhere.  Therefore, it was huge blessing when I found a big cute bag to consolidate my stuff.

As I dug through my purse this morning looking for my keys I was caught off guard with all of the things that I "need" in there. Here's what I found today in the abyss I call a purse.

• Keys. Yes, thankfully, they were in there.
• Cell phone. Actually, it is rarely in there, and when it ends up in my purse I can never find it fast enough to answer it. If you call, and I don't answer, it's probably because my phone is vibrating in the bottom of my purse.
• Pager. Unfortunately, it's usually in there even when I'm not technically on call.
• Diapers and wipes. What good mom wouldn't be prepared for accidents? Occasionally, I have extra clothes in there, too.
• Ketchup packet. Who knows what problems you could solve with ketchup when you have two boys who love to eat.
• Family Medicine Board Review book. Yes, it is the size of a text book.  I also always carry a pocket OB book, my Harriet Lane (a pediatric pocket textbook), and a little notebook that I call "my peripheral brain" that keeps notes of medical things I can never seem to remember. I actually use these often.
• Gloves. Yeah, it's January in Nebraska and these are a necessity.
• Stethoscope. Most mom's probably don't carry this, but I rarely leave home without it.
• Gum. A.K.A. emergency tooth brush.
• Hot Wheels car. It's small, quiet, and may keep my boys entertained for a few minutes. I should probably keep two in there to avoid battles.
• Wallet. Hopefully, it's in there.
• Cash. After taking Dave Ramsey's class, we use cash for our everyday expenditures, and because I never know when I'll have a free 20 minutes to run to the store I usually have some on hand.
• Pens. Honestly, there are probably 20 buried in there.
• Hair brush, compact, and "feminine hygiene products." I could probably pare this down some considering my current pregnant state, but you also never know when you'll need to help out a friend (or concoct a diaper).
• Pictures of my kids. Never mind that Owen's photo is two years old, and Griffin's is at least one. I'd feel like a bad mother if I didn't have anything.
• An assortment of bracelets, bangles, rings, and necklaces. These are things that I thought looked cute when I left the house but then decided weren't so cute after all or weren't so practical for what the day had in store. There would probably be shoes in there, too, if they'd fit.
• Laptop & charger.  I don't always carry this around because it puts the bag's weight a little over the top; but it is in there most work days.
• Candy - suckers & fruit snacks at the moment. Another mom essential.
• Hospital I.D.'s. One for St. Francis (so I can get in after hours), one for Mary Lanning (where I worked last month), and I used to carry one for UNMC and Offutt Airforce base. Offutt hunted me down to get that one back, and a few weekends ago I realized maybe I should still carry one for UNMC because of the discounts when we are back in Omaha.

Amazingly, when I organize it just right it all fits, but this bag has clearly been put to the test. The rips and tears are getting bigger, and it is a matter of time before I hang it up for good. I've started the search for a new one, but the replacement has big shoes to fill - literally! 

A Quiet Moment

Is this actually a quiet moment to myself?  It's Saturday.  I'm not on call.  No one is in labor.  Jason and Owen are at basketball practice, and Griffin is taking a nap.  I'm showered.  I did my Bible study.  Laundry is started.  The house is picked up, not clean, but not so embarrassing if someone pops by.  It feels like there hasn't been a moment like this is weeks, maybe months.  Ahhh...

 

I really do love my life.  Just about every part of it.  But it can be exhausting.  Just looking back on the past few weeks there has reason for exhaustion (and excitement, too)...

 

... with my family:  Griffin now eats with a fork and drinks out of regular cups, he also has added new words to his vocabulary including "book" and "bath" which sound almost identical.  Owen went a whole day without diapers.  Jason is really enjoying coaching basketball - even though they did only score one point in their first game.  And my growing belly is unmistakably pregnant now.  I rapid cycle between excitement and panic at the thought of soon having three boys.

 

... with my job:  I've seen a lot of great cases lately!  (Great in the sense that I'm learning, not great in the sense that these are real people living through it.)  First, I started out the month with a lady who came to the ER for a pulled back muscle and in a matter of hours was sent to Omaha for concern of acute leukemia.  Then on my call night, I admitted an infant with what turned out to be a stroke.  That same night (at 3AM) I almost sent her peer down the hall to Children's in Omaha because her blood work looked so bad.  Whatever we did, worked, and by morning she was better.  Medicine is amazing.  Additionally, this past week I helped take care of lady who had a perforated gastric ulcer (i.e. a hole through her stomach), and yes, that is a bad thing to have.  Just yesterday she got out of the ICU.  I also saw a young lady whose own body was destroying her red blood cells to the point she had less than half the blood cells should have.  And, lastly a frustrating case of a patient refusing to be induced into labor despite the fact that the fluid around her baby is dangerously low.  Did I say that medicine is amazing?

 

... with my church:  Jason and I have been a small part on a team of people working to reinvent our Welcome Team at church.  We just had a big recruitment push the past two weeks, and had a great response.  Also, my Monday night women's Bible study is back at it after a break for the holidays.  It's great to share good food and time in the book of Ruth.  Lastly, we also recently started a couple's small group in our house.  It's been a little bit of a struggle getting going with the craziness of December, but we really enjoying getting to know some new families.

 

In my opinion, that's a lot for the 19 days of January so far, and it makes me really appreciate the rare quiet moments like this.  Unfortunately, it's over.  I hear Griffin jabbering away in his crib.

Moments of the Month

December is nearly over and I realize how much I've slacked in keeping this updated.  Sorry.  Here's what you've missed...

Impromptu day trip to Omaha.

Christmas quickly got into full swing when Santa visited the boys' daycare.

Owen turned 3.

The first big snow storm meant a snow day to stay home and play.

Santa came to the Newman house a weekend early.
He brought Owen a balance bike and Griffin a piano.

The Zlomke Christmas celebration had plenty of fun games.

Candle-light service in Texas on Christmas Eve was a
good reminder of the reason for the celebrations.

Christmas morning did not disappoint.

Owen loves bowling... unfortunately.

They were such good travelers considering
the 15 hour road trip each way.

We had a great time hanging out with family and each other.

Miracles

In our small group, part of the homework last week was to list 10 miracles from the week.  It was a great exercise to remember how blessed we truly are.  On the other hand, it was kind of embarrassing that it took me a while to get to number ten.  I guess I need to practice reflecting on the blessings of every day.  So, in an attempt to start practicing, here's a new list of ten of the many miracles from this week.

1. Delivering a baby.
2. Not needing a coat in December in Nebraska.
3. No admissions to the hospital on Saturday.
4. Being pregnant.
5. Coming home to Jason cooking dinner... and it tasted good, too.
6. The Internet.
7. The human eyeball.
8. Driving a car.
9. What you can see with a CT scan.
10. Griffin learning to play peek-a-boo.

It's a miracle.  Everything is a miracle.  Thanks for entertaining me and helping me to be more grateful for every day.