Queasy

A healthy young guy came in to clinic to have a few small skin lesions treated.  He works in agriculture and as expected was about a foot taller than me and weighed probably twice as much as a non-pregnant me, too.  He was pleasant, and we chatted about the weather as I prepared the few things I needed.

 

Lidocaine.  Betadine.  Gloves.  Blade.  Silver nitrate.  Antibiotic ointment.  Bandaid.

 

After I cleaned his skin I grabbed the syringe (and attached "tiny" needle) with the numbing lidocaine, and I proceeded to nonchalantly poke him and then watch the skin rise and bulge as the medication infiltrated the tissue below.  "Stick and a burn."  He got a little more quiet, and as I looked up into his already pale and freckled face I noticed he was growing more and more pale.

 

Ooops.  I didn't even think to ask this 6-foot-something 200-something pound guy if he wanted to lay down or got queezy with needles.  Thankfully, I didn't have to catch him this time.  We successfully got him up to the table and laying down for the rest of the procedure (which took about 30 seconds), and he did fine.

 

Later he told me he didn't like needles.  Shocker.  He thought he'd do okay this time because he hasn't had a problem since his seventh grade shots.  I smiled and was just grateful to not be picking him up off the clinic floor.

Seasonal Affective Disorder

This spring has been depressing to say the least.  I am lucky to not be one who struggles with true major depression, but the unending days of cold have been wearing on me.  As I scraped the ice off my car last week I really felt it.  It was frustrating that the flowers that had started to bloom were now drooping and brown.  I felt bad for the two ducks in our front yard that were taking cover against the house during the ice storm.  It has been aggravating to not be able to take the boys for a walk to the park in mid-April or be able to get ice-cream on our trip to the zoo.  And I'm tired of wearing a winter coat and putting hats and gloves on the boys in the morning.

Am I the only one?

Today, our small group Bible study decided we didn't care.  We (and our kids) needed to get out for an afternoon at the park.  The forcast high for our day was in the 60's, but when it was still 47 degrees and windy at 10:45 this morning I feared this Spring's curse wasn't going to be lifted.  As I was preparing my complaints to God about how much I hated the weather the sun began to shine.

And we had a great afternoon (minus Griffin falling off of the play ground)!  My melancholy mood melted in the sun, and the smell of rain, grilling burgers, and freshly mowed grass made it even better.  Ahh.  Finally.

I really needed this day.

Top 10 Reasons You Know You are at the End of Your Pregnancy

10.  When you go to take your Family Medicine Licensing Board Exam and the lady checking you in gets that sad, sympathetic/pathetic look on her face and says, "You know what, we're going to let you have the 'Special Accommodations Room.'  You'll be the only one in there, you'll have a fan if you get warm, you can get up and go the bathroom whenever you need, and we can switch chairs if you get uncomfortable.  You just let us know."  (And then an hour later a guy in wheelchair shows up and has to go into the standard testing room.  Sorry.)

9.  It's not uncommon to have vivid dreams when you're pregnant, but you know it's bad when you dream clearly about huge varicose veins and leg swelling the size of elephants'.

8.  Eye-belly contact.  This is probably more awkward than eye-chest or eye-hair contact.

7.  Sympathetic "You look miserable" comments.  Yes, I am; but I'd still prefer "You look cute" or "beautiful" or "great" even if it is a lie.

6.  You want to eat and don't want to eat at the same time.

5.  Online baby shopping at 4AM.  There comes a time when you realize everything you haven't done or purchased to get ready for this baby.  Thankfully, this intersects with the time when you can't sleep and are up for hours in the middle of the night.

4.  You can't sleep on your stomach, back, or either side.  And, it takes monumental effort, 10 minutes, and 6 pillows to even roll over to try different sleeping positions which inevitably won't be comfortable.

3.  You stop wearing make-up because nothing can hide how unattractive you feel so why even try.

2.  You literally can't wait the 3 weeks for the car seat you love that is on back order.  (Hence, #5 above.)

1.  Your scheduled C/S day that is circled, bold, capitalized and followed by several exclamation points on the GMail calendar is now just one click away.  25 days!

Catch Up

So I went an entire month without writing.  Big deal.  I guess I've been busy... or lazy.  And with as much "stuff" coming up in the next several weeks, I can't promise it is going to get any better.

 

In one month-ish we are going to have another baby.  It's a shock to me, too.  Even though we've had 8 months to prepare, we are definitely NOT prepared.  No name.  No bed.  No nursery.  No carseat.  Clothes are still in boxes downstairs.  At least we did buy diapers on our once-a-month April shopping trip in case he comes before May.  The Type A planner in me is kind of freaking out.

 

Then again, this is our third boy.  What could we possibly "need" that we don't already have.  The budget-conscious-scraping-to-get-out-of-debt person in me is at war with the planner-perfectionist in me.  For example, do I buy a brand new breast pump because I can, or do I find a gently used one on CraigsList because I should, or do I go uber-frugal and try to salvage the one I have (which I bought on CraigsList 4 years ago, by the way)?

 

While baby shopping sounds like fun, even taking 10 minutes to browse Amazon makes me feel guilty.  You see, I should be studying for another little test coming up.  My family practice board exam is NEXT WEEK.  Yeah, like 7 (wow, actually 6) days away.  It's only a test to say that I'm qualified to practice family medicine; no big deal.  After taking: MCAT, Step 1, Step 2 CK, Step 2 CS, and Step 3 to become an "M.D." you would think one more test to become "Board Certified" wouldn't be necessary.  Haha.  How embarrassing would it be to get this far, just months away from being "done," and then fail?!  I should probably study, huh.

 

If that wasn't enough, I have a senior research project and presentation due 3 days after my board exam.  It's the thing I'm the least worried about, and that usually means it's the thing that is going to go the worst.

 

Oh, yeah.  And... I, Jason, and Owen have all been sick this past week.  Why not pile on vomiting, diarrhea, fevers, sinus pressure, and sore throat when I already don't sleep and ache all over?  Needless to say, it has been, and is going to be, a long few weeks.  I can't wait for maternity "vacation."

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.)