Highs & Lows

I am now officially two weeks into my internship and I can now safely conclude that being an intern must feel somewhat similar to being bipolar. There are highs and there are lows, but there isn't a whole lot inbetween.

Yesterday, we got swamped. Our eight or nine patients in the ICU all had complex problems that were often times a bit too severe for me to comprehend, let alone repair. Many of our patients required other minor, time-consuming floor procedures. Consequently, I was running around all afternoon, such that by the time I had finally checked off the last item on my to-do list and dictated a few notes it was nearly 7:00 pm. I got home and I was too tired to eat. Too tired to talk to Cami or my Mom who called that evening.

I crashed into bed at about 8:30 and the next thing I knew my alarm was ringing. It was 4:45 am already. Time to start a new day. Awesome.

Things were a lot slower today. We didn't have anybody actively trying to die and most of our patients were content just lying there like sick little bumps-on-a-log. This gave me good opportunity to take things at my own pace. First thing on my to-do list was to remove the urethral stents from the patient in bed one. It seemed a simple enough task, so I went ahead and did it. You could literally train a monkey to pull these stents out, and I shouldn't have run into any complications. But I did. In an effort to free the stents from the foley catheter it was attached to, I punched a hole in the foley tubing. Instantly, pee started shooting out of the foley with a high pressure stream like a leaky hose. I got it all in my face and on my shoulders. Acting quickly, I did what I could to plug up the leak with some tape before timidly going to the nurse and explaining to her that the patient needed a new foley because I managed to perf the old one. Fortunately, she was pretty nice about it and didn't make me feel much dumber than I already did. Good one, Dr. Tim.

Several hours after my foley fiasco, I got a page from another intern covering the vascular service. He was responsible for getting an arterial line in one of his patients and had failed a few attempts. He was frantically looking for an upper level resident to help him out, but most upper levels were in the OR. He was afraid of what his team might think if he hadn't accomplished this "simple task" by the time the rest of his team returned. I felt a lot of pity for him and since things were slow, I told him I'd be happy to help out. Not that I was an art line specialist by any stretch of the imagination. In fact, I had only learned how to do them a few days ago and was batting .500 on the two lines I had attempted.

Nevertheless, I stepped up to the plate, and even with him nervously futzing around at my elbows, was able to get the line in relatively easily. He was amazed and asked if I had done a lot of lines at UCD. If he only knew. Good one, Dr. Tim.

Are You Kidding Me?!

This past weekend was almost a disaster. It started off right before I was supposed to go home on Friday. I was helping put in a central line on this old lady in the ICU and gave her a pnuemothorax. In other words, the needle I was trying to stick in her subclavian vein, punctured her lung instead. We had to put in a chest tube and I didn't end up going home until 7:30. It was a good thing that the lady is nearly completely comatose and didn't really suffer much because of my ineptitude. However, I suffered pretty mightily. Especially when I had to call her family and tell her what I did.

Saturday morning, I showed up for my 24 hour shift right at 5:30 AM. I was expecting to have to cover the SICU and the burn unit. Fortunately for me, I didn't. However, before I got too relieved, I discovered instead that I was actually covering the trauma ICU and the trauma floor. A whopping 50 patients altogether. I just about barfed when I found that out.

I spent the better part of the morning just trying to figure out where I was supposed to be and what on earth I was supposed to be doing. Turns out we were understaffed due to some scheduling issues and everybody was running around willy-nilly.

Patients coding, patients needing a-lines, patients needing meds, nurses needing authorizations, patient's families wanting to talk... It just didn't stop. When I finally started to feel like I was starting to get the hang of things, the trauma codes started to roll in.

FYI: Any level 1 trauma center has a protocol for dealing with nasty tramas as they come in. Typically, there is a grading system which alerts the hospital to the severity of a patient's condition before they arrive. This allows the hospital to prepare itself for the likely necessary interventions before the patient arrives. This means that any surgical resident on call gets a paged to the ED to triage the patient. No matter where you are or what you are doing, you are supposed to drop what you are doing and get to the ED.

You would not believe the type of stuff that was rolling in. From the guy who was gored by a bull's horn directly in the groin, to the guy who blew off his hands stuffing toilet paper into civil war re-enactment canon filled with black powder, to the two drunk guys riding in the back of the truck who were ejected and smashed face-first into a telephone pole. It was absolute mayhem. Of course it was, it was the Fourth of Freakin' July. My first night on call was on trauma on the Fourth of July. I don't think I had a chance to sit down the entire night.

And that's not even counting all the calls I got from the floor. In between triaging the aforementioned, I would have to answer all my pages and run up to the eleventh floor to figure out what was wrong with the patients already unfortunate enough to have been admitted to the hospital. As soon as I had an inkling of who the person actually was, or what was going on, I'd get another page informing me that there was yet another trauma in the ED. This same process contined. All. Night. Long.

Fortunately, as battle-scarred resident told me sometime around 3:00 AM, "they can hurt you, but they can't stop time." Eventually, my shift was over. I signed out my patients to the incoming resident, drove home, and collapsed into bed around 7:30 AM Sunday morning. With a sleep latency that might rival the most severe narcoleptic, I am pretty sure I was asleep before my head hit the pillow.

As rough as it was, I learned a ton, and for the first time realized: "If this is as bad as it gets, I can definitely do this." There is still a LONG way to go, but I can definitely do this...

Internship: Day 1

I think I spent all day day with a "deer in the headlights" look on my face.

Day one was pretty rough, but I made it through. I think I only questioned my career choice once and felt like crying twice. There is SO much to learn! The hospital is a maze, the computer system is crazy, everybody talks funny, and, oh yeah, did I mention that just about everyone is SICK?! Good heavens! What am I doing surrounded by all these sick people?! If that wasn't bad enough, they tell me I am supposed to be taking call all day Saturday. In the ICU. Are they crazy? Don't they know I don't know anything?!

Friends, if you ever happen to cross the path of an intern, give them a hug. They could probably use one...

Here We Go Again...

I begin my first day as a paid physician on Wednesday.

This is kind of a strange feeling…

Since last Friday, I’ve been getting oriented. I’ve been briefed on the benefits I can expect, turned in all sorts of paperwork, and signed numerous forms and papers. I’ve sat through incredibly boring lectures about the EMR system employed at Baptist (what everybody here calls the hospital), taught how I’m supposed to wash my hands, and even been given the contact information of the lawyer I am supposed to contact if I’m ever sued.

I got my official schedule on Friday. As an ENT intern, I’ll be splitting duty as an indentured servant between my colleagues in otolaryngology and those in general surgery. Essentially, I’ll spend six months doing the bidding of the general surgeons, and the other six months engaged in things more otolaryngological. I spend four weeks on each of the following rotations:

-General ICU
-Dermatology
-Pediatric Surgery
-Emergency Department
-Neurosurgery
-Night Float
-ENT x3
-Anesthesia
-Surgical Oncology
-Plastic Surgery
-Cardiothoracic Surgery

Some of those rotations should be intense; others might give me a little more time to catch my breath. All in all, it should a long, hard, exciting, tiring, amazing experience. Is it any wonder I’ve been having trouble sleeping these past few days?

Admittedly, I am a little leery of starting my intern year in the ICU. It should be one of the more challenging months of my internship and I almost wish I had a couple “easy” rotations under my belt before I jumped into that one. On the other hand, at least this way, my inevitable dumb decisions and mistakes can be blamed on me being a brand new intern, an excuse with a limited shelf-life.

All across the country brand new interns (who mere weeks ago were simply know-nothing medical students) are invading hospitals nationwide with all of the responsibility and none of the experience of real doctors. Friends, take this one from me: Don’t let your loved ones seek medical treatment in a teaching hospital during the month of July. It will just be better that way.

And thus, it will all officially get started tomorrow. I don’t know how much time I’ll have to chronicle my experiences during the coming months, but I will try. Cami has promised that she is going to take a more active role in authoring entries. I have a feeling she just might do that. It is going to be an interesting year, friends. Let's hope we both survive...

The Next Phase Begins

Well, we made it. 3,023 miles, 45 hours behind the wheel, and thirteen states later, we arrived in Winston-Salem, North Carolina. We arrived here Tuesday afternoon and picked up the keys to a furnished apartment, where we will be residing until our home is finished sometime in August. For those of you who have never moved across the country: Don't. For the morbidly curious, here are some of the "highlights" of our little adventure.

1. Eaglewood Apartments wouldn't let us park our Relocubes in the apartment complex. So, to pack up our belongings, we had to move everything down three flights of stairs, load them into a truck, drive them out of the apartment complex and around the block, unload them from the truck, and finally load them into our cubes. I thought it might be easier to install a zipline from our balcony window, over the fence, and onto the street. Eaglewood poo-pooed that idea. They also deep-sixed my plans to use two ladders to go over the fence instead of around it. Thanks a lot, Eaglewood.

2. Only one person showed up to help me move everything. Were it not for Tom Stetser, Cami and I would still be trying to empty our apartment. Tom, you just might have earned yourself naming rights to our firstborn.

3. Fact: Everything we own baaaaarely fits into two ABF Relocubes. For awhile there, I thought we were going to have to sell the couch. Let's just hope everything we own survives being crammed into two ABF Relocubes.

4. Immediately after I finished packing, we hopped into the car to start the trip. With all the stress about packing, we had sort of forgotten about actually moving. Since we left California so late, we didn't end up pulling into Salt Lake City until 1:30 AM. This was a bad idea. We were so tired that I think I may have been asleep when we pulled into Cami's sister's Cinda's house. Normally, this wouldn't be such a big deal, but I may have been driving at the time.

5. Cami actually let me sleep for three hours so I could wake up and take her to participate in the Ragnar Relay the next morning. She bears all responsibility for writing about this. Please bug her until she does.

6. Leg #2 of our journey: SLC to OKC. 16 hours. Since Cami had gotten a grand total of six hours sleep the previous two days, I did a lot of driving. I finished off Utah, drove Wyoming, and tackeled most of Kansas and Oklahoma before we arrived at my sister Missy's house. Fortunately for me, Cami was awake enough to handle Colorado.

7. Do you want to know what humidity is? Try Wichita in 101°F weather. I almost barfed when I got out of the car. Seriously. Right there in the gas station. It was gross.

8. Dumb & Dumber quotes are the perfect compliment to any long distance road trip.

9. We tried to see if we could identify a license plate for every state in the country. We were able to witness the plates of 43 states' plates. Pretty sure the states we didn't see don't really exist.

10. We ate the greasiest, most deliciousest BBQ pork burger at the Interstate Bar-B-Que in Memphis, Tennessee. Cami found the place on Yelp, which contained the following review from one satisfied customer: "Must be a good place, because I've just seen 6 or so of the fattest people I have ever been in the presence of stroll in!"

11. The best squeegee in the country belongs to a gas station in Corinth, Mississippi. This gas station was located a couple miles from the "Super X," which, as far as I could tell, was the porn equivalent of a Super Walmart. Way to go, Mississippi!

12. Overnighted near Huntsville, Alabama at my sister Cindy's house. They were away on vacation, but were kind enough to ensure that their cat was still around. Harry Pawter, who looks like a fat, gray, cottonball with legs, kept us up all night hissing and banging his head into the door.

13. We finally arrived in WS, NC to pick up our keys from our new landlady Bunny. She is an interesting woman, who showed up at the door and explained that she was naked under her bathrobe, because it was just too hot. TMI, Bunny, but thanks. The new apartment smells like old people, but it's cheap and charges by the day, so we can fly the coup as soon as our home is finished.

So there you have it. Cami went back to California today to work a few more days for UC Davis and will rejoin me here in about three weeks. I start my internship tomorrow with orientation. I am super freaked out nervous about beginning, but we'll save all of that for a future post.

It's So Hard To Say Goodbye...

Today is the big packing day and we're supposed to hit the road tomorrow afternoon. With our U-Pack "Relocubes" parked outside on Kincheloe St (outside our apartment complex, which is long story I don't wish to go into right now), we have enlisted the help of the Ward Elders' Quorum to pack up everything we own into two 6x7x8 foot cubes to be shipped to Winston-Salem, North Carolina. Sort of crazy.

As the picture above can attest, our house has been an absolute pigsty for the last month or so, as any efforts at tidying up have been swallowed up by the sentiment: "Hey, we're moving." We have slowly been working on compiling all of our earthly possessions into little cardboard boxes. Packing and moving is always such a strange experience. As the process progresses you continually ask yourself: "How on earth did we ever accumulate so much stuff?" Eventually, you become less and less sure that you are going to fit everything neatly and securely into a box, let alone into the moving van you rented. As packing progresses, more and more boxes are taped and labeled "Miscellaneous," and the very thought of unpacking all this sends shivers down your spine. Then there's the whole process of actually moving dozens of heavy boxes down three flights of stairs and playing Tetris with your available cargo space. Add to all of that the worrying about what's going to happen to all your stuff as it treks across country... I really dislike moving.

Fortunately, we won't be driving a big truck across country, just our little CR-V with all of the "really important stuff" in it. We're going to make a stop in SLC, so Cami can visit her sister Cinda (and maybe participate in the Ragnar Relay). From there, we travel to Oklahoma City, to overnight at my sister Missy's. At this point in our exodus, we'll probably drive straight on through to Winston-Salem. I'll start orientation shortly thereafter and Cami will fly back to California to tie up some loose ends at work before joining me later in July. Our little home won't be done until early August, so we'll be living in a temporary apartment until we can officially move in. I really don't think I am going to be able to shake the feeling of being a vagrant for quite some time. Did I mention I dislike moving?

On top of all that, there are the mixed emotions associated with leaving a place and an environment you have grown to love. We didn't anticipate staying in Woodland when we got here four years ago. We initially thought we'd move to Davis (close to the school with lots to do) and then relocate to Sacramento when the school moved. We investigated Woodland on the recommendation of a family friend, and because it was much cheaper than living in Davis. We liked it immediately and signed a lease for our apartment without hesitation. Two years later, when the MedEd building near UCDMC was complete, we contemplated making the move to Sacramento but just didn't feel right about leaving. We felt at home in Woodland and, only slightly less importantly, we didn't want to do all that stuff I was complaining about in the first three paragraphs.

Now, whether we like it or not, we're packing up and moving far away. For reasons I may discuss in the future, I've had a feeling for a long time that NC is where we're supposed to be for the next five years, but that doesn't necessarily make leaving "home" any easier. We have had a lot of really good experiences here and been blessed with choice friends who made us feel welcome from the very beginning. Though we anticipate a lot of great experiences in our new home, we are reluctant to leave so many good friends and memories behind. So, thanks for everything, Woodland. Thanks for an education, UC Davis. We'll always look back on our time here fondly...

Sweet Success

Well, it took over eight hours (seven and a half in the saddle), but I did it. Check this one of the list of things to do before leaving California: Ride my bike from Sacramento to Merced. I had Cami drop me off around 6:30 AM Saturday morning. I had my iPod with me and my bike mix. I believe Angels & Airwaves started me off, ran into rain with the Foo Fighters, hit Modesto with No Use For A Name and finally pulled into Merced with Weezer. I almost made it through that entire 8.5 hour playlist. For a while, I was worried that I would run out of music.

Other than the rain (which actually felt very good) and the VERY annoying motorists (who scream at you or whip by without giving you any room), rude pedestrians (who try to trip you as you ride by), and the city of Waterford which has changed the name of Hickman Road to F Street without bothering to tell me about it, the ride was great. Most of all, it's an awesome feeling to know that my two legs powered me every single foot of the 130 miles I rode. Sure, I'm a little saddle-sore today, but it was totally worth it... just don't expect me to do it again anytime soon.

Spelunking?

I went along with my sister's kids to Angel's Camp to visit the California Caverns as part of the Farewell to California Tour. Well, this wasn't an official part of the tour per se, but it sounded like my sister needed to get the kids out of the house, so I figured: "Why not?"

I've never been spelunking before. I don't know if what we did technically classifies as "spelunking" (which, by the way, has officially won the award for "Coolest Name For An Outdoor Activity), but it was a lot of fun and the kids loved it. Clearly, any cave tour that is suitable for kids aged six and up wearing shorts and flip-flops couldn't be too intense, but the lack of intensity did not detract from what was otherwise a pretty cool cave.

One of the coolest parts was when they shut off all the lights. I have never experienced anything that dark. I don't think there was a single, solitary photon bouncing off the million year old stalagmites or stalactites in that cavern. Kind of an eerie feeling, actually. Such profound darkness causes the mind to wander. A mind wandering in complete blackness ultimately arrives at thoughts such as: "Dude, I am screwed if the lights don't come back on." Fortunately for everyone, the lights did come back on. Phew!

The Farewell Tour is rapidly approaching its conclusion. We are scheduled to make the BIG move next Thursday or Friday. In addition to packing up our entire lives into cardboard boxes, I am also trying to squeeze in my Farewell to California Bike Ride and one last trip to Merced (those might be one and the same). I hate moving...

Car 4 Sale Again

The following is my actual Craigslist posting:

"Awesome red Kia Rio for sale by owner. Be the envy of all your friends as you drive through town in this one-of-a-kind sub-compact. Its manual transmission proves that you know a thing or two about driving real cars. There are four doors, but the rear two and back three seats are purely for aesthetic purposes. Car has approximately 73,000 miles, but fine Korean craftsmanship ensures that it will keep driving until the millennium. Car comes with state-of-the-art CD player! Tires are recently replaced, but the Kia's amazing acceleration may melt those puppies off at any minute. This car gets great gas mileage, and contrary to commonly-held perceptions, does not run on AA batteries. The car's title is squeaky clean and the car itself is in great condition. KBB lists a cherry ride like this for over $3000! Asking $2500, but will consider any legitimate offer.

Owner is moving across country and needs to sell this OTHERWISE PERFECTLY FUNCTIONAL AUTOMOBILE! Call or email now while supplies last."

Clearly the shrewd advertising worked. Just sold the car and got my asking price. Dude even paid cash. I didn't even know they still printed bills anymore. Although, I wish he had brought some larger denominations. It was a little weird sitting in the Roseville Galleria waiting for Cami to pick me up with 500 $5 bills.

Goodbye, sweet Kia! I will miss you and all four of your awesome cylinders! May your next owner love you as much as I did.

Pig Party

The Farewell Tour took me home to Merced yesterday to spend a couple days with my parents, my sister Cindy and her four offspring while they are in California. Unfortunately, Cami is still a working stiff and couldn't make it with me. In addition to seeing friends and family, the best part about making a trip home is the food. Nothing tastes quite as good as a Mom's home cooking and, as far as Moms go, mine is an amazing cook. I was certainly looking forward to a lovely, relaxing meal, especially after the heaping dose of snobbery we received in Napa. As luck would have it, Mom was making pasta, which is exactly what I had at that other place. Which got me to thinking, how does Mom's place stack up against that fancy Italian restaurant?

1. Presentation. The Italian place offered fancy table settings, extraneous silverware, and quiet jazz music playing in the background of a dimly lit restaurant. Mom's place eschewed all formal tableware, utensils, napkins, and pretty much anything else you might ordinarily expect to find on the dinner table. The table itself was draped in thick plastic and placed smack-dab in the middle of the backyard. The spaghetti itself was distributed down the center of the table, easily within arm's reach of anyone who wanted to grab a handful. Advantage: Mom

2. Food. The Italian place offered a well-designed, well-crafted penne pasta in red sauce. However, the price of each plate forced you to eat as slowly as possible so that you would savor every morsel and have some hope of getting your money's worth. Mom offered regular ol' spaghetti and garlic bread made with that secret ingredient only found in Mom's spice rack. Since the "Pig Party" motif required that you eat without utensils, you could literally eat by the handful and food had a way of ending up pretty much everywhere. Mom wins again.

3. Company. The Italian place was quiet, but there were a few parties around enjoying their meals and talking in hushed tones. Most people were dressed for the occasion and seemed to be celebrating something. Mom's place was filled with four little rugrats, a mom, a grandma, one feisty grandpa, and me, of course. The dress code was evidently clothing optional. Kind of progressive for Mom's house, I know, but it made clean up a lot easier. Again, Mom has the upper hand.

4. Entertainment. The Italian place had some jazz music and a piano player eventually showed up with a well-stocked tip jar. Given the company and the environment, it is not surprising that dinner at Mom's ended up breaking into a food fight. Everyone had fun with this, except Bryce. He seemed to be a conscientious objector using food as a weapon and ran away anytime anyone got near him with a spaghetti noodle. Mom easily wins this comparison.

There you have it, on an objective, point-by-point analysis, Mom wins hands down.

The Pig Party was a blast and after we hosed off we all jumped and/or were thrown into the pool. Of course, this inevitably lead to some spaghetti being brought into the pool. I wonder if my parents will put up one of those signs that you see all over. You know, the ones that say: "We don't pee in your pasta, don't spaghetti in our pool." In any case, there is nothing like a home-cooked meal.