The Cherry On Top

The perfect conclusion to a miserable call day: Getting spit on by a patient in the ER. Not just a little spittle, but a full-on, bloody, mucousy, thick loogie right smack dab in the middle of my dress shirt. Poor guy had broken his mandible and wanted to clean out his mouth. I handed him a kidney basin and next thing I know, I am staring at a dirty, red, coagulated booger slowly oozing down the front of my shirt. Thanks, dude. I really needed that today.

Q2

I am finishing up my neurosurgery rotation. It has been a rough week. Since coming back from vacation, I have been working "q2 call." For those unfamiliar with the terminology, q2 call is more or less medical slang for being on call every other day (q from the Latin quaque meaning every). Q2 call, in my opinion, is the closest thing to cruel and unusual punishment that a resident can endure.

My schedule requires me to show up to work on a Monday morning at 5:30AM and work thirty hours until 11:30AM the next day. I'm responsible for all of the 70 some-odd patients on the neurosurgery service, as well as any new patients who need to be admitted to the service overnight. With such a busy service, there is precious little opportunity to sit down and think, let alone catch a moment of shut-eye. After the shift, you go home and crash. But since it's q2, the whole process repeats itself the very next day.

Thirty hours on, eighteen hours off, repeat.

When I show up for my call, they hand me the neurosurgery "consult pager," which is the first-contact number for all hospital questions regarding neurosurgery patients or potential patients. Clipping that pager to your belt is like hanging the proverbial millstone around your neck. It is absolutely miserable.

At around 11:30 last Wednesday night, I sat down for a moment to put in some admission orders for a patient I had been called to see in the ED. Over the course of the next hour and a half, I think my pager went off about 30 times. Think about that. That's an average of one page every 3 minutes. How can anybody expect to get anything done, when every few minutes you have to stop what you are doing, pick up a phone, wait for the person to answer, listen to their question, and try and remember which of the 70 patients you are caring for is the particular patient you are being asked about, before providing them some therapeutic course to take? It is nearly impossible.

It got so bad, that I would pick up the phone to return a page and be paged twice more while still on the phone. There was a medicine intern sitting next to me in the charting room where I was located. As page after page came in, I watched as his eyes got wider and wider. During a brief moment between phone calls he incredulously asked me "What service are you on?" I could hear the relief in his voice when I told him I was on neurosurgery--a rotation that he, as a medicine intern, would not be subjected to.

90% of the pages you get are simple (and occasionally idiotic) questions that are easily addressed and resolved. However, every now and then serious questions and situations arrive via page and they need to be tended to immediately. In my short time on the service I have seen more than a few patients rapidly deteriorate and some even expire. Every page needs to be returned as soon as possible.

Fortunately, thirty hours does not an eternity make and being busy only hastens the passage of time. Still, I think I will be one happy intern when I switch rotations next Tuesday... even if it will be to working the night shift for a month.

What a year.

I love America and Tim!

Last weekend Tim and I took advantage of his first PAID VACATION!!! and went up to Washington D.C. People always tell us that this phase of life (married with no kids) is the best time to travel. Obviously, we agree with them, but we really haven't been able to do much traveling due to a little something we call "medical school" and the schedule and financial restrictions that come along with it. We had a lot of fun seeing the city, historical sights of our nation's capital, and just hanging out together all day. Here are some pictures of our weekend. I'm sorry that most of them are of me, but that just shows you who carried the camera.

Dear Tim, I know you hate these posts with a million pictures, but I'm actually posting on our blog, so no complaining. Love, Cami

The trees out here are so pretty right now. Here is Tim's attempt to capture it from inside the car. Classic road trip maneuver.

Tim and I with one of our tour guides at the Lincoln Memorial. I definitely recommend going to the memorials/monuments at night. Very cool.

Me trying to recite the Gettysburg Address by memory standing in front of it. I made it through the first few sentences without any problem, the next few with a little bit of prompting from Tim, and then it all feel apart. Sorry Abe!

Me with both tour guides, one of them being the best hostess ever! It was fun to hang out with Debbie & Kim and see where they live. They were also very good trip advisers.

All of us in front of, but very far from, the Washington Monument.

Okay, and now for the fun part...we took a tour of the city on Segways! I know that some of you are thinking that is nerdy, but no mocking us unless you've actually done this before. It was a lot of fun even if I did think I was gonna get hit by a car for the first 10 minutes of the tour. And yes, we had to wear helmets. While we were on the tour, this Japanese tourist walking past us near the capitol stopped us and took our pictures and then had his wife take a picture of him with us. Awesome.

After our tour, for our segway graduation ceremony, we received official "Segs in the City" licenses. All this means is that if we wanted to give them more money, we could take the Segs out by ourselves.

Are you sick of pictures yet? Don't worry, I'm almost done. I need to get more pics of Tim in here. This is one of him being super sneaky as he climbs through the air vents at the International Spy Museum.

We were able to go to the Washington D.C. temple while we were there. We went on Halloween night, so it was totally empty. Tim thought he forgot his black socks (when we got home he found them hidden in a pocket of his bag) so he had to wear white ones. This is one of those things that REALLY bothers Tim. He couldn't get over it, so I made him pose for a picture.

Here is a picture of us being in love at the D.C. temple. If this picture grosses any of you out (which I totally understand because I hate seeing pictures of other people kissing) please refer to the next photo.

Okay, the pictures are over. Activities that aren't pictured: touring the capitol, Library of Congress, Supreme Court, Smithsonian Museums, National Archives, riding the Metro, and Debbie's awesome hair on Halloween. We really did have a fun trip and visiting D.C. always reminds me how much I love our country and makes me want to study American history. Thanks again to Debbie and her roommates for letting us stay in their guest suite. You guys are awesome!

Lost And Gone Forever

Cami and I kicked off "Vacation Week" today with a trip to Charlotte. I got a tip from a nurse at the hospital that Guster was staging a 10-year anniversary tour celebrating their album Lost and Gone Forever. Guster was one of my favorite bands in college and Lost and Gone Forever is still one of my favorite albums. Since I had the week off for vacation, it seemed a good opportunity for us to head down to the "Queen City" and get a little taste of Charlotte for ourselves.

The concert was held in a little venue called the Neighborhood Theatre, which they somehow managed to squeeze hundreds of people in. Waiting in line to get in, Cami expressed concern that we might be the "old people" at something like this. I argued that we were certainly within one standard deviation of the mean age of the crowd and it did seem that most people in attendance were in that immediately post-college crowd, though I did see a few silver-haired individuals roaming around. Which got me to imagining my Dad at a concert like this. And while I think he might like most of what Guster has to offer, I think attending last night's concert would have driven him crazy.

We managed to secure a great location. We didn't want to fight amongst the crowd in the open area beneath the stage and so we set up camp on the wing immediately to the left of the stage. As the concert got ready to start, nearly every other available inch of floor space was occupied, so we ended up having some great real estate. Except for the fact that immediately behind us, a group of incredibly pretentious forty-somethings, who were desperately clinging to cool by attending this concert and constantly talking about how hip they were. Fortunately, they got too drunk to continue that conversation before they drove us crazy.

The concert itself was a blast. It always amazes me that a lot of these musicians look so normal (and dorky). When they came on stage, Cami was surprised and said: "I can't believe that these are the guys I listen to in my car." Believe it, Cami. They played two sets, including the entirety of Lost and Gone Forever. They were a lot of fun, the sound was good, and their drummer was amazing. Cami and I just kept staring at him... We would have been making lots of witty comments about his profession, but about 30 minutes into the show we couldn't hear each other anymore, so our witticisms were implied.

All in all, we had a great time. Came home went to bed, and now we're of to Washington DC for a few days in our Nation's Capitol. What a great week...

From Flat to Fabulous in Seconds!!

Last Friday, I had a great 28th birthday thanks to thoughtful emails, phone calls, gifts, and Facebook messages (nothing like Facebook to make you feel popular, am I right?). But I have to give a special shout-out to my friend Cianne for giving me the gift I've been needing my whole life.

A little bit of background: While living in Utah for over four years during college, I always felt a little bit out of place. It wasn't so much the fact that I didn't own Dr. Marten sandals, eat every other meal at Cafe Rio, call soda "pop", or belong to a multi-level-marketing scheme, but it was more about the fact that I couldn't achieve the Utah girl hair. No matter how hard I tried, I could never get my hair to elevate off of my head.

Cianne, being a Utah native, must have sensed my lack of hair skills and came to my rescue with Bumpits™. You are probably wondering what in the world a Bumpits™ is, so here is a brief explanation from our friends over at Sally's Beauty Supply:

"Bumpits™ are an exciting new revolutionary way to create perfect volume. These comfortable, leave-in self-gripping, hidden inserts create perfect volume every time! Bumpits™ are simple to use and cost less than one trip to the salon."

Thanks to the genius of the Bumpits™ inventors, my hair can go "from flat to fabulous" in just three easy steps:

Step 1: Simply part hair at crown and gently tease!
Step 2: Firmly place Bumpits™ insert behind part line!
Step 3: Firmly spray. Finished!

Here is a before shot. Look how flat my hair is. Boring!!


Then, three easy steps and my hair went from flat to fabulous in seconds (actually minutes).


I know what you are all thinking..."Cami, it is too good to be true!!!" But this is for real, people. If you don't believe me, check out this. If you do believe me, still check out this because it is seriously awesome.

One more thing, Bumpits™ come in four colors to match your own hair color, light blonde, medium blonde, brunette, and black. You will also receive three different sizes so it is possible to have not just one, not two, but THREE bumps all at one time!! What are you waiting for? The Utah hair look is only a click away, get ordering!!!

And one more shout-out to Cianne. I owe you. Big time.

Neurosurgery: It's Not Just For Brain Surgeons

I guess I have survived the transition to my next rotation: Neurosurgery.

My experience with the brainies so far is that they are a little too smart for their own good. Neurosurgery is a seven-year residency. This means that the chief residents have more training under their belt than do many of the attendings in several other fields... and they know it. Not a talkative bunch, but pretty opinionated. Don't get me wrong, they're a nice bunch of guys, they're just pretty cerebral and I don't quite fit in.

Neurosurgery is the only residency that allows its residents to break the 80-hour work week. They are one of the busiest services in the hospital and have a patient census that typically numbers up to 70 or 80 patients. They have their own special alphabet soup of procedures and diagnoses: ACDF, EVD, and NPH. The attendings all have very strange preferences and are very particular about what is done and how to do it. It's not just simple things like their preferences for specific pain medications or when to discharge a patient. It's about everything. And everyone of the attendings has their own set of rules. Which are impossible to decipher until you have already made the mistake.

Just yesterday I went to consent a patient for a spinal fusion. No big deal, I have done dozens of consents in my short career as a physician. I nonchalantly informed one of the NPs on the service that I had done so. Immediately her eyes got as big as dinner-plates and informed me that they don't let interns do that. I think she almost broke out in a cold sweat as she told me the horrors of what might happen if I was caught having committed such an atrocious sin. Quickly, we paged one of the upper level residents to atone for my mistake and I was fortunate to avoid the tongue-lashing that would have had my name on it.

I have a feeling it is going to take a while to figure out how to not to get tripped up by all the nuances and peculiarities, as well as the grueling nature of the service. However, fortunately for me it will take one week less than it would have otherwise. I was granted one of my two weeks of vacation this week and am looking forward to enjoying some R&R as well as a trip to DC with Cami. It couldn't have come too soon.

Now, if you'll excuse me, I have to go take a shower and wash all the kuru off.

Appearing Busy

Finished my last shift in the emergency department. The ED was alright. Eight hours on, sixteen hours off. Sure, which eight hours of the day it was varied from day to day and I could be working from 8AM to 4PM one day and 12 AM to 8 AM the next. But only eight hours a day? I couldn't complain about that... except, I found myself complaining about that.

With all that time off I got used to the idea of doing the reading I wanted to do, working on projects around the house, taking naps, and even just taking my sweet time getting ready in the morning. I also found myself resenting the fact that I even had to go in to work in the first place. All that time off made me grumpy. I hadn't felt that way about going to work since I sold my soul to the all-mighty dollar and took a job as a a telemarketer in college.

Flashback: The summer before Cami and I got hitched, I decided I ought to earn a little extra dough in addition to my job teaching at the MTC. Telemarketing jobs were very easy to come by, advertised good reimbursement, and were compatible with my already established work schedule. Only one problem: I absolutely HATED the work. I would wake up in the morning dreading the fact that at 4:00 PM that afternoon I would have to go to work. Every hour passing was an hour closer to that misery. Suffice it to say, I wasn't a very good telemarketer (I still feel dirty), and when the opportunity came to pick up extra shifts at my other job I gladly quit the telemarketing profession and haven't looked back.

Back to the Present: Certainly, working in the ED wasn't nearly that bad. In fact, once I got into the fray, time in the ED passed quickly and as long as I wasn't doing a pelvic exam or dealing with sacral decubitus ulcers, I was fairly content. I got better at grabbing the nosebleeds and ear-pains before the other residents signed up for them, and would like to think I learned a fair amount of stuff.

The other knock on the ED, and shift-work in general I suppose, is that the last 45 minutes of shift are generally wasted. At 3:20 PM today, I knew that my relief was going to be arriving in approximately 40 minutes. I was sitting on two patients and didn't want to pick up another one. The initial work-up for an ED patient is the most time-consuming portion and picking up a patient 40 minutes before your shift is up guarantees that you will be staying overtime.

I quickly learned that the goal during those waning moments of a shift is to perfect the art of appearing busier than you actually are. It is a far, far better thing to look busy, than to actually be busy. If I appear busy, no one is going to ask me to take on extra work, I get home when I am supposed to get home, the ED residents (who actually get credit for the number of patients they see) get to work up more patients, and patients get seen by physicians better trained at emergency treatment. You see, everybody wins.

All this in mind, I worked the last 40 minutes of my shift today to perfection. Running back and forth between my two patients, checking and re-checking their labs and films, assisting nurses with the heavy patients and basically avoiding the "pit," where the residents do their dictating and charting and, most importantly, where you sign up for new patients. As planned, I signed out my patients, and said good-bye to the emergency room exactly on time. I was brimming as I rode the elevator up to the main level and I realized I will never have to perform another pelvic exam again.

So long, emergency room. I'll see you again, to be sure, but only as a consultant. My next rotation is neurosurgery. It starts in about nine hours. I suppose I ought to start getting ready for bed, because, like the beginning of every rotation, tomorrow is going to be a long day.

The grand adventure continues...

The Only Prescription...

Cami has been complaining that she hasn't been feeling to well recently. She's had a bit of a temperature. Being a doctor has a few perks, and even though this therapy probably isn't FDA approved, I decided to write Cami a prescription for the best antipyretic I know.

One Hundred Grand

Congratulations to us! At approximately 12:13 AM EST, a visitor from Chennai, Tamil Nadu, India stumbled across our little corner of the world wide web. Whoever he (or she as the case may be) was, it was the one-hundred-thousandth time a visitor showed up at our website since we started keeping track in April of 2007.

The majority of our hits likely came from Cami who has been known to frequent our blog and its links when things get slow at work. Which is frequently. Another huge chunk of our hits came from random people, like our visitor from India, who likely stumbled across the blog by googling an image or phrase utilized in our blog. A small but significant portion of those visitors are, of course, people like you who are bothering to actually read this post.

We enjoy writing and keeping this blog up-to-date, and enjoy the fact that you seem to enjoy it as well. So, we'll keep writing if you keep coming. And, to be honest, we'll probably keep writing if you don't keep coming, too. So, continue to do what you want, and we'll do likewise.

Here's to the next 100,000!

Visitors

For those of you who frequent Kim's blog, this is old news, but for those of you who don't know who Kim is, she is one of my beautiful cousins who came to visit me! The other beautiful cousin is Debbie, sometime referred to as Dibbie if you are a writer covering high school tennis for the Merced Sun-star. Kim and Debbie both live and work in Washington D.C., which is just a short 5-6 hour drive from here. They were nice enough to make the drive down here to hang out with me and Tim. Unfortunately, their plans to hang out with Tim didn't really pan out, since Tim decided to get sick.

On Saturday I gave them the grand tour of Winston-Salem, which included a tour of Wake Forest and the Reynolda House. Our tour of campus turned into a driving tour since the weather was very wet. Despite the rain, Debbie and Kim liked the campus and we managed to get a few pictures in. I've only been working at Wake Forest for about six weeks, but I was still able to impress them with the random facts I knew, like why all of the trees on the quad were covered in toilet paper (a tradition after every big athletic victories). We also toured the Reynolda House, which was the home of a big tobacco family here in Winston-Salem. Tobacco and cigarettes are basically what funded the growth of this city, which is why so many people here smoke. The tour of the house ended up being a lot of fun and I'm sure it is something I will do often as we have family coming into town for visits.

We spent the rest of the weekend playing cards, cooking, eating, watching movies, and talking. I seriously love my cousins! Kim and Deb, you are definitely invited back and next time I'll put a sign on the guest room door that says "The Little Mermaids" so it feels more like a family reunion.

We had a great time and loved having people over to visit. So if any of you are having the itch to come and make the trip to Winston-Salem, you are welcome to stay with us.