Tuesday, November 17, 2009

New

There used to be a time when I wanted another baby. I would think of my life as a mother and refuse to believe that that chance to cuddle a baby was over for me. And I would hide the sadness by feigning relief at infertility. That was years ago. Evan was 3 or 4 years old: still young, but undeniably growing up on me. About 5 years ago. But it never happened, and I just assumed that God forgot.

I always said I wanted to be a doctor. I guess secretly I never believed it could happen. But then something crazy happened, and I made the first step that was more of a leap of faith. And then came progress. And before I knew what was happening, everything I have always wanted was right there within my reach.

I did that for myself. Suddenly the idea of Evan being an only child wasn't so bad. It meant I could have everything I wanted: a career in medicine, a husband I love, being a mother. I didn't have to sacrifice a thing other than sleep and some elbow grease. Perfect.

But God, if He or She exists, does have a sense of humor. Immersed in my world of school and work, I never noticed that my boobs hurt that badly until one day when I stopped to pay attention. So I took the test that had nothing to do with pre-med, and it was positive before I could even put it on the counter to wait the requisite three minutes. Of course it had to be wrong, so I took another. Same result. So I called a doctor and got orders sent to a lab, just to be sure. Yes. We are having another baby.

I was completely in shock. Not according to plan. Evan will be 9 about two months after this one is to be born. Then I thought about how I was almost done. About applying to med school with an infant in tow. About another mouth to feed. And I was upet.

But nature took care of that. Over the weeks, as my belly first turned softer, then started to firm with the swelling of new life. And I saw the flutter of a heart beat, strong and persistant, on a screen. Saw the smile light John's face and the excitement flicker in Evan's eyes. And suddely, my outlook changed.

I get to try it all again. I get a chance to amend the errors I made with Evan, as we parents do sometimes. I get the last chance to be the perfect mother. To smell thebuttermilk breath of a newborn and feel the flutter of batting eyelashes against my cheek. I get to sing lullabies again without anyone insisting they are too old for them. I get to witness first steps and first words again. To hear a baby's giggle. To buy those tiny clothes and smell baby lotion.

So considering names, I go for meaning and not trends. And my first inclination is the Emily I have always wanted. But then I see Amelia's meaning: work, strain, effort. And I know that this is the one. But what for a boy? John and I could not agree. Until, at the very end of the alphabet, I found one that brought tears to my eys.

The meaning of Zachary: God remembered.

Monday, November 2, 2009

Surviving H1N1


Where in the Hell have I been lately?


Well, Organic Chemistry is trying to kill me, I swear. And I have been working like a dog thanks to the pesky H1N1. I havemore updates later, but those will come unde separate cover...


What is it like to be a respiratory theapist in the throes of an early and horrendous flu season? "Suffocating" would be the first word I would choose. Everyone with a cough is in droplet precautions, which means I have to mask up before entering just about any room in the hospital. And we have gotten so out of hand with it! I had a vent patient who was known to have aspiration pneumonia. He had been on the vent for weeks when I went to treat him a few days ago. Imagine my surprise when I see a large "Droplet Precaution" sign on his door in the ICU. Why? Because he has pneumonia, we assume he has swine flu. Ridiculous.
Another example: I was working the ER the other night. The doctor was ordering my services for everyone. After about 5 unnecessary breathing treatments, I asked why a patient in with nausea/ vomiting with 100% clear lungs would need it. His response? Well, I think she has H1N1, so she may wheeze in the future. Again, ridiculous.
People are so panicked. Checking into the ER for sneezing, literally. Entire families checking in together. The ER's are clogged with this stuff, limiting access to care for people who need it most.
It irks me in a big way.
I know the flu sucks. I also know a new strain of anything is scary. But if you are healthy and just having manageable symptoms, there is nothing that can be done for you in the ER that cannot be done at home. So stay there. Tylenol works for fevers, Gatorade and Jell-O work for dehydration. And these are all infinitely cheaper than an ER bill.

Tuesday, September 22, 2009

I'm a Double Major in Moleculr Biology and Biomechanics On a Pre-Med Track

Mouthful, isn't it?

I have one more day off, then back to class I go. Kinda excited, kinda nervous. Calculus has never been my thing, but it has to become so this quarter. I dropped that physics course and 3rd chem course due to my illness over the summer, and they are prerequisites to all of my fall classes. Most professors are forgiving, and are letting me slide. Except for my Genetics professor. She isn't very favorable to my staying in her course, but if one of my advisors has anything to do with it, I will remain in the course. (Yes, I said one of my advisors, as in I have 3: one for biomechanics, one for molecular biology, and one pre-professinal advisor who is going to help me get into med school. As if things weren't confusing enough...)

My feelings of "I am really doing this?" have turned into "Am I really going to do this?" The idea that I am on the track to accomplishing everything I have ever wanted in my life is so surreal. I envision myself graduating medical school, of reciting the Hippocratic Oath, of doing it, and in the back of my mind are these doubts that it will really happen. I've always been Andrea, the girl at the top of her game. But I haven't really been competing, thus far, with a slew of others at the top of their games as well. Is my "top" good enough to compete with theirs?

I've made up my short list of where I am going to apply. I should be starting that process later this year. So here it goes:

Universty of Michigan
Ohio State University
University of Kentucky
University of Louisville
University of Cincinnati
Indiana University
Wright State University
Vanderbilt University

Hopefully one will bite.

Saturday, September 12, 2009

It Started (Warning: Language)

How Odd

It seems so strange that we celebrate Evan's birthday in the same month as one of America's greatest tradgedies. But I remember holding my newborn son at home when my mother-in-law called to tell John and I to turn on the television, to see what was happening.

I was completely selfish that day. I remember instantly thinking that my husband, just three years out of the Marine Corps, would be going to war. A war I would ultimately end up watching on CNN and Fox News nightly while I did my housewife duties. I know so many people who have served in that war. And John was almost one of them. What would I have done? It's hard to imagine. I know I would have waited faithfully for his return home. But I could not imagine the constant fear that he wouldn't be coming home. And livng my life daily wthout him here with me.

So on the 8th anniversary of 9/11, I spent the day thinking about them. About the boys who fight for us, about their wives and kids who wait here at home in a world that does not stop for them because their husband or daddy is away. About all of our brothers and sisters we lost, whether directly or indirectly, because of that fateful day.

Tuesday, September 1, 2009

Tuesday, August 25, 2009

Yesterday was the Day I Almost Died.


All I could think was, "Please, do not let me die like this." Curled in the fetal position of my bathroom floor, covered in my own vomit and feces and sweat while some faceless EMT or Paramedic, or both, worked on me. I could hear John's voice in the background, telling them to "please, just hurry. She's had these reactions before. She knows what they are."


Everything had been fine about 20 minutes ago. I had awakened from a nap after working all night. I had a sore throat that had persisited through the last half of my shift, and was still there when I woke up. I took a sample of the Avelox my family doctor had given me the day before I was hospitalized for pneumonia. A couple of minutes later,I ate a candy bar from Evan's school fundraiser. I started having this intense itching all over my back, and I made John scratch all over. Then I had these stomach cramps that were bad enough that I went and sat on the toilet. It was there that I started to feel lightheaded, felt the thickening in my throat, the tightening in my chest. I yelled for John to call 911 as I fell to the floor in front of the toilet and began to vomit. while clear drainage poured from my nose.


I got the terrifying feeling of taking a deep breath, but the air wasn't getting anywhere. In between gasps, I would shout "Please hurry!" to anyone who could hear me. John kept trying to reassure me : "Baby, I hear the sirens. They're closer." I remember telling him I was going to die.


EMS arrived, and I was assaulted with the questions I ask my patients: "Ma'am, what's your name, allergies, date of birth. What happened today, what's your health history, are you on illegal drugs?" I don't know if the words were coming out. I tried to tell him to hurry while trying to answer his questions. Did he really just ask me if was on heroin? John's response: "Dude! She's a registered respiratory therapist!" I smelledthe new plastic of the nasal cannula, asked fo the nonrebreaher instead. "My sat's okay. For my comfort," I croaked. I begged for the Epinephrine I knew was in his bag. The miracle drug that would stop me from having to have an emergency cricothyroidotomy when what little left of my airway was long gone and the only way to get air to my lungs would be through the whole they made in my neck right there on my bathroom floor. More importantly, the miracle drug that would ensure I would be alive when Evan got out of school in just a few short hours. Ahhhh, Evan. Funny how I can be in hell, knowing my life hangs on how many more seconds it takes this EMT to give me the epi when he appars to not be grasping what is going on, to focus on the sound of John's voice somewhere behind me, and through it all, only be able to see Evan's face.


I don't know where it was in the progression of things when the image of my surroundings began to fade and blur around the edges, when I collapsed the rest of the way, still begging for epi, and thinking of my mom and how I didn't want to, but it would be okay to just go ahead and die. That John and Evan would be okay, that my life insurance was adequate. And I just let go.


Then I felt a pinch in my arm. When I realized I could beathe just a tiny bit better, I realized it was epi, then the EMT said it was epi. That is when I started to vomit again, and someone thrusted my own bathroom garbage can under my face. When my bowels completely released. They were asking me to sit up, to help them help me to stand. I have no idea how I got on the stretcher. But then I heard the clacking of the wheels, saw daylight and the flashing lights in front of the house. Then I was at the hospital, and there was more epi, more Benadryl. More oxygen and questions. And IV, followed by even more Benadryl, Pepcid, steroids. The cold washcloth as the nurses cleaned me up. I begged hem to close the curtain. "I work with these people", I wailed. And sleep. A sleep deeper than I have ever known. And you wake up and it is all over. "Mrs. F, we are going to send you home on a medrol dose pack and I want you to take Benadryl every 4 hours for tonight. And you must get an Epi-Pen. You need to have one with you at all times, do you understand?"


Once home, more sleep. But this time, I would wake to John and Evan's faces. Feel my son kiss me on the cheek, and hear John tell him that Mommy had been sick while he was at school.


And I thought to myself that, though the hours/ days/ weeks/ months/ years of my life have been or will be consumed by images of scrubs and stethoscopes, textbooks and classes, hopes and goals and ambition, isn't it funny that when the edges started to fade, it wasn't any of that that floated with me just beneath the surface as I resigned to my death. It was John's voice and Evan's face.

I have had anaphylactic reactions before. Only none of them were so memorable. I woke up intubated after one of these episodes, but my only memory of that was feeling nauseous and waking up fighting against the tube. Other times, I sought help before it got to that point. I never felt myself slipping away like I did this past week. A later recounting of the experience to my doctor confirmed that I was dying that day, that I was almost gone. Now there are just a few reminders of it left: bad memories, a bruise on my arm from the EMT's rough injection technique, and fear. Fear that my body can react so violently to something to which I have been exposed my whole life without incident.

Now, because I feel like I need to, here are some links for more info:






Tuesday, August 18, 2009

Nothing Like The First Day

Evan's fist day of 2nd grade....

Here is to a fresh new school year. To learning more, and making new friends. Harder math and more challenging reading. Improved handwriting.

But for us, as parents, it is always about so much more...

I don't know about others, but for me, it is always about being one year closer to the day he will leave the nest. One less year to have him with us. It is always the year I will be more involved, more patient about teaching him new things. Watching him grow a little more. One sad day, I will be able to sit back and see that my work is finished. But now, in the middle of the greatest responsibility the world has to offer, I am amazed and realize that these are the days for which to live.

Monday, August 17, 2009

In Awe

Read here about what USMC 81 posted about honoring Medal of Honor recipient CPL Jason Dunham, USMC. I wish I could get the message across to our young people that our true heroes are not "gangsta" rappers, but rather young men like Cpl. Dunham, who saved the lives of his fellow Marines by using himself to absorb an explosion. Truly a hero among heroes...

Ha Ha

Just some RT humor.....

Wednesday, August 12, 2009

Seriously?


Okay so seriously, it is that time of year. The only other time where it is more expensive to be a parent is at Christmas time. My little list started as just a few uniforms. We inventoried the closet to see what uniforms from last year could be reused and came up with a healthy stack. Next was the list of supplies. Evan's school does something differently: each year, when supplies are donated, they divide them up among the students. Say, for example, that each second grader needs 4 boxes of crayons for the year. If enough crayons are donated so that each child can have 2 boxes, the school does not make us buy the 4, but rather he 2 that are lacking. In the end, the supplies that are donated end up saving each parent some money. So now supplies are added to the list.
But then I start to think about things. He'll need new underwear, and socks. And undershirts. Oh, and shoes. We need a pair of gym shoes and a pair of oxfords. And we can't forget that he needs a couple of new belts. And a light jacket. And of course we cannot forget the backpack. Heaven forbid it not be the preppy one with his name embroidered in the center... And of course somewhere before next Wednesday, we will have to get a haircut. Before I know it, a couple hundred bucks for a few uniforms to add to what is left from last year...well, let's just say that the sum morphs into something else entirely. In the meantime, I mention to him that the plan for later in the day is for us to go school shopping. This is the look I get from him. (See above) Why is he so sad? You would think he was the one footing the bill.

Monday, August 10, 2009

Morbid Fascination


So I am revisiting the Triangle Shirtwaist Fire. Again. Reading and digging a little into Women's History, and seriously wondering if perhaps I would be better suited to a degree in the subject, with the addition of my pre-med classes, than I would be a degree in molecular biology. How awesome would it be to spend my days and nights learning of this stuff that weaves itself into everything we are now???




But anyhow, right now, my distraction from chemistry exams is Von Drehle's Triangle. Of which I am about halfway finished. Next, I plan to take on Carry Me Home. After that, who knows.

Sunday, August 9, 2009

A Lot To Say and Don't Know Where To Start

This has been the week I almost became my mother.

I remember the faint burning in my chest to tell me that I was coming down with something. I remember the taste of illness in my mouth when I would cough. I don't remember how I got from the onset of a mild chest cold to the panting, dysneic existence I knew the night John rushed me to the emergency room. I just knew I couldn't breathe. I felt like I was dying. And the life of my mother flashed before my eyes, like her choices were manifesting themselves into what was to become of me. Alpha-1 Antitrypsin deficiency. That was all I could think. Genetic emphysema aggravated by several years of just plain ol' self-neglect in the form of Marlboro Lights. The last time I mentioned te disorder to a doctor, I was asked if I wanted to know how I would die. I said no. When death is the culmination of drowning in your own fluids, who wants to know of its appraoch? Certainly not me, so I declined the test. But this time, when I mentioned it to the pulmonologist, he didn't give me a choice. He just nodded and scribbled somethng down in my chart. An hour after he left, a lab tech showed up in my room to draw some blood. No questions asked. No chance to chicken out.

I will not die her death any more than I will live her life. The test was negatve. I have the time and the chance to make the choices necessary to ensure that I will not have the same demise. Those goals I have set for myself? They are still attainable. As I lay in that hospital bed this week, I told myself that, should the test be positive, I would abandon the whole doctor thing. I would instead focus on my son and my husband and live my life leaving well-enough alone.

Instead, I didn't have to make the choice. Instead, I was branded with bilateral pneumonia with secondary areas of atelectasis. In layman's terms? I had pneumonia in both lungs that was bad enough to require a week-long hospitalization, and was horrifying enough to cause some collapse of several lobes of my lungs. In other words yet? I became my patient. And for the first time in my life, I did not want a cigarette. I was scared. I was confronted with my own mortality. So now, here I am making soe major adjustments to my life.


Incidentally, this is what happens to an arm after 15 gazillion needle sticks and IV attempts.

Saturday, August 1, 2009

My Baby Boy Is Coming Home!


Just for fun, Evan has been staying down at his grandparents' houses for the past few weeks. They do this every summer since we moved away. But this time it has been over 3 weeks and I miss him dearly. But today, his grandfather is bringing him home. I am so excited to see him!

Fritzy Keyboard = I Am Not Lazy!

I m going to type this without going back and checking for typo jut to prove my point. I am not doing this intentionally, bt unless I peck at the keys very slowly and deliberatly, it skips letters. I am wonderng what my son has spilled down between te keys or if there isa ay t clean it. I like the keyboard we have now. It's the Dell one tat came with the computer. But in the meantime I should mention that I am tryin t go back and fix any and all typos, but there is such a huge amount that I am prone to miss a few. I hate lazy people who do not go back and check spelling, grammar, and typos, so just know that I am not one of them.

Friday, July 31, 2009

Speaking of Babies, Did I Ever Tell You WHY Evan is a Miracle?


It was just a couple of weeks after we saw the two pink lines on the little stick when the beeding started. The OB referred to it as "threatened spontaneous abortion". Miscarriage. But maybe not, because there on the screen was a tiny beating heart. The shock of realization on John's face will never leave me. His baby, who he said looked like a bean, there in living color. So I started the visits to the oupatient lab every other day, where they would leave black bruises on my arms in order to siphon from me the blood that would tell them that our baby was thriving. And every other day, we would wait and cry and pray that he was. Or wait for the call that it was all over, that we would try again, that they needed to schedule a D&C. We just waited.
Then one day it was over. I was so happy on that day. I envisioned my body making the discovery that this angel was there to stay for 40 weeks. To stop trying to get rid of him, that he was no intruder, but rather a welcome passenger. The nausea and vomiting were signs of life within me, and they were welcome too. We picked names. Emily for a girl. But what for a boy? He should be named after his father, we decided. But we hated the idea of relatives in southern Kentucky calling him "Junior". So we perused the books for boy names. The control freak in me was beside heself. We needed a boy name. Brady? Tucker? No, too trendy. Then one day I saw it: Evan: Welsh version of John. Little Evan for a boy. Named after his father, but still his own person.
The happiness was short-lived. My body is stubborn. I felt the first contraction a few days later like a gentle tugging within me. But wait. Accoding to the calender, I still had 5 months to go. That gentle tugging turned to tearing, ripping, searing pain. Thoughts of all of the bleeding, John's excitement, Evan or Emily, pink or blue...they all swirled in my head as John rushed me to the hospital. And the first feeling I ever got of John-and Andrea-Against-the-World was when the young doctor told us that th medication did not work, that the contractions were continuing, that he was sorry, but I was having a miscarriage. I wonder what he thought of us, as we clung to each other, crying those big hot tears, grieving for the baby that wasn't to be. Married for about 6 months at the time, we were all each other had in that moment. I imagine it was pity he felt. Or determination. Whatever the reason, a second dose of mdication was given, and the contractions stopped. And we rejoiced. And I returned home a few days later. Only to return again. Same scenario, different day. Again and again we grieved for the loss of our baby, only to find out that it was another near-miss.
After 2 weeks of trips back and forth to the hospital, we met the doctor who would test our resolve. More pre-term labor. But this ime, the doctor and nurse came in to the room and pulled up chairs by my bed. They started speaking of babies with profound disabilities from prematurity. Of families wrecked with medical expenses. Of our youth. The doctor actually said the dreaded word next. Abortion. He told me to let God have our baby, that it wasn't in the cards, that we could have another. I didn't understand. Was the baby okay? Wasn't it just my body? Didn't they have medicine to stop the labor that had been working? Wasn't I at 20 weeks of pregnancy? The age of viability, as they had been telling me during previous visits? I didn't understand, but we knew we needed to find a docotr who wanted us to have our baby like we wanted to.
A couple of months went by, and we switched hospitals to one with a top-rated NICU in preparation for a birth of a very premature infant. We toured the NICU. The hospitalizations continued as we braced ourselves for heartbreak. I learned what the "Special OB Unit" was at Good Smamritan in Cincinnati. I spent over a month there, on magnesium sulfate drips. At such a high dose that I was not permitted to get up to go to the bathroom or even roll in bed by myself. I had chest x-rays every oher day because such high doses were associated with fluid on the lungs. They would cover my arms in hot packs to relieve some of the pain from the viscous fluid going into my veins. They said it was about the thickness of corn-syrup, and that is why it was so painful. Every third day, they would come in and stop the drip because it was not safe for me to be on it any longer than that. And every third day, the contractions would start back up. I got yet another course of steroid injections to prepare the baby for the early birth that could not be stopped. I met a maternal-fetal specialist who was the best in his field and began to get ultrasounds twice a week. We learned tht it was a boy in there. That there was no infection in the amniotic fluid, and no other reason for me to be having the preterm labor. "Sometims this just happens", they told me. But with each week, I got closer to the day that our baby could be born, that the rate of survival for him increased just a teensy bit.
I ws sent home. I was on a medication that would lower my blood pressure so much that when I would take a hot shower, I would pass out from the further dilation of my vessels. I was on another that caused such horrible acid reflux that I was essentially vomitting without wretching. Huge moutfuls of hot sour acid would wash up without any warning. But my baby was okay.
It got to the point where we thought Evan would survive, and we begged the doctors to deliver him. "You can help him", I woul plead. I just wanted them to make it stop.
A little past midnight, on September 1st, 2001, it finally did. I was havng hard contractions, and a nurse midwife who had never seen me before insisted that I was not dilating. And she said I wasn't due for anothr 5 weeks. We laughed at her like maniacs and begged for the on-call obstetrician. I blurted out words like fetal fibronectin,amniocentesis, ultrasounds, steroid courses in all 3 trimesters, hCg levels, magnesium sulfate, age of viability... She started telling me about "what is best for the baby", and a cried hot tears as I told her of the unspeakable hell I had endured for my body to continue to provide a home for this growing baby. I knew from my experiences that if you start labor at 36 weeks, they will let you go. I was 35 weeks. And I didn't care about a few more days. I couldn't do any more. My body was physically, emotionally, and mentally drained in every way imaginable.
The OB finally came in, and he ordered everyone to get off of me. He put his hands on my giant belly and felt as contraction after contraction ripped through me in waves. Contractions that felt like they were ripping me in two, but were not causing any results. And he told me to breathe through them. The monitors came off as he let me feel this last bit of pain unencumbered by the trappings of modern medicine. And he explained to me how they usully do c-sections after just a day of labor, citing failure to progress as the justification. And I had been in labor for literally 17 weeks. I had endured my hell, and he wanted to help it end for me with a c-section.
After that, I didn't feel another contraction. They never stopped, even as th doctor cut through the soft layers of my abdomen. And I was prepared for the silence that follows a cesarean birth. The birth canal doesn't squeeze the fluid from the baby, and often they need to be suctioned. Plus this was a baby who was early. The last to develop is the lungs. He may need help. But from the instant he was exposed to this world, my son let out the lustiest cry I have ever heard in a newborn. And tears choked my voice as I shouted out that his lungs were okay, long before I had ever laid eyes on his beauty.
There is not a day that goes by in my life wih Evan and John when I don't look at my little family and have waking nigtmares of what could have been. Where I do not thank God for the sloppy kisses and brown eyes that sparkle with laughter and amazement and wonder. Where I do not count my blessings. He truly is my Evan from Heaven. Our miracle. A tribute to God or Allah or the science of modern medicine. Or maybe a mother and father's determination.

Jordan Leon




Welcome to the world, Little Jordan. He is my sister-in-law's much-anticipated sequel to Joanna, who will be 2o years old in February. In other words: our new nephew. Over 9 pounds of bouncing baby boy makes her my new hero. 6-pound Evan was nuthin'!
We haven't seen him in person yet. I'm afraid. John and I toyed with he idea of another baby. We would have scares, where Mother Nature would be late. I would mention it to John, and he would sprint to the store to get a home test. And it woul be negative. And we would speak words of relief to each other that betrayed the hint of regret in both of our eyes. And we would remind ourselves of why we didn't need another. I worked hard to get to where I could earn a decent living and give Evan the life I always wanted to give him. I had these lofty ideas of higher-and-higher education. I had such a hard time having Evan, that he truly is a miracle, and one miracle is enough for any family.
It is sort of like the window of opportunity passed us by. I started school and my RT career, though not in that order. I traded visions of a new baby girl in pink for the vision of me in a white coat. And med school and a new baby is not a good combo. A baby that John would have to raise by himself. And by the time I am finished, I will be in my early 40's. And consiering the problems I had with Evan, each passng year makes me more of an obstetrical nightmare...
So we are finished. And it was a hard choice to make, and I can only hope it will be worth all of this in the end. But baby Jordan reminds me of what the other option was to be...

ICU Bed Vs. RT's Foot.

You can barely see it in this pic, but I ran into a little trouble at work Monday morning. Errrrr, more like it ran into me. I had the SICU, and I get a call that we are transporting one of my patients for a stat head CT. Oops, they forgot to call me, and transport is already there and ready to go. So instead of hooking up the transport vent, I decide I am just going to bag the patient fo a quick trip down and back. Off we go.

We ge down to CT without a hitch. Once there, I move to the other side to the bed to arrange IV lines and such for a safe transfer from the ICU bed to the CT scanner. That is when the very sweet patient transporter starts pushing the bed. Right over the top of my right foot. The ICU bed that weighs as much as a car, without the squishy air-filled tires.

But I am a trooper. I stay, balanced on one leg, bagging the patient until the ordeal is over, then hobble to the ER for x-rays. This is where I learn that the male RNs in the ER really are knights in shining armor. Poor Ben gets down on his knees and takes my shoe and sock off. My rubbery shoe. After working 11 out of 12 hours. And he says nothing, even tough I am crying and blubbering about smelly feet and stubbly ankles. Then Steve comes in to make sure I can walk on crutches. Don't even get me started on Norm, the security guard who wheeled me into my room and filled out the incident report for me. They are all angels. You just can't see their wings through the scrubs they wear.

As for me? Outlook not so good. I am on crutches. I am off of work, which I hate. The employee health nurse was teasing me about my control issues and workaholic tendencies. She asked me if I was taking my pain meds, and I told her no, that they drug me up, and she laughed and said that it is because they make me lose control of the situation and sleep. She's probably right. So for at least this week and next, I am just a student.

And I am bored.

Wednesday, July 22, 2009

Back in My Element

I love this commercial.

Okay so what's up in my world? The same. Work and school and homework and just a little sleep thrown in. And now working out again. Back to the grind in the gym. I started back last Thursday. I have already lost 10 more pounds and almost 4 inches of of my waist. Go me!

Though I love swimming, the pool hasn't bee my friend recently. Read about it here.

Wednesday, July 15, 2009

16 out of 18

The word of the day is tired. I work entirely too much. Out of the past 18 days, I have worked 12 hour shifts on 16 of them. Evan it is at his grandparents' house in Madisonville. Chemistry starts tomorrow. Watch a video.

Wednesday, July 8, 2009

My Animals Hang With the Animals

Today I took some time away with the fam for a trip to Cincinnati Zoo and Botanical Gardens. We had fun, aside from Evan complaining about his feet hurting after he insisted on wearing flip-flops. I'm glad I got this time with him, though. I have to work tonight at 23:00, and work twelves for the next 7 nights. By the time I am finished with this stretch, I will be back in class. He is going with his grandma this weekend to King's Island, along with John and his cousin Joanna, then making the trip back to Madisonville with her to spend the week at his grandpa's house. Summer is flying by. At least I got a little bit of time with him first.


By far my favorite pic of the entire trip. The goat kept trying to eat Evan's shirt, so Evan would giggle and step away, then try to pet it again. Each time, it would get a mouth full. It didn't tear the shirt, but it did give me a great photo op.
Too cute for words.
This damned thing. I was leaning over the glass, trying to get a good shot of the sea lion that was underwater playing with a ball. All of the sudden, this #$%^& popped it's head up at me, scaring me to death. Note that the camera was not zoomed for this pic!
Lucy wouldn't wake up for me and I was very disappointed. (See below.)
Awwww. Lucy the Baby Bearcat. Sponsored by the University of Cincinnati. Go figure.
The seductive ape. I kindly left the other one out of the pic, who was showing its hand in its mouth repeatedly. I had just said "What is it, bulimic?" when it purged its food into its hand to feed its baby. Disgusting.
This is "Francois". Some type of monkey that had Francois in it's name. It had a faux-hawk and white muttonchops, and was the coolest monkey ever.
I don't know what in the hell this thing was, but when we went to walk away, it made some weird crying sound until we came back.
The polar bear insisted on showing me nothing more than his browneye as he ate his lunch.
I think John was making funny faces behind me.
So peaceful here. I didn't want to leave this spot.
The big one and the little one take a break to eat popcorn.
I have this horrendous phobia of snakes. Just walking into the reptile house was a huge step in conquering my fear. And it was packed too. As I looked at the snakes through the glass, I was sizing people up to see how much effort it would take to knock them out of my way if I needed to make a break for it. Then I saw this S.O.B.....
Evan kept calling this rhinoceros "Clyde". I have no idea where he got that name.
Evan poses with the likeness of his father.
Is that the Fergie family? Mom, Dad, and Evan.....
The gorillas were pensive.
The bearcat would not be still for her photo shoot. I swear I stood there for about 15 minutes trying to get a good shot. No wonder UC thinks this is a good mascot....stubborn as hell!
I think I interrupted the sexy time of the "Giant Bait", as my hillbilly husband called them.
These lizards were looking at me.
The lemurs. This is when Evan screamed "Look, Mommy, it's Zoboomafoo!"

Monday, July 6, 2009

The Ball Tick and its Aftermath

When we were out in the country weeks ago, on John's Dad's property, we found ticks on us. Yes, as in multiple ticks. We got them off, even though I was grossed out entirely.

So fast forward a couple of days later. I think it was a McDonald's we were at for breakfast. For the umpteenth time that day, I caught little Evan scratching his nether regions. He never does that. Well, being that he is getting older and more aware that Mommy is girl, I sent John into the bathroom with him to inspect. Yep, you guessed it! He had a tick fully embedded.... there! So John tries to get it out, to no avail. I call the doctor, and she is going to get a male colleague to get it out if I will just stop by the office. At this news, Evan starts wailing. He doesn't want the doctor to do this. So I call the in-laws. They're country people and know more about this crap than I do. My father-in-law tells me to hold a match to it. Seriously? Did he even hear where I told him it was on Evan's body???? But the heat idea....hmmmm. So I get Evan in a hot shower, hoping it will back out enough to get the sucker out. Of course not.

I have no idea how I did it, but I managed to convince the kid to let me have a crack at it. I hope no neighbors were looking through the windows, because I had to have my son lay on the floor, and I had to get my face very close to see what I was doing. But armed with nothing but a pair of tweezers, I got the damned tick out. Ewww. The entire time, Evan was whimpering about the "ball surgery".

So here we are a month later. The spot where the tick was located looks awful. And Evan has developed this horrific rash all over the lower half of his body. We have tried every over-the-counter cream there is, from anti-inflammatories to anti-fungals. Nothing is fixing this rash. A week later, when it is actually worse, we take him to the doctor.

My child has lyme disease. So now we are on a one-month, three-times-a-day course of antibiotics. So much for summer!

Friday, July 3, 2009

Taking the Bait


I immersed myself in kid lit. I had to see what the fuss was over, and now I see. I finished Eclipse late last night and am now reading Breaking Dawn of Stephanie Meyer's Twilight series. This is the last book, then I can go back to big-girl books.

Wednesday, July 1, 2009

Sticky Situation I Found Myself In


A Patient is completely alert and oriented. She is intubated and has been on a ventilator for days, thought the initial problem had nothing to do with her lungs. Now she is awake and demanding to be extubated through hand gestures. Her vital signs look amazing. She has an order for a wean in the morning. But she insists on now. The family is called in to speak with her, and the family agrees with the idea of honoring her wishes. Her doctor, on the other hand, did not give the order, but did not tell us not to extubate, either, but simply made the statement that extubation would be at her wish and not his order. You put her on a t-piece and monitor her. There is absolutely no change in vital signs for 2 hours. You get a blood gas, and it is textbook-perfect. What do you do?

I'll tell you what I did. I pulled the damned tube, documenting heavily on her stability and the family and patient's wishes. Apparently, this has been the talk of the MICU. My director, critical care coordinator, and supervisor have commended my actions, saying I did exactly what I should have done in that situation. The director has even gone so far as to copy my charting to place in my personnel file along with a typed commendation from him. Only one pulmonologist has said anything. She wanted to know if it is "standard practice to extubate a patient in the middle of the night without a physician's order". Absolutely not. But to honor a patient's wishes while safely monitoring the patient's cardiopulmonary status...My intent throughout the whole ordeal was to watch for anything that would indicate that she would not be able to handle extubation. Had anything come up, I would have immediately had a discussion with the family regarding my concern. But nothing did. I could find no reason to leave her intubated against their wishes. And the outcome has been phenomenal. She hasn't needed so much as a breathing treatment since I did the deed.

So my Big Boss is recognizing me, stating that I have done a tremendous job for the hospital since I have been employed with them. Up until recently, I didn't even know if he knew that I work for him. But according to a phone conversation this morning, he has been getting a lot of positive feedback about me. Kind of makes my ears burn a little bit, wondering what has been said and when. But overall, it feels great to have your hard work recognized.

Saturday, June 27, 2009

No Summer

Okay. I have been through hell and back over the past few days. It all started with physics. As in I dropped it. After 3 days of studying non-stop, I was not at all ready for the first exam. We were to have an exam every 3 days over 10 chapters each. Nope. Not happening. I decided it would be better to take the class during a traditional quarter instead of the 4 week long summer sessions. So.....
I went online to look at my account for UC to see what this would do tto my tuition. This is when I found out that I would not be getting my S.M.A.R.T. grant. Uh-oh. Furthermore, they did not kick-in my metropolitan tuition rate that I became eligible for when I changed majors then picked up the double major. Big Uh-oh. The grant left me about $1300 short, then I was assessed a $4800 surcharge for being out-of-state. The moral of the story is that I ended up owing UC over $2K. Lovely.
First they told me that it had to be paid this week or my classes not only for summer, but for fall as well, would be cancelled. I asked about what would happen if I just dropped the rest of the summer courses, and that was no good either. In stead of owing $2K, all of my loans would drop out because I would no longer be enrolled, so I would owe 50% of my tuition with no aid. About $7K. What to do? And regardless of what I do with UC, I cannot just transfer to Northern Kentucky University (with their much cheaper tuition, but much lower academic standards) because until I satisfy this debt, there will be a freeze on my transcripts. Grrrr.

So the plan is work. Work. Work. Work. And save. No more eating out or quick trips for coffee. No more of going to the video store and renting literally piles of movies. No more. Thanks to UC, my summer has turned into nothing more than work and school, school and work. Not that this is a change from previous quarters, but I was hoping to find some time for at least a little bonding with Evan while he is out of school for the summer. Instead I have to be content with just going to work. I did finally speak to someone in the collections department, and she said what the university did to me is ridiculous, and has set me up on a payment plan. 2 payments of $1000. Thank God I have the type of job with the type of pay that I can work about 3 extra shifts to make $1000. Well, maybe 4 or 5 if consider how my dear Uncle Sam rapes my overtime pay. I've already made a start. Instead of being off from Monday through Thursday this week, I have picked up shifts on Monday, Tuesday, and Wednesday. Which has the added benefit of putting me in overtime by the time I get to my scheduled shifts on the weekend. If you consider that The 4th of July is this coming weekend, and that will be holiday pay AND overtime, so double overtime for those 2 nights, I may be able to satisfy the first part of that $2K obligation this coming payday.

Wednesday, June 24, 2009

Sunday, June 21, 2009

Frailty of Life


So....I really want to blog about the experience I had this morning in a code. An experience so bad that it left me questioning if I want to stay in this world I have lived in for several years: The World of Medicine. A 36-year-old female with breast cancer suffering from complications from a lymphectomy. There were those of us on the ICU team that had been working on her for hours before one of us hit the blue button that would signal the hospital switchboard operator to make the overhead call of "Code Blue", then there was the general crowd that shows up when the code is called. Those of us that knew the story tried to resuscitate the young woman with faces that were streaked with tears. One of my colleagues came to check and see if I needed any help, and saw that I was crying, so he offered to relieve me. Her mother was already there, but we kept her alive until the "rest of her family" got there. When we realized our efforts were futile, the Nursing Supervisor went to get her family. Allowing the family at a resuscitation attempt is kind of controversial. Is it cruel? But studies have shown that families deal better when they see the effort we are putting in to save their loved one. So while I hate it because it does not always allow me the mental distance from the situation, if it helps them, so be it. But nothing prepared me for this. Her weeping husband. And her nine-year-old daughter who was wailing in pain and anguish. I tried to count the number of ceiling tiles in the room. I inspected my shoes. I didn't have to look. By now, my hands hold within them the rhythym of breathing and I can deliver breaths at a steady pulse while intentionally not looking. But this time that didn't stop the tears. This time it was my family I was seeing, no matter where my eyes tried to focus.
I could not get John's face out of my head. Or Evan's voice. My reasons for living. And undoubtably, the husband and daughter were hers. They were robbed by the intricacies and the mysteries of the human body. And like us, I am sure they had plans for their future. The husband had been out of town, and didn't know that he would never see his wife again. I still cannot get the image of his pained, tear-streaked face pressed to her cold, pale, lifeless one. The picture serving as a study in the contrast between death and life. And her death proved something to us all. She was in the MICU, the unit of the hospital to which I have been assigned for going on the past 2 months now. Our MICU is new. State-of-the-art facility and equipment. Staffed with the A-team of the medical world. Even we therapists are a select few. We are all oriented to the unit, but non-hackers weed themselves out. But this morning, nothing we had to offer could have been enough for her. Which is scarier than you could imagine, because it humbles all of us. It shows us that we cannot fix everything with almost unnecessary cruelty. And while we are all there, working our demanding schedules to pay for kids' tuitions or the new family minivan or the plasma tv that society tells us we need, we are forced to face the idea that we are away from the very ones we are doing it all for. That life is frail, and would it be better to be at home, snuggled in bed with our spouses or waking in the morning to sloppy kisses from our young children. Because as we were witnessing at that very moment, life could have other plans for us.

Thursday, June 18, 2009

Guilt and Sadness


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Before I know it, Summer will be gone. Evan will be back in school. And starting tomorrow night, I am back to the grind. By the time I get off of work on Monday, it ill be time to head to another quarter of classes. And at the end of the Summer, this baby of mine will be 8 years old. I know I will not be getting a break until we are both off for Christmas.

I look at those brown eyes and I miss it all: the sloppy kisses and macaroni and cheese faces after dinner. The cuddling and giggling. Getting his bubble bath ready at night. Making sure he learns math. And I look at the stretch of time ahead of us and I realize that by the time I finish medical school, this little boy will be 13 years old. Is it worth it?

I had a talk with Evan just now, asking him if he wanted Mommy to go to school to be a doctor, even though it is going to take a long time. He looked at me with those big brown eyes and said yes, very emphatically. When I asked him if he would still think I was a good Mommy if I continued to be away, he said yes again. I asked him why he wanted Mommy to be a doctor, and he told me that he has the smartest mommy in the world, and he knows I can do it. So now I am sitting here at my desk typing this, amidst the crepe paper flowers and finger-painted rainbows he has given me from art class in school, and I have found out the truth.

I am so very blessed. For some reason, whatever higher power is out there has decided that I am deserving of this amazing little person in my life. How lucky could I be?

I Did A Good Job


We went to the grocery store as a family, which is usually a mistake. For the first time in a long time, little Evan was very well-behaved. When I told him no to the sugary crap because it wasn't "good for our bodies" he replied with an "Oh, okay". He helped me keep track of what we needed here at the house. Overall it was a nice experience. When we get to the checkout, he asked for a candy bar. I thought it over and said he could. Hershey bars were 2 for $1. He got 2.

Later we get home, and I have finished putting the groceries away. He comes up to me with this huge smile on his face and hands me one of the candy bars. I ask if he is sure he doesn't want to save it for another time. He shakes his little head and says, "No, Mom. This is for you because you did such a good job picking out groceries."

Wednesday, June 17, 2009

Endless Downloads, Cracker Crumbs, and More


OMG.

I hadn't been into my office in days. I have instead been vegging out with the laptop on the sofa, which is infinitely cooler than the office in the absence of AC.

So today, I walk into my office only to discover that my desktop on the big computer is covered with icons for those free game trials you can download online. I have spent all day getting those off of there and making the computer like Fort Knox so I won't ever have to do that again.

And Chhez-Its. All over. The carpet beneath my feet looks like a pale shade of orange because they are ground into the carpet. They are between the keys of the keyboard, in the mouse, everywhere.

The kid is now banned from the office.

Sunday, June 14, 2009

Failure


Sometimes I have the autonomy to override a doctor's orders. Sometimes I do not. This weekend was an example of a time when I did not. It was also an example of the concept that just because we can do something to prolong a life doesn't always translate to we should. A lesson in medical futility and ethics. I have been assigned to the MICU for the past 6 days. The sickest patients in the hospital were once again in my care, as is happening even more frequently now.
A patient was admitted on Wednesday night, and by Thursday, it was well-known that there was nothing we could do for him. The name was familiar to all of us, but none of us could place his face. Disease had ravaged his body until there was little with which to work. I am not going into detail about the disease process or any other fact that can be used to identify this patient because I want to protect him as I am legally obligated to. But he was very, very ill. I watched as a parade of specialists for just about every body system in a human organism came and went from his room, speaking with his family.
I'm sorry. There is nothing more we can do.
We will provide him with comfort while he makes this final journey.
We will allow him to die with dignity.
I made sure he had enough oxygen, then went on to other patients of mine. Patients who were not breathing on their own, hooked to my ventilators. Not much time passed before another specialist came to see the patient. The patient, on top of everything else, had a raging infection. Sepsis. He wanted me to suction the patient, something we don't usually do for the dying patient because it is so uncomfortable for them. I asked him to explain why. His follow-up was that we were going to suction him, and then intubate. Within 15 minutes, the family wants to do everything. Put him through the medical gauntlet. The doctor seeing the patient for his infection bypassed the cardiologists, nephrologist, pulmonologists, neurologist, and oncologist. Told the family we could fix him.
My experiences with family members facing the loss of a loved one have taught me something. You must be very careful when you walk into the room of a dying patient. Because any tiny word you utter can be misconstrued as hope. Hope where there is none. And they grab onto to that like a life preserver, and hang on to it. To the layperson, this would seem like a gift to them. Instead it makes it worse. The patient passes away anyhow, after they have thought it was not going to happen. From the minute we know that death is looming, our care shifts from the patient to the ones left to live. Every action becomes about them. Making it easier for them. Never more difficult. The have enough difficulty to face.
We failed that family. We didn't do what we should have done for the patient.
We intubated. I hooked him up to the machine that would breathe for him. I stood at the bedside and cleared mucus from his chin and smoothed down his hair while the ventilator hissed and puffed behind me. In that instant, I realized who he was. One of our regulars, I would always save his breathing treatment for last because we would always end up talking about his military service and kids. Through all of his admissions, he never forgot that my son's name is Evan. He would always light up and ask me if my Evan was still driving me crazy. He always called me his "Breathing Angel" because he said I always seemed to show up in the same instant he was thinking about calling for a PRN treatment. I tried on several occasions to explain to him that it was probably due to the fact that he was due for his medication and less about me. "In fact," I would tell him, "I'm actually really mean in real life." He would always giggle and shake his head, telling me he couldn't believe it.
I almost didn't recognize him through all of the tubes and lines.
Within 5 minutes of intubating him, he tried to go into cardiac arrest. We brought him back. I heard his ribs crack during CPR.
By the time I had reported for the next day, he was on continuous dialysis. We had given him the maximum amout of medication allowed to maintain his blood pressure. Dopamine. Levophed. Vasopressin. I was no longer able to maintain any sort of oxygen saturation on him. We had to insert an arterial line in his femoral artery, in his groin. His body temperatre was 88 degrees. We had him wrapped in heated blankets and a warming system so that only his face was visible. He had a rectal tube inserted that was draining blood. 10 IV pumps going. About the only drug category we didn't have covered was sedation. Through all of it, he didn't need any.
The family still was clinging to the hope that we could fix him. Despite the fact that we told them repeatedly that it was gettting worse. They held fast to that life preserver. I left my shift praying for his death.
By the time I reported for my shift the next day, he had died on his own. It took 6 nurses and me to remove all of the lines and tubes. His body released every fluid in it. There was a piece of tissue that I assumed to be a part of his trachea that came out when I removed the endotracheal tube.
I didn't cry. Instead I hated my job. I was upset that I didn't put my foot down for him and advocate for him. I realize that even if I had, and refused to participate, they would have just called another of the therapists. This was one of those that I could not override.
I still feel like I failed my patient. I wasn't his Breathing Angel anymore.

Tuesday, June 9, 2009

What if Atlas Shrugged?


Considering what is going on in our world, I have been pondering this question. In Atlas Shrugged, Ayn Rand tells the story of the "Producers" of society, and the world that saps the life out of them.

Who are the producers? We are. The people who go to work every day and perform a function from which society can derive some benefit. This could be in the form of a beautiful opus that we all enjoy, a knowledge of medicine and the power to heal that comes with it, or a delicious meal that we can cook for others. Whatever the contribution, we make one. What is our thanks? We get taxed. We pay through the nose. If we put our foot down, we are "selfish". Don't we want to help our fellow man? When is enough enough?

I want to put my foot down. I want to say "No more!". I am sorry that the Jones' next door do not have health coverage. I truly am. But since when is it my responsibility to pay their bills? Did they lose their job do to the collapse of out auto industry? Well, I tried to help. They were selling their ability to make cars and I contributed to their cause by purchasing a new vehicle.

Now Obama is wanting to tax our health benefits. My gut reaction, in the face of even more taxes, is to quit. I obviously will not be doing that, but I want to. If we all did, the powers that be would have to find another way other than taking it out on the hard-working people who break their backs to make this world go round.

I think I need to revisit my old dog-eared copy.