Definitely back

I'm definitely back in the PICU. This time around, I feel that some of the kids I'm taking care of are even sicker than the ones I had last year. One of my patients is on both ECMO and CVVH and is hanging in the balance, so I have had a crash course in both of these over the last two days. Both of these are largely run by the fellows and attendings, but I'm doing my best to keep up with what's going on. I spent thirteen hours in the PICU yesterday and another seven and a half today plus an additional four in clinic; I'm tired of being at the hospital! I have another thirteen to fourteen tomorrow and at least ten on Thursday, and then I'll be there thirty hours straight Friday through Saturday. I will work again Sunday through Friday (no more overnight call during that period though) and then will have two glorious days in a row off. :)

Being the most senior resident on the team has been a very interesting experience. I have a sub-intern (4th year medical student) on the team, two second year residents, and one second year outside rotator, and since none of them have been in the PICU before Monday, they have been looking to me for guidance. I've actually surprised myself at times when I give answers I didn't even know that I knew. We had a new admission early this morning right before rounds, so with the help of the night float team, I did a quick history and physical in addition to seeing my regular patients. I didn't have time to print up my history, so I apologized to my attending that I was going to present off memory. When I was done, he gave me a huge compliment in front of the team by telling the med student, "Now that was a perfect history; Sarah told a story with that one -- something that tends to get lost when people have their papers in front of them ... great job, Sarah." I actually felt not on top of my game since I had been so rushed that morning, so when my attending complimented me like that, I got a much needed boost. Being that I'm back in the PICU, I'm a little more emotional than normal, so I'm surprised I didn't start crying in front of the team!

Knowing that Hubby will be back in town in two days for two months (yay!!) makes this month easier to bear. I also love having Sebastian home to greet me at the end of the long day; his little tail wags a mile a minute every time I walk through the door, and he makes me laugh with his silly puppy antics. My little family is my escape from the stress of the PICU, and I am so thankful for them!

Wakey wakey ...

I am done with nights for a bit! I have three days off, and then I switch back to PICU days for a month (only two overnight calls for the four weeks). To try to switch my body back to days, I'm going to stay up as much as I can today and sleeeeeep like a baby after a sushi date tonight. Poor Hubby has barely seen me this week; I left for work Sunday around noon, got home the next morning around eight AM when he was already working, and proceeded to sleep until five PM. I'd leave for work around 6:30 and be gone all night til eight the next morning every night through last night, so it almost felt like an out of town week for us. He was so sweet and grilled filet mignon two nights during the week so that I would be well fed for the night (hospital food gets old!), so that made me miss him even more. We decided to go out for a date night to catch up on everything that has happened this week; I can't wait!

Even though we didn't see much of each other this week, I was so thankful Hubby was here this week; I was part of a really sad situation involving a young kiddo earlier this week, and when that got combined with another stressful situation at work, I broke down crying in front of one of my favorite pharmacists. Coming home to a long hug helped my tears to dry and my spirit to heal. I already know that the PICU will have sad stories (as it always does), so I look forward to having his support close at hand.

On another exciting note, Hubby will be out of town for another week and then will be back in our own city for at least TWO MONTHS. There really aren't words to express how overjoyed I was when I heard this project came through. We haven't lived in the same city consistently for that long since we were engaged, so I am THRILLED. This project is such an answer to my prayers. As an added bonus, the project is coming when I should only have to spend four of those nights in the hospital. While they will be difficult intense months for me (PICU and Cardiology senior), having my best friend home at the end of the day will make everything more bearable.

Same old song and dance

My internet isn't working on my laptop at home, and even when I have been home, I have been sleeping for the last four days. I'm on my fifth night in a row of night float. I have a great team, so it has been bearable, but I am ready to be done. I get a two night break starting tomorrow, and then I just have five more nights to go after tonight!

If things will slow down a little tonight, my team is going to have a dip party. I brought fixings for guacamole, my intern brought hummus as well as artichoke and crab dip, and one of the second years is bringing cheesecake dip for dessert. Yum!! Having fun when you're stuck here at night is essential to survival, and tasty food sure doesn't hurt.

Hubby is scheduled to get home tonight, so I should see him in the morning when I get home. We're going to make fajitas again either Friday or Saturday night so that I can make my guacamole for him again (one of his favorite things in the world). Kroger had a huge sale on berries this morning, so I bought strawberries, raspberries, and blueberries to make a delicious dessert that also utilizes marscapone cheese and ladyfingers. I'll still be on night float next week, but he'll be home that week, so we'll at least get to see each other when I get home and before I leave. We're going to have good times this weekend!

(I know the font is messed up on this post, but the computers here won't let me adjust it. I will fix it after Hubby fixes my internet this weekend.)

Travel Size Comfort

My hubby is a frequent traveler, and before we got married, it became a joke among my family that everything in his life is travel size including his wife (we have a 12 inch height difference between us). A little over a year into our marriage, we adopted Sebastian, the best Yorkie ever, so we now have a travel size dog. Prior to getting our dog, I had done a lot of research on breeds and decided that I wanted a terrier; I was scared of having a big dog pulling me behind him down the street, and the terriers seemed to have such great personalities. I had originally selected a Norwich terrier but then found out that these dogs are ridiculously expensive, so our plan changed to a more easily accessible Yorkshire terrier.

Sebastian turned out even smaller than we expected; he still only weighs about four pounds and is small enough to pick up with one hand. Don't let the size fool you though; he is all dog! He loves to hide his puppy treats, and when he thinks someone is intruding on his home turf, he is quick to jump to my defense and growls up a storm. That being said, he's one of the sweetest dogs I've ever met. We have 2400 square feet in this house, and he typically wants to be in the two square feet that is my lap. Unless he gets extremely fired up, he almost never barks (no yappy dog for me!), and he somehow always seems to know when I am upset or sad and sticks extra close during those times.

I started getting migraines on my thirteenth birthday. My worst experience with them was a period during the winter of third year of medical school when I got into a bad cycle of headaches and had to take some pretty strong medicine to break them. Since then, I've been blessed to have had the headaches space out, and when they come, they have been easily controlled. Today I worked from home, and this afternoon I was hit with a horrible migraine out of the blue. Many times I have auras before my migraines (vision changes are my normal auras), but I had no warning with today's headache. I put Sebastian outside for a bit and retreated to our dark, quiet bedroom. After about 45 minutes, the worst passed, and I was able to get up and leave the bedroom.

I think Sebastian knew something was wrong when I let him back inside. He's been extra sweet and has been glued to my side ever since I let him inside. Hubby's out of town this week, so it's just me and the puppy tonight. I remember our first year of marriage when I would be all alone during the week when he traveled, but now I have Sebastian. :) He may be just a puppy, but he provides 4 pounds of warm snuggly comfort and keeps me from feeling alone when Hubby is gone. Other dog lovers will understand; he is more than just a dog to me!

Outside my comfort zone

Last week I had the blessing to spend half a day in a clinic for refugees. As it was explained to me, these are not just people who have come to America in search of a better life; they are people who have been forced out of their homes by persecution and are here in America because it has been deemed unsafe for them to return home. The stories the clinic staff told me left me flabbergasted and reminded me just how naive and sheltered I am. Few of these people speak English, and many of them know no one else here except for the family members who have fled here with them.

By the time the patients are seen in this clinic, they have typically been in the country for a week or less and are being seen by a doctor because some flag popped up on their initial screening exam by one of the nurses. Frequently this complaint turns out to be something very minor such as a cold or a knee ache from five years ago, but sometimes it turns out to be something more. During my visit to the clinic, a patient returned to the clinic for the results of blood work drawn a few weeks earlier. It turns out that this teenage patient had a chronic disease that we were the first to diagnose. The patient had initially come for evaluation of a cough and had no clue that we were about to present dramatically important news.

Had this patient been born in America, we would have caught this disease when the patient was less than a month old. Although there is no cure, we would have been able to provide close monitoring as well as therapy to help deal with the symptoms of the disease. I honestly do not know what the future will hold for this patient since I have never seen this disease diagnosed so far along.

I'm guessing my attending figured that since I will be through with my training in less than a year, I was qualified to deliver this news, and she reminded me to keep it as simple as possible since the family had likely never heard of the disease. When we brought the patient and the parents back to the exam room to speak with them, we quickly ran into an obstacle. Like most of the other patients in this clinic, the family did not speak English; we were prepared for this and used a worldwide translation phone line that we have available. Unfortunately the language spoken by the family is extremely common in their home country but barely spoken elsewhere; my attending informed me that there are only two or three workers in the entire world that are employed by the translation line who speak both English and this language, so when they are not working (as was the case this day), we were just out of luck. We ended up figuring out that the father spoke a little of another language in addition to his native tongue, so we used a translator to speak that language, and the father then had to translate into his native tongue for his wife and child. The situation was far from ideal, but I hoped that we were able to provide a little help to them.

The entire experience left me speechless for several days. I started residency two years ago with minimal comprehension of Spanish; now I'm comfortable taking a quick history and answering simple questions in Spanish, and even when I use an interpreter, I understand the majority of what is being said. Working in this clinic was completely different. I didn't have an interpreter readily available, and most of my patients that day did not have any resources whatsoever. The clinic was located where it was because most of the patients would be able to walk to it, and we had to figure out ways to get the medicines we prescribed for the patients rather than just writing a prescription and sending them on their way. I felt like I was almost practicing medicine in a third world country, yet here I was in the middle of one of the biggest cities in America.

Even with everything I see on a regular basis, I still am sheltered from certain parts of the world. I get to go back to this clinic again this week, and I'm looking forward to having my eyes opened again to something new.

EEEEEEEEEEEK!!!

I didn't feel like cooking tonight, so Hubby and I decided to make a fast food run. We're trying to keep Sebastian adjusted to riding in the car, so I carried the little guy out to the car with Hubby following behind us. As he opened the garage door, I let out what was apparently a blood-curdling scream -- there was a dead mouse lying in the center of the garage right next to my side of the car!! I touch disgusting things at work all the time, but seeing the mouse really caught me off guard. Hubby thinks the mouse died from the heat; I don't care why he died, but I am glad he wasn't alive to scurry up onto me!

I don't think I'll be going out to the garage in the dark anytime soon.

Happy 4th of July!

I've only been off nights for five days, so I'm still not fully adjusted to living normal hours. Hubby and Sebastian are both fast asleep next to me, but I'm wide awake; at least What Not to Wear is on. :)

I'm about to enter my longest stretch of time off in weeks; I had today off, won't work Saturday or Sunday, and don't have to go to work until Monday afternoon. This is phenomenal!! Hubby and I spent the day scrubbing the house from top to bottom; we are exhausted, but the place looks amazing. Tonight he grilled fajitas while I made guacamole from scratch ... soooo yummy with lime tortilla chips. We also enjoyed a lime curd tart that I made yesterday. After dark, we attempted to walk to the end of our street to watch a local fireworks display about two miles away, but some local geniuses decided that popping fireworks over parked cars and small children was a bright idea, so we left. Poor Sebastian couldn't take it outside; he did just fine once we got him away from the madness.

Tomorrow we're going to run errands, and I may try my hand at another new dessert if I can make a selection among several great recipes I've been wanting to try. All I know is that we are going to relax!

On a different note, I doubt that anyone from the military reads this, but on the off chance that someone does, I want to say thank you to all the brave men and women who are serving our country and to their families for supporting them as they serve. We appreciate your sacrifices and are grateful for all that you do.