I'm still standing.....yeah, yeah, yeah

My title for today's post pertains to many things that have happened over the past 3 weeks, all discussed in fun detail with pictures below :)

1.  Hurricane Sandy - 10/29/12 - "You Bitch"!!!  (Love this line from Legally Blonde).  That's right....whether you called it the "Storm of the Century"...."Frankenstorm".....or some other cutesy name in quotes, this storm came and kicked NJ's ass (as well as NY, Conn, Delaware, and many other ocean front properties from NC up the east coast).  Unfortunately, the NJ shore took the brunt of this monster, and destroyed most of it.  The most amazing thing to is that although there is so much destruction in NJ that stretches for hundreds of miles, the news continues to focus on one area....Staten Island/NYC.  Yes, these areas were also hard hit...and yes people lost homes and lives.....but what about NJ??  Now that I am a NJ resident I can see the disproportionate news coverage and it kind of sucks.  The news should be more focused on telling all stories equally....oh wait, that NEVER happens!!  But seriously, people are starting to panic.  Long lines at gas stations.....power still out for many...no heat...no food.  Even more interesting is that the gov't has provided shelters for people who are displaced, and yet, some of these refuse to go.  They instead yell and bitch that nothing is being done for them.  Now, I am not saying everyone is doing this, but I have been fortunate to see the news lately and many people who are being interviewed are complaining.  What needs to be explained to these people is that rebuilding will NOT occur overnight.  It will take months....mostly years before things are fixed.  So the news needs to start focusing on this....explaining to people that a magic wand will not be waved, and POOF, their houses and possessions will be restored.  Help is here, and more help is coming...so take advantage of it and above all else, be patient.  It took New Orleans 4 years to recover following Katrina (and they are still recovering).  Hurricane Sandy was bigger, and caused more damage across a huge area that is grossly over-populated....so this is going to take a long time.  

Currently, I am still without power...no heat...no internet.  My good friend (and fellow ED resident) Jess has graciously allowed me to stay at her place and I have happily accepted :)  And although I am very grateful and thankful for Jess's generosity, I am hopeful that my power will be restored soon and I can stop eating out almost every meal...and I can sleep in my own bed :)  And now for a few pics....of a giant tree that fell outside of my apt....and my bike's narrow escape!

 Poor tree.....almost hit my bike!!

Amazing how such a big tree with thick, deep roots could be toppled.

And of course, my running path was devastated....poor Johnson Park and poor trees :(

2.  Tough Mudder 10/20/12 - after much convincing by my fellow residents (Jess and Chris), I decided to pay $200 and run in the Tri-State Tough Mudder.  I diligently worked out for this race....long runs...push ups...pulls ups.  The day of the race was gorgeous...60 degrees...sunny.  This race was really fun, but also a beast.  The running through miles and miles of mud was fun,  but extremely tiring.  Some obstacles were awesome....some were very dangerous (Peg Leg...I'm thinking specifically of you).  Our team finished the race in 4 hr and 35 minutes!!  And we got our cute orange headbands, and a t-shirt, and a free beer.  And then I thought, that's the end.  And I was grossly mistaken.  Because since that day in October, I have had lingering injuries....my left shoulder...my left foot...my right achilles tendon.  And because of all of these wonderful tough mudder gifts....I have not been able to get back to my pre-race work-outs which are kind of disappointing.  What does this all mean??  Well, when I do this race again next year with my best friend, I will be sure to prepare my muscles even more for the beating I will force on them.

Before (nice and clean)

After (all muddy :)

Alright, time to get going.  Need to study some toxicology!!!  Just a friendly reminder to vote on Tuesday...our country depends on it!!!  :)

Crap....I lied!!!

Yes, I know I have said over and over that I would try to post more....well, I lied!!!  So sorry!!!  Now stop whining about it and just be happy for that rare occasion when I do blog ;)  I have a lot to catch up on, so lets begin

1.  Today happens to be the end of my vacation.  I spent the last 2 weeks visiting family and friends.  I ran through Washington, DC.  Explored Luray Caverns in Virginia.  Climbed Bald Mountain in the rain.  Ran in my new trail sneaks (more on this in a minute).  Ate the best 30 cent wings w/a guinness at the Black River Ale House.  I walked Z and  mousse.  I worked out.  I rested.  I watched SVU marathons.  I read non-medical books.  I shopped online and in stores.  Overall, I had a great vacation.  But secretly, I can't wait to get back to work....and the ED.

2.  Prior to vacation, I spent 4 weeks in the surgical ICU.  The nurses were awesome!!  The fellows were great.  I learned alot from my attendings.  I also woke up almost every morning at 4:30am to write crazy, detailed notes.  I saw patients heal and be discharged from the unit to the floor or rehab.  I also saw patients die.  I learned about the long term management for head injuries, hemorrhagic shock and bleeds from every orifice. Unfortunately, I only did one central line and 2 arterial lines (that pesky white cloud will never leave me!!).

3.  I passed Step 3!!!!  No more crappy, expensive tests of my medical knowledge :)

4.  I have lost 16 pounds since April 1st!  Woohoooooooo!!!  I have been running, biking, doing HIITS training in my living room, and eating very well.  I plan to lose just a tad more fluff before my gym officially opens and then I hit the weights hard for a nice chiseled look :)

5.  And because I feel I am in such great shape...I am running the Tough Mudder on October 20th!!  I was convinced to join a team and show my true grit and determination for success.  Nevermind that this is my first mud run and that I signed up for one of the toughest and longest races (12 miles....over 20 obstacles!!).  Go big or stay home!!   LOL....that is what I'm doing.  I bought a new pair of adidas trail sneaks and have been practicing running through mud, gravel, wet leaves, in the cold, in the rain.  I know I will never be able to truly mimick game day conditions, but I am trying to prepare the best I can.  Although the thought of spending over 3 hours wet, cold, and tired at times sounds ridiculous even to me, I know I am going to kick this courses ass!!!  And then celebrate with a beer! Maybe 2 beers :)

6.  I got a new tattoo....well, actually one giant tattoo.  It is not finished yet.  I have only had 2 sessions and I'm thinking I will require 4, maybe 5 more to be truly done.  But so far, it looks amazing!!!  I final pic to come, but that probably won't happen until late next year.

7.  On a personal note, I bought a groupon for laser hair removal....a brazilian.  Of course, after 2 sessions the results were amazing and I decided to purchase a package to have my under arms done too.  I have my 3rd session coming up and so far I am loving it!!  Can't wait to do my legs....can you say laser addict??  LOL.

So before I sign off, and then not post for another 3 months....here are a few pics.  Enjoy!!

 My sister and I on Bald Mountain, Old Forge, NY.

 I love this pic!!!

 Gorgeous views....

 Arlington National Cemetery, Virginia

 At the Women's Monument, Arlington National Cemetery

 Women's Monument.

 Looking out over the Cemetery

 Luray Caverns, Virginia

Death's randomness

It has been about month since I started second year and all of my shifts so far have been in my homeland of Emergency Medicine.  Most days, I am the resuscitation resident.  My job is to pick up the sickest of the sick as soon as they roll into the department and utilize my medical magic to make them all better.  In some instances, that magic works.  80+ year old with congestive heart failure, totally crapping out due to his lungs being flooded with fluid....slowly tiring out...turning blue (cyanotic in our world).  The magic of intubation and a ventilator as well as a stay in the medical ICU makes this gentleman all better.  Job well done resus resident!!

But there are many other instances that no matter what you do, no matter what you pull out of your magic bag of medicine tricks, people die.  Two weeks ago, I had a cardiac arrest.  The guy was 50+ years old.  He was home on a Sunday morning, with his wife and daughter.  Suddenly, he clutched his chest, turned white, and collapsed in front of his wife.  She quickly started CPR, which was continued by the medics for 45 minutes with the addition of two shocks from the AED, and multiple doses of epinephrine in an attempt to re-start the heart.  Of course, we continued the code when this patient hit the door...CPR...more epinephrine...sodium bicarb....calcium chloride.  Checks for pulses....rhythms on the monitor....and ultrasound of the heart all showed the same thing.....no cardiac activity.  Eventually, you realize that no matter  what you throw at this gentleman, he will never return.  I pronounced him dead, and with my attending, we informed the family (how this occurs is another talk for another day).

Contrast that patient with my overdose one week ago.  Woman in her 50's comes in unconscious.  Not even a deep sternal rub or poking her nail beds with my pen could arouse her.  Blood pressure was 58/40 manually...breathing was slow and erratic.  A quick look at her history in the computer showed multiple episodes of overdoses and suicide attempts.  I intubated her...threw 6 L of fluids at her...placed a central line...started pressors in an attempt to raise her blood pressure.  Managed to get the BP to just over 90/50 at the max of my pressor of choice, Levophed.  Lactate 9.8...patient making little to no urine...ABG shows pH of 7.0.  I admitted the patient to MICU and thought to myself, this patient won't make it and she finally succeeded at doing what she has attempted to do for the past year.  Two hours later, patient self extubates herself...sitting up in bed....and swearing at me!!!  Calling me a bitch for not letting her sign out AMA (against medical advice).  Your welcome for saving your life.  I am sure I will see her again sometime soon.

In both of the cases above, my patient's did not take care of themselves.  The 50 year old man had hypertension, diagnosed years earlier, but refused medications (plus he was grossly overweight) and hadn't seen and doctor "in years".  The 50 year old woman was a chronic alcoholic and drug abuser who continuously ravaged her body with poisons in an attempt to end her life.  As emergency physicians, we take care of all....we never turn people away....never discriminate based on medical history, race, religion, socioeconomic status, or sexual orientation.  We work hard to save everybody.  And sometimes we succeed.  And sometimes we don't.

Death is ironic with a sick twisted sense of humor:  why would the person that wanted to end his/her life make it and the one who never even had the thought of dying is gone, forever.  Of course, I will never have the answer.  But I do think about death often.  I have to.  It is part of my job.  I mentally re-live my actions, judgments and decisions regarding my patients to be sure I didn't miss anything....that there wasn't anything else I could have done to save my patients.

Death is just one of those variables I have no control over, no matter how hard I try, it will come...randomly...or, not come just as randomly.  Unfair advantage.  Not cool death.  :(

Let Year #2 being.......NOW!!!

July 1st = 2nd year!!!!  :)  I am beyond words to describe how excited I am.  Tomorrow I start my first resuscitation shift in the adult ED.  As second years, we are responsible for the sickest of the sick that come through the door.  So any cardiac arrest....and stroke...and potential intubation or central  line...or pretty much any patient that is about to die...we are to jump on that patient, use the magic of medicine to stabilize them and get them nicely packaged up to the ICU as quick as possible.  When we are not in our department, we are scheduled to work in the ICU's.  So this year I will complete a medical ICU, surgical ICU and pediatric ICU month as well as toxicology rotation (which are also really sick patients).

This past year flew by.  It seems like yesterday it was July 1st and I was starting orientation month with my fellow co-interns and we were discussing what would happen on our first shifts as residents.  I do remember August.  And how hard that month was.  Not because of the medicine.  But because of the system.  I needed to learn the computer and the nurses and charting and the "way" things were done in the ED at RWJ.  Of course, after the first month things became much easier and then it was only a manner of learning more medicine :).  The difference starting tomorrow is that I already know the computer system, the nurses, charting and the RWJ way.  At least in the beginning, its going to be a sprint to pack my head with every piece of critical care knowledge I can find which will make July a pretty tough month mentally.  But it's all down hill from there!  So flippin excited just thinking about it that I can't contain my self right now!!!  LOL.  I feel like a little kid on x-mas eve.  I need to stop blogging about this and go to bed before I stay up all night.

So before I say good night, I will leave you with a nice pic of me during my Pediatric ED rotation, which I just finished on Friday.

Hey, this is peds....acting like a kid is encouraged!!!  Everyone have a great night!  :)

"Courts Set Up for ObamaCare Final" foxnews.com

Since I am on vacation, and catching up with my news, I have decided I have time to tackle....er, opinionize on the national healthcare debate. Now, I am fully aware of all of the "sides" in this debate. Please keep in mind that this is solely the opinion of an emergency medicine resident and that if you ask my family, internal medicine, pediatrics, or surgery friends they will have many different opinions. I am also aware that even in our specialty, there are numerous opinions on how to fix this whole system. This, of course, is just mine and since its my blog I can say whatever I want :) Here are the top 3 reasons I despise government care.

1. When I think about the "federal government" and "healthcare" in the same sentence my first thought goes to the VA hospital. I had the fortunate and humbling experience to volunteer at one in 2001. For me, it was a great experience. For the patients, doctors, nurses, and staff...not so much. So much waiting (for treatment, for procedures, for medications)....too much red tape (paperwork, paperwork, and more paperwork) to accomplish anything. I always wondered why it was so difficult and the answer by all those I worked with always contained some form of "because we work for the government".

Years later, I worked for an Ob/gyn who slowly started to stop taking Medicare patients for the simple reason of reimbursement. Any other insurance provider would compensate the doctor within 30 days of his electronic bill. Medicare would take 90 days. And, if anytime within the year, the government felt they paid too much, they would just take it back. No questions asked. It would take months, sometimes up to a year to garner any explanation. It became too time consuming with all of the phone calls and paperwork. Time that was taking the doctor away from seeing patients. So, no more medicare. Which in the end, only hurts the patients.

What do these two examples above represent? The fact that the government already has control over some if not many aspects of medicine and already they fail miserably. They have not proven that they can manage any aspect of medical care appropriately and yet, we the people want to hand over all medical care to our government. Every big name program they have their hands in (Medicare, Medicaid, Social Security, the US Postal service) are all FAILING!! I just don't see how they will manage everyone's medical care with a track record like that!

2. For too many years, reimbursements were higher for "procedures" like surgery and less for "preventive care" like seeing your doctor regularly for check-ups (we can blame the government for this one as well). So now, we have a system where new medical graduates gravitate towards surgical fields where the money is and less towards the primary care specialties (family medicine and pediatrics). The federal government wants to shift the system where more money goes to preventive medicine which is FANTASTIC!! And I totally applaud that idea. However, our system is not in the position to accept that change quickly. There are not enough primary care doctors to take on new patients. In addition, residency spots (all of which are partly paid for by Medicare dollars) for family medicine and pediatrics have remained stagnant over the last 10 years. If you cannot graduate enough residents to fill the need, you will have a severe shortage of doctors. Which means what?? Which means they will show up in the Emergency Department looking for care.

Now you may be asking yourself why I, an emergency resident, am upset about that. It's more money for us right?? WRONG! Because the government compensates the ED very, very poorly. Plus, we are not trained to be primary care doctors. We are an entirely different specialty with a different mindset. I don't treat long term. I treat short term. I look at each of my patients and think "what could potentially kill you today?" and then I search out those things with my plethora of testing. If I rule out my potential fatal list, you go home to follow up with your primary care doctor. If I find something, you now are admitted for further work-up. I do not counsel, or spend hours convincing you to eat properly, or exercise, or take your medications as prescribed. I just don't have the time because while I am dealing with you, I have someone in respiratory distress who needs a tube in their throat!

What this all means is that we routinely see primary care problems in the ED and many repeat offenders who cannot get appointments with their doctor. This puts pressure on us (the ED) to be something we are not, and also impacts patients who truly have a medical emergency and need immediate care. I love my my primary care friends and colleagues! I just don't see the government giving them the resources they need (more residency spots, more incentive to go into primary care, better money) to tackle this entire situation.

3. By far the biggest problem I have with the healthcare bills is the individual mandate, that all must participate or be fined/jailed. To give the federal government that much control is beyond unconstitutional. If the government can tell you what to buy in terms of healthcare insurance because they deem it a "national problem", then what prevents them from telling you:

- What to eat? From now on, all must purchase tomatoes, or bananas, or broccoli everytime you are at the store because obesity is overrunning America and these things are healthy

- What to drive? All Americans must purchase an electric car, because pollution...and costs of oil are increasing....and because we believe America will be better.

- Where to live? All Americans must move away from natural disaster areas that include tornados, hurricanes, floods, earthquakes, etc because it is just too costly to continue to re-build. Where would be all live?? Montana....Idaho...North or South Dakota.

I could continue on with my list, but I will spare you my continued rant. I do, however, want to point out one final thing. Prior to 1973, healthcare was between you and your doctor. It was supply and demand....there was no middle man....you negotiated amounts to be paid and for most people, medicine was affordable. Then the Federal government stepped in and mandated with the HMO Act of 1973 that employers give their employees health care...and they gave tax incentives to employers, not employees or the individual. And HMO's were born. And so began the illogical coupling of employment with health care and the exponential increase in health care costs over the last 40 years. Today, your congressman are so quick to denounce HMO's and the costs associated with them. But, our government made those rules!!! They imposed by federal law the above ideas and look where it got us. And now, they want to make more laws?? To "benefit" all? Be careful America.....be very careful.

Back to my home!

In my world, home = ED!!!

Tonight I start back up in the ED for 2 weeks....YIPPEE!!!! On Friday I finished one month of OB, which involved 15 shifts of 5pm-7am and countless numbers of aliens shooting from vaginas. As most of you know, I am not a kid/infant/child person at all and this whole month just exponentially proved to me that I never will be! I also realized that I have little patience for women giving birth, especially teenagers who whine and bitch about how much it hurts...should have watched the Miracle of Life before you decided to put that uncovered penis in your vagina.

Below is a small sample of the most ridiculous things heard while rotating on OB:

1. "How did this happen??" Amazes me that women now a days don't understand how they can get pregnant...We are in the 21st Century...COME ON!!!

2. "Well, I haven't had sex with anyone in the last year, so I have no idea how I got that STD." This was said while the husband was in the room: he was more upset about her telling us that they didn't have sex than the fact that she had a sexually transmitted disease/and wondering where she got it...LOL!

3. "I don't care if I have an ectopic pregnancy, I am keeping it!!!" Of course, this was after we told her that she needed to have the pregnancy terminated or it could rupture and she could potentially die....she then proceeded to sign out AMA (against medical advice).

4. "But if I don't satisfy him, he will cheat on me like he did during my last pregnancy!" Patient's reply when she was told that because her water broke early at 26 weeks, she should not put anything in the vagina until she delivers.

5. "I really needed a cigarette and the patch is just not cutting it." Said by the patient who was caught by the nurse climbing back into the window of her room which happens to be on the 2nd floor of the hospital!!

6. "Just be gentle honey, I haven't used this thing in years!" Said by the 90 year old women who came to the ED complaining of vaginal bleeding...I totally laughed out loud, which in any other situation would probably be a giant no-no, but the patient was laughing with me so I think its ok.

Time to get ready for my ED shift!! I work 9pm-7am tonight and I am SO EXCITED!!! :)

?!@#$%

When did it become 2012????

Yes, I know it has been months since my last post. And you can be certain that after this one, I probably won't post again for another 6 months. Just how I blog.

I guess I should recap the past few months....I will be short.

- Trauma - great....glad its over

- Adult for 2 weeks - I <3 ED

- Vacation for 2 weeks - Michigan is nice! Hello friends and family!

- Adult - I <3 ED

- EMS for 2 weeks - I am so bored, but I was able to watch Start Wars I-VI for an entire shift.

- CCU for 2 weeks - daily cramping in my hand.....just too much writing

- Peds ED - cough, fever, vomit....repeat x 30....finally one sick patient!

And today starts my next block (4 week rotation) in Adult ED!!!! Yay!! Did I mention that I <3 ED :)

So, what have I learned over the last 7 months.....that everyday I am so far behind! I am fortunate that with my residency I have time off to read about the important diseases and pathologies I will experience. But the amount of material seems to grow exponentially every day. I understand that this is how residency is....its meant to kick your but with information and patients and time (in fact, while entering my duty hours in the computer this morning I decided to add all of my hours up since Aug. 1st and the number said 1567! Wow!! By the end of my first year I will have worked 3000 hours!! And if you string that out, that will be over 9000 hours at the end of residency which is just crazy to think about). I sometimes feel that I have this huge puzzle in front of me with pieces that are missing all the time. Now, I am sure that in a year or two I will be cleaning my apartment and may find those pieces under the refrigerator or in a box somewhere. I just wish I could find them today!!!

Off to read before my shift! Take care (hopefully I will write more, but I wouldn't count on it knowing me!)