The paper man in the ICU

Hello droogs!

Again, I feel compelled to tell you all that I'm not dead. It's been two months since my last update. In that time, I've rotated through surgery and adult internal medicine, and I'm now getting underway in pediatrics. Or I should be. There was a death in the family recently. Sudden. H1N1, actually. And no, I'm not holding up so well, since you ask. I'm sad and tired, and infected with a strange sour cynicism that's permeating my blood like poison. Half the time I love talking to my patients, and the other half I want to tell them to go away and leave me alone. I can't give you a pill that will make it all better. I can't give you a shot that will make it so you don't have to try. I can't carry you. I can't even carry myself.

But it's not that bad, really. It's not. It's just beginning to tell on me, is all. Medicine is emotional work, but we are not permitted to be emotional while doing it. And my weariness and personal burdens just make it a little harder these days.

Some things do help, though. Caramel apples, for example. My friend who makes balloon animals at the farmer's market. Season 3 of "Dexter" on DVD. Curried apple soup. And, just lately, the paper man in the Pediatric Intensive Care Unit.

The paper man is a life-size cut-out of Robert Pattinson, who stands guard over the hospital bed of a very sick patient. On my first day in pediatrics, I caught sight of the paper man while on a tour of the ICU. The lab tech was coming in to draw blood, and was stepping very carefully around the paper man. She couldn't help elbowing him, though -- These rooms aren't very large -- and she set him swaying back and forth like a tree in a high wind. People kept moving in and out of the room, and they were all so very careful not to disturb the paper man. They tiptoed, they sidled -- As though he were a real person, whom they didn't want to disturb. I was trying so hard not to laugh, I almost busted an abdominal muscle.

I love to see the paper man standing there, when I poke my head in the PICU. I swear, if anything, being in medicine has made me more open-minded. I don't feel inclined to make fun of anyone's consolations anymore. If Paper Pattinson is what it takes to help one very sick patient get through the day, I'm happy to see him. Whatever it takes. Whatever you need. We go through so much here, in the hospital, sometimes more than anyone else will ever know. We swallow so much. We lose so much. Who am I to begrudge anyone their consolation? Granted, cigarettes are some people's consolation, and when they smoke them around asthmatic children and make them sick, I have to say I do begrudge them. And alcohol isn't always a harmless consolation, particularly not when it causes children to be beaten and abused. But the paper man? I'm all for him. After all, it was JK Rowling who carried me through the first two years of medical school, and an eccentric fascination with Elijah Wood that carried me through some of the most difficult years of my adolescence. I know about consolations.

And, in that spirit, this latest mix is affectionately dedicated to the paper man in the PICU. It's just a few chill songs I've been listening to on the bus lately. I hope you're all well and healthy out there in internet-land. Thanks for sticking with me.



*

In which Cecilia writes a SOAP note on herself.

General Surgery Progress Note

Subjective: Patient had a difficult overnight. She reports significant difficulty sleeping, with strange dreams about having forgotten something terribly urgent. She complains of a lack of food, and of the unreasonableness of her daily waking hour, 3:15 AM. No acute issues. Denies shortness of breath, chest pain, nausea and vomiting. Upon questioning, she reluctantly reports that she is passing flatus and making urine.

Objective: Vitals: Temperature 37, Pulse 70, Blood Pressure 100/70, Respiratory Rate 11, Oxygen Saturation 100% on room air.

Ins/Outs: None recorded. Nursing staff reports very little water intake, as the hospital's tap water tastes unbelievably bad.

Labs: None ordered.

Exam:
General: Thin, somewhat undernourished female. Has not bathed properly in two days. Awake, alert, oriented to self, place, and time.
Cardiovascular: Regular heart rhythm, no murmurs appreciated. Somewhat tachycardic, particularly when confronted with an attending surgeon on staff rounds.
Respiratory: Lungs clear to auscultation bilaterally.
Abdomen: Soft, non-tender, non-distended. Three scars from laparascopic appendectomy in 2006 appreciable. Bowel sounds hyperactive in all four quadrants, most likely due to persistent hunger.
Extremities: Trace edema in feet from hours of standing. Bruise on left knee from being nailed by automatic OR doors.

Assessment: 26 year-old female whose name no one remembers, with an extremely interesting history that no one cares about, is status post 5 weeks of a general surgery rotation. Doing well, all things considered.

Plan:
-See the patient through a week of three exams, including a shelf exam, which she must pass at all costs. Increased dosage of caffeine may be necessary, adjust as tolerated.
-Feed the patient. Goddammit, feed this patient.
-Due to a combination of anxiety and adjustment to duty hours, patient is willfully depriving herself of sleep. Efforts must be made to correct this deficiency, as it represents a danger to herself and others. Wine protocol shall be implemented if necessary.
-As often as necessary, please remind patient that she will be released soon. Any day now...
-Just as soon as she passes her shelf exam.

*

Not dead!

Hello droogs!

I'm sorry I haven't updated in so many weeks. I've been busy getting used to life on the wards. Basically, the hospital has eaten me. I see the world now from inside my apartment, then from inside my car, then occasionally in glimpses through patients' windows. Like an inmate, I wax nostalgic for the things I used to do on the outside. For the days when I at least felt like I knew what I was doing. For a time when 7 AM didn't feel like late morning.

Surgery has been, in many ways, a Buddhist discipline for me. Letting go of desires. Being present in the moment. Mindfulness. The whole dance of the operating room is an exercise in mindfulness, in my opinion. In order to keep from violating the sterile field, you must be aware of every movement, every posture, everyone else's position in space, the placement of every instrument... Your mind has no room to be anywhere else but the present. It's almost zen.

Maintaining control is key to survival, but releasing it is also key. You have no control over the grouchiness of the scrub nurse. Become aware of it, then let it go. At this moment, you have control over the way you hold the suture scissors. Hold them. Use them. Then let them go. You have no control over the next task you will be assigned. Perform it. Let it go. Let go of your hunger. Let go of your desire for sleep. At this moment, you must look up lab results. At this moment, you are a gofer. This annoys you. Let go of your annoyance. It is impairing your performance. Perform. Dance. Then let it go.

Work. Listen. Obey. Study.

Then let it go.

The letting it go is the hardest part. The hospital follows me, haunting my mind. I can't dream, can't fantasize, can't be with my family. I am afraid I missed something, afraid I made a mistake, afraid that I'll discover a horrible scene upon my return to the hospital. I am afraid of my residents, afraid of my interns, afraid of my patients, afraid of doing anything lest I do the wrong thing. The hospital is a separate world, and my existence outside it has become truncated, amputated, dissolved. I can't have a train of thought that doesn't lead back to the hospital, so I try to derail the train. I have to have a glass of wine in order to sleep. I read more romance novels, because I'm afraid I'm losing my sex drive, and I'm afraid if something that basic goes, I'll lose the higher bits of who I am. I'm already losing the foodie -- I live on cheese sandwiches and raisin bran now. And writing? Forget it. I'm even starting to lose the music. No one plays music anywhere in the hospital. I'm told it used to be allowed in the OR, but then there was a crackdown. Shame.

Speaking of music, I did make two mixes, both consisting of songs I thought about while roaming the hospital. One is hip-hop, one is chillout and classical. Enjoy, and please forgive my sporadic posting. Not all rotations will be this involved, I'm sure.





:-)

The Moving Dance

Hello droogs! You may be pleased (or at least mildly interested) to know that I am still alive and thinking. I survived my Boards, and I'm busily settling into my new place.

Yes, I moved. I moved during Pride weekend. From an apartment perilously close to Loring Park. Those of you familiar with Minneapolis probably just cringed, because you know that Loring Park is the central site of the annual Pride festivities, which, while intensely fun under other circumstances, are not an ideal backdrop for moving out of your apartment. The whole ordeal felt a lot like a Gogol Bordello album: madcap, wild, gypsy-ish, and sometimes worrisome. Now, don't get me wrong -- I like Gogol Bordello, but imagine having their music on constant rotation for three days or so, and you will get an idea of how I felt by the end of my move. Dear. God.

Oh, and that was right after I took my Boards, too. I don't really want to talk about those. Frankly, an eight hour test is not a particularly interesting subject for blogging, and I'll tell you in all honesty, I have no idea how I did. None whatsoever. And I don't want to think about it. I'll deal with the results when they come -- No point in worrying now. Even though this test determines my ENTIRE FUTURE. I feel the anxiety coming... Okay, change of subject in three, two...

So... Now I'm nailing up pictures, figuring out where to put lamps, and settling in for my final weekend of freedom before I start surgery on Monday. I have a bottle of my favorite wine (Grego garnacha), a stack of non-medical books, a bottle of bubble bath, and a bowl of bing cherries so big I may be sick -- My personal recipe for a perfect weekend! Sure, some of you may think it's lame, but I've always been a bookworm, a nerd, and a homebody, and after the week I've had, I think I deserve a peaceful slice of private paradise.

As to the title of this post... It's related to this week's mix. Better late than never! I present, for your enjoyment, a sampling of the songs I listened to while I was packing up my apartment for the move. (No Gogol Bordello. Don't think I'll be able to listen to them for a few weeks yet..)

Enjoy!



Or, if you prefer the 8tracks platform (I know I do!), enjoy here.

:-)

This makes me happy!

Buffy teaches Edward a lesson. Hell yeah.




(via Hoyden About Town)

:-)

Relax, dammit! A mixtape in honor of Boards.

Today's extra mixtape was inspired by Twitterfriend and fellow med student @Inna84, and the track she posted to Twitter yesterday (It's the last one on the tape). Also featured is Melody Gardot, the super-sexy differently abled jazz vocalist, the mysterious and brilliant Lhasa de Sela, and a new song from Federico Aubele, featuring the vocalist from Brazilian Girls (If you like that song, incidentally, it's free on iTunes until Tuesday). Twelve tracks of musical chillout-ness, for your listening pleasure!

Oh, and if you're wondering what Flight of the Conchords is doing here, well, laughter is relaxing! Obviously.

I've been having some trouble with my embeds, so I'm going to exhort you all to go directly to the tape on 8tracks.com, here: ♫ http://8tracks.com/mixes/33087

Enjoy!

:-)

Poll results

Morning Droogs!

The poll closed last night. 7 of you voted, which is nice, since I thought I had about four readers. (All right, 'fess up: Who voted twice?) Only one person thought I definitely should not keep making a weekly mix. There were 3 enthusiastic yesses and 3 sure-why-nots, so I'm afraid the ayes have it. The beat goes on.

To that one droog: I'm sorry! I will try to update more often, but I make no promises, since I made this blog for pure self-indulgence, and not really to fulfill some larger purpose within the blogosphere. I decided long ago that I didn't want to maintain an "issues" blog or a "current events" blog, as I don't feel I'm really qualified to do either of those things, and frankly, I have no interest in being flamed. And I don't talk about the nuts and bolts of med school all that often for two reasons: 1. It's unbelievably boring, and 2. It's really hard to relate the non-boring parts without violating someone's privacy. So I do write about issues, and current events, and what's on my mind, but not consistently.

Okay, now that we've established that... Back to your regularly scheduled Sunday.

Oh, and Happy Father's Day, Dad!