February 22nd, 2004

White Coat

Let's go get some call rooms and lay low, shall we?

So I'll never learn to please everyone, and that's okay. And if I say it enough times, I'll believe it, right? Maybe it's just because I have no control in my own life, and things will even out as I become less completely dependent on the whim of the School of Medicine.
Feel sometimes like maybe I shouldn't say anything at all, as it all comes out offending someone or putting me in the wrong position. But even that sounds wrong to me. I'm not feeling sorry for myself, I'm frustrated at what seems to me to be a decline in my ability to say the right thing at the right time. It used to be something I was so very good at, they told me. And now...
Now I need to learn to relax - that's what's missing. I'm too used to having to be right.

Came in this morning at 0700, we were capped already. Two new patients for me to make three, but the nausea lady is going bloody well home. My side is hurting again; I think I'm unbalanced somehow because it's always the left and always a sharp muscular pain. Should take some more ibuprofen.

So my two new patients, one is terribly interesting and has pancreatitis secondary to a triglyceride (cholesterol) level something like 20x what the top end of normal is, but when her PCP sees her her triglycerides are under control. The other is a very nice old lady who has terrible oxygenation for some unknown reason. Both took forever this morning, since I waited around to try for an arterial stick on both. I got a stick with no results on the pancreatitis girl, and got RT to sign my procedure log anyway. I just want my procedure log full! Discovered to my dismay that a rectal exam I had previously done had disappeared. Will have to fill in with one I didn't get signed by S.

And then it was 1500 by the time I was done with everything. I'm starving now, thinking I should go get food.

My nausea and vomiting lady left, finally. She's been wandering around the hospital, going out to smoke, complaining that only IV phenergan works for her nausea but refusing to stay on the floor where she belongs. I want to take her seriously, but when all she does is bitch that we're trying to wean her off IV's it's hard to do. And when she doesn't act sick, it's hard to believe that she's dying of horrible nausea all the time.
If you're in the hospital, be sick. Get better and go home. Don't come here for your med fixes.

Jenny's patient down in detention passed one of the two razor blades he swallowed today. And a Pepsi tab. One to go. Psych recommendation: Keep patient away from sharp objects and things he can swallow.

Joe's patient is trying to die. A week ago he was trying to talk around his vent, because he can't draw pictures well or write at all, he being illiterate. Today his blood pressure is dipping below 50 despite being on 3 drugs to increase it. We watched him for a bit, heaving chest with the sudden inspiration-expiration of the vent, lying there with hands starting to swell. "I've seen people hang around in the 30's for hours," the PICU nurse says. "I hope he's done by six."
We're callous in our futility. Something happened yesterday or the night before, and he got a bowel obstruction and he swelled up and we couldn't do anything about it because you have to be able to treat something, not just an observation. He's on antibiotics and getting good care and we don't know what happened. But now, as A puts it, we're just looking busy. We're doing things because we want to give ourselves the illusion that we're doing things. His QRS complex is wide because his body can't perfuse its tissues any more, so he's going into lactic acidosis. We could give him bicarb, buffer that. The QRS would look better. It wouldn't really make a change in him except that his heart would go on working a little more nicely as the rest of him died.
Funny how it works.

Doing a chart biopsy today and found the following tidbit:
FAMILY HISTORY: The patient is deceased secondary to MI at age 72. One brother with MI at age 40. Sister with mitral stenosis and MI in her 30's.
The patient is deceased, eh? This was from an old admit history in the computer, on the lady we admitted today. I just laughed for a while. The assumption is the patient's mother or father is the deceased party.

Think I'm going to see about a bite to eat or something, before the cafeteria closes and I'm stuck eating from a vending machine like I did for lunch. Ham and cheese on Texas Toast, a bag of "munchie mix" - Doritos, Sun Chips, Pretzels and Chee-toh's all in the same bag. And half a Coke. I threw the rest away because I couldn't cope with the sugar. That and the idea of the migraine hiding in the rest of the bottle.

I feel like I should be complaining of a headache; I have the same sort of general malaise. But I don't have a headache. Instead, I have no textbook and thirteen hours before I have to do anything again. Why am I here?
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Cane Chinois

It was supposed to be a short post...

So I misspoke my first entry today or the last one last night. It should've been Why is it called a pair of underwear? Hopefully that makes more sense to people.

"Thirteen patients. I want everyone out of here by 11 tomorrow." Yes, sir. If I'm out at 11, and I only have 2 patients, and it's a Monday...
Would it be bad of me to go home and do my laundry and see my Angel again?

I'm randomly flipping through LJ's, using the Random button. I automatically exclude any journal that doesn't use at least fifth-grade grammar and spelling accuracy. There go about half of them. I have yet to find one that holds my interest and has been updated recently.
I think, if your journal is friends only and you want to say "I don't want people reading this unless I know them" then you should say that. If you want to say "I don't want people reading this unless I personally approve them first" you should have a writing sample available so that people can evaluate whether they want to be approved by you. No, really. Why should I ask to be friended otherwise?

Hyperkalemia girl, once we got the arterial gas back and the art K, turned out to be much better. I would feel bad about not getting her stick, but the RT didn't either - he had to call the big bad chief RT, who had to go all the way to the elbow to get it. And I got the second art stick I did today on the very second try, and the nurse complimented my technique. She was a very nice nurse, took her time and let me take mine. The first nurse, the one who showed me, was nice but harried - and I hate wasting nurses' time.
Art sticks, check. Now I need to place two NG tubes and figure out where my missing rectal exam went. Should just have Sabrina sign on one, I know I did one she didn't sign on. And the NG tubes...well, suppose I'll have to sign on for an SBO or something, or hang around an ED for a while. Got one in Anaesthesia and never got it signed off on.

You know, reading back through my Recent page suggests to me that I'm spammy as all heck. It must be a burden to read through all of this verbal diarrhea when I'm on a call night or a lot has happened. Once upon a time someone came across my journal just when I'd had two long hard days in a row, and said something about my depth of conviction and all that. I wonder, does that still hold up in the day-to-day doldrums of what I'm doing?
I write, not so much to entertain, although you know, O Best Beloved, that I compose sometimes, little essays that strive to convey truths - I write because, as I said so long ago, I have to. All of this, all these things - thoughts and events and people and places and non sequiturs that flow through my mind - it's write them down or they stay there, locked in my head, becoming nonsensical with time and battering at my mind. Sometimes it's prose, sometimes it's poetry, sometimes, when it gets really bad, it goes onto paper in a notebook of things to write about someday.
Those are the things I never write about. I have one poem and a short story reserved for those who understand the fine line between short story and mental reality - two things and a hundred first paragraphs about the morning when I was molested on the way to the bus stop. I have never written about my grandmother dying, nor more than a sentence about my grandfather's second wife wasting away into nothing and dying from cancer while I was in France. I have never tried to turn my words to so many things - the things that left me numb at the time, that now I cannot find a beginning to write on - because they've been there too long.
When it's dark, and you come up behind me in the darkness on a sidewalk, I will turn to look back at you before I move off to the side, and I will slow down and tighten my hands into fists - thumb on top - until you pass by. Do not startle me. Do not cover my eyes. Do not - as my sister learned, in Chicago, in the middle of the holiday crowds - cover my mouth.
These are the things I don't write about. I allude to them, in the metaphors of my poetry, the things that are uniquely mine; I touch on them and shy away. These are the things that clutter my mind, shape my fears and dull the tarnish of my dreams. And I write, O Best Beloved, because I must.

Do not feel obligated to read.
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