It's all about the call

I have 8 call days of internship left. 8 more to complete before the end of May. There will be many more over the next three years of anesthesia training, but only 8 more this year (Year in the academic sense. Starting and ending in July.)

Being on call, meaning staying at the hospital over night, really wears on me. Not only does it mean 30 hours shifts and lack of sleep, it means being away from my family for extended periods of time.

Being on call also has it's own language. Such as "float," "mole," "second call," and "third call." And the infamous "q."

As in q3 or q4...or even worse, q2.

Q means every. Q3 means you take call every third night. Q4, every fourth night. So, doesn't q2 just sound fun?

This is how I know that Hubster understands the language and the system. He looked over the SICU call schedule and exclaimed, "I can't believe they have you q3 for most of the month!"

Call can be stressful. Most of the bad things that happen, happen at night. No one seems to have strokes or chest pain in the middle of the day. This problems lurk around the corner in daylight hours and then pounce once it is dark.

The worst of the worst happens at night. This is when patients crash, when surgical complications manifest, when airways are lost, and blood pressures tank. It is at night that intubations are done, central lines are placed, and codes are run.

I've spent many call nights at the bed side, pushing emergency drugs, hand pumping blood and fluids, watching chest compressions being done.

But not every night. While the bad things do seem to cluster in the night hours, most nights are not full of panic and anxiety (and dare I say it...excitement.)

For the most part, call is just really, really, really annoying.

In the ICU, all the beds are open to the central nursing desk, so you can sit at the desk and have a direct line of site to each patient. It's very noisy.

Every time an infusion finishes, or every time an IV tube kinks or clogs, or every time the smallest bubble is in the line, the IV pumps alarm. There are eight patients each separate SICU bay. Each patient has between 2 to 12 IV pumps. They are alarming all the time. Each patient has EKG monitoring, oxygen monitoring, respiratory monitoring, and if they are intubated, ventilator monitors. If this fall off (which they do), or if the patient's heart rate, oxygen saturation, respiratory rate, blood pressure, or any other parameter we happen to be monitoring goes outside the set parameters (even for three seconds), the alarms go off. There are alarms dinging and ringing ALL THE TIME. The majority of these do not need responding to. But we monitor, just in case.

I hear the dinging of the alarms in my head all the time, especially in the quiet of my call room, or as I'm trying to fall asleep post-call at home.

Most things on call are easy to deal with. Orders to be clarified, labs to be followed up, pain medicines to be adjusted.

There are usually quiet moments to escape to the call room. But it is hard to sleep. I lay there, and I just know that my pager is going to go of, at any unpredictable moment. I can't relax, I can't sleep comfortably. I usually just lay there, on the uncomfortably thin mattress with the uncomfortably thin blanket, and wait for my pager to go off.

You can absolutely bet I have my call days marked on the calender and am eagerly crossing them off, one by one.

The Drive Home

Every single time I drive home, this makes me happy.


(And yes, that is the edge of my car window. Another car was coming, so I had to hurry and had no time to make sure it was perfect. But you get the point.)

It's a beautiful way to come home.

Stop by Leigh vs Laundry for The Happiness Project, and post a picture of what makes you happy.

Sunday

This Sunday was cool and rainy.

This Sunday consisted of...

Early morning rising for a 6 hour shift in the ICU.

Mangoes for breakfast when I got home...


Banana bread for mid-afternoon snack...


Funny faces...


A drive through the countryside (because that's exactly what it is here in Iowa...countryside)...

Forgetting my camera on the drive...

Blanket houses with a huge stack of library books...

A short nap on the couch...And then being bounced awake...

Spaghetti squash for dinner...

Overall, I'd call this a pretty good day.

The Hardest Job of All

Being a parent is a lot of work.

I think I just made the understatement of my life. Similar to saying I'm sort of tired and I work a lot and Our house is a little messy.

Parenting is intensely rewarding. The milestones, the memories, the overwhelmingly happy moments.

But it is also grueling and many times, thankless. There are no gold stars, promotions, or pay raises. Sometimes it feels like there's not even any seniority.

I'm pretty sure that most parents would agree with me.

Which is why I don't understand why we are so quick to criticize each other.

Obviously there are things that are completely wrong. But most things are just a matter of style.

So when I get comments from other parents like You let your children eat processed wheat and sugar before they were a year old (or ever.) or You let them stay up past 8 pm or You let them play in the fully fenced backyard by themselves or You whatever, I don't understand.

Most of us are doing the best we can. Very few of us are perfect parents. There will be speed bumps and potholes along the way. There are for everyone. So criticizing each other for little things like when we introduced cow's milk or what time we set for bedtime doesn't make a lot of sense.

I was having lunch with some medical school friends several years ago and we talked about our childhood. Someone talked about how they had their own organic garden and never owned a television and went to the best private school. Another friend shrugged her shoulders and said that she had been raised on after school specials, white bread, and Twinkies. The funny thing is, we all ended up in the same place.

I do try to limit television, encourage fruits and vegetables, and develop creativity and curiosity. Do they watch more television than I would like? Yes. Do they always go to bed on time? No. Do they end up crying over having to eat green beans and snarf down donuts? Yes.

But I think that as long as I love my children and am involved in their lives, that counts for more than anything else.

Apple Blossom Time

Have I mentioned yet how much I am truly loving spring?


The days have been warm and calm and perfect. The flowers have been out in full force.


The gorgeous days make me restless...I can not stand to spend a moment indoors while it is sunny outdoors.

In a fit of wanderlust, I packed the boys in the car and went to the local apple orchard. A little bird had told me the trees were in bloom, and my source did not fail me.


The boys ran between the trees, racing each other down the rows.



They gathered handfuls of dandelions.


The subtle smell of apple blossoms, the scent of grass, the sound of bees and Bugs and Monkeys...the day was an iconic spring moment.

Kite Flying

Happiness is...

Kite flying.


In fact, this is so much happy-making fun, that it deserves more than one photo!




Join the Happiness Project at Leigh vs. Laundry and share what makes you happy!

Domestic Needs

I'm right on the edge of giving in. Nearly everyone (okay, every female) I work with has been talking about how it has changed their lives. We are not really in a position to do this. But, like I said, I'm about ready to cave.

I think I need a cleaning service.

I always thought that by the time I actually reached the point in my life that I was able to pay someone else to clean my house, I had arrived.

Well, I definitely have NOT arrived. But I still need the cleaning lady.

Some of you may wonder at this. After all, doesn't Hubster stay home? The answer to that is...yes.

I think I need to go back a little bit.

Hubster was the oldest of a large family...of boys. He and his mother will admit that he was sent into the world with practically no domestic skills. Okay, not practically no domestic skills. Just absolutely no domestic skills.

Seven years of bachelorhood did not promote any self-education in the area.

When I married him, he could build a house from scratch, fix a car, and change the motherboard in a computer. But clean a window, sort laundry, or boil water...not so much.

During medical school, we were both very busy. Between my long study hours and Hubster's full time job and part time classes, and the boys, anything domestic was low on the priority list.

I remember studying late into the night for neuroanatomy finals. I looked up the study area across the hall to see one of my classmates. His wife had brought him dinner for him to eat while he studied. She had also brought their pajamaed children up to the campus to kiss him goodnight.

It was at this moment that I had a revelation.

I needed a wife. Someone to cook and clean for me.

Hubster is an amazing husband. He is supportive, hardworking, dedicated, loving, handy, and able to open pickle jars. Hubster is an amazing husband.

But he is a terrible wife.

The last 9 months have expanded his skill list. He is now nearly proficient at laundry sorting and doing. He can scramble eggs and make a casserole. He is an amazing father. He takes great care of the kids.

But the house...not so much. Don't even get me started as too why this might be. I could go on for a very long time. But that's beside the point.

And this brings me back to my first point.

I need a cleaning service.

Someone needs to clean the bathrooms, the windows, and the baseboards. And it doesn't look like it's going to be anyone living here.

Spring

I love spring.


Especially this spring. The spring that came and stayed. So different than the Utah springs I've known that aren't really spring at all, but a yo-yo of winter and summer.


All the flowers...


The yards full of blossoms...


All the warm days....


It feels like a reward for having survived the hard Midwestern winter.


Next winter, I'll know there is something to look forward to at the end of the deep freeze.

Play Date

If there is any one thing I excel at, it is worrying.

I worry about everything. There doesn't have to be a particular reason for me to worry. It's just what I do. That, and multi-task. I worry about the bills, the house, the future, my kids. Especially my kids.

And since moving, one of the things I've worried about the most is Bug's ability to make friends. There were not many kids in the apartments we lived in. He attended a new school each year. All things that have not be very conducive to forming friendships. On top of that, he's extremely shy.

Early in the school year, Bug was enrolled in a peer relationship building course, a special program designed to help those who where, well, struggling socially. It's a small group with a guidance counselor where they talk about how to make friends, what makes a good friendship, etc.

We've encouraged him to make friends. I ask him how things are going. He's attended (with encouragement from me) every birthday party and social event he's been invited to.

But it didn't seem to be making any difference. His teacher still said that he played mostly by himself at recess. He was still very quiet in class. He never talked about other children at school.

And I fell into what I do best.

I worried.

Was Bug going to grow up and resent me for moving him around so much? Was that going to be the reason he couldn't make friends? Was he going to be lonely? Would he end up being the kid that was teased and picked on and never fit in anywhere?

Turns out, he just needs a little extra time.

Two weeks, he came home to announce he had been invited over to play at a classmate's home. Which he did. He then invited his friend over to our house. And now, they are back and forth regularly.

I know...it's just my kid playing with another kid.

But it makes me want to do a happy dance in the kitchen and cartwheels around the back yard.

It's great to see Bug with a friend. He looks so happy as they play baseball out back and board games in his room.

Now that that issue is taken care of, I can get back to worrying if he's going to make the "right" kind of friends.

Handful of Flowers

Happiness is... three year old bouquets just for Mom. Dimpled little fingers stained yellow. Sunshiney flowers by the dozens.

These moments fill my heart to overflowing and set it breaking all at once.

Join in the Happiness Project at Leigh vs. Laundry. Post a photo of something that makes you happy.

Post Call Haze

I'm not sure I'm completely coherent at the moment. Instead of coming home from call and taking a nap like a normal person, I started cooking breakfast while still wearing my scrubs.

This post, like this morning, is a completely random collection. It's the best I can do.

Anytime I feel sorry for myself, overworked, and abused, I just look at the neurosurgery residents. And I feel better about my life. Neurosurgery has got to be the hardest thing on the planet. Seven years of grueling residency. No thank you.

I remember as a kid I would pick up bugs and worms and it never bothered me. Now, spiders have me running to the other room and even ladybugs and rolly-pollys make me a little queasy. I was reminded of this when doing yard work and the boys wanted me to hold a huge fat earthworm. I did oblige. Because I had gloves on. But it was still pretty bad.

I overheard my fellow residents talking about what time they go to bed. And that's when I realized that I get a lot less sleep than I need to. No wonder I fall asleep in conference all the time.

Twice over the last week, I've ended up shopping at places that only take cash. Guess who doesn't ever carry cash? I didn't realize non-debit-card-accepting stores still existed. I need to start carrying at least a little. I realized this even more when I drove past girls selling their last Girl Scout cookies.

I'm coming to terms that Hubster just doesn't care as much as I do about what color the curtains are for the guest bedroom. Or the rug. Or the color of the shutters. Or what artwork we hang up.

There are only 5 episodes of Lost left. What on earth will Hubster and I talk about after there is no more Lost? Obviously, I'm kidding. We can still talk about Survivor.

Bug ended up winning our family's March Madness bracket pool. Who would have thought? He was far behind going into the Elite Eight. But take out Syracuse, Kansas, and Kentucky...and a boy's got a chance. I was actually leading up to that point. But Bug picking Duke as the National Champion earned him enough points to take the lead from me. Our prize is lunch at the restaurant of your choosing. When we asked him what he wanted, he had one word. "Steak."

I think I may still be awake enough to exercise tonight. At least I changed out of my scrubs today. Seriously, sometimes it's tempting not to. Those things are comfortable, if not completely unflattering.

Hopefully, after some sleep, I will have some slightly more coherent thoughts for you.

Touch Ups

Since the fireplace makeover in the fall, we haven't done any significant changes or improvements to our house. Oh, the list of to-dos and want-to-dos is still very long. But the cold weather had us less than enthusiastic about tackling any projects. And the dwindling of the initial home improvement budget had covered the essentials and not much more.

But we are still moving in, still tweaking things here and there, still touching things up. We are still making this previously neglected house a home.

Here's what we have been up to...

New lighting fixture in the dining area. The previous light fixture had a single light bulb and such limited ability to actually light things that dinner felt more like a poker game in the back room of an cheap Italian restaurant than a happy family meal.

Dim old light fixture

Bright, new light fixture

So pretty and shiny!

New lighting fixture in the family room. (I'm slightly obsessed about having light.) The old one, while nice enough, didn't light the ends of the rather long room. It left the fireplace and toy shelf pretty dark.


And we've finally hung up art work! Most of the wall are still bare, but we're slowly taking care of that.


I'm pretty particular about what I choose to hang on my walls. I want it to mean something. So most of the art are pieces that have been made by myself or family members, or that are incredibly sentimental.

These are our tribute to Mondrian. Bug and I made these over Spring Break. I love how they play off the bright colors and linear lines that are already in the family room.


And these...

Monkey's contribution on the left, Bug's contribution on the right

These were made by my two favorite artists of all.

These are just little changes, but they have all made a big impact. It's amazing what a difference actually being able to see each other's faces at dinner can make.

We do have a HUGE project coming up (keeping fingers crossed!). Hopefully, it will be ready to reveal around the beginning of the summer. Any guesses?

Awkward

Here is the scene that unfolded at work last week.

A fellow resident and I are working together to provide anesthesia for patients undergoing very short procedures. Working together, we can get patients into the procedure room and then back out to the recovery room, and then turn over the room, making it ready for the next patient, faster than if just one of us were doing this on our own. We also have our attending anesthesiologist with us, since as residents, there are parts of delivering anesthesia that have to be done under supervision (okay, you can all breathe a sigh of relief).

The day has been going very smoothly. We've come up with a rhythm of move the patient in, move the patient out, go go go, that works very well.

We're laughing and joking with the surgeon and the surgical resident.

Somewhere near the end of the of the day, the attending surgeon, a 50-something male, turns to me.

"Katherine, I have a question. I heard that CRNAs (certified registered nurse anesthetists) don't like doing [type of procedure]. Have you encountered any of this attitude?"

I shrug. I tell him that I haven't worked with any CRNAs, so I can't speak to their feelings about doing this type of case.

And that is when he looks at me, after now two days of working today, and says, "What? You're not a CRNA?"

You could feel the awkward silence fill the room like a shock wave.

Maybe it was only seconds later. It felt like minutes later that my attending turned to him and said, "Absolutely not. Katherine is one of our anesthesiology residents."

The surgeon apologized briefly, muttering something about now seeing the "MD" on my name tag.

Afterwards, the nurse and the surgical resident both approached me and apologized for the surgeon's remark. As the nurse, um, so aptly put it, "The only reason he assumed that was because you have a va-jay-jay."

But it's hard to be offended. Now. I've been encountering this assumption since the day I enrolled in medical school.

When people found out that I was in medical school, whether it was overly nosy passengers on the train as I commuted, or neighbors, or even distant family members, the most common response was "Oh, that so nice that you're going to be a nurse."

On clinical rotations, both during medical school, and during residency, walking into patient's room, I've heard on more than one occasion, "Oh, my nurse is here."

With some patients, it doesn't matter that I introduce myself as "Doctor," or that my white coat says "Dr." or that my name tag says "MD."

Admitting a patient into the intensive care unit just last night, it happened again. The nurse was hooking up monitors and IV tubing as I did a quick neurological examination. Once the patient was settled and able to talk, I introduced myself.

The patient looked from my blond, 5'5 self to the 6 foot tall bearded nurse standing next to me. "But aren't you my doctor," the patient said to the nurse, who laughed and corrected him.

As a female, I've come to accept that I will always be mistaken for a nurse.

Okay, before you go and assume that I'm all hating against nurses, let me clarify.

I'm NOT.

I love the nurses I get to work with. Especially the amazing ICU nurses. Most of them are more experienced in what they do than I will ever be. While physicians write orders and notes and philosiphize about the sublteties of pharmocokinetics and pathophysiology, nurses are taking care of patients. They are handing the patients pills, turning them in bed, bringing them blankets, wiping their mouths after they vomit.

Nurses are amazing and critically essential to patient care.

But here's the thing.

I'm not a nurse.

I used to get upset when people assumed that, because I was a female in healthcare, that automatically made me a nurse. I don't get mad or even embarrased anymore. It's been a frequent occurance, and eventually, I've gotten use to it.

But some of the internal reactions are still there, popping up automatically. Whether it is a patient, a relative, or an attending surgeon who assumes that I am, I occasionally feel that it devalues the years of hard work that I've had to go through to get where I am. I feel that it reprsents ongoing gender equalities in my field. That even if I'm just as qualified as my fellow residents, that being mistaken for a nurse by patients (and colleagues) could hurt my chance of promotion and partnership.

I've worked hard to get to where I am. I've sacrificed a lot. Some days, I'm not sure it's been worth it.

And while it is discouraging to still encounter the assumptions and attitudes, I've come too far to be thrown off track by an awkward moment.

Newly Planted

Happiness is...newly planted window boxes.

Stop by Leigh vs Laundry to see what makes other people happy.

Back to Normal

It's easy to forget how hard it is.

As I get further on in my training, the hours feel a little less demanding, the answers come a little faster, the work feels a little less intimidating.

But confronting sickness and death? That's something that never changes. It's something that never gets a little easier.

In the last 24 hours, I have stood by a bedside as family members watched. I stood, my stethoscope to the patient's chest, listening for the thud of a heartbeat, the whoosh of a breath. I listened for a long time, knowing that I wouldn't hear anything. I looked up at the family, and they know it too.

I left the room to call time of death.

In the last 24 hours, I have stood by a patient's side as they stroked out in front of me. I watched them panic as they lost the ability to talk, and then to move, and then to respond, and then to breathe. I might be able to place breathing tubes and central lines and start medications. But I couldn't stop it from happening.

Despite being busy doing what needed to be done, it felt like I just stood there and watched it all happen.

In the last 24 hours, I have felt powerless, sad, scared, angry, and empty.

Some days, I don't know how to come home and feel normal again.

The hole inside of me feels like it's ready to suck the joy out of my entire life. And take me along with it.

I don't know how to come home. To play games with my boys. To read them stories. To laugh at Hubster's jokes. I sit in the car in the early morning before going inside. Anything normal inside of me has been changed to yucky, dead emptiness.

And at times, I don't want to fight it. I want to give in to the sadness.

And then I see Monkey crack the door just a little and wave excitedly to me. I feel him hug my knees. I feel Hubster's kiss. I hear Bug's welcome.

And I realize that I still feel. That I can recover. That I can go back to normal.

Scenes from Easter

Status Update

I'm so grateful that Karen and Jennee have their weekly "Let's Face It Friday," because without it, I would have made my list of New Year's Resolutions, posted them, and then promptly forgotten about them. Or at least ignored them and any associated feelings of guilt from the abandonment.

But this way, I'm motivated to go back, look at my list, and see how I'm doing. And remind myself of the things I've forgotten.

I don't do this weekly, as both Karen and Jennee do. But I think that monthly is a good compromise. I do try to do this on the last Friday of each week, but somehow, last Friday got away from me.

So here's the status update...

My 2010 To-Do List: March (ish) Version

-Lose 5 pounds by May 1st, then another 5 pounds by September 1st.
I was making good progress with this goal. But I haven't weighed myself in almost two weeks. So I'm not exactly sure. And I'm not going to go weigh myself right now, on account of the pizza I just enjoyed. The good news? My pants aren't any tighter.

-Be able to touch my toes.
I can totally touch my toes now. Yep. I just stood up and checked. I can do it. With my knees straight and without bouncing. I can't stay down that long. But I'm sure it will get easier.

-Get my passport.
Still haven't done this one. Actually haven't thought that much about it.

-Date night with Hubster once a month. 2/12
January: Nope. February: Yes! And March...yes. This one was hard. We had decided to go out for my birthday. But because it was my birthday, I was in the mood to spend it with all of my boys. But then I thought about how little we go out as a couple, and how we do need that time. So we found a baby-sitter and went out as a couple. Without the kids. It's actually refreshing to go to a restaurant without someone climbing under the table.

-Pass the boards the first time.
Check!

-Use my crock pot (at least) once a month. 3/12
January: Barbecue chicken.
February: A whole chicken with red potatoes and carrots.
March: Blackberry-balsamic marinaded chicken.
Noticing a trend here? I am using it each month. But now I need to set another goal to cook something other than chicken.

-Finish moving in.
I did take two boxes out of the garage and emptied them. I hung some artwork up. We're moving in the right direction.

-Finish moving into this blog.
I like to think that I'm moved it. But then I see my extremely boring header, and I realize I do need to dress the place up some.

The nice thing about having goals that you have to continue to work at is that it becomes easier with time. I'm not so nervous about trying to find a babysitter. I have found my crock-pot cookbook. Exercise has been come (almost) part of the routine.

And I get to brag about how well I'm doing each month.

Fitness Plan

Exercising is hard for me to do.

Mostly, because I'm just not that big of fan. But I always try to blame it on other things. I don't really have the time. I can't afford a gym membership. I don't have the time. Oh, did I already use that excuse?

All those excuses are true. The time and money that going to a gym require just aren't really an option. We don't have the space or money for a home gym.

I used to run frequently, but got bored out of my mind about the same time I got tendonitis and shin splits.

I tried work-out videos, but the downstairs neighbors at our old apartment just didn't seem to appreciate my efforts.

And then, a little over a year ago, my brother in law brought over his Wii Fit.

Just to clarify. No one from Wii Fit has ever contacted me to promote them, review them, or compensate me for my feelings. But they should.

It was love at first sight. I used it religiously for nearly 4 months and lost almost 10 pounds.

But then we moved, and my BIL wasn't keen on us taking his Wii Fit with us.

Then, for Christmas, Hubster got me a Wii Fit Plus.


And it was that tingly, new relationship feeling all over again. With the Wii Fit, I mean.

I've lost 4 pounds using the Wii Fit. I can't use it as frequently as I use to, or for as long. But I love my Wii Fit.

The boys love it too. It was responsible for keeping cabin fever at bay during the long Midwestern winter.

Then, for my birthday, Hubster surprised me again. This time, with the Wii EA Active that I have by eying at every single trip to Wal-Mart.

Active is great. It is a much better work-out than Wii Fit. It makes me sweat, my heart pound, and prevents me from being able to walk normally for two days after.

I'm doing their 30 Day Challenge right now. Hopefully I'll have some good results at the end of it.

A couple things though.

Wii Fit is so much more fun! The activities are just more fun and feel more like games than exercises. It uses Miis, which are just so dang cute. And it is competitive. I love being able to beat Hubster's boxing score.

See, I told you that Wii Fit should contact me. I'm nothing but complimentary.

And the best thing is this.

It doesn't cost that much money. Okay, if you don't have a Wii system to begin, it cost a bit. But it's a one time cost, not a monthly bill.

The whole family can (and does) use it.

And I can exercise whenever I have time, for as long as I have time, without ever leaving family and home.

Now, all I need are some really good results, and it's perfect!