The Kindness of Others...

Bryn-Erinn and I are blessed to have friends, acquaintances in our life that enrich our day to day. We have many who do a large amount of work at our church. We have co-workers who help us in may ways from covering for us, answering questions, or just giving support. Being a resident has given us some sympathy that in some ways has been unexpected, and greatly appreciated. This usually comes from doctors and their families knowing how lean the life as a medical student and resident is. However we have also had untold support from our family, that has been life changing/enriching in many ways. Bryn has a client who found out that I love hockey and decided that we needed to see a professional game. She is the same lady who gave us the Gopher hockey tickets. This last week she gave us tickets to see the Minnesota Wild (previously the North Stars). The game was great and the Wild blew the Maple Leafs out of the water with a final score of 6-1. It was great to see the excitement of Bryn-Erinn as the game progressed. It was a great distraction. Also one of my colleagues, who is a Pulmonary-Critical Care fellow, is Japanese (Nagamatsu Soichiro). I often practice my Japanese with him. While we were working together at Regions I asked him if he knew of any computer programs for 1-3 graders to help them write/read. After his last trip to Japan, to visit family he brought me a grade school study book. Remember that as you look at the cover that they read most books from what we would consider the back to front. We are grateful for those who help us and we wanted to give a thank you shout out. Thank you.

Shaken...

When I was a second year medical student I was taking one of my courses in PCM (principles in clinical medicine), which placed me in the ED (emergency department) for a term. A level one trauma center was an exciting place to be as a student, and I was always eager to to see what I would learn on any given week. One evening the resident was seeing a man who had been sick from some time. His home health nurse insisted that he come in as he had been febrile and he had a cough that produced yellow brown. He came in and his chest x-ray show that his entire left lung was completely filled with pneumonia. He was started on antibiotics, but as the night wore on he began to feel that his breathing had become more and more labored. After a while it was decided that the pt would be intubated. The resident prepared for the procedure and the patient was induced. This involved giving the patient medications to sedate and paralyze him. The resident inserted the mac blade and tried to visualize the vocal cords to insert the endo-trachal tube. She couldn't see them. She tried again, but she couldn't see the cords and ended up putting the tube into the esophagus. The patient was bagged, and his oxygen saturation was brought back to normal. Another attempt was made for intubation and this time the tube was placed in the trachea. The respiratory technician began bagging the patient, and pus started coming out of the tube, occluding it. The tube was suctioned, and with the next breath the tube agian filled with pus. At this time the patients heart stopped and I began compressions. He was resuccetated, and rushed off to the ICU. After he had been passed off to the ICU the resident went to the hall and cried, totally crushed that she couldn't do better for the patient. At the time I didn't understand the feelings that she was having. The attending gave her some words of encouragement, and she returned to finish her shift. She likely returned home that evening and cried. The patient spent a hard night in the ICU, coding another two times. Three days later the patient passed away. It came out during the ICU stay that the patient had been treating his pneumonia with cocaine delaying his presentation, and sealing the end of his life.
Of course, this experience left a distinct impression on me. Now I'm the resident. I knew that some time during my training and professional life that I would at some point be the resident that had to make a hard choice. I have been a resident now for just over six months. I have seen many people pass away. Some that I have known for a very brief time and some for a longer time.
This being said, I had a patient this last week that has effected me in a way that I haven't previously felt. The case isn't as complicated as most. The pt was a elderly man who had a very bad heart. However this wasn't the cause for his presentation to the hospital this time. This winter a very nasty virus has been going around causing gastroenteritis (I got it, see my posting on 1/13/09). He was very dehydrated, and he was placed on observation status by the emergency department. We replaced his fluid losses, checked out his heart, and fixed and electrolyte deficits. When someone is placed on observation status they can only stay in the hospital for 24 hours and then they have to be admitted or be sent home. As this patient's time was running out we couldn't find a reason to admit him so we had to send him home. The patient asked to stay one more day, and I spoke to his wife making the same request. I reassured the patient and his wife that even thought he wasn't feeling back to baseline that he was ready to go home, and I discharged him. The next morning I received a phone call informing me that the patient had passed away in his sleep at home.
This news sent me into shock and self doubt. I began to doubt my dissensions and my abilities. In the end I now look differently at the work that I do, but I have to continue. It is unlikely that the outcome of my patient would have been different if he would have been in the hospital. At best he would have coded and we would had preformed CPR, which is far more brutal than anything you see on TV. He would have ended up in cardiogenic shock and had a long stay in the CCU. At his age he would have less than 5% chance of surviving that episode intact. And aboug a 5% chance of surviving with neurological impairment or life support dependent. All in all he was able to pass in peace at home.

Sick...

When I see people in the hospital, and they are chewing me out for one think or another, I always try to remember that they aren't feeling their best. This hit home this last weekend. Mike Wilson, a friend of ours from Portland, came to the twin cities for his internal medicine interview. Saturday night, we went out to eat at one of our favorite restaurants, A taste of India. It was a wonderful meal as always, and very tasty. After dinner I went to work -I'm working the night shift. I hadn't been at work very long, 2-5 hours, when I started to have the runs. As the night progressed I started to feel more and more sick to my stomach. By morning I asked my senior resident if she wouldn't mind if I left a hour early. I could barely walk to my car with out feeling like I needed to wretch my guts out. I made it home without any events. I felt like if I could just make it home to sleep I could let this all pass and have a good day off (I get Sunday nights off). I slept for a good 4 hours or so, but then I awoke feeling like I needed to have another bowel movement. I make it to the restroom, however the previous night's dinner had found a new way to exit and I expelled my stomach's contents into the bath tub, much to Mike's dismay as he was getting ready to shower. To my surprise this caused Bryn to go into fits of giggles, as she rubbed my back and gave comforting words. Mike offered to wash his hair in the kitchen sink, as Bryn helped me wash out the tub. I spent the next 8-10 hours after that with a Home Depot bucket and my bilious emesis. Some time during that night I was finally able to keep some water down, which was good, as Bryn and I were on the edge of taking me in for IV fluids at the emergency room. I spent the next day trying to rehydrate and later that night I ate some soft food for the first time since that fateful dinner and the loss of 5 pounds. My stomach still aches from this episode, and Bryn would attest to my pathetic weak state. In my medical opinion, I would guess that this was a bacteria with a preformed toxin, due to the quick onset and duration of 36-48 hours.
On a happier note, for the moments that I wasn't gazing into the bottom of my bucket, we had 5-7 inches of new snow. I also included some of the beautiful ice formation on some of our older windows.

One to replace all others...

It goes without saying that I'm a tech geek. This a very well-known fact to those who know me. It is a title that I wear proudly. Currently our computer to human ratio is 5:2 (2x laptops, 1x media center PC, 1x desk top, 1x server). I also have our house wired (really wireless) so that anyone with the passkey may access our photos, music and videos. Above that, I can access our home from anywhere that I have an internet connection.
Just before Bryn-Erinn and I were married, I made an $80 purchase of a used Pronto TSU-3000 universal remote on Ebay. I spent many hours programing the menus, and "teaching" the remote the signals for our home entertainment system. The remote had some problems (i.e. we had to change the rechargeable batteries every 36-48 hrs), but overall it worked just as it should. That is, until we moved. It likely was dropped too many times for the old girl to handle. So we pulled out the old remotes (7 in all, featured in the picture along with the broken Pronto remote) to work the VCR/DVD, stereo, internet radio, TV, etc... Overall this wasn't a bad thing, but it did make a mess (as pictured). We have been dealing with this backup until I had a great idea for a solution.
When I started the program at the University of Minnesota, they gave us a Palm TX to use for our daily clinical activities. The down side for me was that I already had a pocket pc which I had a few hundred dollars of reference (non-transferable) materials already installed. Further, I had it all set up to use just as I liked it. I also have a hard time with the palm OS. So the Palm sat on the shelf not being used. I was even going to sell it. Over the break I was reading a book on setting up wireless homes. In it I found mention of a software program for the palm that turns it into a universal remote. I did some research into the different brands of software and decided on NoviiRemote Deluxe version 3.73 for $25.99 (holiday sale). This is a great piece of software that lets you teach your palm to send out IR signals to your equipment. So instead of buying another remote sometime in the future when we had the money (not any time soon) I was able to return us to the bliss of one remote on the ottoman. It took a good part of the day to program, so there is some sweat equity involved as well. The remote has only been in use for one day, but I installed a bunch of free games on the Palm so it could also dub as entertainment by itself. The only downside is that you have to point more directly than the Pronto, but this is only a minor inconvenience.

For all you other tech geeks out there, here is how you can have your own universal remote to control anything that takes an IR signal, for less than $75 bucks: palm tungsten on Ebay $45, software $25.99, time 4-6 hours.