Never a dull moment in El Sereno

I hope they’re not bringing anyone to Kaiser…

Nike Avant – My 2nd most favorite running shoe (Nikon 35mm 1.8 at 1/100 sec)

I’ve never really been a runner.  Don’t get me wrong, I’ve always loved the spirit of competition.  I mean, I watch the olympics religiously every 4 years (2 if you count the winter olympics), I play tennis, basketball, sometimes even some racquetball, and every saturday and sunday, more often than none, you’ll find me glued to a TV set watching my beloved Lakers or the USC football team play their hearts out (UCI has no football team, so I’ve gotta rout for someone).  But running?!?

Growing up, I never really thought of it as a true sport.  It wasn’t as glamorous or flashy as football/basketball and runners always seem to appear once a year during the olympics or world championships, but fade away just as quickly, never to be heard from again.  I think most people in their 20′s would feel that way about running.  However, somewhere down the line, something just clicked.  I think it was probably around the same time as when my metabolism started slowing down, or maybe it was when the long hours and poor food choices at work started helping add a little more weight to my 5’8 frame than I had wanted, but any case, with weird work hours and a demanding schedule, basketball/tennis/racquetball/soccer and other organized sports became out of the question.  It became all about the gym…and of course, the wonderful world of running.  I don’t know how it started, who recommended it, or even how I started getting to like it, but one thing’s for certain, it works!  It’s helped me to get back into shape, keeps me fit, and challenges me every single day to be better than me, and not just someone else.  When you run, it’s just you, your mind, and your body.  No excuses, no talk about the guy taller than you or stronger or more athletic.  It really just comes down to playing a game of one-on-one with yourself, with you either losing or winning depending on whether or not you reach your goals.

I think that’s why I ended up choosing the field of medicine.  In the same competitive light, I thought of medicine as a way for me to get a chance to go one-on-one with whatever diseases walked through the emergency room door with my patients.  I believed that if I was really good, really really good, I’d be able to win most of the time (this is where you’re supposed to insert the bright-eyed and bushy tailed comment about interns).  All throughout medical school and even during my first couple months of internship, I thought that winning this competition was what doctors were supposed to do–we stomped out disease, cured cancer, delivered babies, performed surgeries–and people lived.  But now having been part of the care of over 100 patients–seeing the sick, the short of breath, the homeless, the frustrated, and all the heartbreak that comes with it–I’m coming to realize that no matter what I do in this game, I’m eventually going to lose.  Time always wins, and all I’m doing is just helping to stall or forego the inevitable.  I guess I’ve kind of always known that, but it’s the first time I’ve really been able to admit that everything we do is temporary, and that in the end, there’s no medication, tube, procedure, or special medicine that can keep us all from dying…it’s just inevitable.

Gosh, it all sounds so depressing doesn’t it?  Not as glamorous a life at the hospital as you’d expect, I’m sure. Certainly not as glamorous as Grey’s Anatomy makes it out to be.  I guess I just had a really bad day today and everything just snowballed.  Patient’s were sick, balls were dropped, people got worse, and I guess I’ve always been the type of person to blame things on myself, whether or not it was really my fault.  In any situation, if I was there, then my mentality always revolves around the fact that I could have done something.  I feel I’m just as responsible as the guy standing next to me.  That’s always been my mentality.  Well…no matter what anyone says, or what happened today, I watched someone really sick get even worse on my watch, and that’s been hard for me to swallow.  If we were keeping track, today’s score card reads Disease 1 point, Sam 0 points.  I went one-on-one with disease, and instead of just trying to beat me outright, it threw me a curve ball that I just didn’t know how to hit.  I sort of just froze (though I have to admit, I did the best that I could), and people got worse because of it.   I might have gotten yelled at and had things said to me that really bruised my ego, but the thing is, all the negativity ended up turning into something tangible and concrete, because I took all of it, analyzed the situation, and proceeded to park my butt at a computer and read everything that there was ever to know about non-small cell lung cancers, arterial blood gases, and indications for intubation.  It took one incident to remind me that my first year of being a doctor isn’t going to be a 5K cake walk leading me to dermatology, but a marathon that will require a lot of patience, discipline, and will-power to make it to the end.

I ran again today, not for the competition, but as a de-stressor.  I guess it’s kind of become that for me…a therapeutic way to push aside all the tangential thoughts, and feelings of self-doubt; allowing me to leave behind the negativity/blame/frustration of the day with each step forward I take. I guess that’s all you can do sometimes, because mistakes are bound to happen…I just hope I never make a mistake that leads to someone’s death. Although the circumstances of today’s events will probably be forgotten by most people, I just can’t help but feel that when we walk into the hospital, we’re just not expected to do better, it’s demanded of us.  You learn from your mistakes, you grow, and you cross your fingers and hope that it never happens again.  I guess that’s all you can really do.

And for some poignant reminders:

• Indications for intubation:  profound disturbance in consciousness with the inability to protect the airway
• tracheobronchial toilet
• severe pulmonary or multisystem injury associated with respiratory failure, such as sepsis, AIRWAY OBSTRUCTION, hypoxemia, and hypercarbia

Some objective measures to determine the need for intubation:

• RR > 35 breaths/min
• vital capacity <15 ml/kg in adults
• inability to generate a negative inspiratory force of 20mmHg
• PaO2 < 70 mmHg (especially when on 15L face mask)
• A-a gradient > 350 mmHg on 100% oxygen
• PaCO2 >55 mmHg (except in CO2 retainers)

With last year’s election being old news, I struggled to figure out what kind of pumpkin I wanted to carve for the family this year (yes, political pumpkins were carved last year).  I came across hundreds of designs, but seeing as how the kids have been really into playing super mario kart lately, I thought I’d carve them out a little piece of videogame heaven!

I never leave home without my handy dandy electric carver

It only took about 2.5 hours this year as opposed to the 7-hr? pumpkin last year, but here it is.  It’s-a-mario!

So the plan is to make it to halloween with at least 3 pumpkins this year, though its been difficult, as albertson’s, target, and ralphs all seem to be out of high quality pumpkins.  I drove around Alhambra, Pasadena, and off the 60 freeway today looking for a pumpkin patch and after about 1.5 hours of driving, I finally found one!  Guess that means I’ll be spending my free time this week hallowing out and carving wonderful works of art for the nieces/nephews.  Halloween always brings back fun memories…and even though it’s hard and takes so much of my time to carve these things out, it ends up being so worth it to have the kids enjoy the pumpkins, even if it only is for one day!  Happy early Halloween everyone!  Stay safe!

A special Halloween treat

So life has been busy. It has been about 3 weeks since I last updated, but to be honest, not much has happened. I’ve been over at Cedars Sinai for the month working in the Emergency Department and it’s really different from the Kaiser system. Aside from the fact that they get celebrities rolling into their ER pretty often (yes, there have been sightings), you get a different population of people. You get the extremely rich, the poor, the homeless, and of course, tons of actors (aka – eye candy). Working there has not only helped me to see how “private” healthcare works, but also gave me a glimpse of what life could be like as a full-fledged doctor in a hospital without a true resident service. Private attendings take care of their own patients and are responsible for doing everything (sometimes from home even). It feels so much more inefficient than having overnight residents, but I guess I’m biased and don’t really understand how the private doctor thing works yet. Anyone want to shed some light? Any insight would be much appreciated!

As for work, just started night shifts back at Kaiser in LA. It hasn’t been all that bad, but the worst is still yet to come from what I hear. On a side note, it’s nice to see all the other residents from Kaiser again. Haven’t seen anyone from the hospital in over two months and had an interesting encounter yesterday. On my second day back, I stumbled across a half-awake, half-asleep resident (pretty typical when you’re working nights) in the lounge delighting in the smooth deliciousness of Trader Joe’s Pumpkin Butter, in addition to a bottle of Naked Orange Juice, Starbucks Coffee, and a diet coke (sounds like the perfect combination for a major sugar rush don’t you think?).  Now I’ve had starbucks, a diet coke, and naked OJ before, but never all in the same sitting. And pumpkin butter?!?  What is that!?!

I decided to google it after my night shift and discovered that this stuff is apparently ALL the rage nowadays.  It can go on anything! AND… it’s supposed to be way healthier than regular butter/margarine.  Score one point for the half-zombie resident and ZERO cool points for me.  Guess I’ll be picking up some pumpkin butter (especially given the halloween season) next time I’m at the grocery store…maybe it’ll help me be just a little bit cooler and just a tad bit healthier!

And just as an aside…this is awesome:

check out what he does at 1:37 (so wrong…but so funny) Boop!