iliana_sedai

The September call schedule has been posted.

September is the first month our new anesthesiology residents start taking call duties. This means they start out not knowing what to do and looking lost and carrying bags of "emergency" equipment (not just endotracheal tubes and suxamethonium syringes and doses of atropine, but even such things as an emergency supply of metronidazole in case there's a colon resection that needs doing 'stat'). This means they barely know how to do anything at all, much less their own cases in the middle of the night.

September is the first month I start taking the "first call" position -- which is to say, I will be running all the operating rooms at 'Man's Greatest Hospital' for the duration of the call. And guess what day they have me doing first call for the first time? 7th September. Labor Day!

As Husband found out while crunching a year's worth of operating room data from our 53+ operating rooms, Labor Day was the worst day of the year, and the only day in which eight (eight!) emergency traumas, aortic dissections, closed head traumas, and dead bowel disasters rolled into the OR at once! Keeping in mind that we only have 5 available residents to do these cases, so there aren't even enough bodies on call to do 8 emergencies!

And the crew I got? The "second call" resident, who is supposed to handle the "advanced" cases, is a guy who officially has The Biggest Black Cloud Ever -- and he will by then have no experience with vascular, thoracic or cardiac cases, and won't know how to place a quick central line or float a pulmonary artery catheter or place a double-lumen endotracheal tube for lung isolation. Then there are two brand-new first-year residents who will be doing their first call ever. Then there is H, who can float a PA catheter but who, one month ago, was accused of lifting up his surgical mask and blowing his nose into the surgical field -- which, at the time, happened to be an open chest.

Doh!  *headsmack*

My feet and knees ache at work by 3pm no matter what shoes I'm wearing. Sometimes I go back to the locker room in the afternoon and change my shoes just to change the pressure points on my feet. I thought I was done with lots-of-standing jobs when I was done with Starbucks in 2001. Oh, no. I stand all the time. I walk all the time. My ankles and footsoles ache all the time. My knees feel the strain.

I have a pair of coral pink striped Dansko clogs which the patients -- and the nurses -- think can travel to Kansas with three clicks of the heels. I have a pair of bright yellow Crocs and when I'm in a stall in the women's toilet, people call out to Kate, the lesbian chick at work who also has infamous yellow Crocs. Both pairs are battered and blood-stained, and don't ask me why I continue to wear Crocs with holes all over them when I'm messy and drop blood all over the floor on a regular basis. My feet hurt and I will wear what I want, damnit.

I've been thinking about retiring both these pairs of shoes and getting new ones. But you know... it's work. I've decided I don't want to spend $120 to replace a pair of Dansko clogs that I'll just leave at work forever. I've decided I will never wear Danskos outside of work again. I've decided that work shoes aren't worth spending money on. I've decided that my feet hurt no matter what.

Work... just isn't worth buying cool shoes for. Blood stains go away, come again another day.

Yesterday evening I submitted my application to the one year Critical Care fellowship at My_Hospital. I hope to hear from them soon (a couple weeks? a month?) and I hope they answer positively by sending me a contract to sign. We shall see.

Currently sitting in the department library at the hospital.  I'm knocking down my call duty for the month of May -- the first one was for 24 hours from Friday 7am until Saturday 7am, the second one is today.  Tomorrow morning when I get off work at 7am, I will be done with working weekends for the rest of the month!

Friday call
The Friday call wasn't bad.  I saw 10 patients in pre-op clinic from 8am to 5pm, then went upstairs and did a craniotomy for semi-ruptured PCOM aneurysm (which had presented with worst headache of life).  The case was smooth and nice and ended at 10:30, allowing enough time for me to drop the patient off in the neuro intensive care unit before going up to the labor and delivery floor.  At labor and delivery, I slept from 11:30am to 7am and then went home.

Craniotomy for aneurysm
This was maybe the fourth or fifth time I did one of these.  I like these cases;  they are usually not terribly difficult but interesting and unique.  Here's how we do them at our hospital under general anesthesia:
-  IV access:  large bore peripheral IVs (I put a 16-gauge  in each arm) .
-  Invasive lines/monitors:  Just an arterial catheter (20-gauge left radial) in addition to standard monitors.
-  Uppers and downers:  Phenylephrine infusion ready to go to get blood pressure up, nitroprusside infusion ready to get pressure down.  Sticks of labetalol, glycopyrrolate, phenylephrine and ephedrine drawn up for boluses.
-  Blood products:  4 units packed red cells and 4 units fresh frozen plasma in the room.  (I have never used them.)
-  Surgery specific drugs:  Dexamethasone, furosemide, mannitol.  IV lidocaine for Mayfield pin placement.
-  Deliberate hypothermia:  Circulating water mattress plus forced air convection mattress underneath, forced air convection blanket on top of patient. fluid warmer.  So, I think cooling the patient for a deliberate hypothermia technique for cerebral protection is a bit dodgy if you ask all the other hospitals and look up the studies.  But they are stubborn here and they do it for every case, so we cool the patient down to 34 degrees C prior to aneurysm clipping and warm them back up afterward.
-  I chose to run remifentanil, nitrous and isoflurane for the anesthetic, and also dosed vecuronium as needed for paralysis.
All in all, nice case, nice evening, nice call.

Star Trek
We saw the new Star Trek movie last night.  I enjoyed it.  I think it was a "good" summer action movie -- not epically great as the reviews all seem to conclude, but good.  The prelude in the beginning -- flashback to the birth of Kirk and the childhood of Spock -- was a slow start but it eventually caught up and moved along at a steady pace.

Critical Care fellowship
After discussing with Luke, we have concluded that the most sensible thing to do is apply for it.  If there's a golden other opportunity that presents itself after I apply and before I finish residency, I will take it.  Otherwise, fellowship it is.  I'm just waiting to start my month of cardiac before I submit the application -- I think the fellowship director will want to know that cardiac fellowship is definitely ruled out before I apply, as they have lost potential critical care fellows to cardiac fellowships in the past.  Ultimately I am very eager to finish residency and start working as an attending so we can improve our finances.

Summer camping/photography expedition
Have started getting excited again about planning our combined driving/camping trip to Yellowstone National Park this July.  My parents are planning to meet us there.  Very excited about taking the tripod along to get some still landscapes -- maybe we will even try some night landscapes -- with exposure bracketing.  Luke is excited about fiddling around with some real HDR images.  Plan to book flights after we get back from the UK at the end of May.

Saw an ad on Craigslist today for "Pet Sitter: Pet CPR Certified!"

I reckon that if your dog, cat, bunny, hamster or other furry or feathery darling has a cardiopulmonary arrest, CPR would be cruel. Sudden Death is the best way to go... I absolutely would not want a foolish CPR certified pet sitter. My cat is DNR (do not resuscitate).

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