A laugh

This post is one of the pre-written posts I mentioned earlier. I've been sitting on it for a couple months, trying to tune it up, but at this point, I give up.

Sometimes, laughter is good medicine. Sometimes, when faced with horrible situations, the only way to deal is to throw up your hands and chuckle.

One month on ICU, I had nothing but nightmare calls. My first call I had four patients code in a row, nearly back to back, and all four expired: four emergencies, four families destroyed, four tense situations full of panic and fear, over 80 minutes of sustained adrenaline with no release, on top of an already busy ICU call night full of septic shock and DKA.

Codes are agonizing. Only about 20-30% of in-hospital codes survive 24 hours, so it's a situation that destined to have a bad outcome. When I first started running codes, I did not save anyone through my first twelve. I was ready to quit residency. I should've gotten at least three of them to come back, if only for a day.

And then there's agonal respirations. During the code, it's a good prognostic sign, but after the code? It's probably the most horrifying physiologic response I can imagine. Every now and then you hear about someone coming back after being the code being stopped, but for the most part, agonal respirations are like a knife in the back.

And it's bad enough to have a patient die, but then facing the family is that much worse. It's like tearing your heart out piece by piece. It's always the same. The wife drives in to the hospital at 3 AM, still in her nightgown, sitting patiently at the nurses station with a cup of disgusting coffee which she can barely hold onto. And to have to tell this poor woman that her husband of 40 years is dead? It makes me nauseous just remembering.

There was another resident in the hospital who helped me through some of the codes, and in the morning before checkout, we reminisced about our terrible night. He loved vasopressin because you can't chase it with epi for five to ten minutes, so that's five minutes you can sit back and think. That doesn't sound like a lot of time, but if you're running the code, five minutes is a lifetime.

"Man, I love vasopressin. Five to ten minutes? That's half the code right there! It's Code Blue cruise control!" We both chuckled. Not that there's anything funny about watching four lives slip through your fingers, or telling four families that their loved ones were dead. It's just that when you have no other protection, nothing to hide behind, all you can do to keep going is to laugh. Because laughing is breathing, and on some days, it takes all the effort in the world to take that next breath.

Fin

Lately, I've been writing all my posts on paper and trying to edit them. I've been a little more concerned with my writing style, etc. but I've been discovering that I just don't have anything to say. I'm feeling good about my career and where I am professionally. I just don't have much to say.

And the things I do want to say are all things that I can't talk about for one reason or another. And this is just too restrictive a medium.

Finally, my personal life seems to be more of a concern to me than anything else. I was talking to a resident a while back, and he was telling me that he doesn't have time for his personal life. And from my own experience, I couldn't help but say that you can't just have a professional life. There needs to be some balance. That's something that I'm still missing.

So, for now, I have nothing left to say. And honestly, I was thinking about taking this blog down, but I couldn't do it. I don't know what this blog means to me anymore, so I'm giving it a rest.

Why I love beef

The story of vaccine is such a good story. Vaccine comes from the Latin word for cow 'vacca.' Why? The first vaccine was created by Edward Jenner. He observed that milkmaids were less likely to catch smallpox. What was it about the milkmaids that made them less susceptible to smallpox? The milkmaids were exposed to cowpox, a similar virus. He rationalized that exposure to the more benign cowpox was protective against the deadlier smallpox. So, he isolated the cowpox virus (vaccinia), injected it into people, and for the first time, people were vaccinated. All thanks to the cow. We don't call it being 'Jennered.' You're vaccinated.

There are other good stories in medicine. Pasteur was discovering germs. Lister was cleaning his surgical instruments. Beyond being good stories though, it's useful to remember their contribution to medicine. Their amazing discoveries are now barely worth mentioning in medical school because they are so self-evident, but that is the sign of a great discovery. It's right under our noses. It's also a good reminder that our current safe boundaries were once unknown frontiers.

Biggest winners

I was shocked when I saw the TV show, "The Biggest Loser." These people were competing through weight loss, and it was astonishing to see people distraught over only losing 2 or 3 pounds in a week. Healthy weight loss is one pound a week. These people are losing 5 to 10. Healthy weight loss represents a change in lifestyle. It's a marathon, not a sprint.

But even worse was that these folks were crying and feeling horrible about not losing enough weight. Losing weight and being healthy should be a positive, happy thing. It shouldn't be about feeling bad.

One of my patients was upset that in 3 months, she had only lost 5 lbs. but I was happy for her. "If you lose 5 lbs every 3 months, that's 20 lbs a year. You keep it up!" Those are the folks who are winning, nickel and diming their way to better health.

No choice

As a doctor, my whole life is making decisions. On an average day, I am deciding if I need to start another BP med, whether this lady should be admitted, if this guy needs an EKG, if I want an x-ray or a CT scan, if these medications are safe together, if I should give this patient with drug seeking behavior any more Vicodin. There are a lot of decisions, some of them easy, some incredibly hard. These choices can be the difference between life or death, and can have a huge impact on people's lifestyles or wellbeing. At times it can be pretty stressful.

So, when I go on vacation, it doesn't matter where I go as much as what choices I have to make, because once the pager is turned off, so is my decision making engine. Over one of the holiday weekends last year, I went on a short vacation, and people kept asking me what I wanted to do: when to eat, where to go, what to do, what to buy, what to drink... and finally I said, "No more decisions!" I don't want to make any decisions! Don't give me any choices!

Some people want to go to someplace fancy or unique or whatever in order to relax. For me, relaxing is a chance to get away from making any decisions. I just want to be told what to do. And that is surprisingly wonderful.