Sleep is Good

My grandmother suggested I tell you all about what my daily life is like, so I thought about many options available to me and I selected the "day in the life" approach. I have to start off by telling you that my children and wife are occasionally able to share a free on call weekend meal with me in the hospital, and so if you were to ask them what I do I am sure their answer would include "Doctor, surgeon, sick people, hot dogs, cutting on people, grape fanta, giving people medicine so they feel better, and french fries." The hot dogs might actually be higher up on their list, you are welcome to call and ask them yourself and I am sure they could tell you.

I am just picking a regular day, not an on call day since the on call day is not something I usually like to re-visit. Typically, I wake up around 5:20 and am out the door to drive it to the hospital around 5:35. I arrive and print off my patient lists from the computer so I know who it it I need to see that morning. I then check on the laboratory values of the patients I am going to see, and then any recent radiographic tests as well, and if the patient has a chest x-ray already back by 6am I will look at that real quick as well. I try to start "rounding" on my patients by 6:10, which involves seeing anyone who just had surgery or is new on our service before the others who are either ready to go home soon or are "rocks," and will likely be there for some time to come.

I usually start with gravity rounds, where I start on the highest floor first and work my way down to the lower floors. This is only the case if I don't have patients in the ICU or other "units" to see, and then they are seen first because they are more urgent. Going to the patient room, I take the chart from the pull-down and quickly look at any new orders (tells me what is really going on), overnight vital signs (this includes pulse, blood pressure, oxygen saturation of the blood, respiratory rate, urine output, intake and other output if the patient has drains or tubes or is vomiting or eliminating). Armed with this information, I look at the other doctor's notes if they are decipherable, and then charge into the patient's room where I spend usually less than 2-3 minutes asking incredibly pointed questions that are never to be repeated outside of the correct context. The conversation goes something like this, "Hi Mrs. Smith, sorry to wake you up again, any troubles overnight? Were you able to walk around at all yesterday? Are you eating anything, any nausea? Passing and gas or stool? How well is your pain controlled? Is there anything you need? Okay, I will see you later on, send you home, or explain the plan, etc..."
I then quickly scribble out a note that includes how long since they have been in the hospital, or how far out from their surgery or trauma they are, any other major issues being treated for and then pending tests or evaluation or upcoming studies or surgeries and other plans, or even when I think they will go home or back to the nursing care center, or whatever. I sandwich this information around a very detailed exam where I mention they were breathing, had a pulse, and their belly exam or wound inspection and status, and the character of any fluids draining out of anywhere.
This is repeated on the 7-15 patients I see every morning until around 7 or so we usually have some sort of educational meeting, where we also meet with the other members of the team and discuss all of the patients with each other and then go from there to the Operating Room where we first meet the patients if we haven't already, or else go straight to the OR suite and announce our presence to the scrub team and pull our gloves and gown so they have all of that. As we are scrubbing in with the attending, we fill him in on all of their patients and see what they want to do for each one and what the plan will be. After the cases we some times will physically "round" with the attending physician or we will go do other duties that may include but not be limited to pulling out drains, draining an abscess, pulling our or placing a chest tube, ordering special studies or reviewing studies with the radiologist and attending, seeing any new patients that have come to our service and getting them checked in to the hospital, and if we are lucky catching a quick lunch.
If we are on call, we get paged at any time for questions up on the floors, new traumas that have come in, or other questions that are inappropriately asked of us. If there is time remaining after the cases in the afternoon, we will quickly go over the list of patients with our team of residents (oh, each team has at least a chief or senior resident and an intern.... often a mid-level resident as well, and then 3-6 attending physicians, whose patients we are responsible for)and then make sure everything is tied down for the next day and tell the on call staff about anything that needs to be taken care of, results that the attending needs to be called about, drains or lines that need to be removed, changed, or placed. Hopefully it is only 5pm and we can go home, at the most it is 7pm by the time we get out and sometimes it is 4.
On call, means we do all of that and then at 5pm we are responsible for all of the surgical patients, any new surgical patient that comes into the ER, or that is already in the hospital but has become a surgical patient. This is typically very busy and means answering pages from all over the hospital for most of the night. Things seems to calm down normally around 11:30pm, which is typically the calm just before the shooting or drunken trauma comes in. You would be amazed by how many innocent people are shot by folks, especially when they always say they were just minding their own business (at 3am). Just a lot of crazy people out there, you know.
The on-call day ends at 7am, when you get to ditch the pager to the next on call resident. Hopefully you have been able to round on some patients before 7, but at times this is very difficult, especially if any traumas come in after 4am. In order to go home after being on call, you must have rounded on your patients, checked out with your team, possibly helped with 1-3 surgeries and then checked out again. We are required to be out of the hospital for 8 hours following being in the hospital for 30 hours continuously, but we never have to come back in before 6 the next morning, which is nice, since at times we may be on call again. Typically, I get four week-end days off a month, which is when I get to help Kristi out a little bit and hopefully sleep in some too.

That is about it... I think I will have to discuss some interesting cases and interactions if I get a chance next time I comment about work.

Yesterday, the weather was so perfect, and I was stalled in my research so I took the day off after the 7am education meeting and we went to the Cleveland Zoo, raked leaves in the afternoon, and played with the children. Tomorrow I start the neurosurgery service, so that will be interesting for me. I will be the only resident on the service, which will be no fun, but fun because I get to do whatever case I want to in the operating room, as there will be no competition. Just means I will have more paperwork and dictating to do... Oh, I forgot to mention that in the course of a normal day we are required to keep up with our dictations and paperwork, try to go to office hours, read topics for upcoming educational conferences, etc...

Have a great week
Dr. Meat

October 2006

Lessons in Physics

Most of us eventually "discover" the truth that we don't really have the ability to know everything about anything. There are some things we learn through experience. Some things we learn from the experiences of others. Then there is everything else that we really don't know the first thing about, and try to just make it through life without having our ignorance come up and bite us, or at least not while others are watching.
Although experience is a pretty good teacher, it's utility is not only in making one less ignorant. Confidence is what experience is really good at. Now, this is good and bad in that a little bit of knowledge is good in helping you mentally get going and helps you try new things and learn more because you think you know how to cover yourself if you get into trouble. Experience and the confidence it brings also can get you into trouble by allowing you to think you can do things or go places you really can't and shouldn't and just got away with it one or two times before is the only reason you think you can safely do it again.
This is all in reference to life, of course. Specifically, I am thinking of my lovely children, the lovely weather, and my current occupation. Just because I dug through the garbage once and nothing came of it doesn't mean I won't get it if I venture in there again. Just because it is October doesn't mean it won't snow and be nasty outside. Just because I know how to start an IV doesn't mean I can get away with starting a central line or just because I can put a scalpel on a handle doesn't mean I know the difference between nerve and tendon.
That being said, this past few weeks have been pretty good... I guess. The weather predictably unpredictable, the children have been growing up and learning new things with us, and we are getting closer to our first spring in Ohio. For the past 10 days I have been on call nearly every other or every third day, which makes for little time for much else. I am finally done and now I get to join a team at the hospital that is short a person, so I get to keep on rounding every morning, which is good for me I am sure.
Apple season is here, and Kristi took the kids to Amish country with Mrs. Sobie, a former ATI mom who is very knowledgeable about these things. So, we have lots of apples. We are still raking leaves, and watching some snow fall once and a while. Anne is getting a little bit better with her eczema, and that makes us pretty happy (now we have all 4 eye teeth coming in) for the most part. We had a wonderful time on Saturday at the mansion of the guy who was co-founder of Goodyear Tire. The children are learning more and more about animals and letters and numbers and phonics. Anne is walking like a champ, and that has helped her frustration level, which in turn helps ours. Jan and Alec now have I John 1 memorized and enjoy reciting it for those members of the treats for verses club.
We are still working on social graces, keeping our voices down in public, second and other ballet positions, recognizing the warning signs of a BM when Anne is in the tub with us, keeping the doors closed and only necessary lights on in the house, gravity, inertia, and responding to authority.
I have been able to get to know some of the other residents a bit better after being on call with some who I have not really worked with that much, which has been good. I was on call Sunday and over a patient with appendicitis that I was lining up to go to the OR one of the Emergency Residents says, "Hey, you sure missed a good sermon at church today." I, with experience, have learned a few social graces so I by-passed the "who in the heck are you" and replied, "Yeah, my wife emailed me and said Steve did a very good job explaining the Word and the place it should have in our lives."
Feel a bit more ingrained here since I have started running into nurses and residents and just this morning I chatted with a family doc at the hospital who goes to the Church we have been attending. Sure are nice people, and what impresses me is they seem genuinely interested in growing spiritually and being challenged and knowing what God says and how it should change the way they live. The kids are very much learning and growing, and talk about the Bible stories they learn each week. That is good too.
Well, that will do it. I have some "research" to attend to and must get back at it. Also, I need to get some exercise. This week we have Andy Smith coming by on his way back to Bible College from DC, we are having dinner with the Pastor's family, and multiple other appointments and engagements.
Feel free to drop us a line any time. Next month I think I have Neurosurgery, but I may be bumped back to Cardiovascular/Thoracic service as there is a shortage of intern over there.

David

A Carne by any other name....

This week and next week have their share of 30 hour shifts for David. While he is gone and kids are in bed I am spending time sifting through piles of names. (This pregnancy has required time spent with my feet above my heart and there honestly are not alot of productive things that can be done with your feet piled on pillows or propped against the back of the couch. Looking for names is something that works here.) This used to be something that my friends and I did for fun - as 13 and 14 years olds we all had lists of names that we absolutely, positively loved. I guess that I lost my list.
Seriously...David and I have a hard time picking out names for the new people in our family. Not exactly sure of why, but something to do with how important it is, how frequently it will be used, how it will have much to do with the impressions others have of him/her when they first meet, etc.
So many names that I just "like" don't go with Carne. Some of them just don't go with the names of the siblings. Some of the names I like were David's neighbors while he was growing up and he hated them. Some of them I just like on paper, I don't like the actual sound of them.

Alec thinks that we should name whatever it is "Spanky Alfalfa". We aren't asking him anymore.
Jan is agreeable to most any name that I suggest, but would really like to name it (whatever it is) "Sasha". Don't ask me why. Why can't I be as opinionated as that?

I am wishing that I would have told that ultrasound tech that I would like to know if the baby is a boy or a girl, just so it would be narrowed down a bit. If anyone was wondering there are about 3x as many girls names as there are boys names. Well - we have two months plus to figure it out so it isn't panic time yet.

One of my favorite verses is in Isaiah - asking Israel if a mother can forget her nursing child - and then says that even she may forget but He will not forget them. He has their name written on the palm of His hand. I like to think of my name being written on God's hand. I like to think that whatever my next child's name is, God has it written on His hand.

I learned something new about Ohio this week. They celebrate a holiday called Sweetest Day. October 21. It is like Valentine's Day for the second time around or something like that. Advertisements everywhere - even a Sweetest Day section for cards at Target. This may be a day that has a honored and illustrious history but I can't help wondering if it is just a ploy to get people in Ohio to spend more on cards, chocolate and flowers at a time of year when Hallmark type stores just don't get alot of business. I probably shouldn't be so cynical - maybe by the time we leave here I will celebrate it as though it is a real holiday...but I doubt it.

Looking forward to tomorrow - Starting tomorrow David gets to come home in the evenings for three days straight. Tomorrow will be my Sweetest Day.

Fall is fall so you fall

Well, I suppose I should write something since I have this blog now and I am on a month of research. That means that I get much more time to be at home than normal, which is good because I wasn't expecting to have a month like this until I retired or got fired or something. I am actually working on some research, so it is all legit. Just that if there is a nice day and I have gotten to a place in my work where I can put it up, I am not encouraged to stay, so today I packed it up around 1 or so and we went hiking and played outside and went to a pumpkin patch so the kids could get frustrated in the hay maze and cry about not wanting to go through the tunnels in the hay fort. The weather couldn't be any more lovely here today, and I was debating with my research "supervisor" at about 12:50pm today if I could in good conscience take the rest of the day off and then she said there was talk of the "S" word coming to town on Thursday night or Friday morning. The next thing she heard was the door to office closing behind me.

This past few weeks have been pretty busy. We took the kids to the Columbus Zoo on Saturday, which was incredibly fun and action packed. They have a very nice zoo there, only thing is it's 2 hours away, and we have to pay half price, which is not all that much, but when you are used to going to the Zoo for "free" it is hard to swallow. Not that hard, I suppose. I am now becoming a great fan of the Gibbon species, they are gobs of fun and really entertaining. Nothing like having kids, for sure.

We have been learning lots about leaves here as well. I went out last night and "mulched" the leaves and then mowed them up so they all fit in only one trash bag.... only to get home today and see more leaves on the lawn than last night. I suppose it is like taking a bath or something, feel like you should but you will just stink again anyway so feels like a waste.

Also in the past few weeks, I ran in a 5-person marathon relay team with my fellow residents against a team of our attendings. They even brought in some "ringers" from other non-surgery departments to compete with us, but I think they should have saved the expense because we have a heavy-duty team here. We started off with Paul, a second-year guy here who is built like me and plays lots of soccer and lacrosse, then had a body-builder type who is a fellow intern but can run alright, and then Jill, the third intern this year with me who ran track in highschool and ran about 7 min/mile for over 6 miles. I think by the time I got the handoff we were already 20 minutes ahead of them. They treated us and our wives out afterward to a "clam bake." Now I haven't been to many clam bakes, but this was not what I expected. I started to wonder and had even dusted off my hip waders when the chair of surgery announced one morning in resident conference, "Oh, for that clam bake, the country club requires sport coats." I didn't think clams were that up and up, but that is why I am still a resident, I suppose.

We had a great time and Kristi and I were able to sample a whole new world. Was also fun to meet the attendings at a more "informal" setting and also to meet their wives was fun.

The kids are enjoying the last few days of summer here, and enjoy riding their bikes a lot. Alec has been showing his skin to the neighbors because the shirts are just too itchy, dad. Anne has really gotten the hang of the walking thing, and is tromping all over the place. Her rash is still pretty bad and is just sort of kept at a dull roar with the steroid cream and other creams and dietary modifications. She has her moments of being pretty miserable and we all feel pretty bad for the little cutie. Kristi is getting near to the end of things with number 4 and we are happy so much is behind us and are praying the Lord will be with her during the next few months and that her body holds up through this pregnancy and delivery. We are very much looking forward to seeing Heather here for the birth, as well as some family just before and then after the birth as well.

Another week of leaf raking, bike riding, and digging out the snow clothes is in store for the Carne family in Akron, OH. God has been very good to us and we are more grateful than we can explain.

David "Pre" Carne

My running teammates are calling me Pre, after the famous runner from that other school in Oregon. That just shows you how little they know about running. I have been wanting to ask them what is so ferocious about a seed, but maybe I will wait until May or June, when the football season is way past us and maybe they won't get too excited.