Today I turn 33. I look at myself in the mirror and wonder how I got to look like this and who am I? I am sure this is the first of many similar questions on many future birthdays.

Today I turn 33. I look at myself in the mirror and wonder how I got to look like this and who am I? I am sure this is the first of many similar questions on many future birthdays.

Posted 1 year ago
1 note
A Day in the Life of an Interventional Radiology Resident 5:45 am  Alarm goes off.  Shower, dress, eat a quick breakfast (protein bar) and head out the door. It is freezing! Radio says 18 degrees. Brrrrrr. Get to the hospital and get my daily morning Starbucks. Walk along the long lobby feeling the frigid breeze as I pass by each door. Finally up to the vascular interventional radiology (VIR) suite. 6:30  Prepare for morning rounds. An intern is going to be presenting all of the patients today and he has never done it before. I give him some last minute help as we wait for 7:00. 7:00 Attending shows up and we run through all of the cases for the day. We look at the CT scans and MRI’s and figure out how we are going to attempt each case. Unfortunately the newbie who is running the list has left a lot of questions unanswered, so we will have to spend the first part of the morning calling a bunch of the ordering physicians to figure out what the heck they want us to do to their patients. 8:00 I page like 4 different people to get some answers.  I also talk to the technologists and give them vital info for each of the day’s patients. 8:30 First case of the day… it’s a portacath removal. A portacath is a small plastic triangular object that sits directly under the skin of the chest. It has a tube that runs under the skin and connects to the jugular vein. It is used to get chemotherapy. During this procedure the patients are wide awake because we only use local anesthesia. I like to talk to them while I am taking it out and hear about how they have survived cancer. Today the patient is a convict who is handcuffed to the gurney. He is very quiet and only tells me he had lymphoma. I make an incision with a scalpel and then spread away the tissue from the portacath with forceps. 5 minutes and it is out. 5 more minutes and I have sewn him back up. 9:00 A patient needs to be consented in the hallway. Before we can do any procedures, we have to discuss the risks, benefits and alternatives of the procedure and get the patient’s written consent. I say hello and introduce myself and start going through the spiel. This is a lady with renal failure on dialysis. Her current dialysis catheter is not working and she needs badly to be dialyzed. Her potassium is through the roof and she is starting to get chest pains. Just as I am beginning the talk she stops me and asks if she can have a warmer blanket. I say sure. I continue. She stops me again. She says that she recently had a bowel movement and would like to have her potassium rechecked. I say that doesn’t make sense, and we need to get the catheter in her soon so she can be dialyzed. She says she wants to talk to her kidney doctor before we do anything. I start to get frustrated. We are trying to help her get better, doing exactly what her kidney doctor wants and she wants to speak to him first. I catch myself and remember that this lady had renal failure and it must be very difficult. I excuse myself and call her kidney doctor to come by. 9:30 Second case… I scrub into a difficult case with one of the fellows. It is a man with a dialysis fistula. Instead of having a tube to be dialyzed through, he has a connection of an artery and a vein in his arm created by surgery. This is called a fistula. Unfortunately they get clotted off very often and need to be reopened with balloons. I stick a needle into his fistula and run a wire through that needle. Using x-rays I see the wire go centrally towards his heart. I take the needle out and place a short tube in over the wire. The wire comes out and I inject contrast while shooting x-rays to see what the veins look like. There is an area right near the heart that is narrow and is causing the flow to be decreased in the fistula, making dialysis difficult. We put a wire back in and run in a catheter over the wire that has a balloon on the end. Once we see the balloon is positioned in the narrow portion of the vein on xray, we inflate the balloon to expand the vein. This is called venoplasty. We do it in several other places. Just as we are finishing an attending pops in to tell me there is a patient in clinic that I need to see. I rip off my surgical gown and gloves,  grab my white coat and head for clinic. 10:30 Clinic patient is an elderly lady that was experiencing frequent nausea and abdominal pain. After an angiogram, she was diagnosed with having a narrowing in the artery that feeds blood to the bowel. She wasn’t getting enough blood to her bowel and that was causing her symptoms. One of my attendings threaded a wire through the narrow area and blew up a balloon to expand it. He put a stent there to keep it open. A stent is a small metal object that looks like a Chinese finger trap and it keeps vessels open. As soon as the procedure was over her symptoms went away and she has not had them since. This was a follow up appointment and she was doing very well. She was very excited that she could eat pizza again. 11:15 A second year resident is putting in a portacath. I supervise to make sure things go well. My pager goes off. Pediatric resident. I call him and he tells me there is an angry mother and father of a child who is supposed to have a procedure. They want to know what is going on. I look into it. This is a boy who had clot in his leg. He and his parents have come from 150 miles away to have a particular one of our attendings perform a procedure to break up his clot. But nobody told them that this attending is not going to be working for the next week. They have been waiting in the ICU for the past day and a half. I go to talk to them. 11:30 I walk in the room and the first thing the mom says to me is “Just be glad I am not packing heat!” Uh-oh. I spend the next 20 minutes getting yelled at for something I was not involved in. But I listen and repetitively apologize because I am representing our department to these people and they have a right to be upset. Fortunately, the doctor they came a very long way to see decides to come in on his vacation day to do this child’s procedure and by the end, mom and dad are no longer upset and are even laughing with me. 12:30 Third case… A  portacath removal and a dialysis catheter exchange on the same patient. Doing both procedures takes a while. In the middle, the technologist who is working in the room with me gets a phone outside in the control room. I watch her as she begins to cry and then starts wailing loudly. I am in shock. She runs out. I asked what happened. I am told that she just found out her father died. She was not expecting this news. I am again in shock and I start to tear up. I stand there for awhile trying to imagine what she feels like. Then a different technologist comes in the room and I finish the case. 1:30 Second clinic patient. This is a middle aged man with multiple sclerosis. He had his jugular veins opened up with balloons and stents. The swelling he had previously in his head and neck has gone away. He says he is doing well. He explains to me that he believes his MS symptoms are due to the narrowing of his neck veins. I have never heard this theory before. My attending explains that it is a new idea that is gaining popularity. I learn something new. 2:30 I finally eat lunch. 3:00 A patient in the holding area needs to be consented. I do that. 3:30 Fourth case… A lady with endometrial cancer has tubes running from her kidneys to her bladder so the growing tumor will not compress the ureters and prevent her from being able to urinate. She also has tubes running from the kidneys out her back connected to collection bags. She no longer needs these tubes. I take them out… very carefully. 4:30 A break in the action. I start my dictations. Every case needs a report saying exactly what we did. I start working on these so they will all be done by the time I go home. We have a voice recognition system so we don’t need to type. That’s good because I don’t type very well. 5:30 Last case. A lady that had a liver transplant is here for a biopsy. Her doctors are worried that her body is rejecting the transplant. By getting little pieces and sending them to the lab they can determine if there is rejection or not. I do the biopsy with ultrasound. I hold a probe against her ribs and guide a needle into her liver. I take several tiny worm-like pieces of liver and then stuff tiny pieces of porcine gelatin into the holes I made to stop the bleeding. The procedure goes very well and we have good music playing while doing it. 6:30 Finish up dictations. Just about to walk out the door when I get a page about a patient from earlier. It is the one that had the portacath out and the catheter exchanged. He is bleeding through his bandages. I walk over to the recovery area and place more sutures into this patient. I even use skin glue called Dermabond to close his surgical wounds. We get the bleeding to stop, but he will probably be back tomorrow with more bleeding. 7:15 pm   I walk back across the long lobby and into the cold. I will do it all again tomorrow.

A Day in the Life of an Interventional Radiology Resident

5:45 am  Alarm goes off.  Shower, dress, eat a quick breakfast (protein bar) and head out the door. It is freezing! Radio says 18 degrees. Brrrrrr. Get to the hospital and get my daily morning Starbucks. Walk along the long lobby feeling the frigid breeze as I pass by each door. Finally up to the vascular interventional radiology (VIR) suite.

6:30  Prepare for morning rounds. An intern is going to be presenting all of the patients today and he has never done it before. I give him some last minute help as we wait for 7:00.

7:00 Attending shows up and we run through all of the cases for the day. We look at the CT scans and MRI’s and figure out how we are going to attempt each case. Unfortunately the newbie who is running the list has left a lot of questions unanswered, so we will have to spend the first part of the morning calling a bunch of the ordering physicians to figure out what the heck they want us to do to their patients.

8:00 I page like 4 different people to get some answers.  I also talk to the technologists and give them vital info for each of the day’s patients.

8:30 First case of the day… it’s a portacath removal. A portacath is a small plastic triangular object that sits directly under the skin of the chest. It has a tube that runs under the skin and connects to the jugular vein. It is used to get chemotherapy. During this procedure the patients are wide awake because we only use local anesthesia. I like to talk to them while I am taking it out and hear about how they have survived cancer. Today the patient is a convict who is handcuffed to the gurney. He is very quiet and only tells me he had lymphoma. I make an incision with a scalpel and then spread away the tissue from the portacath with forceps. 5 minutes and it is out. 5 more minutes and I have sewn him back up.

9:00 A patient needs to be consented in the hallway. Before we can do any procedures, we have to discuss the risks, benefits and alternatives of the procedure and get the patient’s written consent. I say hello and introduce myself and start going through the spiel. This is a lady with renal failure on dialysis. Her current dialysis catheter is not working and she needs badly to be dialyzed. Her potassium is through the roof and she is starting to get chest pains. Just as I am beginning the talk she stops me and asks if she can have a warmer blanket. I say sure. I continue. She stops me again. She says that she recently had a bowel movement and would like to have her potassium rechecked. I say that doesn’t make sense, and we need to get the catheter in her soon so she can be dialyzed. She says she wants to talk to her kidney doctor before we do anything. I start to get frustrated. We are trying to help her get better, doing exactly what her kidney doctor wants and she wants to speak to him first. I catch myself and remember that this lady had renal failure and it must be very difficult. I excuse myself and call her kidney doctor to come by.

9:30 Second case… I scrub into a difficult case with one of the fellows. It is a man with a dialysis fistula. Instead of having a tube to be dialyzed through, he has a connection of an artery and a vein in his arm created by surgery. This is called a fistula. Unfortunately they get clotted off very often and need to be reopened with balloons. I stick a needle into his fistula and run a wire through that needle. Using x-rays I see the wire go centrally towards his heart. I take the needle out and place a short tube in over the wire. The wire comes out and I inject contrast while shooting x-rays to see what the veins look like. There is an area right near the heart that is narrow and is causing the flow to be decreased in the fistula, making dialysis difficult. We put a wire back in and run in a catheter over the wire that has a balloon on the end. Once we see the balloon is positioned in the narrow portion of the vein on xray, we inflate the balloon to expand the vein. This is called venoplasty. We do it in several other places. Just as we are finishing an attending pops in to tell me there is a patient in clinic that I need to see. I rip off my surgical gown and gloves,  grab my white coat and head for clinic.

10:30 Clinic patient is an elderly lady that was experiencing frequent nausea and abdominal pain. After an angiogram, she was diagnosed with having a narrowing in the artery that feeds blood to the bowel. She wasn’t getting enough blood to her bowel and that was causing her symptoms. One of my attendings threaded a wire through the narrow area and blew up a balloon to expand it. He put a stent there to keep it open. A stent is a small metal object that looks like a Chinese finger trap and it keeps vessels open. As soon as the procedure was over her symptoms went away and she has not had them since. This was a follow up appointment and she was doing very well. She was very excited that she could eat pizza again.

11:15 A second year resident is putting in a portacath. I supervise to make sure things go well. My pager goes off. Pediatric resident. I call him and he tells me there is an angry mother and father of a child who is supposed to have a procedure. They want to know what is going on. I look into it. This is a boy who had clot in his leg. He and his parents have come from 150 miles away to have a particular one of our attendings perform a procedure to break up his clot. But nobody told them that this attending is not going to be working for the next week. They have been waiting in the ICU for the past day and a half. I go to talk to them.

11:30 I walk in the room and the first thing the mom says to me is “Just be glad I am not packing heat!” Uh-oh. I spend the next 20 minutes getting yelled at for something I was not involved in. But I listen and repetitively apologize because I am representing our department to these people and they have a right to be upset. Fortunately, the doctor they came a very long way to see decides to come in on his vacation day to do this child’s procedure and by the end, mom and dad are no longer upset and are even laughing with me.

12:30 Third case… A  portacath removal and a dialysis catheter exchange on the same patient. Doing both procedures takes a while. In the middle, the technologist who is working in the room with me gets a phone outside in the control room. I watch her as she begins to cry and then starts wailing loudly. I am in shock. She runs out. I asked what happened. I am told that she just found out her father died. She was not expecting this news. I am again in shock and I start to tear up. I stand there for awhile trying to imagine what she feels like. Then a different technologist comes in the room and I finish the case.

1:30 Second clinic patient. This is a middle aged man with multiple sclerosis. He had his jugular veins opened up with balloons and stents. The swelling he had previously in his head and neck has gone away. He says he is doing well. He explains to me that he believes his MS symptoms are due to the narrowing of his neck veins. I have never heard this theory before. My attending explains that it is a new idea that is gaining popularity. I learn something new.

2:30 I finally eat lunch.

3:00 A patient in the holding area needs to be consented. I do that.

3:30 Fourth case… A lady with endometrial cancer has tubes running from her kidneys to her bladder so the growing tumor will not compress the ureters and prevent her from being able to urinate. She also has tubes running from the kidneys out her back connected to collection bags. She no longer needs these tubes. I take them out… very carefully.

4:30 A break in the action. I start my dictations. Every case needs a report saying exactly what we did. I start working on these so they will all be done by the time I go home. We have a voice recognition system so we don’t need to type. That’s good because I don’t type very well.

5:30 Last case. A lady that had a liver transplant is here for a biopsy. Her doctors are worried that her body is rejecting the transplant. By getting little pieces and sending them to the lab they can determine if there is rejection or not. I do the biopsy with ultrasound. I hold a probe against her ribs and guide a needle into her liver. I take several tiny worm-like pieces of liver and then stuff tiny pieces of porcine gelatin into the holes I made to stop the bleeding. The procedure goes very well and we have good music playing while doing it.

6:30 Finish up dictations. Just about to walk out the door when I get a page about a patient from earlier. It is the one that had the portacath out and the catheter exchanged. He is bleeding through his bandages. I walk over to the recovery area and place more sutures into this patient. I even use skin glue called Dermabond to close his surgical wounds. We get the bleeding to stop, but he will probably be back tomorrow with more bleeding.

7:15 pm   I walk back across the long lobby and into the cold. I will do it all again tomorrow.

Posted 1 year ago
7 notes
Thanksgiving Call My wife says I should tweet about what I do all day in the hospital. I say that’s crazy. First, I don’t have time and second, it’s not that interesting and I don’t think people would want to know. So I am creating a Tumblr blog of the day in case anyone is interested… 7:00 am. Happy Thanksgiving. I jump out of bed with excitement as I anticipate 24 hours in the hospital (sarcasm). I am distressed when I realize my white coat is missing. Oh well, I will have to make do. Grab some water and a protein bar and I am out the door. 8:00 am. Walk in the hospital. I say hello to the resident that is leaving and grab the pager. Fortunately, he has no disasters to report. I get a piece of scratch paper and write down all of the phone numbers I need for the day. This piece of paper is my most valuable possession for the day and must not be lost. I turn on my pedometer app on my iphone and start my walking rounds. First stop, interventional radiology. En route the pager goes off and there is a text message from an internal medicine guy about a patient that needs an upper GI study to make sure his bowel isn’t twisted. The patient is eating and doesn’t not appear to be completely blocked up, so I don’t think that this study needs to be done on thanksgiving. However, if I do it, maybe he will be able to leave the hospital a day sooner and Obama will be proud of me for saving medicare dollars. Plus, I don’t feel like arguing. So I agree to it. Once in the interventional radiology suite, I see that there is a patient who needs a drain put in to an abscess in her pelvis tomorrow. So today, I will have to go see her to talk to her about the procedure and get her written consent to do it. While I am preparing the paperwork, the pager goes off. It is the MRI technologist telling me that there are requests for three inpatient MRI’s and I need to tell her how I want them done. I tell her that I am in the middle of something and I will stop by the MRI area in a little bit to get everything squared away. 8:40 I am walking through the lobby on the way to see the woman for the pelvic abscess consent. I call the interventional fellow to tell him that there are no cases that need to be done today (yet). He offers to bring me some Thanksgiving food later on. Very nice of him. Get to the abscess patient’s room. I announce who I am and what I came to talk to her about. She immediately starts crying. She had this procedure done before and it was very uncomfortable for her. She is extremely anxious about having it done again. She blames radiology for the drain not working last time. My pager goes off. It’s the technologist telling me she got an order for that upper GI study.  I excuse myself from the room to call her back. When I return a nurse is there giving the patient an anxiety pill. I am grateful. I continue on with the consent process trying to be as sensitive to this patient’s feeling as possible. She signs the form and I move on. I head downstairs to the MRI suite. I have yet to get the coffee I meant to stop for. Hopefully soon. I walk in and say hello and start researching the MRI requests so that we do the right type of studies for these patients. While I am doing this the tech brings me another request to research… fine. While researching, the pager goes off.  A baby with possible appendicitis. Come read the ultrasound. Ok, be in there in a few minutes. I go. I read the ultrasound and then I do the upper GI. Both normal. 10:00 Pager. There is a lady in the intensive care unit who is bleeding in her throat after having a breathing tube placed. I gather all of the information and take it to the fellow to discuss whether or not this case is urgent enough to interrupt our attending’s Thanksgiving. The pager goes off. There is a 3 year old in the emergency room who can’t keep any food down. Can I do an upper GI… you bet. 12:00 Woman who had breast cancer and a breast reconstruction now is having pain in the mastectomy site. Ultrasound shows no abscess. Just post surgical fluid. Pager goes off. Women in the intensive care unit needs dialysis, but the ICU team cannot get a dialysis catheter into one of her veins. She needs dialysis so badly that she is incoherent. I go see her. Sure enough, zonked. I get consent for the procedure from her husband. I call in the technologist, the fellow and the attending. As I wait for them to come, I get a few sweet moments to watch football. Then the pager… vaginal bleeding in the ER. Ultrasound needs to be read. 2:00 Interventional team has come in and is getting the lady a catheter for dialysis. I am sorting through a stack of interventional requests to determine which ones are urgent and which ones can wait. I make up neat little packets for each one. Consent form, anesthesia assessment and order form. I mark which room each patient is in on the top of each packet. I plan my route through the hospital.  6 bed tower, 6 women’s hospital, 6 neurosciences, MICU… 4:00 Phone call from the neuro fellow who is now home. “Can you do me a favor?” Sure… Fill out paperwork for general anesthesia for neuro procedure tomorrow and then page the anesthesiologist to discuss it. Sure… no problem. Oh yeah… I forgot to bring the barium to the patient who is getting a gastric tube tomorrow.  At this point I am feeling quite lazy, so I tube it to the ward. Beats walking all the way to the neuro hospital. 6:00 I sit down to my thanksgiving dinner. Turkey, stuffing, mashed potatoes, green bean casserole and apple crisp. All for my little red $8 holiday voucher. I watch the football game while I eat and eavesdrop on a family eating thanksgiving dinner together in the hospital. They have a loved one who is sick here. But they are together. 7:00 Pager goes off. Man fell from 14 feet- two weeks ago…? So why is he coming in now? He has abdominal pain. Turns out his son was playing around and punching him in the stomach. His spleen was lacerated from the fall, but now after the horseplay it is actively hemorrhaging. If it does not get fixed, he might die. So I call back the interventional crew. They are not happy, but everyone understands the importance. Pager goes off. MRI of a spine from a man who has metastatic cancer and cannot move his legs. 9:00 Request comes through for a lumbar puncture. There is a 24 year old who attempted suicide by shooting himself but survived. Now he is in a vegetative state. His primary team thinks he might have meningitis. They have tried several times to get some spinal fluid, but cannot do it. So they ask me to do it with x-ray guidance. I call for the patient to come down to the radiology department. In the mean time, I call the patient’s mother on the phone to get her consent to do the procedure. As I talk to her, I try to imagine how she feels. I keep coming back to the fact that she must feel tremendous guilt. 9:30 Patient arrives. With some help, we transfer him on to the x-ray table. I get a needle into his back and the spinal fluid seeps out slowly. Throughout the whole time, all he does is twitch his leg. There is also an occasional moan. Because the fluid is so slow, it takes 45 minutes to collect 10 ml. I stand there with the technologist and exchange war stories. He was in the army. 10-12:00 Ultrasound, ultrasound, MRI, ultrasound 12-1:30 Sleep 1:30-2:30 Ultrasound x 3 2:30-4:00 Sleep 4:00 Ultrasound, help lower level resident with CT 5-7:00 Sleep 7-8:00 Pass on info from previous day to oncoming resident. Get last minute consent for abscess drainage Thanksgiving call.

Thanksgiving Call

My wife says I should tweet about what I do all day in the hospital. I say that’s crazy. First, I don’t have time and second, it’s not that interesting and I don’t think people would want to know. So I am creating a Tumblr blog of the day in case anyone is interested…

7:00 am. Happy Thanksgiving. I jump out of bed with excitement as I anticipate 24 hours in the hospital (sarcasm). I am distressed when I realize my white coat is missing. Oh well, I will have to make do. Grab some water and a protein bar and I am out the door.

8:00 am. Walk in the hospital. I say hello to the resident that is leaving and grab the pager. Fortunately, he has no disasters to report. I get a piece of scratch paper and write down all of the phone numbers I need for the day. This piece of paper is my most valuable possession for the day and must not be lost. I turn on my pedometer app on my iphone and start my walking rounds.

First stop, interventional radiology. En route the pager goes off and there is a text message from an internal medicine guy about a patient that needs an upper GI study to make sure his bowel isn’t twisted. The patient is eating and doesn’t not appear to be completely blocked up, so I don’t think that this study needs to be done on thanksgiving. However, if I do it, maybe he will be able to leave the hospital a day sooner and Obama will be proud of me for saving medicare dollars. Plus, I don’t feel like arguing. So I agree to it.

Once in the interventional radiology suite, I see that there is a patient who needs a drain put in to an abscess in her pelvis tomorrow. So today, I will have to go see her to talk to her about the procedure and get her written consent to do it. While I am preparing the paperwork, the pager goes off. It is the MRI technologist telling me that there are requests for three inpatient MRI’s and I need to tell her how I want them done. I tell her that I am in the middle of something and I will stop by the MRI area in a little bit to get everything squared away.

8:40 I am walking through the lobby on the way to see the woman for the pelvic abscess consent. I call the interventional fellow to tell him that there are no cases that need to be done today (yet). He offers to bring me some Thanksgiving food later on. Very nice of him.

Get to the abscess patient’s room. I announce who I am and what I came to talk to her about. She immediately starts crying. She had this procedure done before and it was very uncomfortable for her. She is extremely anxious about having it done again. She blames radiology for the drain not working last time. My pager goes off. It’s the technologist telling me she got an order for that upper GI study.  I excuse myself from the room to call her back. When I return a nurse is there giving the patient an anxiety pill. I am grateful. I continue on with the consent process trying to be as sensitive to this patient’s feeling as possible. She signs the form and I move on.

I head downstairs to the MRI suite. I have yet to get the coffee I meant to stop for. Hopefully soon. I walk in and say hello and start researching the MRI requests so that we do the right type of studies for these patients. While I am doing this the tech brings me another request to research… fine. While researching, the pager goes off.  A baby with possible appendicitis. Come read the ultrasound. Ok, be in there in a few minutes. I go. I read the ultrasound and then I do the upper GI. Both normal.

10:00 Pager. There is a lady in the intensive care unit who is bleeding in her throat after having a breathing tube placed. I gather all of the information and take it to the fellow to discuss whether or not this case is urgent enough to interrupt our attending’s Thanksgiving. The pager goes off. There is a 3 year old in the emergency room who can’t keep any food down. Can I do an upper GI… you bet.

12:00 Woman who had breast cancer and a breast reconstruction now is having pain in the mastectomy site. Ultrasound shows no abscess. Just post surgical fluid. Pager goes off. Women in the intensive care unit needs dialysis, but the ICU team cannot get a dialysis catheter into one of her veins. She needs dialysis so badly that she is incoherent. I go see her. Sure enough, zonked. I get consent for the procedure from her husband. I call in the technologist, the fellow and the attending. As I wait for them to come, I get a few sweet moments to watch football. Then the pager… vaginal bleeding in the ER. Ultrasound needs to be read.

2:00 Interventional team has come in and is getting the lady a catheter for dialysis. I am sorting through a stack of interventional requests to determine which ones are urgent and which ones can wait. I make up neat little packets for each one. Consent form, anesthesia assessment and order form. I mark which room each patient is in on the top of each packet. I plan my route through the hospital.  6 bed tower, 6 women’s hospital, 6 neurosciences, MICU…

4:00 Phone call from the neuro fellow who is now home. “Can you do me a favor?” Sure… Fill out paperwork for general anesthesia for neuro procedure tomorrow and then page the anesthesiologist to discuss it. Sure… no problem.

Oh yeah… I forgot to bring the barium to the patient who is getting a gastric tube tomorrow.  At this point I am feeling quite lazy, so I tube it to the ward. Beats walking all the way to the neuro hospital.

6:00 I sit down to my thanksgiving dinner. Turkey, stuffing, mashed potatoes, green bean casserole and apple crisp. All for my little red $8 holiday voucher. I watch the football game while I eat and eavesdrop on a family eating thanksgiving dinner together in the hospital. They have a loved one who is sick here. But they are together.

7:00 Pager goes off. Man fell from 14 feet- two weeks ago…? So why is he coming in now? He has abdominal pain. Turns out his son was playing around and punching him in the stomach. His spleen was lacerated from the fall, but now after the horseplay it is actively hemorrhaging. If it does not get fixed, he might die. So I call back the interventional crew. They are not happy, but everyone understands the importance. Pager goes off. MRI of a spine from a man who has metastatic cancer and cannot move his legs.

9:00 Request comes through for a lumbar puncture. There is a 24 year old who attempted suicide by shooting himself but survived. Now he is in a vegetative state. His primary team thinks he might have meningitis. They have tried several times to get some spinal fluid, but cannot do it. So they ask me to do it with x-ray guidance. I call for the patient to come down to the radiology department. In the mean time, I call the patient’s mother on the phone to get her consent to do the procedure. As I talk to her, I try to imagine how she feels. I keep coming back to the fact that she must feel tremendous guilt.

9:30 Patient arrives. With some help, we transfer him on to the x-ray table. I get a needle into his back and the spinal fluid seeps out slowly. Throughout the whole time, all he does is twitch his leg. There is also an occasional moan. Because the fluid is so slow, it takes 45 minutes to collect 10 ml. I stand there with the technologist and exchange war stories. He was in the army.

10-12:00 Ultrasound, ultrasound, MRI, ultrasound

12-1:30 Sleep

1:30-2:30 Ultrasound x 3

2:30-4:00 Sleep

4:00 Ultrasound, help lower level resident with CT

5-7:00 Sleep

7-8:00 Pass on info from previous day to oncoming resident. Get last minute consent for abscess drainage

Thanksgiving call.

Posted 1 year ago
2 notes
Nov 14 in LA… The Santa Anas are blowing and we might see 80 degrees. Beats shoveling the driveway.

Nov 14 in LA… The Santa Anas are blowing and we might see 80 degrees. Beats shoveling the driveway.

Posted 1 year ago
This is my mother. She is at a time in her life when she should be thinking about retirement, and she surely deserves it. Instead, she continues on at work, miserable commute and all, and is grateful to be employed. I admire her gratitude and her ability to see the bright side. I hope for her happiness.

This is my mother. She is at a time in her life when she should be thinking about retirement, and she surely deserves it. Instead, she continues on at work, miserable commute and all, and is grateful to be employed. I admire her gratitude and her ability to see the bright side. I hope for her happiness.

Posted 1 year ago
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I came out to LA to meet up with Lara on her Making Things Happen tour. Los Angeles is my home town. My parents and closest friends from childhood still live here. There is a lot of emotion associated with coming back. The sights and sounds bring back feelings from my former life, most of which I purposely left behind. It’s coincidental that Lara’s workshop is all about helping people face their fears and I have come here reluctantly facing my own. I downloaded the Hipstamatic app and here are the results of my tinkering.

I came out to LA to meet up with Lara on her Making Things Happen tour. Los Angeles is my home town. My parents and closest friends from childhood still live here. There is a lot of emotion associated with coming back. The sights and sounds bring back feelings from my former life, most of which I purposely left behind. It’s coincidental that Lara’s workshop is all about helping people face their fears and I have come here reluctantly facing my own.

I downloaded the Hipstamatic app and here are the results of my tinkering.

Posted 1 year ago
Just spent the evening with Lara’s grandmother. She has an amazing will and is an inspiration for me.

Just spent the evening with Lara’s grandmother. She has an amazing will and is an inspiration for me.

Posted 1 year ago

Day 10: 4:15 am, a knock at the door. Chantal has woken up to make sure we make our flight. She is so dedicated to her job and our happiness, it is just truly impressive. A man named Smile drives us through the nearby capital city of Castries to the small regional airport. We check-in and they do not have us on their list, but Lara shows them her confirmation number and they add us. The plane is delayed for an hour and a half and we sit. Chantal stays with us the whole time.  Truthfully, at this point, I am feeling less than stellar probably due to the drinks in the pub from the night before.

The plane finally arrives and we say a sad goodbye to Chantal. We promise to keep in touch and talk about how we will become friends on Facebook and follow each other on Twitter, etc. One last hug and she is gone. We walk out on the tarmac and board a prop plane in which we sit facing backwards for a short flight to Barbados. Another 30 minute wait and we are off to Trinidad.

We go through customs and the Trinidadian agent is confused because Lara filled out our form as head of household. It shouldn’t be that much of a stretch because they do have a female prime minister.

We have a 4 hour lay-over before boarding for Miami. Throughout those 4 hours, the memories from the past week swirl through my head ending with concern for our new friends and their neighbors. It is really hard to believe that everything I have written about has actually happened and it seems more like a dream than reality.

We board the jumbo-jet to Miami and make it through customs again with just enough time to spare to get some dinner and board our flight to Raleigh. During the final leg of our 18 hours of traveling, Lara and I reflect about what we have learned on the trip. We both agree that best part of the trip has not been the luxurious accommodations, the gourmet food, the breathtaking views or the island adventures, but rather the people we have encountered along the way. We also agree that the best time is had when you are amongst friends no matter what the surroundings. And finally being in St. Lucia for the hurricane has reminded us of how much we have, how quickly life can change and how petty most of our hardships are on a day to day basis.

Our plane touches down, and I cannot believe we have made it home. I think about the other guests who are still stranded on the island.

Now that we are home, I sincerely hope the memories and lessons from our trip will stay with us for some time to come. I know it will be a challenge as we return to our normal routines, so I have already downloaded some Soca music and plan to wear my wooden bead necklace bought from a man named Sunshine Biscuit to remind me. Lara has been really great about keeping in touch with Chantal and donating money to the Sandals Foundation to aid hurricane victims while trying to get others to do the same. She amazes me with her heartfelt generosity. It feels like this trip has really changed us as a couple and as individuals and I am excited about the change.

In parting, I would like to say a few wise words we learned in St. Lucia: Yeah mon, no pressure, no problem, good vibes, rat-a-tat-tat, by law! and coumbaya. What does that last part mean? I still have no idea.

Posted 1 year ago

Day Nine: Today is the day we are supposed to be going home, but after yesterday’s weather it seems very unlikely. But good news… the gym is still open!

After we shower, we walk down the road to the main lobby. The sights are shocking. There are downed trees everywhere, the pools are brown and overflowing, there are several golf carts submerged in the ocean with only the wheels visible. The buildings seem to all be intact with the exception of small pieces of roofing and segments of gutter that are on the ground or in the pool. The Sandals employees are hard at work clearing debris. Many carry machetes and chop up trees blocking the road. We smile at each person we see and express our gratitude for their hard at work.

There is a throng of anxious guests in the hotel lobby. Many are supposed to leave today and others were supposed to leave yesterday. There is a sign announcing a meeting later that morning in which the latest news from the airlines will be conveyed. The buzz is that the road to the airport is not drivable with several bridges collapsed. Another person says part of the airport roof had blown off. It seems the southern side of the island where the international airport is located had been hit worse. We eat breakfast waiting for the meeting to begin.

An hour later with the lobby packed with nervous guests, a lady with a Dutch accent announces that all flights today are canceled. She than says that our flight has been rescheduled by the airline for one week from now. What?!! I mean another week here would be great, but I have to return to normal life. Lara is even more concerned. She is scheduled to lead a workshop in Houston in four days and has many people counting on her to be there.

There is where Lara really shines. I see the wheels start to turn in her head and her fingers start tapping  feverishly on her iPhone. In a matter of minutes she has checked every airline, but there is no apparent way off of the island. I see her start to become distressed. Then, Chantal mentions that we could possibly take an island hopper to Trinidad and from there fly to Miami. One of the managers is kind enough to let us use his office to figure this out. I say us, but in truth I am sitting outside having a drink playing Angry Birds. Honestly, Lara is much better at figuring travel logistics than me so I just pass the time, knowing that my fate is in good hands.

After about an hour Lara has booked us on a plane that leaves from the small local airport and goes to Barbados then to Trinidad, followed by flights to Miami and then to Raleigh. I can’t believe it.

We spend the rest of the day enjoying Chantal’s company knowing that we are leaving tomorrow. Guests have returned to near-normal behavior lounging around the pool, drinking fruity drinks. The only peculiar part is that since the normal resort activities are shut down, board games are being played all around us. Connect Four, Jenga, Pictionary, Balderdash…

We enjoy one last buffet dinner and then have a few drinks in the pub. The TV is back on and the World Series and football are being shown. We chat with some of the other guests and turn in early because we need to be up before dawn to catch our flights.

Posted 1 year ago

Day Eight: At 6:30 am our butler phone starts making noises. It is a text message from Chantal telling us that our plans to spend the day at the beach are going to have to be canceled because there is a hurricane alert on the island. What? A hurricane? This island hasn’t been hit by a hurricane in almost 30 years… This must just be a false alarm. I can hear it raining outside, but it is nothing extraordinary. I go back to sleep. I don’t think Lara ever woke up.

A couple hours later I wake to the loud howl of the wind outside our window. I peek through the curtains and I am amazed at the sight. The rain is coming down sideways and trees are swaying at severe angles. There are large swells in the ocean and leaves and other debris are swirling in the air. Lara walks over and looks and immediately I recognize a fear in her eyes as she recalls previously hurricanes that devastated Pensacola, FL where she is from.

Lara flies into action securing the outdoor furniture so it can’t be blown into our windows. We wait it out for a while, and although it is quite windy it does not seem to be intensifying, so we do what we always do, go to the gym. We stop at the restaurant on the way back and have some breakfast. As we sit there and look out at the storm, I amazed that the electricity and TV signal remain. I would have thought it would have been long gone.

We return to our room for lack of anything better to do and wait for the storm to pass. About mid morning it begins to intensify and there is wind like I have never seen before. We contact Chantal and make sure she is ok. She has gone home and reports that her electricity is out and she has no running water. Fortunately she made it to the store that morning through heavy traffic and stocked up on water and food.

The rest of the day is spent in our room staring outside in amazement. Impossibly fierce winds, angry rain, loud crashing and chaotic debris. I think about those shanties we saw in Canaries the day before. All I can do is hope that the people are safely sheltered. Lara and I are both somber as the storm climaxes and starts to wane. Thanks to the hotels separate power and water supply we do not have to experience the challenges that the rest of the island face.

As the afternoon gets late, the storm dies down and we venture out to see the damage and try and find some food. We walk to the lobby and see Ficus and another butler Roger who are doing their best to stay cheerful for guests, but in their eyes, I can see concern for their families and homes. I ask if they have been able to check in, but they say the phone lines are down. I try to think of what I can do for these guys in this trying time, and all I can think of is to show concern and to try and make them smile with a joke.

Amazingly the restaurant is open and there is an unexpected array of dishes on the buffet. Lara and I can’t believe that this meal was prepared despite the storm. Again, we can see deep seeded concern in the eyes of all of the employees. It makes us uncomfortable to be waited on by these people who are unsure about the welfare of their families, but we are not sure what to do about that. All we can think to do is ask everyone how they are doing and if they have been able to get word from home.

There is one disturbing moment during dinner when we hear a guest request to speak to a manager because there is no lobster or champagne being served. Lara’s face contorts in disgust and she actively has to hold her tongue to keep angry words from spewing. We leave the restaurant not wanting to be near such insensitivity a second longer.

The night is spent in the downstairs bar. We sit with Ron one of the “playmakers” and Joanie a bartender and hear their stories of working for 18 hours straight. They will sleep here tonight because the roads home are impassable. Despite their predicaments their spirits remain high and I admire them for it.

We make the best of the evening bringing an iPod player with speakers into the bar from our room and playing Bob Marley’s greatest hits. The bar is still well stocked and Joanie keeps the drinks coming. We talk with everyone in the bar and laugh about the karaoke girl from the night before and the ungrateful fool from dinner. There is a unique energy in the room. It is the high experienced by people who amidst chaos and destruction are just grateful to be alive and with each other.

Posted 1 year ago