Black Friday...

My mother and I had a favorite tradition on Black Friday, the day after Thanksgiving. We would get up at 5 in the morning, dress warmly, and head off for the mall. We'd get the front line parking space and sit in the car waiting for 05:55 when we'd go stand at the door and walk in with the rest of the crowd.

We had our list. We'd do our shopping. And, at 08:30, we'd be done. While the rest of the cars were circling the parking lot, my mother and I would be allowing some lucky soul to take our spot as we headed off for breakfast. We might hit a specialty store or two after breakfast. Maybe go to a movie. Pick up something to snack on. Then come home and watch TV while eating leftovers from the night before.

We haven't done this in many years, but every Thanksgiving I still ask my mother if she'd like me to pick her up early to go shopping. She always laughs and asks what plane I'm landing on and is Starbuck's going to open early as well.

This year, I shared my Thanksgiving with family and friends, not my family and not my friends, but nonetheless, a warm loving atmosphere and good food throughout.

I do want to share a poignant vignette shared by one of my attendings yesterday. He stated that they had received a small child in cardiac arrest. The E.D. staff did their best, but there was no resuscitating the child. The family was in hysterics, and this increased as more family members arrived. The child was the youngest of three. It appeared to be a SIDS death.

The family stated that they had never heard of "Back to Sleep," and that the child was always placed to sleep on their stomach, covered by blankets. They didn't know any other way.

My attending stated the obvious, that a child's death is always hard on the staff. He shared that the way he dealt with it was by personally carrying the child down to the morgue. Which he did with this child. No cloth-covered gurney for these smallest of patients.

Tonight I'll be going in for a string of overnight shifts, and I'll be hoping that we're not "in the black" in the E.D. We'll see.

Permanent Ink

I can remember as a teenager having my mother tell me repeatedly that decisions that I made came with consequences. This continued through college as she reminded me on a weekly basis that only I was responsible for my actions. In light of this, I was often not a spontaneous person, and in some ways, this has continued into my adult life. Take tattoos for example...

I always thought about getting a tattoo. The fun was in trying to decide what to get and where to put it. I remember in the first season of "Road Rules" one of the contestants who was a pre-med student got a tattoo of Kermit the Frog wearing a stethoscope on her hip. I thought that was kind of cool, especially when I got into med school. But then, I started thinking... what would that tattoo look like when I was 80? Would that still be cool?

I trained at the V.A. during med school, so I had a great reference of tattoos as the WWII vets were mostly my patients. Following them, the Korean War and Vietnam Vets. A lot of them tattooed. You get to see the effects of time. So I continued to ponder.

As a fourth year medical student working one of my first shifts on my E.D. rotation, I remember a patient who came in. She was in her 80's and as I examined her, I noticed that her tattoos seemed especially bright. I commented to my senior resident, and they too wondered how the tattoos could have stayed so bright all of these years. Finally, before discharging her, I asked her about her tattoos. She smiled as she held out her arms. She told us that she had always wanted to get a tattoo, but that her husband had always been opposed. She said that when he died, about a year later she got her first tattoo. She now had her second. And, this had been within the last two years.

I was thinking about my own permanent ink fancies recently when I had a young female patient who came in with a complaint of "bloody urine." After a few minutes of discussion, "bloody urine" turned into abdominal pain, then she got teary as she described that she was really having pelvic pain. As in most cases, I asked about her sexual activity, and she admitted that she had a single boyfriend but that they didn't use protection because she was trying to get pregnant.

I went through my usual abdominal exam, noting a fresh new tattoo that started above her bikini line and wrapped around her waist. I then explained that I would have to do a pelvic exam because she could have an infection causing her problems. She became more teary as I performed the pelvic, and it became clear that she was having cervical motion tenderness, one of the signs for pelvic inflammatory disease, a process most often caused by an STD.

She started to cry as I explained what I felt was causing her pain, what medications I would be giving to her, and further instructions for her care. She then admitted that her boyfriend had cheated in the past, and she was feeling very stupid because she had just gotten the tattoo. That's when I took a second look and noted a name as part of the design. It's not my place to counsel patients on how to lead their lives, but I silently hoped that the ink would be the only consequence of her relationship with this other person.

I still think about tattoos from time to time... maybe when I'm 80. Now, where would I put it?? Where are yours?

And, Now a Word From Our Sponsor...

I am going to say thank you to Donna at "Dust Bunny Protector" who awarded me the Marie Antoinette Award! It is given to people who we feel blog about "Real Life."

I started my blog in order to keep in touch with family and friends since I have been moving all over the country for the last 5 years. What I never expected was to make a whole new circle of friends who also blog. I really like coming home and reading about others' happenings.

I tried to find people who hadn't been nominated previously, and I hope you enjoy my choices as much as I enjoy reading them:

In no particular order:
Jeanie at "Genii in the Lakes"
Lisa at "Life on a Bison Farm"
Bethe at "Palm Harbor"
Winivere at "Woman in the Glass Box"
Frankie and Bella at "Twin Speak"
Betty at "A Corgi in Southern California"
and
De at "Where Do I Go From Here?"

Thank you for sharing a little piece of yourself and making all our lives just a little better!

Veronica

And Now, Back to the Drama

I think I have mentioned on several occasions that one of the things I like most about working in the E.D. is the patient's back story. Their presenting complaint for the most part is routine, but the way they came to be in the E.D. usually is interesting. That's why I like ECMC. Patients there are not boring by any respect. Every day is like a soap opera; there's a plethora of drama for everyone to enjoy. And, it's played out right in front of you.

So lets get started on today's episode of "As the E.D. Turns." Questions I asked the patient are in red.

Dx: Sickle Cell Crisis - "I think I am dehydrated because I have been drinking anything I can get my hands on because I am upset about my fiancee who got really sick from her diabetes and is now in a coma, and I drink from the time I get home from seeing her until I can't drink any more. And, I am changing doctors and my current doctor only gave me enough pills for a few days because they didn't know me, and now I am out of my oxycontin's and dilaudids, and now I am having a lot of pain, and I think I need a shot of something."

Dx: Constipation - "I've been having abdominal pain for the last two months, and I've been to three different hospitals. My doctor won't even see me because she's only available on Mondays, and I was having abdominal pain, but I didn't have severe pain until today, and I knew that I couldn't wait until Monday, but then she wouldn't see me anyway because I always have to go see the nurse practitioner, and I never get to see the doctor." Why didn't you go back to the last hospital that saw you and has all your tests and records? "Well, I didn't like them there. They told me that nothing was wrong, and that I was just constipated and then they admitted me and then I felt better but then my doctor didn't work there so then I wouldn't have my own doctor, and this pain is so bad and I didn't want to wake up my brother because he sleeps in the room above me but he was so worried about me and what are you going to do to fix me?"

Dx: 4th metatarsal fracture - "Well I was fighting this girl and then she suddenly came out and stepped on my foot, and I haven't been able to walk on it ever since." Well, how have you been getting around? "I've had to crawl on the floor."

Dx: Overdose and suicidal ideations - "Well, one of my kids had a scratch so someone called CPS, and then they said because of the bruises that I would have to go to court, and then my husband said that (mumbles something incoherently) so then I decided that I couldn't live in a world without my children and I took all the pills."

Dx: Multiple stab wounds - "I was fighting with this girl and then all of a sudden I felt this pain, and then I realized that I was bleeding and I couldn't believe that she would do that."

Oh... and the Award for highest blood sugar I've ever seen in a fully conscious patient goes to my homeless man who presented with a blood sugar of 1048. Yeah, that's right! Four digit blood sugar.(btw normal is around 100, most doctors recommend diabetics keep theirs below 160).

And, in my "Art Imitates Life" section: Tonight's episode of Grey's Anatomy had a storyline where one of the doctors Callie suffers a broken nose after getting clocked by the elbow of a patient... during a code today, I was placing a central line in the patient's femoral artery (in the thigh) when I bent over to get something from the kit I had to place on a chair. I was just about to turn back to the patient when one of the nurses toward the head of the bed turned suddenly and clocked me with her elbow. Not enough to daze me, but I did have to suffer through CT and subdural jokes for a part of the shift.

You have to watch out... life moves pretty fast in the E.D. Oh. yeah!

The Boy and Girl Who Cried "Wolf"

There are some patients that drive you crazy. Usually, they are the ones that come into the emergency department with a "I've had chest pain/cough/stomach pain/leg pain/back pain, etc for the last 6 weeks/months/etc. and I thought I should have it checked out." When you ask if they've ever talked to their primary physicians about the problem, they say "I forgot," "He's looked into it and hasn't found anything yet," or "No, I was going to mention it on my next visit, but I thought I should get it checked out today."

It's hard not to discount those patients. Not to be mean, but seriously, like we always ask, "And, what about today made it so bad you had to come to the Emergency Department to be seen?" Two patients that I saw during my last shifts at Suburban are good examples of how even the simplest cases can surprise you.

We'll call the first patient Frank. Frank is around 72 and has dementia. He also had a heart attack about 10 years ago, underwent bypass surgery, and since then has complained on a regular basis about having chest pain. He was brought into the ED in the morning after having been found on the floor of his board and care facility lying in front of the elevator. He told paramedics that he didn't feel well and needed to lie down.

His daughter was called, and he complained to her about the chest pain. She told him that they would "go out to lunch" which she later told me was her way of "distracting him" from his usual rant about having chest pain. She explained that he had been evaluated time and time again for complaint about chest pain, and that all of the tests had been negative so far.

Still, he insisted on coming to the ED, and since EMS had already been called, they brought him in. So, we did our thing, evaluating him for the "chest pain" we assumed he didn't have, and expecting to discharge him after talking to his primary care physician. The first EKG didn't look very suspicious but still had some changes that made it just enough dissimilar to a prior EKG that we were more concerned than previously thought.

You can guess what was happening... his next EKG showed a major heart attack, and an EKG taken about 15 minutes later was worse still. We immediately contacted cardiology, and the patient was transported to another hospital to get angiography. When I called later that same day, a colleague told me that the patient was in the cardiac care unit. I'll find out tomorrow how he did. Needless to say, the daughter felt guilty, we felt guilty, and the patient almost suffered because of it.

The next patient we'll call Thelma. I saw Thelma on my last morning at Suburban. She is a sweet 80 year old lady who came into the "non-urgent" part of the E.D. that I picked up because I wanted an easy last day. Her complaint "chest pain" was classified a "green" not urgent because in triage she related her chest pain to her reflux disease and not as a cardiac issue.

When I talked to her, she was telling me that she'd had the pain for years, that her primary care physician had done multiple tests for it, and that this morning it didn't hurt any more or less than usual, but that she just thought she should "have it checked out." I asked when she'd last seen her doctor, Thelma told me she'd just seen him a few weeks earlier. When I asked if she had told him about her "chest pain" she said that she'd forgotten, but that he had been treating her for her reflux for years.

I went to my attending and told him that I didn't think she really had anything wrong with her. He asked what I wanted to do. I told him, that I really didn't want to do anything, but that we probably should just get a chest X-ray, EKG, and give her something for her reflux. It was an easy morning so far, so he said, "OK."

The EKG was not very exciting. I probably spent about another hour running around seeing other people before I had a chance to look at her chest X-ray. I took a look at it and quickly called my attending over. We both looked at it, and I went over to the computer to see if there was another X-ray to compare it to. Her last one had been in 2001, and there was nothing on the film viewer. All I had was the report. It was negative.

Her chest X-ray now showed a large mass in her lung. My attending and I shook our heads and both immediately agreed that she needed a CT scan of her chest. I told her we had seen a spot on her X-ray and just wanted to evaluate it better. She smiled and said, "OK." Very polite and pleasant.

The CT scan showed about 9 different nodules and some enlarged mediastinal (middle of her chest) lymph nodes. This wasn't infection, this is most likely metastatic cancer. I went back to her room after talking to the radiologist to confirm my suspicians. I asked if she had ever smoked or worked in a factory. By this time, her daughter had arrived, and they both said, "No." But, then they admitted that Thelma's late husband had smoked all his life, and that all of the kids and in-laws smoked.

I explained that there were masses in her lungs, and that the mediastinal nodes could have been pushing on her esophagus causing the reflux-like symptoms and chest pain. I said I couldn't call it "cancer" because that's a tissue diagnosis, but that the nodules were suspicious for cancer. I told them I would be calling her doctor and making a plan.

After talking to him, and he was majorly surprised, I went back into the room and had to explain everything all over again to the son-in-law. He and her daughter both looked somewhat guilty when we talked about the possibility of second-hand smoke having caused her nodules. We sent them off with a referral to Roswell Park Cancer Center. Unfortunately, they're not connected to our system, so I don't know how I will be able to follow up, but I am sure I should be able to find some info.

Again, something so simple... and, I ended up giving this family some of the worst news you can share with a family. I hope they do well. They seem close. I certainly hope they are.

Monday Night Fights, Um, Football

I think at some point I remember mentioning that, as part of our residency training, we learn to work at "mass gathering" events. I had a chance earlier in the year to go to the Bills vs. Raiders game, and yesterday I worked the Bills vs. Browns game where I probably spent about 75% of my time sewing up drunk fans or fans involved in altercations with drunk fans.

It's strange, but I don't mind it. I like to suture. It's almost like artistry. You take something that's torn, or cut or shredded and try to put it back together. Of course, the majority of the suturing occurred on people's faces which leads to the added pressure of making sure that cosmetically suitable results are achieved. And, it doesn't matter that the majority of my patients were so sloshed they wouldn't have noticed if I sewed their top lip to their bottom eyelid; my own pride and perfectionistic attitude wouldn't allow me to accept anything but my best.

Now, having said that, it's a challenge to work on someone who's heavily intoxicated while remembering my Hippocratic oath. If you've never had stitches on your face, or seen someone getting them, it's a pretty intimate situation. Especially when I had two patients needing sutures inside of their mouths because they had cut the inside of their lips.

Beer breath is nauseating. Stale beer breath with cigarette tobacco overtones even worse. Of course, the fun patient of the night was the majorly drunk patient in handcuffs who was jumping and fighting the two sheriff's deputies who had him under arrest. The patient needed just one stitch. On his lip.

Ever try to wash a cat? Yeah, the two sheriffs holding him down looked something like that. To top it off, we didn't have a suture kit, and I was using what I had available... a suture removal kit. So, here I was trying to hold the needle with a pair of scissors and getting a stitch into a moving target.

The sheriffs managed to hold his head but couldn't keep him from talking. I guess I didn't think about the possibility of him spitting or kicking out. He managed to stop talking long enough for me to swoop in, throw the stitch, step back and then take another step forward as I quickly tied my knots and then cut the stitch. No lidocaine for him, but given his blood alcohol level, I don't think he even noticed.

OK, that's it for tonight. I need to write about my last patients at Suburban before starting back at the excitement that is ECMC. Grand Rounds tomorrow, so I should have some time to write... cheers! Of course, always in moderation... :)

These Shoes are Made for Walkin'

Sometimes you just have to buy something because it's so fun! Like these shoes. I now have 4 pairs of Dansko clogs which seem to be the shoes de rigeur amoungst the medical set. Wednesday was payday, so I went to my local outfitters to get a pair of black clogs for work.

I wanted a pair of black ones since I occasionally wear my clogs for quick trips to the market, or for meetings at the hospital, etc. When I went into the store, I saw these, and even though I am pretty conservative by nature I knew I had to get them. They are the same reliable comfortableness of all Dansko shoes, but just a little funkier.

You usually don't think much about your shoes until you are in them all day. And the last 2 shifts have been so hellish that I am glad to be wearing something solid and comfortable to carry me through those long 12 hour days. My colleague that was shopping with me asked what I would do if I spilled something on them, or had something (think biological material) drip onto them. I guess jump back and avoid the spill. I don't care, they're funky and cool as well as practical.

I think the nursing home floodgates opened up the last 2 days, and the ED seemed to be running a promotion on hospital admissions as my admit percentage ratio was around 75%. Last night I was 50/50 between admissions and discharges. There's just too many falls with hip fractures and chest pains to be evaluated. And, it's not even the beginning of pneumonia season yet.

Coming here this morning, I was thinking about how people don't realize that every single step of being seen in the E.D. takes time. You're triaged when you walk in the door. Triage - people who are sicker get to go first. And, you can't fake it. Vital signs don't lie. You can't say you have a high fever and then have a normal temp here. You can't say you can't breathe and then have a normal oxygen saturation on the pulse ox. Roll around on the floor saying you're having severe abdominal pain, and the triage RN will feel your soft stomach and know you're good for another couple of hours.

Then, you get into a room. First the aide takes your vitals. Then the RN does their exam. Then the M.D. gets the chart. After being interrupted by phone calls, bed hold orders, another nitro for the CP in 7, the M.D. will attempt to make it to your room. On the way, the psych patient in 13 will decide the walls are covered in bugs necessitating a B-52 (benadryl 50, haldol 5, ativan 2). When they finally return their second page out to the admitting attending for the patient in 22, the M.D. will make it to your room.

In my case, I then have to present to the attending that is managing all the other 20 patients in the E.D. along with 2 P.A.'s, a med student and another resident. So, I have to wait my turn. Finally, we decide on a plan, order labs, films, etc. I then place the order with the clerk who may or may not have called her kids for the 5th time to tell them that "no, you can't spend the night at Sally's because your father is going to be late and you need to watch the other two." When they finally get around to placing the order, if you have a film, you're again triaged behind the chest pains, the shortness of breaths, the other 10 abdominal pains, and the little old lady who fell over her walker while getting ice cream and now can't stand.

Two hours later when we have a second to look at the results of your labs, if they're all there and I don't have to be calling to lab to see what happened to them, or asking the RN or asking the aide who was supposed to have delivered them, but instead stopped to gossip in the stairwell with the cute guy from the third floor, I will finally see if I can figure out what's causing your _______.

Then I have to again talk to the attending, wait for your doctor to call me back, the consultant to call me back, the admissions' clerk to take the order and find you a bed, and the RN to finally send off the urine sample you haven't provided because you can't seem to hold the cup in the right spot, I might just come into the room to tell you I didn't find the reason for your abdominal pain, and I am going to discharge you to follow up with your primary care physician... which, might I say, you should have done in the first place since you've been having abdominal pain for the last 5 weeks, and tonight thought you should get it checked out because you saw a special on Oprah that talked about colon cancer.

I really should get a pedometer... I'm going to be getting a lot of mileage out of my new pair of shoes. Wait, first patient of the day... I know it won't be the last!

Heal With Nerves of Steel

Suburban has been a really great experience. I am seriously enjoying my work there as I see a great variety of patients and diseases. However, a twelve hour long shift can be taxing, and on Sunday I was getting ready for my shift to be over... Since the board had been full all day, I was planning on seeing one more patient before ending my day, when the family practice resident I was working with asked if I wanted to swap patients.

She had just picked up an abscess case, and I was going to go see a woman coming in from another hospital with an "unusual finding on CT." I agreed as the abscess case could probably be finished before the end of my shift, and I wouldn't have to sign anything out. I am glad I did. I know comments have been made about doctors being the worst patients. However, I've found that working at Suburban, we seem to get a lot of families coming in with family members who are physicians, or nurses, or paramedics, etc. They can cause us a lot of grief sometimes... but, more on that later.

My patient was a college student with an abscess on his tush. He'd already been to an urgent care center and had been prescribed antibiotics, but the abscess had just grown bigger. So it had be opened. Oh yeah. I have a friend from med student who once said that there was nothing more satisfying than draining an abscess, and I have to agree. Plus it meant I got to cut into someone and given the way the day had been going, I was more than eager to wield some steel.

After numbing the area, you basically make two incisions, "place the mark of Jesus on him" as my attending told me, and let everything drain out. I prepped the area, gave the patient adequate anesthesia and enjoyed the gushing, um, fruits of my labor. After exploring the abscess cavity to make sure there weren't any further pockets, I stuffed it full of packing. I then instructed the patient on wound care and told him to come back on Tuesday. I'll be working, so I hope I get to follow up on him.

When I came out of the room, it was like a war zone had set itself up in the E.D. First off, there was a patient found down that the EMT's decided to put onto the rig. Then when he was pronounced, they were obliged to bring the patient into the E.D. as they couldn't then remove the patient from the back of the ambulance. The family followed the patient to the hospital and soon there was the sound of crying and wailing throughout the E.D. At the same time, a family brought in a patient after chemotherapy. They were saying that the patient sometimes got a little "loopy" but this time they were much worse. So much so they were having a full out delirium and screaming and crying in their room. Then, the doctor family member of the patient I had traded the family resident with began demanding and belittling the staff to the extent that security had to be called.

The family medicine resident told me that when she explained to the family member that the attending was dealing with a patient coding (meaning CPR resuscitation) he stated, "That patient is probably dead and my wife is in pain. He should be here seeing her." Which went along with the family member of the delirious patient who kept following the RN's around asking that something be done about his family member. When my attending tried to explain that he had a patient that was sicker, and the family member didn't want to hear it, the quote was, "I have a patient who isn't breathing and this one still is, so I have to attend to them first."

I know it's hard to understand the system of triage when it's your loved one in trouble, and I can sympathize and apologize to patients when I go in to see them, but I can imagine with the change in leadership, things are just going to get worst. But, I will reserve getting on my soapbox for another time. It's late, and there's another shift in about 10 hours, so I better get to sleep. Will follow up on everyone. If there's a case in particular I've mentioned you'd want to hear about, let me know in the comments... We have to follow up on our cases, so I usually know what's happened to someone once they've left the E.D.

Until later... cheers!

p.s. other interesting cases during the shift: Bell's palsy in a 30 year old, an 80 year old runner who still walked 4 miles a day coming in with fulminant heart failure and not really having any symptoms, the 75 year old who went into sustained V-tach and needed to be shocked out of it, both of those patients had to be on amiodarone drips to keep their heart rates regular, and the 30 year old pregnant woman I got to reassure about her baby.

So Much to Learn...

Best quote of the night, "I heard that Obama got elected president, then I started to feel sick to my stomach, and then I just started throwing up."
- 7 year old patient being seen for abdominal pain and vomiting

This is my newest cat Lacey, and some of you know that Lacey is deaf. I discovered it about 2 weeks after I got her when I realized that she wasn't reacting to the other 2 cats hissing at her even though they were mere inches apart. It was also just about the time she was finally over her upper respiratory infection from the stress of a new environment, and she started exploring around the apartment. Most cats will stop doing something at the sound of a loud clap or rustle of a newspaper, but Lacey didn't. I was trying to teach her her name and commands like I had Winston and Sofie, but she just didn't seem to get it.

Then there was the screaming. She would meow softly, then louder, then louder until it sounded like someone was twisting her tail off. And, that was when I was sitting in the same room. If she didn't see someone the scream was even louder. That's when I realized that she might be deaf. I went online and started researching what to do with a deaf cat. My husband laughed when I told him we were now parents of a "special needs" child. Still it's been a learning process for me and Lacey. One of the articles I came across talked about teaching your cat sign language. Given my schedule, it's been a challenge to be consistent, but she's still able to tell me what she needs. And, since she's attached herself to my male cat who is more tolerant of her, the screaming is limited to when she doesn't see him in the room when she wakes up.

I bring this up, because Lacey has taught me how something so simple could become so complicated. I wanted a new cat, I thought it was time. I went to the Humane Society multiple times over the course of about a month to pick out just the right kitten to bring home.

They say that you don't pick your cat, your cat picks you, and it was fated the way I ended up with her. I was casually talking to the volunteer about when they might get some more kittens in, and we were walking by the older adult cat cages. I had briefly noted that her tag read 5 months old without even really looking at her, and I asked about cats making adjustments with adding an older cat.

The volunteer and I stopped and talked in front of Lacey's cage for a while, and it was during that time that I finally took a look at her. She was just about what I wanted with her longer fur and black coat. On a whim, I asked if I could see her and took her to the cat room. She started purring and walking around the room curiously exploring. I didn't think much about the fact that she wouldn't come when called. She was a stray. But, the more I sat with her, the more I really liked her. Then she did the ultimate. I asked if she wanted to go home with me and she fell on the floor in front of me and did the feet in the air upside down glance. I was hooked.

I think about her while I am at work. How the simplest thing can become so complicated so easily, and how I have so much still to learn.

I picked up a chart yesterday that read "vaginal bleeding." Now, I knew this meant doing a pelvic, which I've talked about extensively, so you know my feelings on that, but I figured it would be quick and easy. Not so much. Following a surgical procedure on her cervix, this patient developed a condition which is common 10 - 14 days later which could cause her to bleed to death. As soon as I started my exam, I knew something was wrong, and I called my attending into the room. My patient ended up going emergently to the OR. I will find out what happened to her when I go back tomorrow.

I had another patient who woke up this morning feeling as though the room was spinning. I can tell you there were a lot of college nights I felt the same, but that's another story. He lay back down and then tried again a few minutes later and the room continued to spin. He tried to sit up and then started feeling so nauseated he had to lie down again. That's when he woke up his wife who called 911. Something simple - vertigo, however his blood pressure was 260/140. Not so simple. There's a condition where you can have a stroke or bleed in the cerebellar part of your brain which leads to these exact symptoms. He was rushed to the CAT scan almost as soon as he arrived and was stabilized. He was transferred to our stroke center Gates Hospital within about 1/2 hour after he arrived. I will be checking on him too.

I am still adjusting to life with a deaf cat. She knows finger pointing at door means go through it and out. And, about 75% of the time she actually does it. We're both still learning.

Back from Chi-Town!

Oh what a trip! I can't believe in 5 years how much has changed.

Although I was there for the conference, I really wish that I'd had more time to explore my old neighborhood. My driver back to the airport had actually grown up in the neighborhood where I lived while an intern, and he and I talked about all the changes that Chicago has seen. Like everywhere else, Chicago is being affected by the economy, and we talked about the projects started and not yet complete.

Anyway, on Sunday we had the med student Residency Fair where I was able to share our program with perspective applicants. I was able to meet a lot of people from a variety of programs and hopefully sell them on coming out to Buffalo to interview. We then checked into our hotel and hit one of my favorite spots for Chicago style deep dish pizza - Edwardo's!

I was worried for a sec, because a number of buildings along the street were torn down, but we turned the corner, and there it was! The sauce is still thick, the cheese even thicker and the spinach and mushroom filling, still fresh. Yummy! My colleague thoroughly enjoyed it as well. This one is off Congress, on a street just west of State across from the Chicago Public Library. I remember flying a frozen pizza back to California just to share the taste with my family. Oh, yeah.

During the rest of the week, our days were filled with meetings, our nights with going to different restaurants and having way too much fun! I passed Garrett's several times while out, but I was never able to actually make it into the store. Plus, that large poster board on the table, yeah, I had to carry that on the plane. They wanted to charge me for an extra carry-on which I was able to avoid going to Chicago, so I opted out of stopping at Garrett's to bring back a tub of their popcorn which would have been too much for the trip back. :( Next time.

The conferences ranged from boring to interesting, and it is very exciting to hear what is happening in other parts of the country. While Buffalo is just setting up their hypothermia protocol for post-cardiac arrest patients, other parts of the country, ie: U of Pittsburgh are writing and publishing their results. We have hundreds of possible lectures to choose from, and I chose all the ones I thought would help me at this stage in my career - mostly dermatology and cardiology topics.

However, I did go to some fun ones like "1001 Uses for Duct Tape and a Safety Pin." It was taught by an attending who does Wilderness Medicine, and who shared photos and stories of his travels all around the world. He works sometimes at the clinic on the road up to Mount Everest, and the stories he told about saving lives with just the basics are amazing. I left the meeting both inspired and humbled. There's so much to learn.

I was also very excited to see some friends from medical school who I hadn't seen since graduation and who are now attendings in different parts of the country. It was kind of funny to explain to them that I was still a resident, but we all follow different paths. I exchanged addresses and emails with them. A whole new set of connections.

Finally it was time to come back home to my current world. The children behaved, and my apartment seems to be intact. I worked yesterday and am starting a stretch of nights tonight. Will be exciting to see what I can apply from the conferences I attended this last week just as it is exciting to be contemplating my future...!