Everybody Needs a Little Time Away

I haven't been writing a lot because to be honest, there really isn't much to write about in the PICU. Sure I see my patients every day, and it's really great to see a child you intubated come out on the other side extubated, doing well. But, a lot of our patients have congenital problems, and I have been carrying the same two patients for the last 2 1/2 weeks. I've had other patients come and go, but these two have remained.

So, instead of boring you with the humdrum days of the PICU, I am only writing when something interesting happens... like this weekend. My husband and I celebrated our first wedding anniversary, and he surprised me with a trip to South Central Pennsylvania. He made arrangements at the Olde Fogie Farm Bed and Breakfast in Marietta. It's a real working organic farm full of animals.

We had been talking for a while about "life after residency," and I have been talking about having chickens and some small livestock. So he wanted to show me what it might be like. The B&B organizes "chores" for the guests, so I spent my mornings feeding the animals, collecting eggs, and generally absorbing everything. I think I could get used to the lifestyle.

The other part of our trip involved going to Gettysburg. I think I learned more about the Civil War than I ever imagined I would. It was also interesting being that my husband was raised in the South, so he brought a different perspective to everything. We spent some time at the American Civil War Museum looking at the wax figures and animations. We drove around to see the monuments, mostly those from the South.

We bought a tour book and followed a part of the driving tour and somehow ended up at the brand new Gettysburg National Military Park: Museum and Visitor's Center. It had just opened last weekend, and it was awesome. There is so much to see just in the museum part that we spent several hours looking at the exhibits. There are also some multimedia and film options with admission, but we arrived later in the afternoon and just had time to walk through the museum.

The next day we drove through Lancaster County. Unfortunately, it was Sunday, so almost all of the stores were closed. Which was a bummer since I was shopping for quilts and some good dry goods to replace my stores. We did drive through some beautiful countryside and up across a part of the Appalachian trail. It was really hard coming home knowing that I would be on overnight call the next day, but I felt so relaxed and re-inspired. Sometimes, you just need that little time away.

Happy Anniversary, Honey! ILY

On Scene

As some of you know, I live in Buffalo, NY. As some of you also know I am in training to be an emergency medicine physician. I have talked about my adventures in the emergency departments of our local hospitals, and I have talked about being a part of SMART (Specialized Medical Assistance Response Team) for Erie County. We provide medical support as part of the public health and emergency response systems. We were called to action on Thursday night.

I wasn't able to go to the scene that night, but several of my colleagues did. The next day a new shift of my colleagues went to the scene. And, on Saturday, a colleague and I did. We are there to provide medical support to the hundreds of investigators, evidence collectors, workers, and firemen who are helping with the scene.

As I arrived I thought it would be bigger; larger, somehow. As I walked down Long Street I kept trying to see it. Sure, there were a line of emergency vehicles parked on the street, but still. As I tried to figure out where I was going to meet my colleague, I spotted one of our emergency trailers so I kept walking up the street. And, suddenly, there it was.

They had not been able to begin work the day before because hot spots were still being put out. Suddenly I saw the potential dangers for the workers: large and small twisted pieces of metal, pieces of wood with nails, potential sinkholes, cinder blocks that could potentially trip someone, etc. We made arrangements to be able to administer tetanus shots. We checked our suture materials. We made sure we would be able to arrange for follow-up.

And, so there I was, in the midst of the scene, starting to hear the stories.

I spent the first part of my morning surrounded by the team from the medical examiner's office, and I heard all of their plans for the day. I spent time in their tent. I watched their work.

One of the firefighters from the Buffalo Niagara Fire Department was sitting in his firetruck at the top of the scene where an airport fire truck had sat every night since the accident. I had met him during an exercise almost a year ago, and he waved when he saw me. I spent some time with him as he told me the stories related by the firefighters.

I met members of the FBI and local law. I listened to NTSB and FAA officials as they collected their evidence. Everyone wanted to talk. Everyone wanted to do more.

I was there as support, but I also watched a group of people come together and work for a common somber goal. I watched their painstaking work. I watched the respect with which each victim was handled. Suddenly, I felt the enormity of the situation. And, the scene didn't seem so small after all.

Everyone Has a Story to Tell

I know that I haven't written in a while. Despite my best efforts, I caught the "Pedi Flu." Pronounced Pee-dee, as in pee-dee-atric medicine. So, I have been snuffling and coughing along with my patients. I finally started feeling better this weekend, just in time to start my new rotation tomorrow... the Pediatric ICU. I've heard a lot of things from my colleagues, not a lot of which are positive, so we'll have to see.

I thought I would take the time tonight to wrap up this last month by talking about some of my more interesting cases. Interesting in this aspect - in college I was a journalism major because I found people's lives fascinating, and I wanted to write about them. I get to learn a tiny bit about my patients in the 5 minutes I have to interview and examine my patients. Sometimes I am just left to wonder what their home life must be like... or maybe I don't want to know... still...

Dx: CO exposure
So, we've had a flurry of these as the weather temps dip, and people start burning stuff in their fireplaces or wood-burning stoves to keep warm. Also, kerosene generators and space heaters can add to the problem. I had a mom come in with her three boys. She said the boys had been getting sick off and on over the last 2 weeks. The day before she thought she had smelled gas. She didn't know who to call, and that morning, she called her mother who told her to call the gas company.

When the gas company man arrived, he found two gas leaks. He told her to call her landlord and then get herself and the kids to the E.D. to be evaluated. While I examined her children, she told me about all the phone calls she had made to her landlord, and how she was still trying to get him to fix the leaky ceiling and clogged toilets. I turned and asked her about flushing the toilets, and she said that you had to use the plunger every time and that they were usually backing up.

Now she didn't know how long it was going to be before he would get the gas fixed. I put the two smaller kids on oxygen and wondered if I was going to have to do a social admit for the kids. After I came back in an hour and rechecked their levels, I asked her about her kids' safety and where they were going to be spending the night, she assured me that she would be going to her mother's until the gas could be fixed. She also said she had recently qualified for Section 8 and would be able to get another apartment.

I found the kids knitted hats that had been donated to the E.D. I counseled the mother about stopping smoking. (Smoking will elevate your CO level.) And, I sent them off into the night.

Dx: acute stress reaction
A mom brings her 5 year old son who has been acting strange, hearing voices, acting out in school, and falling behind because the school sent home a note. In the course of my interview and the subsequent psych interview, we learn that the mother had her mother and a sister die in a violent manner in Philadelphia.

The mom had a cousin who lived in Buffalo and was planning on getting married. She asked the mom to be in her wedding, and the mom felt the need to get away. So mom moves to Buffalo with her cousin and brings her two young sons. Five year old son misses dad and cries on the phone every night when he's talking to him.

So cousin gets into a fight with her fiance, and in the course of "needing my space" she kicks the mom and the kids out. So, mom goes to live in a homeless shelter with her two boys and ends up there for about 6 weeks. Somehow, mom manages to get Section 8 which helps her to find a new apartment, but locks her into a lease. Mom can't break the lease or she loses a lot of money. She can't get back to Philadelphia. And, now her five year old is hearing voices.

When I talk to him and ask about his friends in school, he tells me that no one wants to be friends with him. When I ask him if the voice in his head is an imaginary friend, he tells me that who would want to be friends with him. That's about the time that I felt a CT scan wasn't going to do this kid as much help as a psych consult would. Psych was able to hook the mom up with social services who would see about assisting her in getting out of her lease and moving back to Philly. That will ultimately be the cure this young boy will be needing.

Well, it's bedtime for me. I'll be rounding on a new set of patients in the ICU in the morning, and I am sure that there will be many more stories to share. Until then...

Helping the Animals

We'll return to our regularly scheduled programming after this important message for the Humane Society.

As many of you know, I have fur babies. Three of them. Sofie was my first. She was adopted from an organization in Chicago called Cats are Purrsons Too! She's been with me now for almost 6 years, and I love her dearly.

The Humane Society is holding its Spay Day 2009 Photo Contest. One is to choose the cutest pet. The second is to raise money for HSUS, HSI and many other wonderful pet organizations across the country.

I hope that you will take the time to visit the website and vote (yeah Sofie!) for my pet, enter your own pet, or support many of the wonderful organizations involved. I know money is tight, but a dollar or two can help support the spaying and neutering of all animals so that puppy mills can become a thing of the past, and all pets will find a home.

Thank you!

And please, if you enter your pets post the link so we can support each other in this fun and wonderful way!

"Sofie"