Code Blue!

We have all seen CPR done on a dummy - "CPR Sue" or whatever your instructor called the plastic dummy whose chest moved when you directed air through the mouth.

Today, however, I saw CPR done for real on a patient who "coded" (medical jargon for died - well, coding means we are going to try our darndest to bring you back unless you are DNR/DNI...more medical jargon for Do Not Resuscitate and Do Not Intubate). Anyway, this patient basically stopped breathing and despite the advanced age, the family did NOT have a DNR/DNI which means full court press to bring the patient back - CPR, cardioversion (that's the one where they yell "CLEAR!" before you see the patient fly up on TV...and no, in real life, the patient doesn't necessarily jump up that high!), intubation, ventilator, all sorts of heart medications that will bump up your heart activity and restore the beat.

For the most part, a room where a patient has coded is controlled chaos. There is an MD in charge, several other first year residents who rotate doing compressions on the patient (which can be extremely tiring), and a nurse who is preparing the meds and documenting how long the code has been progressing, etc. Oh, there are also several med students who are trying to observe a piece of the action. Overall, the process is quite controlled even though stuff is flying around in the room.

Seeing the chest compressions during CPR on a patient really put me in awe. I mean this patient was just like a rag doll. And in fact, if you are ever in the position to do CPR, they say you need to push down on the chest about 2 inches...and if you are doing it correctly, you will probably break a rib or two in the patient. It is quite unpleasant, actually. Seeing it in person just totally blew me away.

In the end, we brought this patient "back" - though we suspect brain damage due to lack of oxygen. This brings another point up - make sure you discuss with your family and your doctor your wishes and desires if you are ever, God forbid, incapacitated and can't make your own decisions. What would you want done if you ever "coded" - your family should know exactly what you want done so they don't have to make the emotionally gut-wrenching decisions on their own if ever put in that position. And PLEASE, if you have a family member who is older, think about THEM when deciding whether to authorize a DNR/DNI. The process of CPR and intubation and ventilators, etc, is extremely painful. In fact, it can be downright torture in older patients. So please, for their sake, discuss their wishes with them if you can and don't put them through iatrogenic torture unnecessarily.

HUG EACH OTHER!

They say humans need at least 8-12 hugs per day. And it is true - there is so much value in sharing a hug with a loved one or friend. I believe so much positive and healing energy can flow between two humans sharing a friendly embrace.

Working in a hospital with a bunch of pretty egotistical Doctors can sometimes drain any amount of positive energy you have right out of your system. Nobody says hello or shares a smile or even gives you eye contact as you pass by the hospital halls! This can really make you feel lost and alone. Indeed, being from California where, although obviously not perfect, we are definitely much nicer to each other, it can really start to wear on the soul to feel no love.

Therefore, I hope we will all take a moment today to remember to reach out to one of our friends. Share a smile, call them, LAUGH with them. And better yet, as you pass strangers on the street, acknowledge their existence with a smile and a nod of the head.

And afterwards, share how you felt in the comments section here. We can create our own little "Chicken Soup for the Soul" corner.

HUGS TO YOU ALL!

"When the best role model isn't even a person"

I found this article in the Baltimore Sun from an educator in the Baltimore City Public School System, where I also spent two very challenging but extremely rewarding years as a middle school science teacher. The author, David Donaldson, shares a very sobering testimony of some of the challenges our students face. I continue to pray for my own students and for the system as a whole and would ask you all to keep them in your prayers as well. There is an incredible amount of talent in Baltimore City - here's hoping the new Administration's educational equality goals will help move our students in Baltimore forward.


By David Donaldson

November 26, 2008

My advisory class at the Maryland Academy of Technology and Health Sciences, a public charter high school in Baltimore, includes a daily lesson in character building or study skills. Recently, I asked six students participating in the group - all boys - to make a list of five male role models. I decided to participate as well, and quickly came up with a list that included educators, my father and my best friend, an Iraq War veteran.

What was an easy task for me, however, proved rather challenging for my students. I had questions and statements from them ranging from, "Do they have to be males?" to "I can't think of five."

When it finally became time to share their writings, none of the boys selected their father as a role model. Not one of my students has a father as an active participant in his life.

One of my students selected his grandfather, because out of all his brothers and male cousins, his grandfather and he are the only two who have never gone to prison. Another student selected his mother because not only does he buy her a Mother's Day present but a Father's Day present as well.

The most touching story took me by surprise. At first, I thought this regular class clown was going to make a joke of the assignment. However, as he began to explain, I appreciated his sincerity.

"I do not have a father and, well, my mom does her best. However, you said we had to pick a male role model. I could not think of five, but just one. So I picked my dog.

"He does not know if I had a good day or a bad day, but he does know I always need a friend, and so he is always there for me. That is why he is a role model - because he is always there and very loyal."

Maybe you had to have been in that classroom with me to fully experience the moment. But I doubt it.

Family Medicine Rotation - DONE!

Here is a post I meant to publish back on December 18, but forgot! Hope you enjoy!

Week 5 of Family Medicine Rotation - "In Patient Week":
Five out of the six weeks of the Family Medicine rotation is spent at a Doctor's office, working within their practice. But, one of the six weeks is spent at the hospital. My in-patient week was at Mary Immaculate Hospital (where my father used to work as the Pharmacist). Unfortunately, the hospital, known as MIH for short, is a tale of "how the mighty have fallen." Back in its heyday, when my father worked there, it was a model of medical education, offering every "service" as we call the various medical services like OB/GYN, Peds, Internal Medicine, etc. Going to MIH now is like exploring a skeleton of what used to be a vibrant place. Years of mismanagement and budgetary cuts have led to the hospital shutting down its Peds and OB/GYN service and offering scaled back versions of anything else it still has. The hospital is no longer considered a premier place to do your residency. And worst of all, it is about to go through its second bankruptcy - one that many are predicting will be its demise for good. In fact, the sixth floor has been completely shut down.

Doom and gloom aside, there were some highlights - during my in-patient week I learned how to draw blood, start IVs, and the general "Day in the Life" of a Doctor at a hospital. I also met two individuals who actually have been at the hospital since my father's time and actually remembered him. They didn't have any stories like I was hoping for, but alas, it has been 18 years, almost to the day, since my father's passing. I do sometimes wonder, now that I'm in the same field, if my work ethic and personality - or anything, really - is similar to his. I know my family claims we have similarities, but I wanted to actually hear about what he was like from his colleagues. Oh well, I'm a few (several) years too late :)

Overall, my Family Medicine rotation taught me quite a few things - for starters, I do love working with kids. Any time a child would come into the office, I always tried to get their chart! I just felt more excited going into the exam room when a kid was there - trying to help them overcome their apprehension and fear, talking with them about their likes and dislikes, or just plain old talking over their screaming and tears because they knew some shot or another was coming! :(

I also learned that I enjoy working with strong older folks, like my grandmother and some other grandparents I know. In fact, I met more than a few folks in their 90s who were still going strong. One lady, 95, actually went to the Adult Care Centers and taught them dancing!! (By the way, the office I was at catered to Spanish speakers, especially Colombians, where the Doctor was also from - the 95 year old lady was Colombian).

At this point many of you are quickly realizing that I have left out middle aged people. It is not that I dislike this age group, it is just that I find them boring. Sorry to all of you in this age range, but you bore me in terms of medical practice. I have no interest in your complaints and aches and pains. When I step into another exam room with a patient complaining of lower back pain who is 41, I just yawn and wish I was working with somebody else. I know, I'm terrible.

Finally, I learned that medicine can be quite boring sometimes. During my 24 hour call at the hospital, the majority of the time was spent watching movies. Sure, we visited all our patients and made sure all labs and xrays were being conducted and updated, but then it is down time, unless you get a new admission. So, make sure you bring lots of good movies! And your toothbrush - you don't wanna wake up in the middle of the night and see patients with bad breath!

Foley Catheter - Got It!

In all the momentousness of the past few days, I have been feeling like I'm on cloud nine! But don't worry, I'm still focused on my medical education. Today, I inserted my first Foley Catheter in a patient. This is the one that collects urine from the bladder...that's right, the bag with the Pee Pee you see at the side of a hospital bed sometimes, is connected to a long tube that runs up your ureter into the bladder...and those things don't insert themselves!

I also ran my resident through a checklist for what we should do for an Abdominal Aortic Aneurysm (AAA). It was an incidental finding on a CT scan of an elderly lady. These sorts of aneurysms in the abdomen are more common in males, but we see them in females as well. For this particular patient, there really is nothing we can do about it other than continue monitoring blood pressure and administering Beta-blockers to try and prevent the aneurysm from growing in size.

Quotables: The First Mother-in-Law...and MY Mother

“When you acquire knowledge, you acquire something no one can take away from you."

I have heard this quote so many times from my own mother that when I read it in an article in the New York Times, I felt a chill that somehow the newspaper had interviewed my own mother! Turns out it is our new First Mother-in-Law they are quoting.

Many of you believe I am such an ardent supporter of our new President because of his politics. That is only partly true. Let me admit freely on this blog that there are other reasons. In our new President I see a man who faced challenges head-on, never giving up, including some that are quite similar to my own. No father, a hard-working, independent, amazing mother and grandmother team who have raised us, ambitious and often oversized goals and ideas and vision. Where many see hope only in his politics, myself included and rightfully so, I also see hope in his life and message.

I have never really been the type to look up to people like athletes to find inspiration and role models. I usually find my role models and mentors at my Church or through family. But in President Obama, I see somebody who overcame - and not just on his own, but because of an amazing and supportive parent. I hope to do the same. I pray to do the same. And while I have no ambitions to be President of the USA, I do hope to be the best Pediatrician in Fresno, CA some day, making sure that every child in our great Valley receives quality healthcare, quality education, safe and reliable housing and nutrition, and an equal opportunity to achieve their own goals and ambitions and vision.

Because you see, once I earn my MD - once that knowledge it firmly planted in my head - that is something no man can ever take away from me. Amen to that!

We Are America! A Day to Remember

I want to remember this moment! I was witness to our new President being sworn into office. At the exact moment, I was wearing my white coat, stethoscope around my neck, crisp button down shirt with a nice tie and classy pants. I was sitting with my colleagues in the room usually reserved for lectures on congestive heart failure, kidney diseases and other medical topics. We all watched the television screen as our 44th President - indeed, the 44th consecutive transfer of power without incident - took his oath of office. And afterwards, as a thank you from our residents who had secretly collected money, they threw us a celebratory pizza bash, complete with yummy NY pizza and soda. Call it an adult's pizza party for doing our job well.

I want to remember this moment! I was witness to a new President being sworn into office. A President who evokes feelings of hope, positive change, and happiness. One who calls upon us to face our challenges without fear and to stand tall, for we are America.

I want to remember this moment! Forever.

Quotables: Reverend Joseph Lowery

"We ask you to help us work for that day when black will not be asked to give back, when brown can stick around, when yellow will be mellow, when the red man can get ahead, man, and when white will embrace what is right."

This was one of my favorite quotes from the day, delivered by Reverend Joseph Lowery during the benediction.

Oh, Happy Day!!!!

My politics are not really a secret to those who know me well. And even those who don't know me well can pretty well figure out where I stand fairly quickly. (As a quick side note, I want to thank my dear friends - the ones who are happy to debate with me, pretty intensely sometimes, but never take it personally; if you can't handle disagreeing with me, then chances are we aren't going to be friends).

That said, I think we can all agree that a momentous occasion such as the inauguration of our new President is a once in a lifetime experience! Sure, President Obama is our first black President and for that reason alone we can all stand taller. The dreams of so many are realized today!

But I'm also so excited that issues like healthcare for all, social justice, educational equality, promotion of peace and security in a responsible way, and myriad other issues that are near and dear to my heart as a Christian and American will finally be back on the forefront of our government's collective mind. And God willing, with our government working together and our nation feeling a sense of urgency and a positive aura of hope that I haven't seen or felt in many years, we will make our nation even stronger moving forward.

God Bless our new President, our Nation and all peace-loving nations!

7 Stab Wounds

A young male was rushed to the ER recently after being brutally attacked and suffering seven stab wounds. I don't know the details that led up to the attack.

I was on call today and during a slow time, I went to the ICU where this young man was still in very critical, but miraculously fairly stable condition. He had deep cuts; 5 of them along the right posterior axillary region, 1 deep cut along the right anterior axillary region, and a 7cm laceration on the left frontal side of his head.

7cm is about -----------------------------------------------------

In the ICU, he was connected to a ventilator that was breathing for him. He had a nasogastric tube for feeding. He had an IV for fluids because he was losing so much blood that he was tachycardic (fast heart rate); the IV was also administering a medicine that kept our patient sedated and also a medicine (Morphine) to dull the pain. There was a tube inserted into his right lower thorax to drain the blood that was accumulating due to the stab wound and to help reinflate the lung after it collapsed (pneumothorax) by creating negative pressure in the thorax the way your diaphragm usually does. There was another tube inserted into his abdomen to drain the blood that was collecting there. And there was a catheter to drain his urine...but the urine was also fairly red with blood.

He had already had 4 units of blood transfused and more was on the way. They had also ordered FFP (Fresh Frozen Plasma) to help replenish the platelets and other necessary cells that help your blood clot.

He was still bleeding from his wounds.

And I, seeing my first full-blown trauma case with full explanation, was in shock. The RN (Registered Nurse - I always ask Nurses for explanations and tips on how to do procedures because they explain it WAY better than the Doctors and are usually more patient with me) asked me to do an ABG (see post below for explanation of ABG). I couldn't find his pulse at first because it was threading - coming in and out because his blood pressure was so low. I finally found it and got the blood - I found out later that his ABG levels were acceptable, a small victory.

Let us pray that he makes it through this painful ordeal.

Weight Check

A while back I wrote a "Did You Know" about the importance of losing weight in order to reduce our risk for heart disease, hypertension, heart attack, stroke and a whole litany of other terrible correlations associated with obesity.

I invited you, the wonderful readers of this blog, to join me in the journey of weight loss - something that is more lifestyle change rather than diet. In order to stay accountable, it's time for a "weigh-in"!! Actually, my trainer does weigh-ins once a week with me...I do NOT appreciate the constant reminder that I'm either on track - or not. Of course, though not appreciated the weigh-ins ARE critical and crucial to achieving my goals.

Therefore, to jump start the process, I'll put myself out there:
Starting Weight (October, 2008): 242
Current Weight (Jan 11, 2009): 226
Pounds to Goal Weight: 27

Put your goals on paper, tell other people your goals and hold yourself and each other accountable. Hold your pantry accountable, also, by removing any foods that you know aren't going to help you achieve your goals. GOOD LUCK!

EKGs and ABGs and NGs...OH MY!

Procedures are a medical student's dream. They are the times when you feel like you are providing some level of patient care. They are the times you are not just running an x-ray to the radiologist to be read or looking up labs on the computer. You actually get to interact with the patient and provide a service.

EKGs: Set-up the probes on the chest and run the machine. Quite simple, actually. Then sit with one of the residents who is nice enough to give you the time of day (like mine) and interpret the results to determine whether the patient has any sort of myocardial infarction (heart attack) or any sort of ischemia (decreased blood flow resulting in decreased oxygen delivery resulting in muscle necrosis). On a scale of 1 to 5, 5 being the most exciting procedure EVER, this ranks around a 2.5 on the Fun-O-Meter.


ABGs: Acronym for Arterial Blood Gas. We basically stick a needle near your wrist where we find the pulse. Unlike a blood draw you are probably used to, where we go for your veins near where your elbow bends, for an ABG we need arterial blood. This procedure is pretty straight forward but the artery makes is tricky for us because it escapes from us sometimes. We try to find your pulse and stick the needle (picture at right) straight into it...but the artery can trick us quite a bit and we can end up with nothing. But when it does work on the first try (and you really don't want to stick a poor person too many times because these DO hurt) the pressure from the artery is so strong that it fills the test tube by itself, without us pulling up on the syringe! The Fun-O-Meter ranks this around a 3.9.

NGs: These are NasoGastric Tubes - basically a way for us to access your stomach (Gastric)...through your nose (Naso)! The tube is thread through your nose, while you are fully conscious because we need you to swallow so that the tube goes down the esophagus (which leads to the stomach) instead of the trachea (which leads to the lungs!) This is an exercise in some discomfort for the patient, as you can probably imagine! When we are done, we send a puff of air down the tube and listen with our stethoscope to the stomach to ensure the tube ended up in the right spot. Then, we order an X-Ray to ensure the tube has reached the right part of the stomach. Fun-O-Meter Ranking: 4

There are MANY other procedures: blood draws, IV access lines, and others I probably haven't heard of yet. And after doing 100s of the above named procedures, many other med students (and especially residents and doctors) get sick of them; but for the moment, I'm quite excited!

NYC Sites: The New Year Ball Drop

I continue to "live it up" in NYC - I make it a point to explore different parts of the city every chance I get. It is a great excuse to exercise (since you have to walk everywhere) and also a great excuse to get outside and enjoy being free from the confines of being indoors.

2008 has been quite the year. It is the year I transitioned from a lecture hall to a hospital station. From wearing shorts and polos to wearing shirts/ties with a white coat. From wearing no identification to wearing an ID badge at all times and a stethoscope to boot.

It is also the year that I enjoyed an absolutely stunning view of the ball drop in Times Square, NYC. A friend of a friend of a friend (really, no exaggeration) had gotten a hotel room and welcomed his friends to invite other friends. As such, I had the opportunity (once in a lifetime, really) to catch the ball drop from about the same height as the ball itself! I was warm and cozy, unlike the 1000s gathered outside in about 18 degree weather! And I had easy access to a bathroom, another amenity not available to the peons outside. Life was good in the last few hours of 2008!

A couple observations:
1. The actual ball is NOT huge the way it has seemed for the past 26 years on TV. In fact, it is downright small in person. (It is the tiny little green dot in the picture to the right; it does change colors, which is pretty cool!)
2. The distance the ball drops is NOT that exciting, unlike how it seems on TV. In fact, it is maybe like 15-20 feet.
3. All in all, I would be downright PISSED if I had spent 12 hours standing outside in that sort of cold to see the ball drop. I was quite pleased having spent just 30 (FREEZING) minutes trying to get through the blockades with my friends to get to the hotel to see the ball drop about 3 hours later.

All in all, this is definitely a ONCE in a lifetime experience. Emphasis on ONCE. I'm glad I did it but I certainly wouldn't stand outside in the cold to do it again. But I must admit, it was a great way to ring in the new year.

"Rejoice in Hope, be Patient in tribulation, be Constant in Prayer." Romans 12:12

May 2009 be a year that we all can rejoice in the hope for change that our new President promises, may we learn new and more effective ways to be patient with the things that bother us and we wish we could change, and may we be prayerful always that the Lord bless our lives and the lives of others for the betterment of all.

HAPPY NEW YEAR!