a patient's dilemma.

I took care of a patient last night who is 90 years old and pretty functional for her age. If that's not a blessing enough, she's also been married to her husband for 72 years now. Wow, right? This is something I feel we will be seeing less of as time goes on. I wonder what it must feel like to have spent that many years together.

She suffered a cardiac arrest at home, was resuscitated in the field and brought over to our CCU. She was found to have significant coronary disease (left main & 3 vessel disease) and severe aortic stenosis with bypass and valve replacement being her only option; however, given her age the surgeons were not enthusiatic in taking her to the OR--a subject I have many thoughts on. So, the patient and husband are left to make the decision of pursuing surgery despite the risks or accepting palliative care with medications. It seems for the rest of our lives at various times will be faced with difficult choices...this is something we simply cannot escape.

feel your own mortality.

For the past few days, I have seen so many young people come in with heart attacks. It's amazing how in one simple day your life can change. I had that experience myself in a different capacity several months ago when I had a needle stick at work. I watch people, some with no prior medical problems, others who are obese, smokers or alcoholics absorb their close brink with death. It's made me think a lot more about prevention than I already do. Our way of life is integral to our health.

Last night, I took care of a patient who collapsed at home after arguing with family members. She has an underlying abnormality in her cardiac conduction system, called long QT syndrome. She had a pacemaker placed several years ago and was lost to follow-up. A sudden catecholamine surge such as arguing in her case can cause a person with this underlying medical condition to go into V.fib arrest, which is exactly what happened to her. The rather sad and unfortunate circumstance in her case is that her defibrillator did not go off and that's because her 'battery' literally had no life. She was overdue for replacement of her defibrillator. In talking to the family, there was no reasonable explanation why she did not continue to follow with anyone. My thought is that she did not understand the significance of her disease. This likely could have been prevented, which is utterly disturbing and sad to me. She came to me intubated, on pressors and bradycardic...essentially very sick. She's only 56.

When we think of prevention, we typically think of preventing the onset of disease which in the medical world is called primary prevention. There is also secondary and tertiary prevention, which is aimed at treatment and preventing complications of pre-existing disease. This is something that has recently began to interest me, inspiring me to spend a lot of my time empowering patients with knowledge about their medical condition. My experience last night only confirms this need and importance. If I can impact at least one life, my efforts will have been worth it.

my current love.

remembering india.

inspiration from my friend Radhi

I'm a survivor.

Beyond my own expectation, somehow I managed to survive my first night on call in the CCU as an upper level. My adrenaline was sky-high and I felt like the energizer bunny, making rounds repeatedly on patients. I had one patient in particular who had a low potassium of 2.0, from medications he was receiving while hospitalized. Despite our many efforts to replete his potassium it would either not budge or would decrease. I was beyond nervous. I just felt like he was going to code any second. I kept going into his room, making him eat bananas and drink orange juice--he thought I was insane, but he was like 'doc whatever you want me to do, I'll do it, I don't wana die'. Made my heart mush. The morning aftewards his potassium was still a whopping 2.3 after receiving a total of 240 meq of potassium, absolutely ridiculous. I can laugh about my neurotic behavior now, but that night I was literally on edge.

nervous anticipation.

I find before every switch in rotation I get a little nervous, mostly from fear of the unknown. Tonight I find myself a bit more overwhelmed than usual. See, tomorrow I go to the CCU, the cardiac ICU, as an upper level and generally when people decompensate or become unstable, I move them to a higher level of care. Well, tomorrow I will be just that, the higher level of care. I've thought a lot about what exactly is putting fear in my mind and I think it's the stress that comes with knowing that the slightest mistake in a patient's care could significantly affect their outcome. That type of stress simply does not vibe with my personality. I'll also be on call every third night, so this month will prove to be challenging in many ways.

a new year.

It's snowing here and I am craving roasted pears with brown sugar. divine yumminess. I've contemplated hard getting into my car and driving to the grocery store to get all the ingredients, but something tells me the grocery store may have closed early this evening...besides I don't want to give up my valuable covered parking space, ahh the choices in life. So, instead I sit here thinking what a great idea it would be to voice my resolutions for the year of 2011, perhaps in this way it might actually happen. so, here they are:
* to become a nerd, translation = become the best physician I can be
* to emanate pure happiness
* be intentional
* become comfortable in my own skin
* to sustain a healthy lifestyle
* simplify
I realize these are more attributes rather than objective accomplishments as compared to last year, but I think that is quite telling of the place I am in. I am excited to see what the year has in store...come what may.

accepting imbalance.

The demands of life are often far greater than I can handle. I awoke today to several emails stating I must complete x, y, and z or this would be a poor reflection of my professionalism. Quite a threat and a rather intense way to start the day in my opinion. I work at least 80 hours a week and often more than that, but my responsibilities still succeed those hours. I don't know how one finds the time to accomplish all that is needed. I've always strived for a life of balance and pride myself for the ways I've been able to do so. However, today I am realizing that perhaps it is not possible to live a balanced life while in residency because time is simply limited and insufficient. I feel, in order to experience the peace I so desire, surrendering to a life of imbalance is the most probable way. Ironically, I came across this thought during my reading today: 'When you act in ways unlikely to fulfill your genuine desires, you experience the inner friction of a life out of balance.' Interesting.

holding on to perspective.

For a while now, I've been thinking about starting a blog about my experiences during residency and some of the insight/struggles I have encountered along the way. I feel extreme circumstances shed enlightenment and residency is certainly one of those experiences. With the start of the new year, I thought what better time then now to begin this venture. I'm not sure what direction it will take, but for the moment the purpose is to serve as a means to express myself...it will be a little, yet colorful window into my world.

It's interesting to me, the perspective one gains upon returning home from a vacation. It seems the state of relaxation brings with it a fresh and grounded perspective on life. Things don't seem quite as urgent as before and quite frankly for me, the need to please has finally passed. However, before long I know that exhaustion will soon cloud my clarity, overwhelm my body and I will be back where I started. So, the real question for me is, how can one maintain this vision? I'm not sure I understand the answer yet, but I am in search of it...