On Call...

"This is the reason why your headache didn't go away: That's actually pronounced an-algesic, not anal-gesic. Sir, the pills go in your mouth"
~ Turk, Scrubs

I'm fresh out of another night on call, one in which I managed almost 5 straight hours of sleep. It's pretty much unheard of. In fact, I woke up at 4:30am and checked my bleep just to be sure it was still on. Now, that doesn't mean that it was a nice call. It was just a call that involved "sleep." I may have mentioned this before, but I never actually sleep while I'm on call. I'm a light sleeper and the res is never silent. Plus, I hear ever other bleep go off, and the sound of an ambulance backing up sounds shockingly similar to my bleep. As painful as it is to not actually sleep, I'd rather that be my problem than being too sound a sleeper and not hearing the pages (esp with the arrest bleep, or "bomb" as Ben likes to call it, sitting next to my normal pager).

Maybe I was due a gentler call after the last night I had... I don't know. But I've decided that as I'm well past the halfway mark of intern year, I'm going to try to take a learning point or two away from each call I do. Lesson from Friday night: Lots of people want to be leaders, few people actually are.

The arrest bleep went off and I ran to casualty. Some people say that the interns aren't required at the A&E resus, but when that pager goes off, I'd rather be an extra hand than leave them short-handed. We have 3 designated resus beds, and there's no saying that there isn't another in process at the time. On this occasion, there was an ambulance 5 minutes out with ongoing CPR/arrest. One would think the extra time to plan would help... It didn't. I then participated in a 20-minute resuscitation attempt on a person who was, and I know this sounds cold but it's 100% honest, DOA. Why?

Why did we spend 20 minutes (and I'm not going to consider the cost of equipment and drugs) of time on this? That's the lesson. 3 people sort-of, kind-of, maybe tried to run the resus. The person most qualified had stepped back with the feeling of too many cooks in the kitchen. The next most qualified didn't take command of the situation, allowing a lesser qualified person to change the plan from something that was pragmatic and, well, sound to straight algorithm. And the 3rd person that sort-of tried to steer the ship had no clue what the defib was saying, authoritative without the knowledge. I was twice mistaken for someone I wasn't. I had to tell people that 1) No, I am not the anesthetist and 2) No, I am not the medical reg. Now, I do have to say that no one panicked, no one did anything stupid or harmful. We just spent too much time on a no-win situation.

I want to reassure people of a few things. First, under different circumstances (ie: the patient were younger, fitter, hadn't collapsed at home, hadn't been under 10min CPR by the family, hadn't had 40min CPR by the paramedics... It's a distance from A&E problem) it would have been an efficient and probably successful resus. Second, I (as well as most of the interns I work with) am ACLS certified. I wouldn't necessarily be comfortable leading an arrest at the moment, but I could if necessary, and I would if I had to. Overall, mark it down under things I'll try to do better/not do at all.

I did have another great learning moment on call. By pure coincidence, I was in CCU to put an IVC into a patient that had (just moments before my arrival) been due for central line placement. I bumped into the anesthetist who let me stick around and see the central line go in. Now, I've ordered them before, I've dealt with them on a day to day basis, but I'd never seen a central line get sited. And now I have... cool.

A lovely day break.

So... What do you do on a Sunday night in Dublin?

I have a few suggestions:

1. Spring Cleaning. Maybe it was the sunlight and mild weather on Saturday, but I did a massive cleaning of the flat. And since the place looks and smells clean, I bought flowers. The place has a fresh look and feel... Which makes it much nicer to come home to.
   
   
2. Bake cupcakes. Much to the chagrin of my roommate, I'm working on certain baking skills, including what I'm going to call "Gourmet Cupcakes." I bake because it's cathartic, and relaxing, and you have a sharable happiness that comes out of it (as long as you don't burn it). Now, this time around I was making cupcakes for a friend's birthday... And I was putting a little extra on it. It was an experiment. I've never tried anything like it before. But I have to say, they turned out quite nicely, no? I think I'm going to be attempting a few more creative designs in the near future... In all this spare time that I don't actually have... Whatever. Watch this space. But I owe my roomie an apology for torturing her all day with the constant, "Hey, look at them now!" and then telling her we couldn't eat them yet... Sorry.
   
   
3. Catch a show. Saw a fantastic concert last night at the Olympia. First of all, they didn't lose power (sorry Coronas... I know it wasn't your fault, but that did make it a rough evening), though there was a moment with a bunk guitar... Fixed and show barely paused. The openers were a group called The Shoos - a Dublin based band, eclectic group of lads, but a great sound. I'm hoping to see them again in the future (and given that they're opening for a few more bands in the Dublin area, I'm sure I will). Good luck to them with the EP coming out in April! The Shoos were opening for Lifehouse... a band that I've been listening to for more than a decade, but have been around longer than that. Most people know them for their softer, ballad songs, but I will say this: Lifehouse ROCKED. Good job guys! Returning to Dublin for the first time in 9 years, they went through their whole catalog of music, which was brilliant... and a little bittersweet. It was almost like taking a tour through my past dating life... I've had a few of their songs intimately tied to a significant other, including songs being dedicated to me, sung to me, or being 'our song'. It would have been awkward had the songs still made me cry... seeing as the company I was in... But I do have to reiterate, Lifehouse was brilliant! They need to come back to Dublin more often. I'd see them again in a heartbeat.
   
4. Remember the closing time of the public ramp you park your car in... Yeah, that one is a little self-explanatory. Sorry for being a brat about the bill. Sorry for delaying that last 10 minutes. I'm glad we rescued your car!! It would have been fine if we couldn't, but I'm glad we did...

All these things served 2 main purposes... 1. Happy Birthday Muireann! (I hope you had fun!) 2. I'm avoiding thinking about how stressed I am for the impending SHO interview on Thursday...

New Year - New Job

Welcome to Drog, Welcome to Medicine, and Welcome to... well... I don't even know what to say about this.

The mental shift from surgery to medicine is taking me a bit of time. After 6 months of being decisive, cutting, stitching, and sending home, I've found myself with patients that on average are in hospital for months. The mean age has increased, the average amount of time with us has increased, but I have the distinct feeling that what I'm actually doing for the patients is bottoming out at less. The pace is slower, the ward rounds are longer, and the "let's see if this works" takes longer to see than in surgery.

While this is all going on, I've a few things on the front burner - like SHO applications. The most recent landmark of which was a 24hr delay in finding out about interviews. And in my mad panic, Bren reminded me that after 5 years here, I should be darn used to it... And I've come to expect it... But I'm a worrier. And not hearing anything had me sweating. Interviews are coming up soon... Ugh, I need a new suit.

On a similar vein, how the hell has it become February?! There's a part of me that can hardly believe that I'm a month into my new rotation, a month into medicine, and over halfway through my intern year... It's flying. I think in a good way, but in the back of my mind, I'm realising that I'm going to be an SHO soon. That's scary... That's really really scary.

The French are in town this weekend for the Six Nations Rugby... This does not please me. First of all, Rugby weekends make it nearly impossible to do the things you do every weekend just to keep the house running and yourself fed. Second, the French tend to make more of a mess of city centre (not rubbish mess, just walking/pedestrian rushhour mess) than the other blokes that come around. Third, some jerk knocked me clean off my feet yesterday. I've a bruise that covers the bulk of my left side (thigh to mid back) and my neck is killing me... Merde.

Monday is bringing my least favourite holiday, what I tend to call "Singles Awareness Day" or SAD for short. It's one of the worst days to be single... Having everyone remind you that you're single... At least there's a lot of good chocolate around. Mmn Chocolate!

And I think I'm going to leave it at that... Chocolate. Yum... Happy thought of the day.

About that letter...

"You see, I can't survive on my own. Even now, when I finally get to go home, in the back of my head, I'll know the hospital's still here, wide awake. But what the hell. The most important thing is that I got through my first three days without looking like a complete idiot... I'm the man."
~ J.D.
(and anyone intensely familiar with Scrubs knows that he promptly walks into a door)

Hi there 2011.

That's right, I do have a letter to myself. I did read it on NYE. And I did write a new one on Jan 1, 2011...

For those of you who don't know what I'm talking about, allow me to explain. A few years ago, I stopped making a list of resolutions and adopted a new plan. I write a letter to myself. I carry the letter around for a year (it's normally tucked away in a small pocket of my bag). Then I read it on NYE (or NYD). Last year, being a fresh decade, I wrote two letters to myself, but then I only get to read one this year.

I'm not comfortable publishing the entire letter online. It's too personal. But there are a few main points I made to myself last year; those I will share.

• Be Loveable - in the sense of embracing myself and loving me.
• Plans are... like peeing in the ocean - No, Joe, I didn't write that for you specifically, but think about it. You know I'm right.
• Life isn't fair, get on with it - don't take the important people for granted.
• Lose the baggage - it's not just that I'm a pack rat... I carry everything with me.
• Polish your halo - be good.

I asked for 3 main things for myself... I managed 2. And as Meatloaf says, two outta three ain't bad. Recurring phrase: Happy Bunny! (for those of you in the States, this is NOT the same as chubby bunny).

2010 was a good year. It was intense, it was full of change, it was scary, and it's over. To my friends: thank you, you are amazing.

To 2011... Bring it!

Welcoming 2011 with More Music

So, as my tradition stands, I've put together a playlist for the new year.

2011 is a prime year... I've been to a few concerts this year, so there's dedications for those. Most of these are things on heavy rotation, new and fantastic, or things that I have a special tie to. So without further ado, here's Music for the New Year (2011 edition):

1. Trust Me I'm a Doctor - The Blizzards
   [Dedicated to the RCSI class of 2010 - welcome to being real doctors... Scary.]
   
   
2. Wish List - Neon Trees
   [This is the 2nd song from Neon Trees that I'd heard. It's now on my Christmas playlists. I like these guys, they've got some spunk, and it's a different sound than what I've heard recently. Plus... I have a bit of a wish list like them.]
   
   
3. Firework - Katy Perry
   [Ok, Katy's songs get overplayed every time... I think the second I put this on the list, I'm going to be sick of hearing it. But I like it. I admit it. I like it. At the moment, it's being used to promote Love & Other Drugs. Heart.]
   
   
4. Future Kings - Miracle Bell
   [Heard these guys as they opened for the Coronas. They're fun! Their 2nd on vocals/misc percussion/guitar looks like "Tighten" from Megamind or Jonah Hill... Hilarious. But they've got a great sound. I hope they go far.]
   
   
5. Little Lion Man - Mumford & Sons
   [I can't believe I've only had this album since Feb. I love it. Mumford has a great crescendo in just about every song. But this one is my favourite... And it's #1 on my top played list for iTunes right now.]
   
   
6. Radioactive - Kings of Leon
   [I have to give a nod to Kings for their new album. But... There's nothing like hearing a clip of a song, live, when you're in another country, feeling miserable, and stuck in a city that you don't belong in. This song will always make me smile now.]
   
   
7. Sweet Disposition - The Temper Trap
   [After first hearing this in 500 Days of Summer... It is EVERYWHERE. Thank you O2 for overplaying something in every commercial you've ever made... But I still like the song.]
   
   
8. Christmas Lights - Coldplay
   [New this holiday season... And chill... And a bit sad... And brilliant piano music. On heavy rotation for the Season, and probably will keep on into the new year.]
   
   
9. Stuff We Did - Michael Giacchinos
   [If you don't know this song, it's considered the "theme" from the movie Up. It makes me tear up. It's so gentle, and the way it was used in the movie was brilliant. It's also one of my new piano songs.]
   
   
10. All We Are - Matt Nathanson
    [Peaceful with where things are in life... I think this guy is going to be big. He's a bit in the mold of Mayer and Morrison, but he has much more content lyrics. I really like this one. Chills me out.]
    
    
11. For the First Time - The Script
    [Love the new album... I'm considering getting tickets to see them in the Aviva this spring... I'm just not sure I can tolerate the teenagers I'd have to fight off. But I dig this song. Positive in the economic time.]
    
    
12. Curl Up and Die - Relient K
    [Ok, it's been a while since I've given Relient K a listen. This came up on my genius a month ago, and I really like it. It has a different guitar feeling than most of their stuff (and I bit less Jesus than some of their songs). But it's a b-side, so that's probably why. It's not as depressing as it would sound from the title.]
    
    
13. Black Hole Sun (live acoustic) - Chris Cornell
    [I remember first hearing this in Humarock when I was in middle school... Crazy music video. But this is a nod to Chris, and the fact that they're getting back together and making some new music.]
    
    
14. Yellow Ledbetter - Pearl Jam
    [Saw them in concert! Great concert! (totally suited for the O2) Now, this was not played, but it needs to be out there. Plus, I got this on cd for Christmas. <3]
    
    
15. Second Chance - Shinedown
    [I don't know of another song by this group, and I don't know who to compare them to, but I like this. Heard it once, and was sold. Just a bit of growing-pains, bit of positive spin on accomplishments.]
    
    
16. You've Got the Love - Florence and the Machine
    [This has been a great year for this band. I think this is my favourite of their songs, ignoring that it was used a bit too often in Grey's Anatomy commercials.]
    
    
17. All the Right Moves - One Republic
    [There is something great about this song. I don't know if some of it isn't that I found out how they got the fantastic drum sounds in it... it involved an old house, a spiral staircase, multiple floors of percussion, and a moving mic... Cool.]
    
    
18. Come On Get Higher - Matt Nathanson
    [And here he is again. This is such a great song. Light and happy, hopeful, chill... Something I'd love to have a boyfriend sing to me one day.]
    
    
19. Halfway Gone - Lifehouse
    [They're coming to Dublin! I'm super excited for this concert. I've never seen them live, and I've been listening to them since Hanging By a Moment came out my freshman year of college. The new album is great. A bit more rock than they have been recently. Good job!]
    
    
20. Far from Here - The Coronas
    [One of the few songs that went off before the power failure at the concert in Dec. Go Coronas! I dig the new album, and they're very fun in concert, even when things aren't going to plan.]
    
    
21. Raise Your Glass - Pink
    [A nod to all my nitty, gritty, dirty, little freaks. You know who you are. It's a fun song and a great wrap for a cd.]

... Roll on 2011. I'm looking forward to more great music!