Translation

64 year old female presented with nausea and vomiting . No acute events overnight,  nausea or vomiting. No shortness of breath or chest pain.


Physical Exam
Alert and oreinted to person, place and time
Cardiac- Regular rate and rhythm, no murmur, rub or gallop
Lungs- Clear to asuculattion bilaterally
Abdomen- soft non tender non distended

Assessent and Plan

64 year old female with partial samll bowel obstruction.

Nasogastric tube to low intermittent suction
Nothing by mouth
Intraevenou fluid

Abbreviations

Here's a fairly typical surgery progress note.  Please note the complete lack of words longer than "no".    We use more abbreviations than teenage girls texting.  LOL.

64yoF p/w N/V. NAE ON. No N/V. No SOB, CP.

PE
AOx3
RRR no M/R/G
CTAB
S/NT/ND

A/P
64 yo F w/ pSBO.
NGT to LIS
NPO
IVF

babies!

Did you know that babies could be this little? (picture stolen from internet)

That's probably one of my medium sized patients.  They are so tiny it blows my mind.  I put a rectal tube in one baby and after advancing it about 5cm, I decided to shoot and xray to see where it was; and it was half way up his colon!  Stop being so tiny babies!  I can't stand it anymore! They have tiny little hands, and sweet little noses, and they squim around when you pick them up.  Tiny babies are the best.  They are sort of like little aliens.

Compare that to me adolscent patients who are too cool to talk to be about their appendicitis.  Dude.  You'd better tell me whether or not you're having diarrhea; because we might have to cut you open. 

I want to have like 6 babies.  Mmmkay?

Sacred Space

Just finished up my SICU month, and it seems to be that ICU's are very sacred spaces.  Once there was a 8 year old girl, who was probably visiting a grandparent, who was walking up and down the halls with her iPod and singing along to some borderline inappropriate pop radio song.  It was annoying to say the least, but we all sort of looked at one another and shrugeed it off; because if you are visiting someone in the ICU then you are having a very bad day.  And bad days give you the right to sing off key the same song on repeat for as long as you want.  It's a sacred space where all the staff knows that it's a Bad Day for anyone we see, so we're all a bit more forgiving and graceful.

I took call alone in the ICU a few times; far less than interns used to before the 16 hour work rule.  My last call was really tough.  It was perfectly quite from 6pm until 10:30pm; at which point one patient got very very sick very very fast.  I pronounced him dead before 10am.  In twelve hours, he went from sitting in bed talking to me; to struggling to breath and stating that he wouldn't want a breathing tube, he was 82 and had had enough.  Then I was calling his daughter to ask her to come in and say goodbye.  I held her hand as the priest gave Last Rights; and later I removed the last few things that were keeping him alive when we all agreed that it was time for him to go.  I stood next to his daughter and the nurse who had been with us all night as we watched his monitor flat line; and I choke out- "Time of death 9:46am."

Part of me felt like I was invading a sacred space as I stood in that room.  I was a stranger to them, having only known them for a few hours. It's a lot like the other post that I wrote awhile ago about Death; it was such a deeply personal and devastating thing for them, and I felt a bit like a fraud being a part of the moment without truly knowing them.

Sorry for all the sad thoughts.  More cheerful posts to come- I'm on pediatric surgery now and my average patient age is about 1 month.  So I get to hold tiny tiny babies all day.  Love.

Life!

Somehow I'm on call tonight in the ICU, and it's silent.   We are at full capacity in terms of patients; but they are are all sleeping restfully and keeping their vitals totally stable.  Weird....

So I get to update the blog!!  This past month has been really wonderful.  Dan and I have gone to archery classes, and are looking into a few different archery ranges around the city that we might join.  It's been really fun.  Also I love having totally random skills and experiences to confuse people with.  How fun would it be if I just casually slid out of work someday, stating that I had to get to my archery tournament.  AWESOME.

We bought a bunch of beautiful plants at a Conservatory sale a while ago, and they are mostly doing well.  We had to ditch our cotton plant because we found a bunch of bug eggs on its leaves.   Our big plants have been loosing some leaves; I have to clean up after them more often that if they were real pets.