GOLDEN WEEKEND!!

We went to the beach for my first golden weekend in a long time. It was a wonderful trip. I basked in the sunlight (55 spf, of course). I strolled the beach looking for shells. I played with my 8 month old who was in a pretty good mood for most of the trip. I reconnected with my husband. I met minor sports celebrities on the plane on my way back. And I am not too sad to be back... seems vacationing me-style is more work than being on call in the CCU. It is a little hectic trying to get out of town with a baby for just a couple of days. So, I might try to pick a closer getaway next time.

Today, I am on call again. Several of my patients got discharged while I was basking in the sun. The one that remained is getting better; transferred to floor today. I have one admit that is going to the CCU proper- though with every passing minute and every liter of fluid off of him, it makes me wonder if he really needed to go there in the first place. My next one is same story, second verse but hasn't arrived here yet.

I'll probably get some thai food with my husband and child tonight if I am not too busy. So far, I have only had two admissions and it is 5pm. If I get another one soon, that will keep me busy for awhile. For now, it is cold coffee and more reading. Until they call me for orders.

What I've got so far...

CCU service on call... so far (most of my admits will come in late tonight)

1. cute little old lady with pneumonia with afib with rvr (could it be rapid from the infection?)
2. nice middle aged, doctor-fearing guy with hypertension urgency with st depressions in II, III and aVF not resolving now that the blood pressure is down, initial enzymes negative... enzymes pending (oh, and he has refractory hypertension, hypokalemia and metabolic alkalosis)

3 more to cap. There is a chance I won't. Already got 2-3 hour nap in.

I am definitely missing my baby and hubby terribly. I finally got to see them for the first time in a week last night and now I am on call. My husband is with his brother at a baseball game. My baby is with my parents. I am at the hospital, alone, with no resident. Tomorrow we are going to the beach with a friend from my pre-medical school days. We bought an infant life jacket yesterday, along with $100 worth of other crap from Target.

Things good.. well, ok

Hurt my thumb on my first day off in three weeks. It cannot be bent. Plus, it hurts. Not broken. Jammed. Its what I get for being physically active.

Plan to post picture. Someday.

Now post call. Child and hubby out of town. Just me and the cat. Maybe I'll read when I wake up, but my parents promised to feed me. A night alone at home might actually be wonderful.

What I learned today...

Please don't laugh...

The QT interval should be less than half of the RR interval. I know there are some other ways of looking at it, but for the sake of my exploding brain, we are going to keep this simple. I have had several patients with "long QT" and I have had to look up a lot on this.

You cannot give sotalol to someone with long QT, or if they have structural heart disease. I also remember something about haldol and other psych drugs potentially causing long QT syndrome. You can give amiodarone to patients with structural heart disease though. Can you give it if they have long QT? Wish we had a pharmacist on our team this month.

Digoxin slows the heart rate without affecting blood pressure much. It is so funny, because I keep putting patients on this old mostly-forgotten drug. I need to read about it because there are a lot of things to keep in mind while you are using it. And since I am just starting my medical education (med school does not count), I have nothing in my mind and need to fill it up.

It is HARD to find any medical care for the WORKING poor around here. So, even though I am not a huge fan of government run medical care, it is time that someone did something about the fact that I have patients who work 40 hours a week and barely make enough money for basic needs - and they have no health insurance because they are self-employed and not married. But they make too much to get charity clinic. They would pay what they could afford, but I doubt that will be enough to afford a cardiologist. Why do we take care of people who sit on their rears before we take care of those who actually make this country run????? ARGH!

Don't put people on coumadin who can't get their INRs checked. No extra comments needed.

I went to work early, saw my patients and got out of there. My dubin's came in the mail and I am reading it. Maybe I'll take a nap and head back into the hospital this evening once the attendings have had a chance to see my patients.

Planning a break: golden weekend coming in 2 weeks

I am going to use this post to brainstorm ideas for my golden weekend. Its 22-23rd.

Not sure if we can get my parents to watch the baby, but that would be ideal if they were cool with it. I'll just to be brave and ask.

If so, the sky is the limit as far as what we can do. We've got Southwest Airlines passes and it would be great to head for the beach or the mountains.

If we have to stay around here, I would love to go sailing. If we have to bring the child (not a horrible thing by any measure), there is the zoo. Also, we've been doing a bit of renovating and we could get some more stuff from Ikea.

The babe and hubby are headed to Minnesota next weekend. I will finally have a weekend day off and they won't even be here. I can't begin to express how lonely it is without them. My med school buddies are off at programs in other cities and my resident buddies are working. So that leaves my non-medical friends... That or I am going to shop up a storm. Maybe I'll see if I can get some help cleaning our place.

I need to pick a specialty already??

So I went into internal medicine to postpone some decision making. I liked both surgery and medicine, but I thought medicine had more options. Either way, I'd be helping make people better (hopefully) so I didn't feel that much pressure. I am loving the CCU so much that I am teaching my non-medical husband to read EKGs. Where are some med students to teach when you want to? I'm on call tomorrow, a Saturday, and I am hoping I have some admissions so I can actually learn some stuff and get to know some of the attendings. When I started this year I was thinking onc, but I love how much effort has gone into everything we do in cardiology. There have been big controlled double-blinded studies and we actually know what strategies are best. Less guessing. Plus, heart disease is so common that I know I could work almost anywhere when I am through. I need to spend some days in the cath lab, but I have a feeling I'll love it. Just to see such fast improvement will be a cool thing.

Tele monitoring for dummies

I need to learn how to read the incidents on the tele monitor. I have been shown before, but evidently I missed an event. I'm wondering how since I checked it out this morning. Luckily the nurse called me (I'm home)... but that is so frustrating.

On the upside, hubby and I are bonding as I teach him (and myself) how to read EKGs.

Just another update

So, I am in the middle of a 17 day stretch. I thought I had pissed off someone and gotten a horrible schedule... then I found out it is just due to the automatic scheduling they do. Usually someone double checks it, but not last month.

I was really worried about how I would handle it, but I got ZERO admissions last night. What are the odds? This never happened in medical school. Still I'll take it where I can. I had plenty of cross-cover to keep me busy and a patient came into the hospital that I see in clinic. So, I helped take care of her. And I got some sleep. Pretty awesome. Or worrisome. Depends on your perspective.

It was nice to spend some time with the family post call and not be completely zonked. Though, after a nap this afternoon it is going to take some benadryl to get me back on a regular sleep schedule. And I am just one of those people who needs a regular sleep schedule with about 9 hours per night optimally. You MD moms may laugh, but my brain works best with that much and I do whatever I can to achieve that. Basically that means nothing gets done around the house and I am either at work, playing with baby or hanging out with hubby.

Something about mothering

Image by chispita_666 via Flickr

Little one is a formula fed baby. And like all formula fed babies there is a little concern about the iron in his formula and how it seems to be causing constipation. He is on a lactose free formula. We switched him to that when he was very colicky (6-8 hrs per day of crying) and every time we try to go back we run into problems. I don't really know if he is lactase deficient. You'd think I'd know. But he just seems to do better on the lactose-free formulas. All you pediatricians out there can roll your eyes. No, there are no controlled double-blinded studies to support me. He just gets really crabby every time we switch him back and starts spitting up more.

So, we are in a quest to get him regular and his stools soft. I have even considered miralax, though I am not sure if it can be used in babies. The apple juice does not seem to be doing the trick. Next up, prune juice. And prunes as an afternoon snack. Yummy.

Update...

Image via Wikipedia

Admitted 4. Discharged 1 to heaven. Requested autopsy. First time ever. Family thought over. Charge nurse called me at 5pm post call. Had no sleep despite relatively healthy patients other than other mentioned. 5 codes overnight (not my patients, thank god). Prayed with family. Haven't done that lately.

Something's wrong. Sudden death. Runs in family. EKG not giving up any hints. Need answers.

My post-midnight admissions suck. Hard to get an H&P when I can hardly think. Will get better as it becomes more automatic.

Baby has two little tooth bumps. They haven't poked through yet. Slightly crabbier than normal, but still literally a bundle of joy most of the time. Starting to get those baby thoughts again, but need to give myself at least another year before seriously contemplating another pregnancy. My life is hard enough.

Drinking red bull post call and trying to enjoy time with family.

Unit month starts tomorrow.