ProMotion en route

I just ordered my triathlon wet suit today.  I’m swimming the first leg of an Olympic Distance Triathlon in 9 days, a 1 mile swim.  Last year I promised that I wouldn’t do it without a wetsuit to add a little bouyancy and safety to the swim.  With tendrils of seaweed grabbing my ankles and wrists with every stroke, I’ll take a little help from the wetsuit.

I’ve been swimming 3-4 times per week, and it’s going pretty well.  I’m impressed with how good I feel afterwards, my entire body is relaxed, and nothing hurts.  Sometimes I hate coming back to gravity after getting out of the pool.  In fact, I’m almost addicted.  I think about swimming almost non-stop.  This happens every fall when I train for one of the local triathlons.  I’m thinking about doing a 3K ocean swim at the end of September as well…maybe by then I’ll be in shape for the 5K…

I wish I found the other 2 legs of the triathlon as easy as swimming, I’d be a superstar then! In my first triathlon, I finished smack in the middle of the entire field of 250 for the swim, including the men and elite athletes.  I was pretty impressed with myself, but my meager lead of 5 or 6 minutes in the swim didn’t hold up long on the rest of the course. 

Work is a little slow now, I’m doing my “research” month.  I worked a total of 14 shifts, went to ortho clinic a little bit to make up for the time I missed during surgery, and finally turned in an IRB application.  But I’ve had time to get to the pool and train as well.

I start full time again next week, so maybe I’ll have some fun stories.

Do you want another patient?

Anytime a nurse asks you this question, run and hide, immediately.  The question is asked because a) it’s a woman with pelvic pain, and you’re the only one on b) the patient is a child/friend/coworker and the nurse thinks you’ll treat them nicely or c) the patient is very, very sick, and the nurse doesn’t trust anyone else to take care of them. 

Now for options a & b, I’m happy to chip in, but not when there are five other patients who still havn’t been seen.  Everyone here is basically pleasant, and all of us, men included, have been trained to do pelvic exams.  Option C, however, is an exception.  Run into the room as fast as possible because you might get a chance to save a life. 

This time, it was option C.  I walked briskly into the cardiac room, and a woman with an ashen face was sitting bolt upright, half-on & half-off the bed, pursed lipped breathing.  I tried to talk to her.  She would take about five breaths then say one word.  I had to choose my questions carefully so that her one word answers would be helpful.  “Are you having pain?”  Puff, puff, puff, puff, puff, “no”, puff, puff…etc

So with history not helping, an ashen patient apparently short of breath, the answers are quick and simple.  Shotgun approach to SOB.  Nebulizers & Lasix.  BIPAP machine.  Stat portable chest.  Her lungs were a whiteout. No fever, sudden onset.  She had ROPE.  Rapid Onset Pulmonary Edema.  We gave her sublingual nitroglycerin to offload the fluid in her lungs, a touch of morphine.  The bipap seemed to do the trick.  She looked more comfortable.  Spoke several words at a time that I couldn’t understand under the mask and noise of the machine.  I carefully watched her blood pressure as I asked how she felt about a “breathing tube” if needed.  She agreed if neccesary.  I still didn’t know if she’d turn the corner or not.

As soon as the respiratory therapist left, she ripped the mask off and shouted, “Get it Off! Get it Off!”  While it made me more comfortable to see it on her, she was obviously getting better if she could shout like that!  I left it off.  We finally got the catheter in her bladder since she could tolerate laying back a bit, and she put out almost 500 ml right away.  Soon, she was sitting comfortable on a nasal canula chatting it up with her daughter.  She had definately turned the corner for the best. 

It wasn’t until afterwards that I realized I felt completely comfortable directing her care and anticipating the next step.  I think if she hadn’t had rapid intervention (if an intern or off service resident had picked up the chart?) she could have easily crashed and coded right in the ED. 

The Troupe Fantastique

My public announcement is almost a month overdue, but I am pleased to announce the public unveiling of a collaberative group blog called The Lingual Nerve.  The Lingual Nerve is the collective thought of 7 different physicians from around the world, plus a London prehospital provider.   Please scroll back to the July 1 posting by Spacefan, our instigator, for a more colourful (global spelling) introduction of the group.

In the meantime, if postings are a little slow on Mr. Hassle or your favorite blog, hop on over to the Lingual Nerve and see what’s happening.


Resident Sleep Deprivation

Yesterday, I planned to be very productive in the 3 hours of free time I had between lectures ending at 11am, and work, starting at 2pm.  As I puttered around the kitchen cleaning and sorting stuff, I accidentaly stepped on my cat’s tail, resulting in a loud cry.  I felt so badly, that I got down on the floor with her, scratched her head, rubbed her back and apoligized for stepping on her tail.  Then I promptly fell sound asleep for an hour.  On the kitchen floor.