Sunday, July 30, 2006

the magical fluid bolus

a little girl came in to the ED today with a fever to 39.5. i had spoken with her mother several hours earlier about the fever, as well as some bug bites that looked infected and asked them to come in to make sure the bites weren't cellulitic. at that point, her mom told me over the phone that she wasn't too worried, because she was still playing.

by the time she got to the ED, she was no longer playing.

she was, in fact, lethargic.

the dreaded L word that parents throw around willy-nilly without proper respect for the weight it carries. it does not mean they're sitting on the couch all day playing video games or just wanting to watch movies. it means that they are sleepy and very difficult to wake up.

this girl slept through my exam, including the belly exam. even still, this mom did not describe her daughter as lethargic, but, rather, as "a little more sleepy than usual".

1 IV, 300cc of NS, 240mg of tylenol...and presto!

all better.

up, talking, smiling, asking for apple juice and stickers that were pink.

i gave her all the pink stickers we had, including the one of the bear with a pink bow and the caption, "i'm all better!"

Friday, July 28, 2006

non sequitor(s)

went running today. on a windy, hilly dirt road, i could have sworn i saw a mushroom as big as a basketball. turned out to be a rock. some runner's high.

i have a new housemate who is about to start med school after his first career in computers. he's a total wiz and is, as we speak, figuring out how to transfer all my music on my ipod (that came from a computer that no longer exists) to my current computer. brand new music library for me. well, not brand new. it's all my music. but it's now manipulatable on my iTunes.

my new favorite show on t.v. when i can't seem to wind down from a night in the ED is "Throwdown with Bobby Flay", in which the Iron Chef travels hither and yon to challenge ordinary, everyday people to a cooking challenge. Last night was a Texas Chili cookoff. hey, new yorkers can cook chili, too.

work beckons in the morning. at the moment, i am feeling masochistic enough to get up even earlier and run before clinic. i think i really am nuts.

Thursday, July 27, 2006

bad day


(post edited)

on a brighter note, i did my long run yesterday and feel fairly good today. minimal diaphragmatic irritation. hills that used to kill me are now an afterthought. could it be that i am actually getting in shape???

Saturday, July 22, 2006

when you are sicker than your patients...

so it's never a good omen for your day when you feel worse than most of your patients. there's a lovely gastroenteritis going around and, lucky me, i seem to have caught it. not surprising, considering how many times my face has been sneezed and coughed in over the last few weeks.

here's a tip that i learned the hard way. wear a mask when swabbing people's throats. that way, when they gag and cough, you are somewhat protected.

saw some neat stuff today, though, despite feeling wretched.

a resident came in with a dislocated shoulder from a slip-n-slide incident (presumably involving a lot of alcohol). pretty much behaved like an ass, which is sort of what he's known for. a little boy with a septic joint from a laceration that was sewn up a few days ago. a young baseball player with a nasal fracture from trying to catch pop-up flys with his non-dominant hand who had clear rhinorrhea ever since the injury...didn't turn out to be csf rhinorrhea, but it was good to go through the differential. lots of non-specific viral stuff but overall really pleasant families, which always makes things easier.

plus, i was working with one of my favorite ed docs who totally gets my sense of humor. we have a good time. he wouldn't give me an iv, though, for my own rehydration, but that's ok. i guess i didn't really have mental status changes...yet. i've been working on the ORT. alternating gatorade with emergen-C. if i wake up tomorrow obtunded, you'll know why.

based on the number of parents that i convinced over the phone to wait until clinic tomorrow to be seen instead of coming to the ed tonight, tomorrow is a busy day. off to sleep i go...

a running question

a question for fellow blog-reading runners out there.

i've been training for a half-marathon of late. it's a fund-raising event for the hospital where i work. it's going well, now that the blister is healed. but every day when i start out, i have left shoulder pain, no matter how much stretching i do. after about a mile or so, it stops. why is that?

on a somewhat related note, i was just down in new york visiting family and went running in central park, one of my favorite things to do. i started out near columbus circle and ran up around the reservoir. it was a weekend morning, so the park was full of other runners and bikers and families and couples. it was quite distracting, and still somehow motivating, to have other runners around. not that i was competing with any of them, but it helped a bit with pacing, particularly since it was 11am and 95 degrees out.

there was a musician playing on the grass near tavern on the green, a crowd of people sitting and listening raptly. lots of people having picnics on the great lawn with their coffee and bagels. i absolutely love the peace and quiet of living in a small place, but it was nice to be immersed in the city again, even just for a few days.

Monday, July 10, 2006

blisters and such

i've not been able to run this week due to a nasty blister on my left heel.
it's finally healed. 
well, sort of. 
enough to try running again today on my day off from the ED. 
life on the ED rotation is sort of interesting. it's a little lonely, as i work when most of my other friends are sleeping. but it's also pretty neat. i get to see people who are really freaked out, whether for valid reasons or their own imagination, and help them in a very real way. whether it's getting a kid with an asthma exacerbation a neb and a wopping dose or steroids or sewing up a laceration on a little boy's knee. i always tell them how brave they are, even if they weren't really, because that's as much of a band-aid as anything else i can offer. 
the families whom i've met so far in my short 2 weeks on this rotation have run the gamut from those reeking of cigarette smoke and neglected dental hygiene to the most well-educated with glowingly polished veneers. i have to say that i learn something from each and every encounter. 
even if it's just that i should really floss more. 
here's to healed blisters (and other body parts) and to a glorious, sunny day off.

Friday, July 07, 2006

quiet afternoon

i spent the afternoon sitting on a bench at the edge of the town green reading my latest favorite book, The History of Love. it was an interesting exercise in people-watching, too.
there was the group of girls who all looked the same, as if they had consulted one another before getting dressed that morning. the little boy in his motorized wheelchair who was racing in circles around his nanny and her friends with their young charges, all the while a huge grin on his face. the family waiting for their dinner reservation at the fancy restaurant across the street, all dressed up in suits and high heels. they seemed like such a content family. the youngest amongst them was a 9yo girl who reminded me an awful lot of myself at that age. she was just dancing around on the grass, blissfully un-self-conscious, doing cartwheels and congratulating herself when she did a particular move well. she caught me looking at her at some point and we forged an immediate bond, as if she sensed that we were dopplegangers. when they all went across the street for dinner, she looked over her shoulder at me and waved good-bye. i smiled and waved back. i wish her well, oh so well, in this crazy world. 

Tuesday, July 04, 2006

independence day

today was one of those amazing days that i want to preserve forever. if only you could put those days in little snow globes so that you could pick them up, look at them and remember why it was that the day meant so much to you at the time.
my sister and i hiked mt. moosilauke with my chief resident and his girlfriend, who also happens to be an old med school friend. from the ravine lodge, we hiked up the gorge brook trail to the summit. it's a steep hike up but so incredibly beautiful. there's something so amazing about how the vegetation changes from tall, dense pines and birches to the wind-stunted dwarfs at tree line. it was not the best day for views, but that didn't seem to matter, as there was a mystical, blue-purple haze that gave everything a somewhat ethereal hue.
we sat on the rocks at the summit and ate nutella and pretzels. there's nothing quite like chocolate at the top of a mountain. french fries might be better, but i've never been able to find them in such a place.
we hiked down the carriage road (beware the poison ivy!) to snapper, re-entering the dense, lush forest. so many wildflowers blooming, growing in the crevices of the rocks that lined the trail. i wish i remembered more botanical names from my undergrad ecology labs, but they have been replaced with the names of muscles and nerves and bones. for some reason, bird calls have stuck in my memory, though. white throated sparrows were in abundance, singing heartily as we entered their territory. i've always loved their call, so plaintive and almost melancholy.
at the convergence of snapper and gorge brook, there's the class of '97 swimming hole. the water as deliciously cold and made my tired feet feel so much better. i splashed the water over my face and head, feeling the freezing rivulets drip down my neck. nothing quite like it in all the world. it was almost torture to put my shoes back on for the walk up the hill to the parking area.
the last time i was at moosilauke was late fall. the lodge was deserted and it had already started snowing. yesterday, however, the lodge was full of summer staff and visitors, the sweet smell of cornbread lingering in the air. there was a man with dreadlocks playing guitar, trying to learn a song before tonight's 4th of July celebration perhaps.
we filled up our now empty water bottles and headed back, stopping at fat bob's for ice cream. to give you a sense of why it's called fat bob's, a baby size is 1 scoop, kid size 2 scoops, small 3 scoops, medium 4 scoops and large 5 scoops. no wonder americans are overweight. i got a twist with rainbow sprinkles. a little girl in line behind us said excitedly to her mother, "she got rainbow sprinkles!" i remember being that excited for rainbow sprinkles once upon a time.
after a late afternoon nap, my sister and i went to watch the fireworks. it was really quite impressive. greens and golds, red, white and blue, pinks and purples all showering over the river, the boom echoing loudly off the hillsides. during the finale, the song "born in the USA" was blasting over the loudspeaker. my sister and i both looked at each other and wondered why they chose that song, as the lyrics are not the most glowing portrait of life in this country. but i guess as long as the chorus is catchy, what does it matter?
all told, it was a cleansing, restorative and grounding day...reminding me of my own, innate independence and strength and also of my inextricable link to the earth and the people in my life whom i love dearly. i think i'll have to make this a new july 4th tradition.