Last February, I spent 30 delightful miles as a pacer for Barb and Vicki in the Rocky Raccoon 100 miler. Barb is 76, and Vicki is 66. My shift started at 5pm and we continued through the night until Barb had to stop around 3am due to medical issues. Our pace was more of a fast hike than a run, but I was so incredibly inspired by these ladies. And they made a video of their story!!
I was watching this show called "mystery diagnosis" when I was eating dinner tonight, and there was a baby with a disease called "maple syrup urine disease." Apparently, it's a rare genetic disease that has that name because the baby's urine smells like maple syrup, aka the amino acid isoleucine. Basically the child doesn't have the enzyme to break down three amino acids: leucine, isoleucine, and valine (nonpolar, branched chain amino acids). The treatment is to feed the child a man-made formula with very low levels of those three amino acids, and they have to stay on the formula for their whole lives. They can't eat real protein ever.
On the show, the doc finally figured it out, but not before the baby had suffered brain damage from the amino acids building up in her brain, to the point where she fell into a coma. Apparently, screening for this illness is now part of the routine newborn checks. The parents being interviewed said that losing a child was one of the things that they feared most in life, but it was nice that at the end of the story, the baby was now 18 years old and "the happiest person in our family. She goes to bed with a smile and wakes up with a smile." Amazing.
As a side note, why don't they teach you these things in school?? Who knew that people could have gene defects where they couldn't digest specific amino acids? Would have made it a whole lot more motivating for me to learn those chemical structures and pKa values, if I had known that I might meet someone, someday, who that info would help!
Another evening in the ED, and I'm in a blogging mood. Lots of typical folks tonight, and by typical I mean people with a little chest pain or abdominal pain or diarrhea...and then they go home with a prescription or two and some follow-up instructions.There were a couple pregnant women with bleeding tonight. I put them in the category of "typical folks" as well; it's not really "normal" but common. Unfortunately, there was a case of fetal demise of twins. So sad. We also saw an old lady, a really old lady. I can't tell you how old because that would violate HIPPA. But! My doc said she was the oldest lady that he'd ever sent home. And to home she went. I also learned how to read a STEMI tonight, a heart attack that you can read from the EKG.
Usually, the midlevel practioners (MLPs, who are nurse practitioners at our hospital) get to see all the kids, but we got a few tonight. We had a cute little baby who was mildly sick, but I would have loved to cuddle her anyway. It boggles my mind how parents can bring their minorly sick children to the ED and then not spend all their time cuddling and coddling them. Even Supernanny says its ok to let your kids into bed with you when they're sick, and then back to their own bed when they get well. We saw another child with a severe asthma attack. Poor little one!
This morning before work I went to an annual training session for my volunteering position at Texas Childrens. One of the speakers asked us volunteers for stories of times when people expressed appreciation for us. It was amazing to hear the stories about how the volunteers actually helped the medical care of patients, not just their mental health or enjoyment or whatnot. One guy who was a baby holder (just like it sounds) was explaining how he can see the obvious effect of holding babies just by looking at the monitor. Their heart rate and respiration rate drop, their O2 stats rise, and usually they fall asleep or rest much more quietly. Another guy who volunteers by playing his keyboard told us that after he finished playing one day, a nurse told him that they'd been struggling to put a tube into a kid, and the music had relaxed the child enough that they were able to get it down. "Appreciation is the paycheck of a volunteer."
"But Jesus called the children to him and said, "Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these." (Luke 16:18)
Yes, I was there. No, I wasn't being treated there.
I've been working as a medical scribe in an emergency department for almost 4 months now, and I've really settled into the job. Still learning a lot, but able to think more about the medicine side of things than my administrative tasks. I've realized that I want to remember more of the things I'm seeing. I don't really have anyone that I can unwind with from work, not everyday anyway, when I want to swap stories about patients and chuckle over the funny things they did or said, or recall the scary cases and end results. I think it's those kind of exchanges that really seal a case into your memory banks. Who knows when I'll want to pull out a story to use later?
We had a pretty light day in the ED today, so I thought I'd try writing a bit about the evening. And hope I'm not jinxing myself for a rough day tomorrow!
The first patient we had turned out to be a non ST elevated myocardial infarction. That's basically an atypical heart attack. He was a nice old guy, who told us that he had been diagnosed with WPW (Wolff-Parkinson-White Syndrome - better wiki that one, for the medical readers, he wasn't tachy). So with a slightly abnormal EKG and positive cardiac enzymes, he was admitted pretty quick.
The second patient was an elderly lady with lupus, among many chronic issues. She just felt weak and had been vomiting for a few days with dull pain. And she also had this very bizarre vascular stent running along the left side of her body. The initial radiology and labs didn't show much. Then after we'd seen lots of other patients and she'd been here for hours, the results of the CT came back. Ruptured abdominal aortic aneurysm. AAA!!! (literally) The surgeon on call was very concerned despite her normal vital signs, so she got transferred to the med center.
The third patient we saw had bloody urine. For days. Yikes! Super anemic on the lab results. Admitted.
And so you know that we don't just see crazy-sick people...the next patient was in a cycling accident and had several fractured teeth. The next was an elderly woman who was essentially blown over by the wind and had a gash on her face. The next was a young man with pain along his ribs that we concluded was just a pulled muscle. The next was a pregnant lady who was spotting, but not cramping, and she got sent home.
Then we moved to the acute section (seriously, we start with the less sick folks). First, we got called to the sixth floor of the hospital for a "code blue" which means that someone potentially needs to be intubated, ie stick a tube down their throat and help them breathe. While the doctor does the intubation, I usually spend time reading the chart, so I can recite the past medical history or other info the doctor might need. This guy was very elderly, and apparently his wife had brought him to the ED for some oozing decupiti aka bedsores on his rear end. Well, likely to her surprise, he had significant bandemia (very bad thing) and was admitted for sepsis (very very bad thing). Anyway, he got intubated, and we headed back downstairs.
I guess most people were staying home on a Sunday night. We only saw one patient, a Vietnam vet who had sustained a shrapnel injury in the 60s and was paying for it, struggling to breathe tonight. The metallic fragments had never been removed from his chest, and he had a ton of scar tissue and part of his right lung missing. Since we had so little to do, I went in and chatted with him and his wife. He had multiple stories of times where he should have died from the experience "and that's why I'm a Christian today. He'll take me when it's my time and not until then." I could tell that his wife was a trooper too. Long story short, he had a really significant bandemia and had to be admitted.
It was kind of an unusual night tonight. There were very few patients, but the main thing that sticks out in my mind was that everyone was so thankful!
"Therefore, since we are receiving a kingdom that cannot be shaken, let us be thankful, and so worship God acceptably with reverence and awe" (Heb 12:28)
"The Lord is the strength of my life; of whom shall I be afraid?" (Psalm 27:1b)
This is how the marathon went today.
0500 wake up, eat some pb&j 0600 get in the carpool with my training partner Joanne, her husband, her sister, and her sister's bf 0615 get to George R Brown, put on bib, shoe tag, stretch, check bag 0645 get in the starting corral, blue wave 0710 gun goes off for my wave
Mile 0 cross start line, ~2 minutes after gun due to crowd Mile 1 slow start due to cattle like formation Mile 3 decide to pick up the pace, hit goal pace of 9:20 Mile 5 leave my training partner and her sister, feeling great Mile 6 I see my roommate cheering and get excited Mile 7 I see my family cheering and get so excited i almost cry Mile 12 I see my family again, and scream until they see me Mile 13.1 Half PR - 2:05:27 Mile 14 start getting tired, walk a hill Mile 15 quads go from tired to burning, stop and stretch, consider asking family to just take me home Mile 16 I see my family again and get boost to keep going Mile 17 The 4:15 pace team comes, and I get hopeful of making it through the pain with them Mile 18.75 (30K) - 3:00:21 (this may be a PR, not sure) Mile 19 The 4:15 pace team gets ahead, I walk dejectedly Mile 20 I meet a nice woman named Rebecca, we run a super slow pace which is all my legs can bear Mile 21 I find out that Rebecca is Catholic and teaches catechism, interesting conversation ensues Mile 22 Rebecca sees her husband Mile 23 My brother jumps in the race, tells us some interesting stories Mile 24 my quads are burning more sharply Mile 25 My quads are killing me, but I decide I'm done walking Mile 26 My brother steps off the course to let me finish alone Mile 26.2 (or 26.5 according to my friend's Garmin) Finish - 4:25:51, feeling disappointed although only my quads really hurt and a few blistered toes
Finish + 5ish minutes later -> hug Rebecca as she finishes Finish + 15ish minutes later -> hug my training partner as she finishes Finish + 40ish minutes later -> hug my training partner's sister as she finishes Finish + 1 hr later -> photo ops with the fam (to be posted later) Finish + 2 hr later -> arrive at post-run party, consume ~ 1000 calories of pizza + beer
