Ethical Dilema

The awesome thing about working on a Transplant unit is that you get to see all these really sick, dying people recover from their illness after receiving a transplant. The not-so-awesome thing is when you see noncompliant people essentially waste the organ they've been given because they are too stubborn to make the necessary lifestyle adjustments needed following a transplant. Whats even worse? When we work up a patient for a possible transplant evaluation and the patient is already noncompliant - before any of the hard stuff has even begun.

We have this one kid (yes, kid. He's 19yo) and he's already had a pretty rough life -- pancreatic Ca, surgery to cure it, and b/c of the surgery, he has all these small bowel complications, thus he's being worked up for a small bowel transplant. Obv you feel for the kid b/c his situation sucks, but you would think that if he has the opportunity to get transplanted and possibly solve his problems (granted it definitely wont be easy), he would be grateful and willing to do whatever it takes. Instead, he refuses to have labs drawn, refuses to have his dressings changed (his PICC line dressing hasnt been change in a month! Hello, infection?!), he manipulates the nurses and doctors, he refuses to listen to anyone, and he is completely stubborn and noncompliant. And THIS is the guy you want to give an organ to?? Unfortunately the doctors/researchers are so concerned with the numbers that they just want to get as many transplants done as possible. It's a shame, isnt it? I'm not quite sure how performing a transplant that has a fairly decent probability of failing is good research, but what do I know. It seems like such a waste to give an organ to someone who is so unappreciative and unwilling to do the work. (Let me clarify: If this kid doesnt get a transplant, he wont die, unlike those in need of, say, a liver. Although not ideal, he can live with supplemental nutrition. So its not as if not giving him a transplant is a death sentence.)

Well the problem with this particular patient is that they recently found possible mets in his abdomen, which means if he does in fact have cancer again, he is no longer eligible for a transplant. Now, of course I dont wish cancer upon anyone. ...But I also don't want this kid to get a bowel...

Lent?!

How is it already Lent?? Wasnt New Year's like, a week ago?? I cant believe how quickly the last month and a half has gone! I was having a hard time coming up with something to give up for Lent...

• Chocolate? I dont eat enough of it that it would really be a sacrifice.
• Snacking? I would never make it through a night shift
• Coffee? Not unless you want me to be mean and miserable
  
• Alcohol? Ha.
• Maybe just giving up wine? Then that just means I'd come home and have a beer instead.

Well after much debate I think I got it: For Lent I'm giving up complaining about work -- not to be confused with venting. So no more bitching and whining about obnoxious patients, indecisive doctors, pain-in-the-ass med students, the worthlessness of our pharmacy, etc etc. We'll see how this goes..... :-p

Feb. 14

"...General opinion's starting to make out that we live in a world of hatred and greed, but I don't see that. It seems to me that love is everywhere. Often, it's not particularly dignified or newsworthy, but it's always there - fathers and sons, mothers and daughters, husbands and wives, boyfriends, girlfriends, old friends... If you look for it, I've got a sneaking suspicion... love actually is all around."

Happy Valentine's Day. :)

Snow - part 2

Isnt it funny how you take away the option/ability to do something and suddenly thats all you want to do? For example, I spend quite a few of my days off just relaxing and bumming around the apt and it usually quite enjoyable and much needed/deserved rest. Esp when its a fake day off, aka I worked the night before, and esp when my most recent shift was as crazy as the one I had last night. But of course today we have yet another blizzard warning for the DC area (and believe me, it is ridiculous out there) and thus I am stuck inside the apt and all I want to do is go out and do something. But alas I've been laying in bed under the covers about to go stir crazy because I'm afraid either my car wont make it 5 ft without getting stuck, OR mother nature will eat me alive in the snow storm.

Leaving the hospital at 0800 following a crazy night shift. Already blizzard-like conditions:


Streets were empty...


Probably b/c there was barely any visibility. Driving across the Key Bridge - you cant tell from the picture, but normally you would see tons of high rise buildings at the other end of the bridge:


My apt complex at approx 0830



But I do still love the snow! I'm pretty sure I'm the only one on the east coast who is excited its STILL snowing. :-p

Snow!

Snow is so pretty!! :) looking out my window - just a couple inches on the ground:


Crossing over the key bridge looking at Georgetown (yep, on my way to work):


Snow covered trees:



...Then "Snowpocolypse/Snowmageddon" happened Friday through Saturday. ...And I worked Friday night, so getting home Saturday morning right smack in the middle of the blizzard was quite the challenge. I actually didnt make it all the way home, I had to take the GUH shuttle to the metro then walk to my friend Lisa's apt. Yeah, walking during the blizzard was not so much fun. But it turned out pretty well. We hung out all day (way better than being stranded home alone) and then ventured out in Arlington on Saturday night where there were tons of people out. So much fun! (aside from getting shoved into a snow bank for no reason thanks to Matt :-p).

Pics from Sunday, once the snow started to melt and you could finally see the streets:


overlooking the Key Bridge with the Washington Monument in the background:


Look how pretty!:

Fast Forward

Sometimes I really wish life had a remote control to it. You know, you can rewind to relive awesome moments, rewind to redo bad moments ...or maybe rewind to remember moments... like last Sunday for me, but thats a whole different story. :-p

Well, right now I'd like to fast forward. Fast forward to Wednesday. Fast forward to the weekend so I can get a sense of what happens when the Doctor and I no longer see each other at work every day and whether or not we'll still talk. ...Fast forward to when my apartment is once again furnished so I dont have to sit on my living room floor or eat at my desk. ...Fast forward to when I can walk out of my room and not be super depressed when I see Laura's empty bedroom. (...Or just fast forward to if/when Laura moves back to DC, but I have no idea when that will be so I may end up fast forwarding through quite a bit of time.) Mreh.

the waiting game

I hate this game. In every sense. I am impatient and I hate the feeling of helplessness (hello, Type A here, thus I like to be in control of situations). I hated that I had to sit and wait for hours to find out if I passed the nclex. I hate that after you put yourself out there and ask a boy out, you just have to sit and wait for his answer (but thats another story :-p).

But really, I HATE the waiting game when it comes to work. I understand that some situations are minor enough that waiting, seeing, and monitoring is appropriate - like if someone's staples look a little red and inflamed. Could just be irritation, so cont to monitor and if the redness/swelling increases, ok we'll take some action. That is legit and I understand that. But typically if a situation warrants reporting off to the doctor, some kind of action needs to be taken. For example this conversation took place during my last night shift at around 3am:

"My patient is complaining of shortness of breath. His O2 Sats are good: 99% on RA, but I put on O2 for comfort and he says he still feels like he just cant catch his breath and feels tightness in his upper abdomen" (I am 95% sure this patient has a fluid collection in his abdomen which would explain the tightness, and all the fluid pushing up on his diaphragm would explain the difficulty breathing, but I still need to tell the doctor so that maybe we can order a couple tests to confirm. Plus, whenever a patient complains of SOB, it is never ever good.)
"Ok, we can order chest x-ray and maybe an ABG in the morning. Just watch him for now. His Sats are fine, right?"
"Yeah... but he's on 3L of O2 and still feels short of breath"
"Yeah, ok, we'll order some tests in the morning."

WTF. Why? Why do you have to put off ordering these tests till the morning? Why the hell would you put it off for 3.5 hours till the rest of the team gets here when you know that as soon as they take one look at him, they'll order exactly what you just suggested? You're the freakin senior resident! Just order the damn tests. I dont know if its b/c they're not used to how sick our patients are or what, but the waiting game never ends well with our patients. It is not a good game to play with these people. How is it that they dont understand that? Ugh. Frustration.

ohhh boys

Sorry its been a while since the last post, nothing too exciting has been going on unfortunately. Christmas was good, I finished my stretch of days at work and it actually wasnt too bad since I'm friends with the doctor who was there most of the time so that definitely made coming into work way better. NYE was ok. We went to the waterfront where the bars there had open bar. It would've been tons of fun, had I not had to be sober mom the entire night and take care of my ridiculously drunken friends. oh well, it happens. The night all in all wasnt a total bust. :)

Anyway....

While catching up with a high school friend last week, we naturally ran across the subject of boys. We made a deal that if she had a DTR convo with the boy she's been dating for the last 3 months and figure out if they're boyfriend/girlfriend status, then I would ask out this boy that I like. I was all about it at the time of the convo since I do want to hang out with him and I do want to figure out if there's any potential, but now that its actually time to ask him out I am totally chickening out! Which is sooo not like me. Normally I'm the type of girl who can talk to a boy, no problem. I hate all that stupid crap where its like, "wait a minute, I was the one who texted him last" or "we just talked 2 days ago, I should probably wait another day before I talk to him." Its complete BS. If I want to talk to a guy, I'm gonna do it. I dont care. ...Well apparently now I care b/c I'm semi-freaking out just thinking about having to ask him to hang out. We've hung out before in a group setting out at a bar, and we may have done the late night hook up... :-p But the entire purpose of this deal that I made with my friend is to get me and this guy to spend time outside of a bar setting, get out of the random hook up mentality and actually just hang out with him. And as it turns out, this week is Restaurant Week in DC. Pretty perfect timing, dont you think? Now I just have to muster up the courage to ask him... Maybe dinner is a little too formal / date-ish? Maybe I should suggest a movie instead? ahhh I hate boys... (Actually I kinda hate myself for freaking out about this. I mean, he's just a stupid boy... :-p)