IT'S OFFICIAL...

We're going to be WASHINGTONIANS!!! Olympians, to be exact. Yesterday Bryan signed the papers with a great anesthesia group in Olympia, Washington to start in Aug 2010. It was a very difficult decision, choosing between Olympia and Puyallup; the people we met in the Puyallup group were so great, like instant friends. It was so hard to turn them down. However, we feel really good about Olympia and are glad to finally know where we will be going.

Since I didn't take any pictures while I was there, I thought I share some pics of Olympia that I "borrowed" from the Internet.

When Logan heard the news, he said (with a concerned look on his face), "What do they have in Olympia? Do they have any playgrounds?" I showed him some pics of playgrounds in the area, so now he is satisfied. Glad he's so easy to please.

Decisions...

I haven't been in the mood to blog much lately. Seems like all I think about these days is, WHERE ARE WE GOING TO MOVE? I'm driving myself crazy looking through city info pages, maps, photos, school websites, home listings, and way too many online city forums.

Bryan and I went out to Washington state a couple weeks ago to interview for jobs. "REAL JOBS," as Bryan calls them. We had a great time exploring new places and spending some alone time together (THANKS to Kjirsti, Tom, and Deb!). There were a couple cities we felt especially good about and even have a couple of offers already to choose from (yay Babe!). It's very exciting and emotional, trying to imagine our lives in a brand new place. When I get nervous, I try to remember how scary it was to move to Cleveland four years ago, and how comfortable and happy we are here now. Overall, we feel peace about the direction we are headed, so I feel confident that the Lord will take care of us.

When the Exhaustion Sets In....

Residency - there's nothing like it. After four years of college, you spend four years in medical school gaining a foundation on which to base your clinical practice. Then you go on to residency where you actually gain that clinical practice. While I love learning and practicing anesthesiology, it can be gruelling and utterly exhausting at times. Based on raw working hours, we typically work the equivalent of two full-time jobs - anywhere from 60 to 80 hours a week (my high so far is 87). This time is spent taking care of some of the sickest patients in the hospital, transporting patients from the ICU to the OR while ventilating them at the same time and administering potent life-saving meds between breaths. It is also spent in the operating room administering anesthetics, while being continually vigilant in monitoring almost every physiologic function imaginable (temperature, respiration, oxygen saturation, blood pressure, heart rate, heart rhythm, urine output, CO2 waveforms, venous pressure, arterial pressure, airway pressure, muscle relaxation.... just to name a few). Yesterday, I left at 5:30 am and arrived home at about 10:15 pm, then spent all day today with relatively challenging patients. All I can say is that I'm exhausted. Jack London describes my feeling perfectly with this quote from "The Call of the Wild."

"There was nothing the matter with them except that they were dead tired. It was not the dead-tiredness that comes through brief and excessive effort, from which recovery is a matter of hours; but it was the dead-tiredness that comes through the slow and prolonged strength drainage of months of toil. There was no power of recuperation left, no reserve strength to call upon. It had been all used, the last least bit of it. Every muscle, every fibre, every cell, was tired, dead tired. And there was reason for it."

Anyway, my advice to anyone who is considering a career in anesthesiology: think long and hard before you do it. It's long & gruelling, and residency is hard on both your marriage and family life. It's also hard on your pocketbook for upwards of the first 10 years after college, and there will definitely be times that you regret your decision. If, however, you are absolutely convinced that there's nothing else out there for you.... you'll love it. It's awesome. Full speed ahead!"

Finally, I just have to say that my wife rocks. When I was just a schmuck plugging away at college, she decided that I was worth hanging out with, and eventually, even worth marrying. Through more than 8 years, she has put up with occasionally having to feel like a single parent, dealing with my unpredictable schedule and endless hours of work and studying, missing family outings and holidays, moving our family across the country, dragging her into over $120,000 of debt, and living with secondhand furniture because "we can't afford it on a resident's salary." Despite all this, she still hasn't left (and claims that she doesn't plan to!), and occasionally, she even says she enjoys it. She's kind of crazy that way, but hey, maybe I can keep the wool over her eyes for another 8 years. Love ya, babe!

Cameras, Summer's Labor, and Epidurals

Seems like there are a lot of moments when we think "sheesh... I really wish I had a camera right now!" Today was one of those days. We took the kiddos to Baskin Robins to get one of the Tuesday dollar cones and both kids picked out the most chocolaty ice cream cone they could find. It only took about three or four minutes for both kids to have some major chocolate goatees. Even as a 6 year-old, Andrew somehow managed to get chocolate ice cream unintentionally smeared from his chin all the way up to his eyelids. It was quite a site, but unfortunately, once again the camera was sitting securely at home on the shelf. Maybe next time, we'll be more lucky.

Well, tomorrow is going to be a busy day; I work until 3 p.m., then it's going to be a rush to the airport to pick up Summer's mom who is flying in from Utah, and then Summer goes in to Hillcrest to be induced at midnight. Summer's mom was really hoping to come to the hospital for the birth, but odds are that the hospital staff will not want our two sleep deprived kiddos dashing through the hospital corridors at 2 in the morning. That being the case, Nana will probably end up staying home and watching them. Sorry Nana!

Finally, I am pleased to say that the baby's crib, shelves, and dresser are all painted and decked out in baby girl decor. The crib went from being an eyesore which Summer is quoted as saying she "always thought was ugly" to being something she actually likes. After we get the delivery all taken care of, we'll snap some pictures and post them (not that anyone would actually care about pictures of someone else's second hand refurbished crib, but what the hey).

Lastly, a blurb about epidurals. Why would anyone not want one for labor pain? Granted, I've only done about 50 or 60 of them, but I have quite literally watched women going from tears to a smile in a matter of minutes. While I realize there are potential complications, they are extremely rare, and the vast majority of potential complications are very treatable. In fact, I would argue that the majority of people who opt for a natural delivery would still have lidocaine when they go to the dentist. Noone says they want have their root canal done natuarally. Anyway, that's my soap box for the day. If anyone is offended, I'm sorry - that's just my take on the matter. Feel free to buzz me with mean nasty comments if you disagree - I promise I can take it.

**Note: Summer has not yet read, and definitely would not endorse my posting of any of the above comments, and as a disclamer for my own protection, she may or may not agree with any of the above text.

The "On-Call" Misnomer

Okay, so I've talked to various family members (and others) when making plans, etc, and I've mentioned that I can't go to family function X, or activity Y, or project Z because I'm "on-call" on the scheduled day. The conversation has usually run the course of "well, can't you come along and then just leave if you get called in?" The answer: No - this is because 95-99% of the time, when a physician is "on-call," it means he works all night. It doesn't mean hanging out at home 'till the phone rings or the pager goes off; it means that he (or she) puts in a normal day (leaving the house at 5:30 AM to go to work and then working all day), then staying in the hospital and working all night and well into the next morning, sometimes even past noon the next day. Granted, on a very good call day, you may get 5 hours of sleep during the night, but generally it's 3 hours of interupted sleep or none at all, and you put in a solid 24-36 hours non-stop.

As it so happens, I'm on call right now, and I'm writing this blog during the first break in the action that I got today (it's now 3:55 AM) . During the course of the day, I did anesthesia for two surgeries lasting around 7 hours each. They were both laparoscopic robotic surgeries, which I fondly refer to as "robot attacks." Afterward, I picked up the code pager from another resident, and suddenly became responsible for the well-being of around 30-40 post-operative patients, some of them still breathing through a tube. It also becomes my responsibility to quite literally sprint to the bedside of any crashing patient in the hospital (which covers about 4 city blocks) when everything is going awry. During the night so far, I was called to two codes where it was my job to get to the head of the bed and ensure the patient gets oxygen, either by mask ventilating the patient or rapidly sedating the patient and inserting a breathing tube while other residents perform chest compressions/CPR. During the course of the night, I ended up treating some patients with astoundingly high blood pressures, balancing electrolytes, intubating crashing patients, giving potent medicines (called "pressors") to patients with extremely low blood pressures, writing treatment notes, putting in IVs and arterial pressure lines, treating post-op pain, and managing epidural catheters. Despite the crazy hours, stress, and messes (I've even got blood on my shoes), I can still say I love this job.

*2 hours later*..... Okay, I'm back... change that to 4 codes during the night! It's now 5:20 AM and I just got back from two more. All four crashing patients survived (so far). Crazy night! Anyway, the last interesting thing that happened was after my first patient's surgery this morning. I was rushing to get the room turned over and preparing the anesthesia drugs and equipment for the next patient. In the process, I didn't notice that one of the laparoscopic surgical screens was located a few feet away just above my line of sight but lower than the top of my head. That being the case, I rushed over to grab a new anesthesia circuit and clocked myself squarely across the top of my head with the corner of the monitor. It was similar to stubbing a toe... you know, when you can't really focus on anything other than the ardent pain that is searing into the depths of your soul. I paused and took deep breaths for about 10 seconds while holding my head, then brought my hand down only to notice that it was covered in blood. The gash in the top of my head dripped down my forehead and I had to stick some gauze on it and hold pressure to stop the bleeding. Anyway, I couldn't really cancel someone's surgery because I cut my head, so I went and put on gauze and two surgical caps to hide the blood (I figured it wouldn't be very confidence inspiring for a patient to see blood on the anesthesiologists cap), and we proceeded with the next patient's surgery. When I got a chance, I checked with one of my collegues (I couldn't see my wound because it was square on the top of my head), and he said it was borderline whether I needed stitches. I figured I'd just forget it. Even if it left a scar, at least my hairline would hide it. Anyway, other than the head gash, it's been a pretty typical call day. I'll even get to go home in a few more hours!