Actually the title of this post is totally meant to be funny because I spent the whole day in bed, coughing, sneezing, and blowing my nose. So it really didn’t make me a better person, it made me a tired crummy person!
I did have to run to the IRS building to get my tax forms stamped though, so I learned that the building that spans across front street is where the IRS and other federal offices are. It turns out that while I was in school, taxes were taken out of my scholarship that shouldn’t have been taken out. Since there’s a 3-year limitation on redoing old taxes, I had to make sure to get these in, stamped as received, all before 4:30 April 15… which was actually accomplished today even though I was sniffing and coughing while passing through the federal metal detectors…
The fun thing about being on call is when you realize you don’t care that this patient has kept you from getting sleep, it’s the coolest case ever!
We had a patient come in just as my resident and I had tidyed everything up, seen and written notes on 3 broken arms, done our post-op checks, and had already said “goodnight, hope we get some sleep..” Just as we were exiting the elevator, the emergency room number pops up 😦 But when I saw the X-ray, that frowny face turned into a smiley face!! (Did I mention I love trauma?)
It was a fracture known as “comminuted” because there were a bunch of fracture lines creating multiple pieces of bone . Because the limb was turned at an obviously weird angle, we gave a mix of fentanyl and propofol for pain control, brought in the fluoro machine ( live x ray vision!) and had our plaster splint on standby. Then we pulled on it to straighten it out, which is known as reducing the bone. Given the past reductions I’d seen, I expected to have to really tug hard to get the pieces back together. Instead, it moved almost too well! I guess when you have bones in that many pieces you don’t have to force it.
The only thing is, I recently saw a patient who had a lot of muscle taken out of his leg after a fracture that led to “compartment syndrome.” When this happens, the swelling gets so bad that you cut off blood supply to a bundle of muscles within that compartment. The fascia and skin create an almost tourniquet-like effect and the muscle can die within 24 hours. Because this new case was so severe and had so much swelling, I was really, really worried that this fracture might progress also. On admission I placed orders for neurovascular checks every 2 hours to make sure there were still pulses and sensation beyond the fracture site but still went to sleep biting my nails…
So, I learned a little bit and was able to expand my knowledge on the classic compartment syndrome’s “pain, pallor, pulselessness, parasthesia, and pain out of proportion” Though the compartments were really tense from all the swelling, it wasn’t compartment syndrome. I hear it’s pretty obvious when you find compartment syndrome on physical exam (the leg/arm will feel like a block of wood. Really!) But it’s scary nonetheless when you see such a severe fracture with so much swelling! I’m glad I had someone there to tell me NOT to do a fasciotomy, if I was in the middle of Afghanistan on my own and this happened to one of my marines….I still would have waited but I’m just glad everything turned out ok today 🙂
… 1 week later…. After I left post-call, I heard that they did end up taking this patient to do a fasciotomy, but no muscle tissue seems to have been compromised. Compartment syndrome is a clinical diagnosis, though you can use a Stryker compartment pressure machine to get actual numbers. This is used more in exercise-induced compartment syndrome because patients will occasionally consent to having long needles inserted into their muscles for this kind of evaluation.
As I no longer eat dinner with the nuclear family and have the question put to me by my parents “so, how was school today? What did you learn?” I thought it might be a fun experiment to post something to that effect on this blog. Today was a learning-filled day, here are a few:
1.) Blummensaat’s line: A radiographic landmark of the knee at 30 degrees flexion, a line drawn at the distal femur’s cortical line that should extend out inferior to the inferior border of the patella. If the line intersects the patella (and the insall-salvati ratio is less than 1.0) you suspect patella baja, and thus a quadriceps muscle rupture.
2.) Anyone who tells a hospital-admitted marine recruit (who has never gone through MC training himself) anything to the effect of “Do you want a straw? Suck it up!” is a complete tool. TOOL. Just because you’re a pudgy navy officer doesn’t mean you should be a jackass to an injured recruit. Please, I saw you almost die at the end of a 1.5 mile run….
3.) Knowing I can easily find parking within 1 block of a downtown bar with my motorcycle has greatly improved my outlook on socializing downtown. MUCH less anxiety about the anticipation of frustration with parking and circling and fighting over pavement and scoping and tailing people down the street and shelling out $20 because of a Padres game and etc.
Riding my newred 2009 Kawasaki Ninja EX250 motorcycle around my neighborhood to get familiar with shifting, turning, clutch/throttle, I figured I would get the hang of it pretty quick. At least I was able to shift, stop/start, turn corners, etc. but not to a high degree of confidence. I only wished my friend, who SAID he’d be here to teach me, had ACTUALLY shown up. Guess I know what kind of friend he is…
So here I am, practicing and yes, stalling now and then. Thankfully I’m just circling the same 4 blocks around my house which are light on traffic. Here’s the thing: I am teaching myself. Not the way I wanted to do it, seeing as I don’t even know how to drive a stick shift and this is barely my third time on a bike. However, this gorgeous piece of machinery is just sitting in my driveway waiting to be ridden. And my friend isn’t showing up… and I’m waiting patiently…. now impatiently…. now he says he’s too tired and will come by later…. and I figure F it, I’m going.
I’m turning around a cul-de-sac when I accidently give it too much throttle and head straight for a truck. I’m probably going about 7 miles per hour… so no life flashing before my eyes or anything, but all of a sudden the bike isn’t doing what I want and I don’t know how to fix it fast enough. In trying to turn left away from the truck too quickly, I am suddenly down on the ground.
The first thing I notice is a popping sound and some pinging reflection bouncing down the pavement. “Fuck.” I just did something to my bike. Fuck. Hitting the kill switch, I easily stand up and smell gasoline. Um…. ok, I get the bike up on the kickstand and see the gas leaking out. “Shit.” I can’t find where the leak is, so I continue to assess the damage.
The pop/ping was my front left turn signal, the bulb hanging out of its socket. Shit. There’s scratches on the left mirror and a few light scrapes on the body. Ugh. And then… I start laughing 🙂
What a dumb thing to do, the first day I ride my bike I drop it!! Oh well, I’m glad I got that out of the way :)!!!!!!! Even as I write this I’m doing it with a smile on my face…. ha ha leslie, good one!
So I wonder if I should try to start it, considering there’s a small puddle of gas but it seems to have stopped. I’m only 3 blocks from home, would I turn into a huge fireball if I try? Against my better judgment, I walk the bikes a good distance from the puddle and flick back the kill switch then hit the starter button but it just turns over. Ugh, guess I’ll just walk it home. Walk of shame, huh??
Only in my apartment do I actually think to check myself over. There’s no scrapes on my jeans or boots so at least those survived! My thoughts currently are 1.) I’m going to kill Samir for bailing on me, and 2.) I hope this gas leak thing isn’t serious because I’m going to jump back on my bike ASAFP.
By the way, all the guys at San Diego House of Motorcyclesare Awesome and thanks for everything!! I definitely recommend buying from them!! (and p.s., this bike is only new to me, it’s actually used with 364 miles on it!)
As I ran my 6 miler on Sunday, I noted again that when I run on dry sand I tend to start twisting left. Basically, it seems as though my right leg is stronger and pushes off a bit more strongly when I stumble. Which I do know has been a problem since I started running. For example, a short list of my injuries:
Left leg: Shin splints, patellar tendonitis, high grade calf strain x 3, iliotibial band syndrome
Right leg: shin splints.
The last time I noticed a huge difference in my quad strength was last year after I hiked the Inka Trail. I still had my ITBS and spent the whole time with a pair of makeshift walking stick-crutches. When I came back and started working with a personal trainer to recover from the injury, the difference in my stamina-especially with lunges-was huge!
It seems I still prefer my right leg, so to remedy this I tried lengthening my stride as my right leg reached forward, making my left leg push a bit extra. This took too much mental focus and I quickly regressed to my old familiar stride when looking out over the sand to find the path of least resistance. What ultimately worked really well to even out my strides and make my left leg feel the burn was to raise my left arm swing equal to the upswing of my right arm. Easy as that! My hips were squared forward, my shoulders aligned with my hips, and there was no more “oops!- twist left” when stepping into the many dips in the sand. So simple…
Though it almost didn’t happen due to 5 loads of laundry, getting only 3 hours of sleep the night before, and getting out of work late, I did go for my midweek “long” run. Since I was rushed for time, I ran the whole 5 miles on pavement. Oh, and also I developed a blister on my left foot from using a new push-off point while running in sand! So I just put a patch on it and took off.
As I ran, I did enjoy it but it did kind of feel like I was going through the motions a bit. I wondered why I don’t install a treadmill in my living room and run on it while surfing the internet or watching tv.. I mean, just putting one foot in front of the other is pretty easy. Even if I just spend an hour walking as I watch reruns of “Top Chef,” that’s more calories burned, that much more demand on building endurance, and keeping my muscles moving vs. stagnating on the couch.
There are times I feel like skipping…. “it’s too cold… I’ll do it tomorrow…. i could get more sleep if i skip…. ” but it feels like someone outside of my lazy side pushes me into it. Wish I could be more like that side of my conscience! Plus, no matter how much I whine to myself that I don’t want to do it, I am always glad to be there once I’m out there.
I thought I’d just stick to half marathons from now on, but as I flipped through Runner’s World magazine last month, I saw an ad for the San Diego Rock and Roll Marathon. It was in my stale call room on the MICU and I was spending every third night sleeping (ahem, not exactly sleeping… more like sleepwalking…) at the hospital. Spur of the moment, I figured “well that looks like fun. I’ll do that!”
So I started my training last week, again following the Hal Higdon schedule. The difference this time is that
1. I’ve been running further distances prior to starting my training
2. I’m incorporating sand running- my goal is to do 3 dry sand miles per run!
3. No rest days. Still trying to stick to at least a mile a day
4. My cross training will be either kayaking or kickboxing
Due to my work schedule and near-exhaustion, I have only skipped a 5 miler and a day of cross training. Actually, I skipped the 5 miler due to being soooo sore and I’m hoping that kickboxing doesn’t make me as sore next time!
Also, I’m doing Team in Training, which raises money for the Leukemia & Lymphoma society. I went to the initial meeting but haven’t yet been able to meet up with them for the long weekend runs (stupid 80 hour work weeks!) Plus I have to figure out how to raise almost $2,000. I’ll put up a link soon for my website (that I have yet to design) that entails how to make donations! Hope you consider giving!!
Here’s what I’m thinking…. start on the trainer bike then go for the nice Ducati- but in black. Of course, I DO realize people crash… and my head/arms/legs are pretty important to me… so I’m looking at top of the line safety gear. Full protection of head, shoulders, elbows, spine, hands, feet. …. ok, now you can feel free to tell me that I should know better 🙂 If you want me to justify this… well, the weather here is fantastic, I’m moving 30 miles north of SD and want the frequent trips down to be fun, I’ve been thinking about this for a while, it’s cheaper than buying a new BMW, I won’t feel guilty about my carbon footprint on those long de-stressing drives, and hey… motorcycles are just damn cool!
Ninja. This is the newest version, but I’m getting a used, dropped one so I don’t feel bad when I drop it. yes, when… hopefully if…
The bike I want. Isn’t it gorgeous?? I’m going to drive for a few months on the Ninja before I move up to this 696… which I will have to drive easy for a few months to break in the engine, so nobody panic!! (the red is nice, but black is better…)
As I was traveling recently I had the chance to catch up on some reading. I completely forgot how much I love to devour books… and I mean that almost literally! Most days I feel guilty for indulging in something for pure entertainment, since I know that once a book captures me I have to completely surrender all my time until I finish it.
For example, I decided to read “Twilight,” which is now a movie. It’s more for teenagers, but once I started reading it, I could not put it down. I also could not move from my chair, forgot to eat dinner, and after finishing it in 5 hours drove straight back to the bookstore and bought the whole series. Then I finished the second book “New Moon” just in time to go to bed. It’s a good thing I’m a fast reader…
I read the third book of the series, “Eclipse” the next day, after I came home from work. After work the next day I read half of the last book, “Breaking Dawn”. As I was on call the next day I couldn’t justify staying up all night so put it down and worked for 30 hours (well, a 3 hour nap from 10-1 AM) and immediately came home to finish the book.
When the 5th Harry Potter book came out I remember standing in line for the midnight release and immediately went home to read it. I figured I’d just read a little bit of it before bed, but become completely entranced… at some point I looked up and wondered why it was light outside. I looked at my clock and it read 7:00 AM.
Sometimes though, a book will completely underwhelm me. I was looking forward to “Norwegian Wood” by Haruki Murakami but ended up not seeing any point in it by the time I got halfway through. It was only mildly entertaining.. good writing and interesting but not for me. Same with “The Dante Club” by Matthew Pearl. It was a good book but it didn’t exactly seduce me like the others did. Here’s a short list of books that have completely enraptured me, if you find any theme that they all share, please tell me so I can figure out what that intense attraction is!!
“Harry Potter” by J.K. Rowling- all of them!
“Twilight” by Stephenie Meyer- the whole series also
“Shadow Divers” by Robert Kurson
“Swimming to Antarctica” by Lynne Cox
“The Curious Incident of the Dog in the Night-time” by Mark Haddon
“The Lovely Bones” by Alice Sebold
“Lightning” and “From the Corner of His Eye” by Dean Koontz. (another of his books, “The Taking” was good but not as good as these two)
“Jackdaws” by Ken Follet
“The Da Vinci Code” by Dan Brown (but not Angels & Demons)
“Rose Madder” by Stephen King
“The Joy Luck Club” by Amy Tan
“Inca Gold” by Clive Cussler (I’ve read a ton of his but eventually got bored…)
“The Golden Compass” series by Philip Pullman
“Memoirs of a Geisha” by Arthur Golden
These are the only ones I remember for the moment. I just became the proud owner of a San Diego Library Card and checked out “Never Let me Go” by Kazuo Ishiguro and “Time’s Eye” by Arthur C. Clarke (I read “Contact” which was also a great book!) Glancing over my list, a lot of them have been movies, some of which I saw before reading the book, some I didn’t. Plus a few a young adult books, which makes them super easy reads.
My horoscope today was so dead on, it was something about loving stuff like books, comics, video games and how much people would be jealous of my happiness if they only knew! Because it’s one of those things that once I start a great book, I’m anxious about being away from it until I finish. I’ll speed home, stay up super late, skip meals, cut short phone calls… (or ignore them entirely).. basically I am passionate about certain books. And I’m lucky to be a fast reader otherwise I’d never get anything done!
Ninja. This is the newest version, but I’m getting a used, dropped one so I don’t feel bad when I drop it. yes, when… hopefully if…
The Inspired Dr.Mom 