Musings on the Lifestream

The next Dr. McDreamy... It's good to know that our young ones have dreams... ...and light moments in the hospital.

On overnight call in the PICU. During this day, a number of useful hints and life lessons have come up.

The most salient ones being:

1. A 5 day-old baby is not a football. It is not acceptable under any circumstances to throw a baby. Even if it's into a couch.

2. If your baby has a high fever, neck stiffness, and is seizing, it is not okay to refuse to go to the hospital and try to 'treat' this yourself. The baby, if s/he survives, will have lifelong brain damage. There are few things I can guarantee in medicine. This is one of them.

3. When jaywalking across a busy road while carrying a baby, it is not okay to tell the two 8 year-olds with you to just 'run for it.' Especially if there's a large semi truck barreling down one of those lanes.

4. A large semi truck has a very long stopping distance. A very long stopping distance.

5. Do not feed whole grapes to children under 4. Whole grapes have this annoying tendency to get lodged in windpipes, which are remarkably about the same size as the grape. Then the child does really un-fun things like choke, turn blue, and try to die. In case that event occurs, it would be a good idea to call EMS immediately rather than wait around to see if the child will 'get over it.'

...called in for sick call for the second day running (instead of going to the Museum of Contemporary Art).

Now in the LaRa Emergency Treatment Room for a 24 hour shift.

Oh well.

Hopefully I'll be able to get _some_ sleep tonight.

Hope everyone else is having a good Friday night!

I'm now back in Chicago after a long time away.

It's been a great ride to warm climes, and now it's time to come back to work.

I'm working in the pediatric ICU this month, and it's been quite an experience already.

A few notes from the past 48 hours back:

1. It's wonderful stuff - I love it, despite the stresses.
2. There appears to be an epidemic of TVs falling on children this year. I've seen a wave of them this summer, and to date, around 5 have been admitted to our ICU.
3. I don't know what is going on with those TVs - the injuries are getting worse and worse.
4. To wit, a little boy came into our PICU around 3 pm yesterday after he climbed a dresser, after which the TV on it fell onto him. He looked bad coming in. His head CT was ugly, and when we got a pressure sensor in, the numbers made us cringe. Things got worse as the day went on, no matter what we did. We pronounced him at 5 this morning.
5. Nobody thinks to secure the increasingly cheap and increasingly enormous televisions that are making it into homes these days from falling onto children.
6. It's amazing how quickly life can turn around. A 8 month old preemie came in early this morning from our affiliated hospital in respiratory and cardiac arrest. The baby had been doing well (except for terrible lungs due to prematurity). Except that he stopped breathing, then his heart stopped beating. After a full court-press, we pronounced him at 9 this morning. The thing was, he was at the outside hospital just waiting for the labyrinth of paperwork required by the state to go home.
7. 4 hours, 2 small lives gone *poof*
8. There is no sound like a mother's scream when she sees that her child has died.

Another day and night coming up in a freezing day. Let's see what rolls in during my call.

Ob-Public Service Announcement from the Pediatrician:
Please secure furniture, and more importantly, heavy objects (such as TVs and other pieces of equipment) placed on that furniture, so that children cannot try to climb that furniture and tip those heavy objects onto themselves.

Instructions:
1. Go to www.careercruising.com
2. Put in Username: nycareers - Password: landmark
3. Take the 'Career Matchmaker' questions at the upper left corner
4. Post the top 10 results.

Results:
1. Prosthetist / Orthotist
2. Agricultural Engineer
3. Elementary School Teacher
4. High School Teacher
5. Special Education Teacher
6. Physical Education Teacher
7. Explosives Specialist
8. Set Designer
9. Costume Designer
10.Petroleum Engineer

Results (after answering the supplemental quiz):
1. Elementary School Teacher
2. Environmental Consultant
3. Early Childhood Educator
4. Anthropologist
5. Professor
6. Aerospace Engineer
7. Prosthetist / Orthotist
8. Physical Therapist
9. Chiropractor
10. Multimedia Developer

Hmmm. Explosives Specialist? Might be time for a change of career paths...

Now working solo in the La Rabida Emergency Treatment Room, which is quite an experience. However, a pause permits me to make the following post.

Back from diabetes camp. It was a blast (with the usual drama). Definitely feeling the hang of things (this is my third year there). Whee!

Just finished jumping through all the fun regulatory hoops, in the saga that you've all been following (obviously with bated breath).

Step 1 (6/2006): Apply for the USMLE Step 3, with waiver since I'm an old fart and I don't feel like taking steps 1 and 2 again because it's been over 7 years. Have the privilege of spending $680 or so.
Step 2 (9/2006): Getting permission to take Step 3.
Step 3 (3/2007): Taking Step 3, passing it
Step 4 (6/2007): Waiting until I've completed 24 months of residency to apply for my permanent license. Have the privilege of spending $300 or so.
Step 5: Waiting to receive the license. Time passes.
Step 6 (7/2007): Receiving the permanent license. Whee!
Step 7 (7/2007): Waiting to receive my state controlled substance license so that I can actually legally prescribe drugs in the hospital using my newly minted license.
Step 8 (8/2007): Receiving my controlled substance license (for a fun $5). Yay!
Step 9 (8/2007): State controlled substance license in hand, applying for my federal DEA number, so that I can actually write prescriptions with my shiny new license. Pay $560 for the privilege.
Step 10 (8/2007): Receiving my DEA number. FINALLY!

In summary:
$400 for the USMLE Step 1
$600 for the USMLE Step 2 CK
$1000 for the USMLE Step 2 CS (not including travel)
$680 for the USMLE Step 3
$100 for my preliminary Illinois medical license
$300 for my Illinois permanent medical license application
$5 for my Illinois controlled substance license
$560 for my DEA registration and number
$??? for secure prescription pads

Finally being able to work outside the hospital like a real doctor: PRICELESS

Back to work. It's scary - this license enables me to prescribe anything from cocaine to PCP to Tylenol. Luckily, I have no desire to have my friends in the DEA come knocking on my door.

Yay!

Completed another Pediatric ER shift today.

Got a very nasty trauma case today, which inspired the following:

1. Cherish every moment with your children. You never know when the fates may snatch them away forever.

2. For the love of whatever deity (if any) you may believe in, if your child is riding a bike, please do whatever it takes to make sure that they're wearing a helmet. The consequences otherwise will be disastrous.

Let's see if I can get to sleep. Somehow going through this several times this month doesn't make it any easier.

You know how my Windows PC kept crashing and had become slow as molasses? Well, it finally refused to boot, so I had a aluminum doorstop on my hands.

I had a weekend free (finally), I decided to bite the bullet and finally try to fix the damn thing so that I had a somewhat useful computer (instead of an expensive doorstop).

The Many Steps Towards Trying To Fix A Damn Windows Box:

1: Dig through all my boxes to find my original Windows XP CD (SP1 mind you).

2: Attempt to get the bloody thing to boot off the CD

3: Attempt repair using the recovery console. Aha! Corrupted directory and boot blocks. Attempt to repair. Watch as voodoo Little Bunny CHKDSK goes through my directory doing Lord-knows-what.

4: Attempt to boot. No dice.

5: Boot off of Windows CD (again)

6: Attempt to re-install Windows using recovery option.

7: It does a lot of file deleting and copying, then reboots.

8: Boots off my HD, but it looks like a blast from 1995.

9: Goes through second-stage installation, attempting to re-install drivers and other files, prompting me occasionally for discs with drivers (which I have), and files that I don't have (which seems to include most of the Internet Explorer installation).

10: Come to a screeching halt as it asks me for my Windows Product ID. How many of you know your Windows Product ID?

11: Luckily, I have a database of software serial numbers (on my Mac, of course), so a frantic search later (after considering calling Microsoft Customer 'service') yields something that satisfies the anti-copying Stormtroopers.

12: Reboots again. Attempt to install XP Service Pack 2. IE freezes when it gets to the Windows Update page. Not terribly helpful.

13: Opera comes to the rescue; download and install SP2.

14: IE still freezes. Download and install several other updates manually from the Microsoft website. Online documentation is (as expected) completely useless.

15: Nuke IE's settings. No dice.

16: Track down Windows Installer 3.1 (which no one talks about). Install.

17: Now IE loads up the Windows Update page. 73 updates. Yummy.

18: Reboot successfully. 4 more updates. Reboot. 2 more updates. Reboot. You get the gist of things.

19: Now mostly-working machine that hasn't crashed in 18 hours. Yippee. Seems a bit faster, too.

20: Now if I could only get the bloody Palm drivers to work.

Ah, life in Windows-land. I'm so happy I do most of my work on a Mac!

Off to the museum, then LazerTag!

Just completed my last ward month at La Rabida...

On call overnight. Luckily, I got only one admission, and nothing acute came up overnight. I did have to transfer a kid out for evolving pneumothorax. Very impressive physical exam.

It's been an interesting time this year.

I'm tired.

Time to plan my vacation.

Here's my Johari page:

http://kevan.org/johari?view=resonance42

An update (I promise!) shortly...