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About Writing

I knew that I was writing less than I used to, but I just realized how much less when I looked at the Word documents with my writing from the last 10 years or so (that's how long I've been writing online!).

It looks like I wrote a ridiculous amount during the last 1.5 years of high school when I first started writing online. I had some stupid high school drama going on at that time. I don't want to relive that, although I wonder how I would feel reading that now. My frequency definitely fell off during college, but did wind up writing a lot about what my friends and I were doing. There were more entries from medical school than I remembered writing, but I guess I wrote a good amount during my clinical rotations.

All that writing fell way off during residency. When I was on the rough rotations, I didn't feel like writing. And when I was on the lighter rotations, I didn't have much to write about. I kind of like it this way. I think I'm going to be one of those who will say "internship wasn't so bad" because I didn't document it (and therefore didn't make the bad experiences burn on to my permanent memory). I also tend to think that most things are fluffy and awesome in hindsight. It's a weird trait that I have, but I think my life is a little bit happier that way. When I dwell on something negative, I really dwell on it.

In short, I hope I'll write more.

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A Niagara Falls Weekend

The Boy and I went to Niagara Falls, which is hopefully our one of many trips outside the country together. Yes, I know it's not too far. In fact, we went no farther than five minutes into Canada. But it's actually his first trip outside the US and I'm glad we got to share the experience together.

We drove up Friday night and stayed just outside of Corning, NY. I've never not booked a room ahead of time, but this is something he's familiar with, so I just went with it. We wound up at this Econo Lodge that wasn't that great, but good enough for a few hours of rest and sleep. We also got to enjoy some cable TV since I only have an antenna at my place.

I also never knew how much I hate frogs until that night. It had been raining out, which apparently brought the critters out of wherever they live and onto the placement. Since it was night time, I couldn't really see what was in front of me. But wait, what are those thing jumping in and out of the light? FROGS! You have no idea how freaked out I was. This was the closest I've been to frogs since 6th grade science when we had to dissect one, but those weren't hopping around. Speaking of which, there was one unlucky frog that was belly-up on the pavement. Once I saw that, I just ran inside. The next morning, that was the only frog that remained. From our room, I could see a guy step on what was left of it while walking to his car. Gross!

Anyway, the weather was unbelievably amazing this weekend. Seriously, it's Niagara Falls, and I don't want to be bragging about the weather, but it was just beautiful out. There weren't as many tourists as I was expecting with this kind of weather, but I'm not complaining about that by any means.

The best part of the trip was probably getting a hotel room facing both the American and Canadian Falls. I tried staying up at night just to see the lights come on, but they weren't as impressive as I thought they would be and as I have seen in many photographs. Either way, it was awesome seeing the Falls right before falling asleep and right after waking up.

I was trying to think back to my previous trips to Niagara Falls, and I don't remember being on Maid of the Mist, though I wouldn't be surprised if I was on it the first time I was there -- when I was eight years old. I have been there many times, since we used to drive to Toronto when my grandparents lived there. The last time I was there was back in college, when I went with some of my friends.

We were on Maid of the Mist during our first day there. We had dinner at the Crowne Plaza restaurant, where I had the best alfredo I have ever had. I hate to toot my own horn on this, but I make pretty awesome alfredo, but this blew my mind. They had artichoke and leek and mushroom and chicken on the dish. And even though I was really full, I really tried finishing every last bite. We spent our evening digesting our dinners (he had a New York striploin) by walking along the Falls. The next morning was spent walking around Clifton Hill, which is the tourist part of town. Most of the stores were still closed, but we were amused with the "high times" shops and contemplated Cuban cigars. Good thing we didn't get any because we were subjects of "random search" on the way back to the US.

I really wish we had stayed longer, but it was ultimately a regular weekend for me (he was on vacation) and we still had a six-plus hour drive, each way. On the way back, we stopped at Corning Museum of Glass. I went there a few years ago with my parents when I lived somewhat nearby in college. He was in love with this museum. I was interested, but got bored with the historical parts. The glassblowing and glassmaking, on the other hand, was awesome as always.

We're already contemplating our coming weekend, just because we know light schedules for both of us at the same time doesn't happen too often. In fact, we're trying to plan our vacation in March already.

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Cavern Deja Vu

Back in spring 2004, my roommates (plus one) and I went on a trip to Pennsylvania around the area where I live now. We spent a little time in Lancaster and the Amish Country, and around Hershey. It was definitely a memorable trip, although my memories do fade slightly after about six years. I can tell you what we did, but I can't necessarily recall the name of the places we went to.

Today, The Boy and I went to Indian Echo Caverns. I've lived literally less than a mile from this place for the past year, but hadn't visited it yet. It was a combination of its expensive entrance price and my proximity to it and the number of caverns I have previously visited that made me not want to really visit it. But since The Boy has been asking to go for months, I thought this would be a good time. Once we got to the parking area (I would hesitate to call it a "lot"), I felt this feeling of deja vu come over me.

This can't possibly be the same cavern I visited all those years ago, can it?

Week Twenty Four. Deja vu in an underground world.Despite the familiar look of an Indian teepee on the front lawn, the random merchandise in the gift shop and the swings in the back, I wouldn't let myself think that this was the same place. Besides, don't most caverns market themselves similarly?

It wasn't until we descended the 71 steps to the entrance of the caverns that I knew it was the same place. I.E.C. was carved into the stone above the entrance, exactly the way it looked six years ago. From that point on, I knew it looked familiar. In fact, I remember this silly little story they tell at one of the stops about a giant dropping his book and running out (based on the way the stalagmites and stalactites formed). It was as corny as I remembered it to be.

I totally don't plan on going back there for a third time.

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Residency, Year 1: Day 346

I'm nearly two weeks into my MICU rotation and it's draining me. I've always been the type to need 8 hours of sleep every night, and MICU is just NOT compatible with that.

Anyway.

This might be a little morbid, but three of my patients so far have died. Two of them passed when I was there, the other one happened one night when I was not on call. Unfortunately, all three of them coded, though I can't say that two of them were completely unexpected.

The first was Mr. R. He was originally transferred from an outside hospital to the heme/onc service for elevated white count. To about 500,000 (normal is around 7,000). He was undergoing leukopheresis (procedure to remove his white cells) when he was found to be unresponsive. He was intubated and sent to MICU. Over the next couple of days, he developed renal failure. He received multiple rounds of leukopheresis, but his white count would increase in between sessions. Despite being off all sedation medications, he continued to be unresponsive. Our consult heme/onc doc spoke with the family, but they were not ready to give up yet. And then he coded. One of my co-interns was on call that night, and CPR for performed after he went into arrhythmias.

The next was Mrs. D. She was transferred from another outside hospital after she was found unresponsive at home and a head CT showed multiple infarcts. She had metastatic bladder cancer and was undergoing chemotherapy. She was originally admitted under the medicine service, but was transferred to the MICU after an arterial clot was found in her right leg and she went to the OR to get it removed. She came to us because she could not be extubated and was on pressors post-op. Her workup showed vegetations on her mitral valve as well as a mass in her right atrium. Despite the risks of intracranial hemorrhage, the family decided to place her on a heparin drip. She remained unresponsive and intubated for several days. One day, during rounds, she was found in her room without a pulse. She was coded twice, lasting for over 90 minutes. By the end of the code, her face had turned blue and she was cold to touch.

The very last of the three was Mrs. S. She coded this morning about half an hour after I got in. She was transferred from an outside hospital for new-onset cirrhosis and acute renal failure. She was not making a lot of urine, but otherwise wasn't too sick. A few days ago, she underwent liver biopsy, which eventually showed fatty liver and some cirrhosis. She was started on dialysis yesterday, but her blood pressure didn't tolerate any volume removal. In fact, she required a small dose of pressor after dialysis. Over the course of yesterday, her clinical condition was otherwise unchanged. Sometime last night, she became unresponsive and required intubation. About half an hour after that, her pupils were dilated and unresponsive, and she was placed on three other pressors. This morning, we coded her for about 30 minutes when she was found without a pulse. This was totally unexpected. We knew she had cirrhosis, but we didn't know why. She previously had a normal liver, as far as we know, just two months prior. She was sick, but she wasn't in critical condition. She made a turn for the worse so dramatically, and it's not clear why. We suspect that because of her liver failure, she wasn't producing her clotting factors and bled into her brain.

I'm not even two weeks into this month and this is the record I have. Hopefully the next couple of weeks will go a bit smoother. But I'm not holding my breath.

Residency, Year 1: Day 301

I was in the SICU for nephrology rounds the other day. We passed by one of the rooms and I saw Mrs. L's name at the door. That's weird, I thought to myself. She was one of the heme/onc patients that I had during March. She was a newly diagnosed AML. Initially, chemotherapy was delayed because she had some underlying respiratory issues, likely undiagnosed COPD. Once we got her on a good regimen for that, she underwent 7+3. The day before she was supposed to be discharged, she spiked a fever and began having a cough. By this time, she was neutropenic. Repeat blood cultures were negative. It wasn't until another patient was diagnosed with RSV (typically uncommon to cause very serious illness in adults, but immunocompromised patients are a whole different story) that we decided to check her. Well, what do you know? She was RSV positive. We kept treating her with expensive medications, and she held her own for a while, but eventually was intubated and sent to the MICU. Before my month was up, she returned to us, in a much weaker state, and I eventually signed her out to the next hematology intern. I saw that she was discharged home a week or so later.

So I was surprised when I saw her name outside of a SICU room. I went back through her records (which is probably against HIPAA regulations since she wasn't technically my patient anymore), and found that she was admitted a few days earlier with abdominal pain and nausea. A CT scan of her abdomen eventually showed an obstruction with possible perforation. The surgeons took her to the OR and found that was indeed what happened. Luckily for her, the perforation was contained in itself. But unluckily for her, most of her colon was removed.

I went to see her a couple of days later, just to send her my well wishes. It turns out that she was likely in remission for the AML, pending consolidation chemotherapy. Her bone marrow after induction chemo showed that she didn't have residual leukemia. I'm not sure if her bowel obstruction was from the chemo. For all I know, it could've happened even had she not gotten leukemia or chemotherapy. But it's rather unfortunate to get both, don't you think?