At Least Kid Rock Will Miss Me

Thanks Grafs for link for the obituary. :)

'What will your obituary say?' at QuizGalaxy.com

A Turn in the Tides

Today marked the beginning of my long-term care rotation. Yea, not that exciting. Mainly, it's just freaking cold. I froze my ass off down there today. I miss my office, I miss the sunshine, and I miss blaring my music. I think if the long-term care pharmacist heard Buckcherry, it would probably cause him to have a coronary. I'm sure it'll be fine in the end...if they get some freaking heat. Today I had to educate the nurses and physician in one of the units that metoprolol cannot be given IV push in the nursing home. Why not? Because it requires MONITORING - a concept quite abstract to the LTC arena. For example, take one of the guys I reviewed today. His potassium was 5.5 in January...and that was his last potassium. How can you stop monitoring someone when they are hyperkalemic? Sounds like a liability to me. So, monitoring isn't something that really seems important in this arena. Alas, I can handle that - just get me a heating blanket.

Now Appearing in My Yard...

...an official Robert C. Byrd for Senate sign.

Experiment of Faith

This past Thursday my niece turned 8. Axis and his wife decided to have a little family get together for her birthday. After my niece opened her presents, Axis asked me to attend church with him on Sunday. Immediately preceding the service was a discussion on Evolution & Religion. I agreed to attend. I will pre-empt the rest of this discussion by saying that my experiences with church, Methodist specifically, have never been overwhelming. As a child, I remember counting the ceiling tiles in the church ceiling. These tiles, which for some reason resembled railroad tracks to me, were an escape from the monotonous voice coming from the pulpit. I remember being at the baptism of Axis's son and thinking, "wow these tiles look like the tiles from my childhood church"; however, I can't remember anything else from the service.

Today, Axis picked me up and we headed to church. The discussion was awesome. Everyone in the group had a background in science (including a physics professor from the local university). It was like a breath of fresh air to be surrounded by people that echoed my beliefs, rather than confront my beliefs. Best of all, the discussion was just the beginning. The service was amazing. I was so touched by the openness of the church. We focused not only on members of the church, but those of other religions and regions of the world. We blessed the citizens of Mongolia, Afghanistan, and Uzbekistan. We were invited to join our Muslim brothers and sisters as they broke the fast of Ramadan on October 19. Since 9/11, this church and Muslim community have been working together for peace. I think it's amazing. The youth group of the church spent last weekend with local migrant workers. The amount of love and tolerance being taught at this church was breath taking. After the service, the Reverend remembered my name and wished me back another Sunday. I will definitely return.

I think my experiment in faith worked...and I'm finally happy to find a place that fills me with joy rather than a desire to count the ceiling tiles. Come to think of it, I don't even know what the ceiling looks like in this church. :)

Typical Friday - Atypical Lunch

Today was a rainy, dreary day. I spent the morning in the ICU, in which every patients was deteriorating. My Stevens-Johnson patient was tachycardic, had a temp of 102, and had a WBC count of 15,000. Chances are she is becoming septic - not a good thing. My Clostridium difficile patients was taken back to the OR last night for removal of all of his colon except for about 6 inches of sigmoid colon and his rectum. He is now so swollen that his abdomen couldn't be sewn shut. He looks very grave indeed. Did I mention that his WBC count was 69,500 today? Then there was the 92 year old man with blood in his urine. The catheter bag was red, not yellow. And then there was the 62 year old man with 5 second pauses between his heart beats. A heart rate of 30 is never good, and when it takes 5 seconds for your heart to beat again...things are set up for disaster. My liver failure patient passed away this morning. So, it was a very busy and interesting morning.

I decided to take lunch at 12:15. When I stepped off the elevator, I literally ran into my liver failure patient's body. He was so jaundiced that I could see the yellow outline of his body under the sheet. I followed it down the hall and around the corner to the pharmacy. I was beginning to wonder where they were taking his body. As I scanned my badge to enter the pharmacy, I saw them load the body into a service elevator. The pharmacy staff informed me that the morgue is on the second floor. Needless to say, lunch wasn't very appetizing. It wasn't that I had seen the body, but rather the realization that the guy died. I knew he was going to die, but I guess it didn't really "set-in" until I saw his body. It was a great lunch.

This of course is not the first time that I've encountered a dead body in a hospital. During the first day of my first clinical rotation as a pharmacy student, I ran into a dead body on my way to lunch. Of course at that hospital, the morgue was directly across from the cafeteria. Earlier in my residency, I encountered the funeral home wheeling a body out of the hospital. Apparently I'm a bit of magnet for dead bodies. Great...

Intensive Care Notes

This week I have been spending every waking moment in the ICU at my VA. It's probably an understatement to say that I love intensive care. I enjoy working on complex cases and assisting the physician with medication-related issues. Today, I helped formulate a TPN for a critically ill patient. We worked together figuring out how much protein, carbohydrates, and lipids should be fed to her through the central line. So far in the ICU this week, I've seen Stevens-Johnson Syndrome, cocaine-induced vasospasms, chronic liver failure that progressed to multiple organ failure, and Clostridium difficile pseudomembranous colitis which resulted in removal of part of the guy's bowel. I also responded to a code...only the code wasn't really a code. One of the nurses got trigger happy and called the code pager for a syncopal episode. At the time we didn't know that, so the physician and I went running to radiology. I was quite nervous, but ready to help all the same. I'm glad the poor guy wasn't dead. It would've been my first code experience. I'm not sure how I will handle that when it occurs. I get emotional very easily. I like to hope in that situation I could seperate the emotional from the mechanical and just be able to run through the steps. The nurses in ICU are amazing. They like pharmacy, and enjoy our participation in the hectic world of the ICU. Today I assisted the nurse with dressing changes on the Stevens-Johnson patient. I will never forget what that looks like, and will never under-estimate the seriousness of the situation. To put it simply, this patient's skin is sloughing off. Large fluid filled blisters cover her body, and when they pop, her skin peels off. It was difficult for me to see the patient in such serious pain and in such grave condition. Tomorrow brings another day in the ICU, and I'm sure some more neat cases. I'm really looking forward to it.