We had a woman come in tonight who was a drowning. Young and vital and somehow drowned in a freak accident. Asystole at the scene. Probably down twenty plus minutes before she got to us. She was young and I wanted so badly to save her so we hit her with everything--went way beyond ACLS and pushed and pushed and pushed. And she came back. She had a rhythm and she had nice thudding pulse, but she had been down so long that her brain is probably unsalvageable. Even afterwards it was dicey, and really I had to work to keep her stable. Went to talk to the husband. He was there with her children. They were totally unprepared. It was grim work. I never know what to say and find myself stumbling over words and trying to be clear and compassionate and always wondering if I'm doing either. Just miserable. I talked to the Biscuit and asked her to be up when I get home. I realize that I'm wanting so much to save someone to make up for having hurt the other lady so badly. I'm scared and desperate before codes and even before intubations--I'm physically nauseous when I have to intubate someone, no matter how straight forward I know it will be. It would be nice to help someone. To really help someone--to bring them back and give them back healed and whole to their loved ones. U-561

Today at work the Biscuit came in. I was up front checking out the rack--the rack of charts that presages either a good or bad night for us--when a tall gangly woman in an atrocious green dress walked into my field of view. It looked suspiciously like the Biscuit's Sympo-friend and--lo and behold!--it was. Out in the ghetto. And beside her--the Beautiful Biscuit. What a treat! But why.... She came bearing gifts. The type of gifts ER personnel like best--food! Her church bridal shower had ended and she and the green dress had driven forty miles to drop off the left-overs with me at work. She was beautiful, happy, charming and bearing Italian food--I had to struggle to not walk a around with a big sloppy grin on my face. What a woman! All night nurses, techs, secretary and staff were thanking me for the food. At first I demurred, but finally I just gave in and was appropriately gracious. The Biscuit has done more to make me liked by the ED than anything I have done for myself. She's magical! People who like me--my friends and family, even my parents--like me more because I have found her. Incredible!

Full days recently. Originally these days were scheduled for leisure, and thus the front end of my February was stacked with shifts. As it turned out the Biscuit and I planned so much into our off time that vacation ended up being more taxing than a normal work schedule. Fun, a lot of fun, but exhausting. The highlight was going up to Santa Barbara to see the Tour of California come into town. For the unitiated, this is the first year of the TOC--a 9 day long bike race from SF to LA that has attracted top European teams, and the cream of American cycling. Top riders like Landis and Julich and Leipheimer brought there teams over, and the top American teams--i.e. Discovery--came out as well. World class cycling literally delivered to California's doorstep. I love Santa Barbara and this was too good an opportunity to pass up. We went to the top of this monster climb just outside of town and watched the riders race by--they were flying, easily whipping over a hill that would have stopped me in my cleats. The Biscuit dressed up (or, more truthflly, was dressed up) as the Devil; an homage to the Tour de France Devil, Didi. The girl's a superstar. Just so much fun to be with.

Obviously my thoughts are still with that poor woman. I went to see her before my Friday shift and again at the end of it. she's still sedated and on the vent. My heart is sinking. I'm afraid she's gravely hurt. My friends, my fiancee, my colleagues, my old residency director (I've apparently been talking a fair amount, which is rare for me) range from non-chalant to congratulatory. It is good to have that support, but not nearly as good as not needing it. I think about her when I'm waking up to shower and driving to work and between patients and when I'm on my bike or watching Raiders of the Lost Ark with the Biscuit. It will be like that for a while, I think. The Biscuit had her bridal shower today. I took the occassion to go for a ride. 25 miles through the hills out here. Not fun--just grinding up unpleasantly steep hills in a low gear and theh freewheeling down the other side. Good for the legs, but not pleasant or uplifting or escapist. There's nothing like the PCH for long rolling miles of asphalt. But that's a long ways away. The house buying process is going well. 1)Pictures of the house: The kitchen and the back yard 2)Pictures of the Beautiful Biscuit and Shelby U-561

2/15/06 Wednesday, February 15, 2006 I went to see the woman tonight before my shift. She's in the ICU, trach in place, and the nurses are talking about weaning her. They're small thinkers, though, these ICU nurses: they rotate through the unit, work at other hospitals, have a few days off coming--they aren't thinking about discharge condition, they're thinking about the plan for this shift. But I want to know what her docs think her neurologic outcome will be and that information isn't available. Ahhhh--damn it. I've been thinking about it. I feel decent about it all. I could not have lived with myself if I has waited on her and then had to cric her--that would have been crushing. She came in breathing and talking, but her tongue was swollen up and protruding from her teeth. She was drooling and had to tilt her head back to talk. I knew she had to be tubed: if I wait on her and her airway occluded then I would have no excuse for inaction. But I was afraid, and I hoped I could just hit her with meds and hope for the best. You know that feeling--that hope that if you just close your eyes and hold your breath and pretend then maybe, just maybe the problem will go away on its own. I knew I was looking for a way to avoid the issue. But that's not the job I have: I rallied myself and went for the tube. Hindsight is 20:20, but suffice it to say that in seconds I found myself watching her turn blue and knowing only a cricothyroidotomy would save her. Terrifying. A really sickening feeling. My voice and my hands were trembling. I cut and cut and cut in this poor woman's neck. Horrible. I got my scalpel where I needed it, blindly feeling about in the bloody pool I had carved in her neck, and I hooked the trachea. I got the tube in and by the grace of God it was in the right place. We got her oxygen up and it was done. Sure---the bleeding needed to be controlled and the surgeons needed to be called, but this horrible moment had passed and, mercifully, I had suceeded. It didn't feel like other heroic interventions. There was no thrill of challenge, no excitement, no out of body awareness of what I was doing and amazement that it was me--Me!--doing it. Just terror and desperation. I hope I never have to do it again and I wish I hadn't had to do it this time. Ahhhhh....what a job. U-561

I have been eduring really miserable night shifts at work. The problem is that I don't see dictation as "part of the job" and so I let it pile up. And....even though I'm in the fast track area the acuity is fairly high and most of the patients need work ups that can't be put together in 60 minutes. So end of shift comes and I have, literally, 2-3 hours of dictations to do. I saw 26 patients in a 7 hour shift the night beofr last, and more last night. F'ing miserable. I cleaned the rack out so no one who came in at the end of my shift had to wait, but, come on--three hours of unpaid dictating?! After work I met the Biscuit to have the new home appraised and investigated. Appraisal went flawlessly: we needed an appraisal that was a little high in order to have our loan fully finance and the guy let us know early on that that was not going to be a problem. He's a friend of our realtors, "JohnsonSoldit@aol.com", and we understood the guy was a home team ump and would give us a few extra percent if we needed it. The investigator--well, I guess he did his job, too. Apparently the house is a death trap. A place where if the uncontrolled attic fire doesn't kill you the poison fumes from the furnace will and, should you survive that, the Faulty Electrical Wiring! surely will leave you a smoking twitching puddle of nerve fibers. Shit--the place is not up to code on its wiring and this represents either a $300 problem or a $35,000 problem. Oh, and by the way, that slope in the backyard will never be anything more than a swift eroding landslide in waiting. Terrace it? Yeah, if you have an extra $60k laying around. So where does that leave us? I think being brought up to code is a reasonable request. Also, some of the bloom is off the rose: I think we can walk away from this without too much emotional agony. Though, good lord, the broad expanse of hardwood floored kitchen spilling into the beautiful living area is......damn, damn nice. And the little four bedrooms are so enticing (even at about 100sqft each). And the artfully designed backyard, with a little grass, a nice dog pen, and enticing jacuzzi with a view of our very own valley is....wonderful. The realtor told me to be aware that emotions would be in flux throughout this process. We'll see how it goes. U-561

Bought a house today. The Biscuit and I went out on Monday and saw few places--we liked two: a $619k fixer upper with lots of square footage and tantalizing potential, and $700k place that was (as our realtor told us) "turnkey"--just a beautiful place, with all the little touches that set our hearts aquiver. The Beautiful Biscuit and I were torn--what to do? We decided to take a look at a few more of the higher cost places and get some perspective on this $700k beauty. When Friday (yesterday) came around we went out with our realtor and put the hammer down--we saw six or seven places in the space of three hours. Exhausting, but illuminating--there was heartbreak, joy, sorrow, excitement and tragedy. We saw a beautfiful place--large, on a little side street, for a very reasonable $635k. Our hearts leapt! And then we found out it was off the market. Damn! After that we saw a grotesque $680 monstrosity that was decorated in the disco fox-hunting theme. I don't know about the Biscuit, but my spirits were crushed and I needed a good meal and a cold beer to steeel myself and prepare for the next houses. And then we saw the place on Chestnut. Cute. Not large, but about 1800 square feet. Immaculate condition. And designed to melt the Biscuit's heart. Hardwood floors layed out in broad, featureless expanses, and a big open kitchen that invites casual dinner parties and friendly banter over glasses of wine. Beautiful. The backyard has some greenery, a little dog pen, and....a hot tub! Ah, paradise! 4 bedrooms. The Biscuit and I were enchanted. It has 0.3 acres, but the majority of that is unsalvageable hill--we might be able to put in some terraces or (secret desire of my heart) a vineyard and rock climbing wall. God, we loved that house! We saw a few places afterwards, one of which really appealed to me. $650k for a 1800 sgft. place in a tony neighborhood with a large backyard space begging for a little renovation. Tremendous potential and every reason to think the money we put in would be securely invested. Still--it just didn't have the magic of the Chestnut place. The Biscuit loved the Chestnut place, but she thought I loved the tonier place--she could barely control herself when I told her I was marginally more impressed by the Chestnut place. Look--the tony house on the hill has definite appeal: it will appreciate nicely and we can do a lot with the backyard. But it will require work to make it some place that we want to live and I'm not sure I want to put some stress on our young marriage. Come on--contractors and expenses and tearing up the carpet and bickering over hardwood or Pergo, etc.--I'd rather spend the extra money and avoid the potential for marital conflict. We bid on the Chestnut place--they wanted $667,500 and we offered $660,00. A pretty wimpy bargaining position, but there you go--we wanted it and were terrified that it would be snapped up by someone willing to pay a little more. For heaven's sake it was a Realtor.com featured listing! Today I got the word from our realtors that the sellers were accepting our offer. So now I own a house and a $4200 a month mortgage. Ah, misery--what a burden to carry! Still-it looks like I am now a home owner. Wow! A puppy, a home, and soon a wife--I'm leaping into the world of real adulthood. U-561