I haven't blogged in almost a year.  I've been busy.  Every few days, an idea for a blog post will pop into my head, but....I've been busy. 

I'm going to attempt to summarize the last year, probably in a series of posts.  Mostly for myself, so I can look back and know what the heck I've been up to.  Then when the mild cognitive impairment gives way to full blown dementia, I'll be able to reference important life events. 

My last blog post was in March 2012, in which I blasted my esophagus for causing me such misery.  Well, I'm happy to report that after having a 9lb 4oz baby boy cut out of my uterus, the esophageal issues have ceased. 

Luke Larson Bartlett (Larson is my mother-in-law's maiden name) was born on July 24th via a very convenient planned c-section.  Louisa was a very inconvenient, non-planned c-section which occurred after 5000 hours of labor and 400 hours of pushing.  I'm exaggerating a little. 

In the OR, an anesthesia resident placed my spinal and almost immediately I started feeling light headed.  I thought it was because I was laying supine, which I hadn't done in several months, and the baby was laying on my IVC.  Then I heard my heart rate on the monitor start to tank and I heard the number 70....referring to my systolic blood pressure.  I would have panicked, but I wasn't perfusing my brain adequately to do so.  The resident gave me some epi and my SBP came up to 150.  Hypertension feels GOOD!  A few minutes later, Luke was born.  Unlike his sister, he came out screaming!  This was a relief because Louisa really wasn't breathing when she came out and she was a slight purple hue.  I could hear my OB yelling at the nurses to get oxygen on her.  I did panic then, but soon she started crying and turned a lovely bright pink color. 

They took Luke to the nursery to get him cleaned up, but then they didn't bring him back to me.  They were concerned because his belly seemed to be getting more and more distended.  The nurse who relayed this information to me told me that they got an x-ray which only showed 11 pairs of ribs.  And because his belly was getting bigger and he had a skin tag on his ear, they were going to take him to the NICU. 

Um....what?  11 ribs? Skin tag?  Abdominal distension?  All of this information being told to a freshly post partum crazy lady who had a SBP of 70 withing the past 30 minutes and who still has fentanyl infusing. 

So they took him to the NICU and placed and NG tube (small tube that goes from his nose into his stomach to suck out any excess air) and placed an IV.  His abdominal x-ray was unremarkable and he never acted like he was uncomfortable.  He was having normal poops and passing gas too.  They wouldn't let me feed him, but instead gave him fluids through his IV.  He pulled out approximately 4 NG tubes.  I got to visit him in the NICU.  It was nice to be able to hold my boy, but it is quite disturbing to see an hours-old baby with IVs and tubes coming out of him.  The next day he seemed to be doing okay, but his belly was still big.  He was still pooping and seemed to be quite comfortable.  We got to visit with him more and I even dragged my edematous, post op self out of bed and walked down to the NICU.  Thanks fentanyl/percocet/ultram/toradol/ibuprofen.  I also have a fear of blood clots....that will get you moving! 

That night a nurse practitioner from the NICU came into our room to let us know that he'd lost peripheral IV access.  They had poked him everywhere (including his feet and scalp) to try to place an IV, but they couldn't get one.  So she gave us 2 options....either we try to feed him by mouth and see how he does, or they would have to put a central line in him. (A central line is a large catheter that you place in a deep vein, usually an internal jugular or subclavian. This allows for administration of fluids and medications when a patient can't take things by mouth. This is a procedure that I do when I'm in the ICU and it's not without risk - bleeding, infection, pneumothorax).  So you can understand why my initial reaction to hearing "central line" was something along the lines of, "What the *&^#^@%#$^$#!?!?!  Over my dead body!"  That was more of an internal monologue.  So, clearly we opted to feed him by mouth....and would you believe that he did just fine? 

They never did find anything wrong with him and eventually decided we could take him home.  His belly continues to be "protuberant" to this day.  So he got to hang out in the NICU for a few days because he has a Buddha belly.  Sorry Blue Cross. 

Oh, and it's totally normal to see 11 sets of ribs on a newborn chest x-ray.  The 12th pair often hasn't ossified yet.  Thanks Allison Zupon, radiologist extraordinaire!

An open letter to my esophagus

Dear Lower Esophageal Sphincter,

"Hormones" are not an excuse.  I have heartburn from drinking WATER!  You really need to step up your game, you lazy piece of crap.  My esophagus is freaking killing me.  And my sad little H2 blocker...?  It's like Charlie trying to piss out a bonfire. 

Consider this your warning.  Do NOT make me go to the ER and demand an IV PPI and a GI cocktail....and dilaudid....and IV benadryl.   

Sincerely,
CBart

Self Actualization

I grew up an insane KU basketball fan.  I knew all of the players (full names, hometowns, interests), had the press guides memorized each year and would often stalk players for autographs after the games.  Along with this love for KU came the inevitable and required intense disdain for Missouri. This lifestyle continued until medical school/residency/parenthood when there was simply no extraneous time for the luxury of watching college basketball.  During the last few years, I've grown in maturity and have actually decided that, alas, I don't hate Missouri.  What did they ever do to me?  Why should I dislike someone just because they live across State Line from me?  Just because someone went to an institution of higher learning in Colombia does not make them a bad person.  In fact, I have several wonderful friends who went to MU. 

So I was quite frustrated when I watched the pre-game coverage of Thursday's NCAA Tournament games.  Multiple KU and MU fans were interviewed and all of them expressed their hatred for each other.  How sad, I thought to myself....that grown adults act in such a childish way.  Why can't we all just love each other and appreciate and respect each other in spite of our differences?

A few hours later, I turned the radio on in my car, just in time for the end of the MU/Norfolk State game.  As the clock ran out and the commentator announced that MU had dropped to the number 15 seed....








YESSSSSS!  YESSSSSS!  

(Fist pump - fist pump - fist pump!) 

SUCK IT YOU DIRTY TIGERS!!! 

WHAT'S UP NOW?  HUH?  HUH? 

(More fist pumping!  And my face probably looked like this guy's....)

I guess my journey to self actualization and ultimate maturity hit a little speed bump.  But good-golly, there's a part of my soul that rejoices when those punks go down!

Rock Chalk!



Wisdom

A wise and learned woman once said:

'Tis best for thou to empty thy bladder frequently,

for thou never knowest when thou may laugh unexpectedly.

Actually the woman wasn't wise or learned, rather she finally put two and two together after nearly wetting her pants on a daily basis.....with a growing fetus smashing her bladder. 

A flaw in marketing judgement

I appreciate fashion as much as the next girl....well, if said next girl also prefers to live in sweats and t-shirts.  I became a doctor purely so I could wear scrubs to work....just kidding.  Kind of. 

Anyhow.  I received this flier in the mail yesterday for the "designer denim event" at a pea in the pod.  They graciously included coupons for $20.00 off of selected designer jeans.  Fantastic!  Too bad the jeans are all uber-trendy and originally priced at over $200.00.  A few reasons why this is ridiculous:
1) There are starving children in Africa
2) I just bought a cute pair of maternity jeans at Target for $30.00
3) These are jeans that I could only wear for 5 months....or more depending on how many babies I have.  Okay, and maybe at Thanksgiving. 
4) Lets say I have one day off per week for 5 months.  That's 20 days.  That's at least $10.00 per wear.  Compare that to the Target jeans....just a little math test for you.  I'm all about preventing Alzheimer's. 
5) I don't care how fancy the jeans are, they don't make me look any thinner or less pregnant.


Which leads me to the picture on the flier:

(My apologies....I couldn't figure out how to change the orientation.  

Just cock your head.  Then call my dad to fix your neck.)

Where the frick did they find this emaciated pregnant chick?  She's probably not even pregnant.  They probably found some random model with a BMI of 12 and stuck a pillow under her shirt.  Um....does this make me A) Want to buy your stupid, overpriced skinny jeans?  Or B) Want to throw on my favorite granny-panties (thanks mom), Danny's sweat pants, an XL t-shirt with stains in the pits and climb into bed with a tub of ice cream and cry?  Yes...choice B.  And the shoes?  My pregnant ankles would swell up like sausages within 5 minutes of trying to wear those. 

So....pea in the pod....you need to fire your stupid marketing department, which is likely run by men and start the frick over.  Frick frick frick!  

And if you were wondering how to thoroughly infuriate a pregnant chick....well, now you know. 

Back to the VA - a blog for S. Rod....

To ensure my good standing as I return to the VA tomorrow, let me take a minute to give a big shout out to one of my favorite peeps, Stephanie Rodriguez. 

If you've stepped foot inside the KCVA as a medical student, internal medicine resident or fellow, you know Stephanie well.  She makes sure that we are all licensed, oriented, qualified, identified (with multiple sets of fingerprints), certified, familiarized and petrified.  She keeps us on our toes, threatens life and limb when discharge summaries are late and warns us about "special" medical students she's detected during the orientation process.  She also tells tales of a certain staff doctor that she dated in high school. Apparently he was kind of immature....shocker!

Hands down, her most important function is organizing snacks in the conference room.  For whatever reason, snack time occurs on a daily basis when I'm away from the VA ( I know this because I still get the notification on my pager), but as soon as I return, snack time essentially ceases to exist....why is this?  What does it all mean?  Stephanie?

So....my friend, expect to see me bright and early in the morning.  I have forgotten my password and I will need to get my computer access re-established.  Then I will need you to remind me how to forward the ID consults to my account.  And I have like, a million notifications I need you to help me delete.  I will also need some chocolate. Aren't you excited to see me????

CBart

A Happy Reunion

(To the tune of Amazing Grace.....)

Oh coffee mug
I love you so
At work, you comfort me
I lost you in the ICU
Today, reunited with glee!

Ah....so much to be thankful for!

A Brief Glimpse into the Weirdness that is my Brain

I was on long call at the VA last night.  Luckily it was a pretty slow night with only four admissions.  So there was no wailing and gnashing of teeth....the way I prefer it.  And for me, there is nothing quite like post-call sleep.  Crawling into bed, utterly exhausted, with a belly full of eggs and bacon is one of the best feelings ever.  And knowing that the crazy that lives at the hospital is now someone else's problem....well that's good stuff! 

So I crawled into bed at about 10:00am and, per usual, slept like a baby.  With a few interruptions from Charlie.  Per usual.  Luckily he usually responds to me yelling, "SHUT UP CHARLIE!  GAH!"  My post-call sleep was going well until the dreaming started.  In my dream Danny gave me a kiss on the neck....which turned into a huge hickey....because my INR was high.  Then my dad yelled at me because it looked "tacky" and "unprofessional." 

Awkward....

Veteran's Day at the VA

This morning I went to see an elderly patient with severe dementia.  He was in a pleasant mood during my exam and on my way out the door I wished him a happy Veteran's Day.  His face instantly changed and he began to weep quietly.  I could only make out a few of his words...
Laying there....

Dead...

Birds pecking at their eyes....

And then he broke down.  Inconsolable.  There are some memories that even Alzheimer's can't erase.


To those who have served our country so bravely.....

Thank you.

Sometimes it's hard to keep my pants up....

The Quadruple Grenade Sign....the poorest of prognostic indicators.

You say it's your birthday.....

Ah, October 18th.....a blessed day! 

It's really kind of sad when facebook has to remind you that it's your birthday.  Oh well, so be it. 

I woke up yesterday at 4:30am to the sound of my dear husband doing P90X.  He is a freak of nature.  I'm still trying to figure out what mutant gene he acquired that causes him to wake up at 3:50am to work out and that entices him to eat vegetables on a daily basis.  I have the opposite of that gene.  Or I'm just lazy and prefer buttered noodles, take your pick.   

Anywhoozles....I stumbled down the stairs and hurdled the baby gate, as I do every morning.  Yesterday I cleared it without incident....not always the case.  I glanced in the mirror and noticed a few pimples on my nose....probably from my increased Nestle Quik consumption.  I may be 31, but at least I have the complexion of a 13 year old!  Ah...thank you, T-Zone, for making me feel young.   ( I can hear all of you gasping....you thought I was 24, didn't you!?!?!)

Work was uneventful.  I would like to give a shout out to the patient, who prior to receiving a rectal exam from yours truly, stated, "Gosh, I wish you were some old, ugly lady....that would make this easier."  You made my day, sir.  You made my day.  Oh, and you were hemoccult negative....so that's good. 

My lovely attending, knowing that it was my birthday, decided that I should take off early in the afternoon, and so I did.  Thank you Dr. L for being so thoughtful.  And as for you, Dr. P.....YOU forgot my birthday....even though I'm sure facebook reminded you.  But I'm over it.  No, really.....it's cool.  I'm fine.  Clearly. 

I got home and called Danny.  He was at the store picking something up.  I imagined that he was buying me flowers for my birthday.....and the following is what I was planning on blogging after I received said flowers:

"My sweet husband....even though I've told him dozens of times not to buy me flowers.  He knew deep down that I really did want flowers."

He came home with a card and a bag full of Aspen Mulling Spice, a CD and Nutty Bars....no flowers.  And to that I say:

"My sweet husband....he knows that flowers only wither away, but this girl LOVES HER SOME NUTTY BARS!!!"

Later in the evening, Danny and I attended a free dinner at Ruth's Chris.  This doctor gig if finally paying off....'bout dang time!  Unfortunately, my steak came out well done.  In the ultimate show of selflessness and devotion, Danny gave me half of his steak, which was cooked medium to my preference.  I drank 1.5 glasses of wine, and per usual, declared myself drunk after the first glass.  Wine at Ruth's Chris is very potent.  I'm not sure what the speaker was talking about, but he was very energetic....and blurry. 

So that about sums up my birthday.  It was a good one. 

In crummy news, my Grandma B. fell and broke her hip last night.  She's currently at SMMC where they're getting her fixed up.  If you could send some prayers her way, well, that would be nice. 

An Ode to Rachel....on the Eve of her Wedding

All the wine at the rehearsal dinner tonight sent me into an emotional tailspin...several unfortunate people sitting in close proximity can vouch for this.  I will now type and cry, type and cry.  It's therapeutic.


Rachel is the one I met in the 1st grade.  She had just moved from the "dot" and I was her mother's worst Johnson County nightmare.

Rachel was my three-legged-race partner during field day.  We won second place.  I have not seen her move faster than a walk since that day.

Rachel is the one who cried with me before I told my mom about the stupid thing I did in 8th grade. 

Rachel is the one who used to love wearing "country apple" body lotion from Bath and Body Works.  That is, until her mother told us we were too old to go around smelling like fruit.

Rachel is the one I spent countless hours with at 3&2, watching baseball games on warm summer nights. 

Rachel is the one who spent hours with me at Abercrombie & Fitch, even though the plaid carpet made her dizzy. 

Rachel was my very first roommate.  She is the one who tolerated one year of me eating powdered coffee creamer out of the can, leaving my cheese wrappers lying around our room, and setting my alarm clock for ungodly hours.

Rachel is my Endless Love duet partner....even though she always makes me sing the boy part.

Rachel is the one who looked me in the eyes and said, "I've always thought you should be a doctor."  And when she said it, I had the confidence to do it. 

Rachel is the one who thinks that God sent a hail storm just for her, so she could collect the insurance money and buy herself a Louis Vuitton bag.

Rachel is the one I think of when I hear Aerosmith or Tom Petty on the radio.

Rachel is the one who fell in love with a boy named Travis.  And when I saw the way he looked at her tonight as they were practicing their vows, my heart was happy....because I know he is the one. 

Congratulations, my dear friend!

I'll see you in the morning, after I buy myself some waterproof mascara.

First Impressions

I'm fairly certain that when people meet me for the first time, they think, "Now there's a girl who is clearly more concerned with skin cancer than she is with vitamin D deficiency."

This has been on my mind for a while....just needed to share. 

Numbers

Yesterday....

4:50 - the time I rolled out of bed.  Moaning and cursing.

9 - the number of consecutive days I'd worked.

14 - the number of hours I worked in one day.

1 -The number of cinnamon rolls I ate.

4 - The number of cups of coffee I drank.  The minimum required dose to maintain consciousness.

3 - The number of pagers I carried.

0 - The opportunities I had to go to the restroom.

5 - The number of times I've heard Dr. S's sepsis lecture. 

2 - The number of admissions I did after 1600.

7 - The number of times my stupid ID badge fell off my coat.

52 - The number of seconds it took me to pull out a pericardial drain.  My fellow told me if I went too fast I might tear the heart. 

8:15 - The time I left work.

1 - The number of drinks consumed before I declared myself officially intoxicated.

2 - The seconds it took me to fall asleep after crawling into bed.

Happy day off to me!!!  It's about freaking time!

Assumptions....

Several years ago, I promised my BFF Rachel that I would buy her a fancy pair of designer shoes for her wedding.  At that time, she was single and I made this promise based on two assumptions.  Either 1. Rachel would never get married, or 2. I would be extremely wealthy by the time she finally did meet that special someone. 

Well, turns out that Rachel met, fell in love with, and is now engaged to a wonderful guy.  I've learned to look past the fact that he went to MU, and focus on the things that we have in common; a mutual admiration of station wagons (be it Volvo or Subaru), and old plaid-lined Lands End jackets.  We have a strong foundation.  And of course, we both love and adore Rachel.

So....Yay!  Happy!  Fun!  Rachel and Travis are getting married!

And I am left scratching my head as to how assumption number 2 hasn't quite panned out.  Yeah, yeah...I'm a doctor....but I'm so far in debt from my medical school loans that the only thing I can afford to be is a doctor.  And the last time I calculated my hourly wage, it was approximately $4.00.   

None the less, a promise is a promise.

So Rachel and I did lots of internet searching for fancy bridal shoes.  We looked online at Bergdorf, Nordstrom, Neiman Marcus and Saks 5th Avenue.  We both fell in love with a pair of Manolos, only to be crushed when we found out that the $158.00 price was the price for the knock-offs and the real Manolos were closer to $600.00.  Gah....I still weep.

Then Rachel finally narrowed down her favorites to a group of about 4 and let me make the final decision,  which was a bit nerve-racking.  The choice of wedding shoes is not to be taken lightly! 

So I picked out a pretty little pair of Vera Wang slippers and my promise from years ago was kept. 

And if I start looking thinner over the next few months, its likely that I can't afford food. 

Cheers to Rachel and Travis....and Vera!

Oh....and if you happen to be attending the blessed event, please take a moment to admire the shoes.  I would appreciate it.  Thank you. 

Bacon

Dear Cardiology Patient,

Although I have no evidence that you have coronary artery disease and your work up for chest pain has been completely negative, I cannot, in good faith, let you have a regular diet while you are on the cardiology service. While you are in the hospital, you will comply with the low sodium, low fat, low cholesterol diet.  My apologies.

Now excuse me, I have to get down to the cafeteria before all of the bacon is gone.

Your friendly cardiology resident,

CBart, MD

oops....

Today I accidentally texted my pulmonary fellow, thinking I was texting Danny.  I asked her to call the exterminator.  Then I told her I loved her.

Disturbing

Yesterday one of my co-interns was wearing a fabulous pair of Frye boots.  I lusted over them.  I resolved to buy myself a pair someday.  Then I resolved never to spend more than $300.00 on a pair of shoes.  Now I am in a state of perpetual turmoil. 

Then I went home and dreamt that I had my own pair of Frye boots.  It began as a very happy dream.  All of my friends and co-workers were very excited for me and my new boots.  Then I looked down and discovered that my legs were covered in hair....thick, curly man-leg hair!  It was awful!  How could I not have noticed this when I decided to wear a mini-skirt with my Frye boots? 

The dream went on and ultimately I had to shave the legs of one of my (male) staff doctors before I could shave my own legs and remedy the situation. 

I have no idea what this all means....

Still distraught,
CBart

Anatomy of Night Float

I am on my third night float rotation this year and I am starting to notice some patterns....

The phases of night float...by Christi Bartlett

1.  The Mauling Phase
 - This phase begins as I walk through the door of the Med 3 room.  The respective members of the Med 3, Hematology and Oncology teams wait, perched, ready to pounce on me, much like fresh meat.  Then the mauling begins as upwards of 50 patients are handed off to me at a dizzying rate.  I am left bruised and beaten.  I also get to hear about the stuid thing I did the night before and how the staff couldn't believe that I gave a patient 60mEq of K instead of 40......ahem.

2. The Nursing Shift Change Phase
 - This typically happens during or shortly after the Mauling Phase.  Night nurses start their shift and notice loose ends from earlier in the day that I HAVE TO ATTEND TO RIGHT NOW!  There is usually a patient with a blood sugar of 425 during this time, as well as a patient with a blood pressure of 200/98.  Inevitably, there is also a patient who has no admission orders.

3. The "I'm Starving" Phase
 - This phase is usually starts around 2300, and involves a trip to the all night cafe downstairs.  I typically look at the same 3 meal options (frozen pizza, fettuccine and macaroni and cheese) and contemplate their nutrition facts before ultimately opting, again, for the fettuccine.  Then I have to talk myself out of chocolate milk...never easy. 

4. The "I Need More Coffee" Phase
 - This is more of a chronic issue, rather than an acute phase, but not until the "I'm Starving" Phase is over, do I typically act on the "I Need More Coffee" Phase.  During this phase I take the steps up to the 6th floor....to burn off my fettuccine....and I sneak into the nutrition room and snatch some coffee, 2 creamers and 3 sugar packets.  Heaven knows how long that coffee has been sitting there. 

5. The "Code Blue and/or Rapid Response" Phase
 - Just as it seems things have settled down, we hear the infamous beep of the code pager.  Expletives are muttered under the breath of the night team.  We grab our coats, stethoscopes and walk swiftly to the coding patient.  Usually anesthesia and the ICU team have already arrived, so we (the interns) stand against the wall and try to look like we are contributing...the whole time thanking the good lord that someone else got their first to run the darn thing. 

6.  The "Let's Try to Learn Something" Phase
 - This phase involves choosing a previously recorded lecture from a list of podcasts and trying to stay awake long enough to try to sort out ILD, UIP, NSIP, ARDS, AIP, DAH and COP.  This lecture was discontinued early as we decided that our brains were too sleepy/overwhelmed/mushy to retain any of the information. 
*These lectures are often chosen based on the attractiveness of the attending....*

7. The Sleep Phase
 - Hahahahahahahahahahahahahaha...........

 - And when I do get to lay down, I typically have some obnoxious VeggieTales song stuck in my head.
 - And if I don't have a VeggieTales song stuck in my head and I do manage to nod off, my pager goes off 5 seconds later.  Then I lay back down, manage to fall asleep....pager goes off....repeat cycle x 50 bazillion. 

8.  The Check Out Phase
 - No doubt the best part of the shift.  This is where you inform the primary teams of the events of the night and hand off every bit of responsibility to them.  Then you hand off the code pager...such a fantastic feeling. 

9. The Breakfast Phase
 - Usually accompanied by my fantastic co-intern....the other CB.  Bacon is always consumed during this phase.  This is where I drink more coffee....usually to cover up my horrible morning breath.

10.  The Erroneous Post-Check Out Page
 - This is when a nurse calls you about an issue after you've already checked out to the primary team.  It begins with a bit of annoyance because, "why are they calling night float at 7:30????" but ends with pleasure as you return the page and ask the nurse, very nicely, to CALL THE PRIMARY TEAM!  FOR THE LOVE OF PETE!

11. The Car Ride Home
 - This is the part of the day that I don't really remember, but somehow I make it to my house every morning....with just enough energy to climb the stairs and curl up in bed.

Then Charlie starts whining. 

Then I yell "SHUT UP CHARLIE!  FOR THE LOVE OF PETE!"

Ode to Color Pink (Crayon)

Weezy's favorite color
You were Charlie's favorite too
Now you're in the backyark
In a lump of poo