Quick Update

This will be brief as I am exhausted despite sleeping eleven hours last night.  (Okay -- I'll admit those hours were punctuated by numerous coughing spells.)  We had a lovely lunch at the Indian buffet joined by Mama and Mama Phyll.  All I can say is, no dinner necessary after that brunch -- it would only be a downhill move.  

But now the update for which you (probably have not) been waiting.  The telephone meeting seemed to go well -- we're agreeable to proceed and hope Potential Surrogate and her husband are too.  Of course I can't post details about them.  We'll hear tomorrow if they want to proceed.

The remainder of the day was spent reading Dale Dubin's Rapid Interpretation of EKGs, but also a conversation with my best friend who is doing her surgical internship in another state.  S, I miss you!  Come home!

Debating whether or not to celebrate my birthday.  The idea of making a party sounds like too much energy.  Maybe if I don't have to cook/bake...Coldstone cake-batter ice cream cake anyone?  Or my favorite lemon-raspberry torte?

But now, shower and bed.  Five CCU patients tomorrow -- yikes!

Well, here we go again...

Different agency, different surrogate, same process.  Tomorrow we're scheduled to have a conference-call "meeting" in order to get to know a potential new surrogate since she lives in a very far-away state.   

For anyone curious about what these meetings entail, they are usually moderated by somebody from the surrogacy agency or by a psychologist.  The questions usually are  

  o   General Background (hobbies, employment, family, residence)

  
  o   Fertility Story (physician, reason for using a gestational carrier, fertility treatment history and future plans)
  
  o   Surrogacy Expectations (communication, presence during prenatal visits, delivery)
  
  o   Thoughts regarding multiples (including how many embryos will be transferred, views on selective reduction)
  
  o   Views on genetic testing as well as termination of an abnormal fetus. 

Right now I'm dreading another go-round.  Honestly, I'm terrified to do this again.  It just seems like it's only a matter of time until the next disappointment.  And the cruel thing is, the disappointment usually hits just when my hopes are highest.

So meanwhile I'm trying to protect myself.  When nothing works I'll devote myself to my patients and spoil my littlest cousin and pretend she is my own.  I will get used to it.  You can get used to anything, right?  And I'll cling to the promise of those six babies I will (hopefully not until I have lived a long and full life) have in Heaven.

On that strange note, those of us setting alarms of 0530 tomorrow had better go to sleep.  Goodnight all!

Irony of the week awards, and PLEASE -- SOME ADIVCE!!!

I am utterly exhausted, and so frustrated with being such a bad physician and intern, and just wish I knew how to improve.  ANY ADVICE WELCOME!

But at least we have irony.  Here's for the irony of the week awards:
1. My patient asked me if I have any children.  "No," I replied.  "Why?"  His answer:  "You're very maternal."  If only he knew.  Maybe caring for patients will have to be my maternal outlet.  I've come to expect only the absolute worst.  I keep myself going by reminding myself that my Heaven will have six babies eating for me, and my great-grandmother too.

2. I keep getting email from some breastfeeding organization.  Seriously!?  I couldn't do that even if I were ever going to have babies.

3. I also get invited to the Family Planning Conference on a School-of-Medicine-wide email.  Again, seriously!?  My single streak ovary and I only wish I had to worry about family planning.  Instead I must plan a life with no family and learn to accept it with grace.

4. Several people this week asked me "How's the baby?" or "You must be getting excited."  I don't think this one needs an explanation.

Bad Mim!

Honestly, I'm not sure I deserve to be a resident.  I admitted a patient with pneumonia complicated by pleural effusion.  I performed a thoracentesis (drained fluid in the space between the two linings of the lung) and since the fluid was purulent, foul-smelling, and turbid, I labeled it as empyema.  (Which it was -- see the beautiful Gram's stain below!)

As is protocol when performing a thoracentesis, I ordered a STAT chest roentgenogram to evaluate for iatrogenic pneumothorax.

But did I check the roentgenogram?  No!  I am pretty sure I didn't or perhaps I glanced at it far too quickly.  I assumed my senior was following it.  (Shame on me!)  I also shouldn't have assumed Surgery was reviewing it.  (We consulted their service for chest tube placement to drain empyema.)  While I tried to push for a chest tube overnight to drain the empyema, I didn't realize that I had caused a pneumothorax.  If I had, I would have gotten that chest tube in immediately.  Instead, my poor patient didn't get his chest tube placed until the morning after admission, a good sixteen hours after I created a pneumothorax.  He's lucky he did okay.  He was never symptomatic from his pneumothorax but his pneumonia was so bad that he was already requiring supplemental oxygen at that time.

There must be a special guardian angel looking after my poor patients.  And from now on I will make ABSOLUTELY sure I review post-procedural studies on my patients.

Thank you, God, for getting my patient through a serious medical mistake!  Let's hope he and all the other patients have a speedy recovery.