Awakening Our Inner Rednecks

Oh Lordy.

All we've heard about here in Our Town for the past couple weeks is "Man party this" and "Man party that", "James' stag this" and "James' stag that". The female counterparts have been subject to cryptic references to said night of camping, naked skiing, mud wrestling, gun shooting and knife throwing. Blood was drawn, dog bites were received, first aid kits were opened. We heard about the all-meat meals and the 'one guy who brought a vegetable' which was divided amongst the group (the vegetable, not the guy who brought the vegetable). And there was a silent ante which was raised to see what we'd do for Verena's staggette.

Though most of the guys figured we'd have the most fun tickling each other in our panties with rollers in our hair (whilst singing 'Beauty School Dropout') we had different things in mind.

Like gourmet food.
(OK some of you may not think that pureed doritos are classified as 'gourmet' but when that becomes home made chicken nuggets from AMG's nimble fingers, I dare you to question their gourmet nature)
Menu included: fig, Gorgonzola, caramelized onion and prosciutto pizza, risotto balls with Parmesan, smoked salmon and creme fraiche crisps, white chocolate saffron and cardamom truffles with pistachios, preccorino cheese with truffles, mascarpone with blue cheese threads, salad rolls with beet and asparagus, three cheese pizza, home made chicken nuggets, spicy dried olives, apricot and chile crackers, fresh antipasto, spiced eggplant, edamame, berry and yogurt cups, oh I could go on...


And wine.

And sangria.

And Bride-To-Be-Ninja-Snipers.
And normally docile marathoners shooting from the hip.

Howling at the moon.
Hey! Nice Fluvogs!

Note how the rarely seen in the wild Nature Nerd blends in with her background...floral skirt nearly imperceivable, and black top blending into the blanket of night...When she bares her teeth like that look out!! This is often followed by the sound of the mating giggle...

And then we did some gymnastics.

And some more.

And we drank scotch and took pictures of ourselves.

We also pulled each other around in a little red wagon.

And laughed at the people being pulled around in a little red wagon.

And there were moments when I'd thought we'd suddenly ended up on the Jerry Springer Show.

Some of us succeeded at handstands...

Some of us failed.

Some of us won wheelbarrow races...

And some of us didn't even make it to the start line...

And some of us simply seemed destined to spend most of the evening on that dewy grass...
Is that Mandy saying "You don't know me??"

Then we moved on to post-op wrestling...

And sampling of fine spirits...

or perhaps not so fine?

Epilogue.

(for the record the gun wasn't loaded...and neither were we...)

Why I Wonder if I am Cut Out For This

I was putting off writing about him as every time he crossed my mind, my eyes would involuntarily well up and that lump in my throat would appear.

Now as I sit to write the kilometers are stretching out between us and it has been days since I held his tiny hand in mine. Or rather that he spun his misshapen fingers around mine, holding my index in his soft grasp. I could feel the tiny nodules that marred every joint on his underdeveloped body. I was afraid of putting too much pressure anywhere that would invoke pain. I handled his body like he were made of blown glass. Unlike his mother who dragged him in to my office, her arms encircled under his armpits, the rest of his body hanging awkwardly as she walked forward. Her body banged into him with every step.

He wasn't diagnosed with the congenital disease known as Farber's Syndrome until he was three years old, which was long past his life expectancy. Born to a mother who was 14 and looked like an emaciated 12 year old. It felt perverse imagining Paulassie's conception. Her expression shifted from vacant stare to passively disinterested. She was there, but not really. I wondered about fetal alcohol effects when I spoke to her. So instead I addressed Paulassie's grandmother, who seemed to be not only the primary care giver, but also the only wage earner in a house that supported six people.

His disease was essentially autoimmune, like asthma or arthritis. So few cases documented even the massive search engines online turned up only vague references to the disorder or obscure articles in foreign medical journals. Their bodies bent on destroying their own tissues so efficiently that the children rarely lived past 6 months. Their swallowing mechanisms were faulty resulting in many pneumonia's due to aspiration, their eyes were affected by severe astigmatism which made vision nearly impossible, and their joints would be covered in painful nodules which deformed them beyond function. Their larynx also suffered degeneration which caused these babies to have a distinctive hoarseness. The part that I wished I didn't know, was that when these children died and their brains were autopsied it showed that most had entirely normal brains. Thus many live with cognitive functioning that remains untouched. They are tiny creatures trapped inside a ramshackle body, minds intact.

And so there he was in my office that day. His eyes moving back and forth so quickly that it was obvious that he could not be focusing on anything, any attempt to do so was futile. He had a cough that shook his entire body but he lacked the ability to expel the phlegm which rattled his chest with each breath. He seemed listless but alert. A vulnerable little being on the stretcher. I examined him and shuddered at the sound produced by his lungs, causing me to reflexively clear my own throat.

At first it seemed to me to be a routine examination of a handicapped child who had a nasty lower respiratory tract infection. I spoke with his Grandmother about the importance of thickened fluids, his antibiotic regimen, antipyretics, etc. It was the end of the day and I was anxious to take my long overdue lunch break. What more could I do? I didn't know anything about this disorder except what was outlined in his care plan. I was hoping this visit was almost over. His Grandmother remained still. It became evident that she was not ready to leave.

Then she mentioned their last trip to the Sick Kids hospital to see a specialist, it became clear to me that there was a bigger question in front of us.

At age 4, Paulassie had long outlived other children suffering the same disease. At some point there would be a mark of deterioration, a place where the medical care would shift from multi faceted to palliative. But we didn't know when the point was going to be.
He had been ill for several weeks now, the last course of antibiotics seemed to only marginally improve his health. Yes, it could be viral, but it could be worse than that.

As his Grandmother spoke of their trip South, she told me she would never return Paulassie to a specialist again. "He never treated us like we were people, he never shut the door to his office when he looked at Paulassie, he started doing something on his computer and ignored us." By the end of her remarks she was crying. She was a proud Inuit woman, one of the leaders in this community. A respected Elder. She supported her children, husband, and handicapped grandson. I couldn't help but wonder what the eyes of the specialist saw when he looked at her, or her grandson. Perhaps he thought she didn't understand the situation, that she was simple. How could he explain to her the complicated nature of Paulassie's disease, the likely outcomes? So why bother? Her English wasn't impeccable but I was sure his Inuktitut would have been pathetic.

Maybe it was he that didn't understand. That when you raise a child that is in pain, deformed, and requiring care 24h a day you understand the situation on levels than can never be expressed in any language. Dissected by any specialty. You understand that your own heart aches with such heaviness you dare not even hint at it's weight, for if you did you would surely buckle under the burden.

And so it was there in my gray office, as the snow swirled outside and the wind howled, she asked me without saying a word--was this the beginning of the end? And without making a sound I replied--I don't know.

Paulassie smiled and stroked my finger with his own. He twisted his face toward the voice of his Grandmother while we spoke. I looked down at this sweet natured little being who knew not what was spoken, and what was being left unsaid.

Now the tears simply rolled down her face as she tried to convey her fears and her love for Paulassie. Struggling for words she dropped her hands in defeat,

"he is my heart".

Perhaps all that I learned that day has yet to be revealed to me. What I carry now is an attempt at understanding where people are 'coming from' when we see them out of context in Big Hospitals. Here to see The Specialist. For some it is a journey of 1000km, a language barrier, and a claustrophobic city full of strangers. Unfortunately we can never know where people are truly 'coming from'. Yet I think it is something to consider. Sometimes we can't know that when skimming over a respiratory illness in a small child, we may be holding someone's heart so delicately in our hands.

Takin' the Long Blog Home

So the new blog has been minted, Asystole is a Stable Rhythm. It'll take me a while to get it fully up and running, but I created it to keep the medical things and the so-called life things separate. During the transition keep checking here. In the meantime, bear with the journal of events interspersed with occasional medical tales.

I met Keith at a volleyball camp when we were both 15. He was half goth half surfer dude with bleached blond hair and Hawaiian shirts over baggy shorts...or else black sweaters with holes worn in the sleeves for his thumbs and dyed black hair.

We became fast friends and even though we lived almost 8h away from each other and neither of us could drive, we stayed close through the gruesome hell which was high school. Strange when I think about it now because that was before email and texting. We stayed in touch the old fashion way; by phone, letters, visits chauffeured by our mothers. We went to college together and when I transfered into nursing I took Keith out to Boston Pizza (I know, sooo classy) and over a Boston Brute convinced the man that he should abandon whatever science major he was in to join me in the nursing adventure. Not sure how I did it to be exact, but he did hear my plea and saved me from isolation and despair. He crossed the floor. So the two of us set about trying to carve our identities out in a program which seemed to push us to the fringes. We certainly didn't fit in. Much to our excitement, one day we discovered Lana. Another non-conformist who had an open mind and some worldly travels under her belt. The best part though was that she liked to drink beer in the biker blues bar we often frequented. How could we not be friends? So it was that we became a three pack.

So it seemed fitting that on my last night in E-ville this summer, at the end of this part of the journey I should have the joy of dining with those dear friends. You know, the ones who help you stumble to your tent at music festivals, help you finish your patient care plans, and do all the work on the group project for you when your dad dies.

Myself, Keith and Lana 8 years later, in front of my favorite restaurant.

Enter Kara. Childhood friend Numero Uno.


We met when we were 3. At the pool apparently, though neither of us remember. Her mom babysat me when we were wee. What I do remember from those early days is she had the My Little Pony ranch and the Barbie mansion so she was as dialed as any friend could ever be. We were both alpha females so the first 10 years involved almost constant fighting, but once we got that ironed out we were solid. There were many hours spent in the 'time out chair' and trying to negotiate our way out of afternoon naps. But our childhood couldn't have been much more blissful. Playing outside all day, riding skidoos, running around the farm, making snow forts and mud castles. Her folks were strong Christians so pretty much every bad thing Kara ever did was with me (and to that effect, every good thing I probably did was with her).

Last weekend she was out visiting her parents so I offered to give her a ride back to the coast, thus allowing us some catch up time on the 11h drive together.

Recovering forests.
The 'Tunnels of Death' as I like to call them. Ughhh..I shudder every time we have to go through one...
I had a sudden flash back to a trip out to the coast 10 years ago (before going into nursing) where on this very stretch of highway I announced to my roommate that I was going to get into medicine. I was going to transfer into all the pre requisites I needed and put everything into acing school. Well, it didn't quite work out like that obviously. I did horribly in all of those classes. I'd get nose bleeds in physics, I panicked and blanked out in my 2nd chem midterm. I was so stressed I could hardly breathe most of the time. I dropped everything except Bio (which I barely scraped by in). I pretty much gave up on the possibility. For years I convinced myself that I couldn't do it. Wasn't smart enough. Didn't have a 'science' brain. My confidence and dreams of medicine dwindled into almost nothing. It took me 10 years to get up the guts to try again. This time it took. And now I was driving over these same mountains with a new perception of myself. I learned some important things this year, none of them pertaining to the laws of physics or chemistry.
I felt myself freed from the 'if only' mantra that had played itself in the back of my head all these years. If only I could do physics. If only I could do chemistry.
Well, the joke is on you, 'if only' !
'Cuz I did it.

Now we were talking about life, the universe, and everything after. Our female-only vessel stopped at almost every gas station to pee. We drank too much coffee, sang along to the Jayhawks, ate greasy fast food, and loved every minute of it.

We left Hope behind and headed to Vancouver...like so many before us...

"This road trip was brought to you by...VISA".

I arrived in my former mountain town to visit a male who still wants to impress me. Romeo. He's an omega male who chews cardboard to impress the chicks when they come over. You still got it Romeo!

Aside from seeing Romeo, I had the great pleasure of running through the emerald forest with Janet, eating her fine cooking, and catching up with the rest of her family...including her son and my surrogate brother-from-another-mother, Boy.

Since I was leaving early in the am, I paid a late night visit to another gem of nursing school, Rosie (and her man, Dave). Many years have gone by since we've seen each other in the flesh, but it really seems like it was only weeks ago we were bringing in the New Year on Hornby Island, in a cozy Yurt that had the 'Rhyme of the Ancient Mariner' written on the walls.

After breakfast with another blast from my past, Jay, I hopped back on the Sea to Sky highway. Right now it is more like a parking lot with a few 50km/h zones along the way.
Oh 2010 olympics, hear my curse and see my tiny fist waving at the sky!!!

Amazing what a line of credit can get you these days! Yes we were being the plebs in the spa with an automatic timer. Whatev. It made us laugh!

After being 'ladies who lunch and spa' we became 'ladies who whip up delicious salad rolls, chicken marbella, wild rice, summer salad, and lemony dessert for dinner'.

But like all good and bad things my little road trip (all 2100 km in 4 days!) had to come to an end. I hopped back in my non air conditioned ride and headed to the interior. After a great lunch with a former prof and friend in K-Town I drove the last stretch of highway which by now I could just about do in my sleep. I was excited to be heading back to my little mountain abode, complete with John and many opened armed friends who I've missed dearly all year.

This is my favorite spot of the drive as the mountains suddenly appear after coming around the bend.

"I'm coming home, Mountains!! I'm coming home!!"

Then I the reality check that sometimes summer on the TransCanada is no better than winter on the TransCanada!

Another fist raised at the sky...damn you tour buses!!!!
And damn you rental RV's!!!
And double damn you rental RV's with boats on the back and drivers who are clueless to what having a boat on the back means!!

And then, just like that, I was home.

No Fathers Day

When my dad laughed, it was a borderline giggle. As manly a giggle as you can imagine, but a giggle nonetheless. He really let loose though, usually turning his head to the side and scrunching up his shoulders while his whole body shook.

In a word, he was a 'character'. A prankster. Not mean or hurtful pranks, but anything he could get a good story from.

He would perform last-minute pranks, ones that involved no prep or props. Like sticking his big toe on the back of the scale when my mom was weighing herself, or telling the kindergarten kids that rode his bus that there were "two Friday's this week" so he'd be there in the morning to pick them up. My sisters current event for social studies class one day was that the "Pope had turned Protestant" thanks to my dad. He hid pork chops in the pockets of his friends coveralls on a Friday afternoon so that come Monday when they got back to work there'd have a nice surprise with their morning coffee.

When my uncle was particularly proud of his new television set my dad went out and bought a universal remote which he'd bring to their house and use to turn the volume up and down at infuriating intervals convincing my easily flustered uncle that he'd made a dud purchase.

One of his more elaborate stunts was when he surprised my mother on the 'throne' and snapped a picture of her, developed the photo and then cut it to fit in her wallet. I was at the supermarket with her the day she pulled her credit card out and with it came flying the photo of her on the toilet, landing right on the scan pad.

He loved it when I'd get engrossed in something scary on t.v. He'd sneak behind the couch and just as Hannibal Lecter was closing in he'd startle me with a "Haarr!" while I came a foot off the cushions, screaming and yelling "DAD!"

One Monday morning my dad's alarm clock went off for work and he didn't shut it off. His girlfriend thought it was odd because he was always up with the first crackles of the morning news. She turned over to ask him why he wasn't getting up and discovered that he was dead.

I was starting my first day of a community practicum in nursing school that day. I had been dreaming that I was at this odd wrecking yard which was more of a wrecking yard for people, not cars. There were these large looming pieces of ramshackle machinery and I was getting a tour. Just as the tour guide got to a group of Dachau-esque ovens and said "this is the crematorium" the phone rang, waking me up. I was shaking out the images from my disturbing dream but felt something else must be wrong because the phone never rang this early in the morning.

I picked it up to my mothers voice on the other end. She asked me if Benje was with me, I said yes. She said, "honey, your father died today, I'm coming to get you to take you to his place".

I don't remember many clear details from that day. But a few things are still with me. Sitting at my dad's kitchen table with my aunties and his girlfriend, my dog Cubby moping and whining around the house. A petite brunette who worked for victim services gave me some pamphlets and I remember thinking "what a shitty job you've got lady".

I had a professor in university who was a beautiful soul that had seen many tragedies in her time as an ER nurse in Toronto and Edmonton. On a shift when one of my fellow students saw her elderly patient die, Madeline sat us all down and told us how she helped families manage grief. Again and again she stressed that we ought to encourage families to make physical contact with the deceased, show them it is OK to touch their loved ones hand, or stroke their face. Her belief was it helped make the abstract concept of death more concrete. It gave tangible proof to push denial aside and let the beginnings of grieving grow.

The funeral home was at the end of a quiet street in the small town near his acreage. We were sitting in the funeral directors office discussing the upcoming autopsy and the cost and logistics of transporting a body back for viewing. I was tuning in and out. Wait, the medical examiners office? I had been to autopsies there. I hurried that thought out of my mind.

He informed me that I could save 600$ if they could have his ashes FedEx'ed to the church after the autopsy, rather than transporting the body. I howled with laughter, "Fed Ex!!??" I thought that was hilarious . Who knew you could have your ashes sent by priority courier? I was chuckling still when he answered me with a most stern, "yes". I glanced around the room and seeing that I was the only one who found this funny I stifled myself with a "hmfpf" and stared down at the balled up kleenex in my hand. When the funeral director finally asked me if I'd like to see my father I nodded and followed a few feet behind as he led me to the back of the room which served as a chapel.

I stood at the threshold. The length between me and the table which supported my fathers body seemed to stretch out to an impossible distance. The floor was gray linoleum and empty but for the body at the opposite end. To my left light streamed in through the dusty venetian blinds that were half open. On the right were brown padded chairs with metal legs stacked on top of one another.

The funeral director said he would step out to give me some privacy.

I just stood there staring straight ahead. I wasn't sure what to do. I wasn't sure if my legs could get me to the table. One side of my head was yelling "No! No! No! No!" and the other was hearing Madeline's voice telling us about encouraging families to have contact with the body. No way did I want some maladjusted grieving, stunted acceptance to befall me.

I edged forward and arrived at his side. His face was bluish gray. A small trickle of blood was dried in his ear. His mouth was hanging slack and he had enough stubble to warrant a shave. The white blanket was pulled up to his chin. It wasn't my father. The man who was my father had a mischievous twinkle, and was quick to laugh. This thing in front of me was an abandoned carcass. An evacuated shell. I saw that with his soul, his essence gone that he really had very little to do with his body. His skin and bones and eyes and mouth were just a complex interface required by his spirit to interact with the rest of us (who are also trapped by the same limiting coveralls). I knew that he had not come to an end there because having a heart stop beating could not cause such a dramatic metamorphosis to a vessel.

I thought for a moment that he was probably watching me, maybe circling above me somehow. I slowly reached my hand forward, intent on touching his shoulder. As I watched my hand get closer the moment of contact occurred. At that exact second a car horn blasted outside the windows. I jumped into the air and felt the rush of adrenaline hit my fingertips.

And with that I was laughing and waving my hand in the air.

"Hey Dad! Nice one. You got me!!"

So dad, if you're reading blogs out there in the ionosphere, this ones for you.

The Venue of Vultures

How is it that finish lines can feel so hollow? I was driving home from my exam, the last surge of adrenaline from writing was long gone and had been replaced by the anticipated nausea. I was expecting to feel jubilant. Relieved. Excited. It's strange how coming to the end of a long road can be so anticlimactic.
There have been times in my life where I have felt the pull of endless possibility in many directions so it is a sensation I am already familiar with.

In my minds eye I feel see myself running in a canyon, it's hot and rugged and my head is down to follow the rust colored contours. Running, running, running and then suddenly the ground opens up beneath my feet and I am flying through the air.
So far I have always landed on my feet, but at this juncture I have no idea where that might be. This next year is wide open for me.

So this chapter is closed.

The stage, predominately the basement of the central academic building. Often empty, save for a few random people (who also know where the electrical outlets are) playing video games or watching youtube. During the day the large picture windows let you see what you're missing. By night, there is no way to shift your weight to make those fixed plastic chairs comfortable. And generally, around this time the night cleaning crews arrive, and with them the cue to head home.

My last night of studying in CAB.

A major player and ultimate ally here at the university, Raj. This man met me almost every morning and every afternoon, for a total of 3-4h a day to tutor me through the wonderful world of organic chemistry. For the last 6 weeks I've robbed him of his opportunity to sleep in, and any opportunity to eat dinner outside the bowels of the chem building. Raj--you ROCK!




And now for the best part. The last act, the celebration! I was sitting in the students union building a few days ago when I looked up and saw Paul. A good friend and former partner in truancy, vandalism, and general adolescent skulduggery. I haven't seen him since we graduated from high school. It was strange looking at him and seeing a man's face superimposed on the image of my 17 year old version of him. As Friday was his last exam for his most recent degree and my last exam in year of pre req hell, we thought it fitting that we ring in the New Reality together. And as an added bonus, his roommate Jaison was also a friend from high school who I'd often hoped I would connect with again someday.

So we ate, we drank, and were merry.
There really is a special connection that we carry with people who have been in our lives during the tumultuous and wondrous time which is our coming of age. I generally shudder at any thought of high school or the people that I was forced into spending it with, so it was amazing to spend an evening reacquainting a couple of dear friends who had been red balloons in a gray landscape.

So for now, I am free of the venue of med-hopeful vultures. Free to spend time with the important people in my life, time in my kitchen, and time on the trails. And for all of that, I am happy.

The Heart of the Matter

Suddenly I was in the back of that rocking ambulance again. This time with Howard Thorpe. His pallor revealed what his silent lips did not. The wail of the siren bounced around us and the lights of the city streaked past.

He knew what was happening behind the layers of tissue, cartilage and bone. He knew what had occurred deep within his very core. The aorta is the body's largest vessel. A firefighter’s hose of blood which runs the length of the spine where it bifurcates into smaller but also high-pressured arteries at the neck and thighs. A tear in the aorta can cause a man to bleed to death in minutes.

Howard had come in with mild chest pain and leg pain while he was skiing. A neurosurgeon from Montana, he knew that chest pain wasn't to be trifled with, figuring it was nothing but wanting to be sure he came into the clinic to get checked out.

At that time the pain was in the middle of his chest, maybe a 5 or 6 out of 10. His initial exam rang no great alarms. The electrocardiogram was overtly normal, his blood pressure not too low or too high, heart rate was skipping along maybe a bit quickly, but nothing worrisome.

Howard was very personable, kind, unassuming. The clinic was busy that day but he was my primary concern. The broken wrists and dislocated shoulders could wait with ice packs and slings in various positions.

Howard’s family was still skiing on the mountain, unaware of his mid-morning check-in. I administered nitro spray under his tongue, feeling somewhat sheepish as I warned him about the possibility of a headache… like he didn't know! But then, one can’t be sure what medical people forget or fixate on when they are the patient. When suddenly they are on the them side of the ledger. Anonymous in their underwear and open backed gowns status…shuffling with their IV poles to the “patient" washrooms.

Howard said his pain had gone from a 4 to about a 1. I told Bob, the physician, and he advised me to keep his pain down with nitro and continue to monitor him. We nodded knowingly, the new onset of angina now under control. A cardiac foreshadowing. It was minor in the grand scheme of things. Thorpe was in good shape. He'd go home, and with his connections in Montana he would have the best cardiologist who would fast track him in to the cath lab where they would isolate those pesky narrowing arteries and do the things they do to them.

Howard would probably never even have to be an inpatient. He'd be tickety-boo and back operating himself in no time. All of this Bob and I were comfortable with. A nice guy with a not-too-bad diagnosis.

I went to get bed 3 ready for the next fractured wrist reduction. I heard my name from bed 1. "Erin? I just can't seem to get comfortable. Could you give me a hand?"

I walked quickly to his bedside. The head of the bed was raised and he was fidgeting in a strange way, fussing with the pillows. "I just can't seem to get comfortable. Can you lower the bed please?"

There was something about his movements that struck me as odd. Even bordering on alarming. "Where is the pain, Dr. Thorpe?"
"Right here, between my shoulder blades". He reached awkwardly around and pointed to that area on the back that immediately caused the hairs on my neck to stand. A classic sign of an aortic aneurysm. The tearing-of-the-lumen, pain referred to that area.

Trying to mask my reaction in my face or demeanor I helped him settle and quickly found Bob.
"His pain is mid-scapular, Bob...you've got to get in there now".

Bob and I exchanged looks which confirmed that we shared the same thought. Our initial apple-pie assessment of his prognosis had just soured. This was not good.

We moved Howard to the trauma room. Bilateral blood pressures on his arms and legs showed a marked discrepancy in pressure. On top of that, the pulse in his left foot had disappeared. His major blood supply was compromised somehow… his circulation wasn't going where it was supposed to. Now the leg pain made sense. Clinically it was clear that he was dissecting. If he was lucky it would be contained, with the more delicate vessel tearing inside while the thick outer lumen remained intact.

We were arranging the med-evac to the tertiary center which housed the vascular surgeon. At this point it looked like ground transport would be faster than landing the chopper. Someone had to go with him, and that someone was going to be me. Bob explained to Howard what was happening. Strange… or was it… that Howard hadn't come up with that differential on his own. Emergency staff are so versed in the tell-tale red flags of triage that Howards’s textbook discomfort immediately drew the two of us to the same conclusion. Maybe it was Howards denial and his own rosy hope that it was angina that blocked out his objective analysis of the situation. Can a man indeed be objective when he’s subjected to such an experience. …

We loaded up in the ambulance. His son-in-law had arrived but was unable to locate Howard’s wife and daughter on the hill. They had planned to meet in about an hour. His son-in-law was planning to bring them to the hospital as soon as he could but now Howard would have to go without seeing his family.

Dusk and damp misty rain greeted us when we rolled Howard out of the clinic. The fresh evening air did nothing to untie the knot in my stomach as I carried the bulky cardiac monitor behind the stretcher, a cell phone and Doppler to amplify pulse sounds. Two large-bore IVs were running into his arms and I had a pocketful of morphine and Gravol to keep him comfortable during the ride. I had no other drugs or equipment to rely on.

Shaun pulled the ambulance out of the bay… the sirens came then. It’s an altogether different matter when you are riding inside their wail.
As we accelerated down the dewy road toward the highway Howard was asking me questions… almost talkative.
"What are my blood pressures?"
"They are dropping, Dr. Thorpe. The left side is only 70 now."
"Why are you using the Doppler?"
"I can't feel your femoral pulse on the left side. It’s gone." A place where normally the bounding heart rate kicks at your fingertips now gave me only a swoosh-swoosh-swoosh when I pressed the Doppler to his groin.
"These things are so sinister in my mind,” he said. “The only time I see them is when I am trying to repair spinal damage from them".
"I suppose it must be worse to have the medical knowledge, to know all the worst case scenarios. Worse than being blissfully unaware."
He nodded.

I have a strict pact with myself to never reassure patients when I don't know what an outcome might be. It'll be okay. You'll be fine. Are phrases that never escape my lips unless I was putting a bandage on a skinned knee.

Thorpe arched his back grimacing with pain. Said, “It feels like it’s more in my throat now.”

I thought that he was going to bleed out right in front of me. Unsure as to the best thing to do as I watched his pressure plummet, I grabbed the EHS cell phone and called the clinic to update Bob and figure out what the hell I could do in the back of this ambulance if this man suddenly blew on me.

As Bob answered the ambulance lurched to the side, passing an unaccommodating commuter. The phone slipped from my hands and fell into several pieces on the metal floor.
SHIT.

I flipped open my own cell, so thankful that I had thought to bring it. Bob came on the phone again.

"His pressure is dropping. I've lost his femoral and he's getting pain higher up the sternum".
"Nothing you can do, Erin. Keep him comfortable, pain meds, fluids, that is all you can do in the back of an ambulance. It is out of your hands."

What I already knew but couldn't swallow.

Howard refused any morphine. Looking back I think he wanted to be as clear as possible for what could be his last moments. He knew he was a time bomb ticking.

He was silent and I forced myself to respect the desire he had to be alone in his thoughts.

Was he happy with the way his life had turned out? Satisfied? What haunting thoughts came to the surface now? Was it fear… resolve… peace?

His face revealed nothing.

He turned to me.

"Erin. My wife's name is Pauline. My daughter is Isabella. This is my wife's cell phone number. If I don't make it please call them for me. Promise me you'll call them and tell them I loved them." With a shaky hand he scrawled a number on a scrap of paper from his wallet.

I took the number and folded it into my scrubs.

"I promise". Was all I could say. My own heart was thumping in my throat.

He nodded, closed his eyes and seemed to go deep within himself. I bit hard at the inside of my cheeks. I felt myself go cold. I was going to watch this man die. The tinny interior of the ambulance his last vessel, a stranger at his side. My eyes remained locked on the cardiac monitor with its reassuring blips every second.

We arrived at the hospital in record time despite the rush hour traffic and the bridge. Shaun smoothly rounding corners, passing lanes and lanes of hassled motorists.

Howard is whisked into the ER, a trauma bay and team waiting for him. I pass on my report to a disinterested male nurse who is only half listening until I get to the part about the vanished femoral pulse. He glances up at Howard, several feet away being hooked up to monitors, oxygen, new IV bags.

I squeeze Howard’s hand as I leave.
"My name, Howard. Please remember my name, so you’ll know who to leave the message for at the clinic when you call to let us know how you are doing after surgery."

He repeated my name.
“I won't forget. You all did an amazing job. It may be a small clinic, but you all know what you are doing. Had me on my way as soon as possible. Other places might have missed the diagnosis. Shaun's driving was superb. I know how bad that bridge can be. Thank you for everything."

It was weeks before I heard the end of the story. A physician friend of his came to our ER department with gifts, wine, and a letter for the staff.

I still have a photocopy of it in my strong box at home. His handwriting is terrible so there are many words I cannot make out. He had dissected, from iliac crest to aortic arch. 7 hours of surgery and full recovery expected. In the letter he graciously thanked all of the staff. I smiled when I saw my name underlined—I am sure as a reference to my insistence that he remember my name and update me regarding his recovery.

But in it he says, “You all saved my life that day. You saved my life. There is no greater gift we can give each other. So I feel strange presenting you with these small gifts and a card. What can I say to the people who are responsible for me being alive today? Thank you really doesn’t cover it.”

In a strange way I am still haunted by that day. It simply comes at me from nowhere sometimes. As nurses we are placed in situations where a profound intimacy with strangers can be thrust upon us. We bear witness to the most pivotal times in our patients’ lives. In crisis we share moments with patients that is normally reserved for their most treasured loved ones.

“Promise me you’ll call them…”

I can hear his voice. I am in that ambulance. And I am scared. But more than that I am grateful for the precious burden of this work. Work that pains me, pushes me, frustrates me and scares me, but also honors me. Work that takes much from me, but gives moments in return that are profound in a life where superficiality often reigns.

I’m grateful just the same to come back to the present, to be running on the treadmill wondering what I need pick up from the grocery store for dinner.

Teflon Neurons

Voici a little sheet that shows most of the reactions I'll need to know in...oh...36h or so...

Okay. I am officially hitting the wall. No, more like running at the wall, hitting it, backing up and running at it again. An entire year of organic chemistry simply should not be condensed into 6 weeks. It's just not part of the natural order of things. It simply isn't right.

At this point, the real estate in my short term memory has dwindled to nil. I'll do a question, say to myself, "okay, so if I want to turn an amide into a primary amine I need Br2 and OH". Then I go to the next question and I have no idea what I just wrote down. Things go into my brain and then immediately they are gone. It's frustrating. Plus I am just starting to go batty in other ways...I walked into the dry cleaners yesterday and said "good morning!" at 1730h. Then I went to Safeway and walked by a dude waiting in line and started putting my food on the conveyor belt in front of him!

I am getting really excited though that soon all this will be over. I have significantly lowered my standards this week. I progressed from the "must get an A" to a "meh...as long as I am breathing at the end of this I'll be happy".

Also excited about the fact that I can finally stop having this conversation.

The only sad thing about being finished o-chem is I will have to retire my mackin' lab coat. In case you missed it, here is just one part of the bling I put on my sweet little protector of fine sweat pants.


I really may have to bronze it and hang it in a display case of some kind when I get home. That is enough procrastinating for now. Must return to the reagents. Uhhhhg....reagents.

Another Day on Call in the Arctic

I miss working. I can't believe I just wrote that. It's true though. Feeling nostalgic today I was reading through my journal from last fall when I was working in a remote Inuit community in the Western Arctic. It makes me antsy to get back into the trenches. A year is a long time to be away. Here it is:

I actually was part of saving a man's life today.
Cut my finger trying to eat a muffin.
And watched some bad Canadian television.

It was so interesting to see the events of the day unfold in a dream-like sequence...I felt like I was watching it all from behind glass, yet so in it I could barely raise my head above the smell of benzoin. The benzoin was being used as a tacky assistant, since the EKG stickers were sliding off the patient as fast as we toweled him and applied them. The cold sweat seemed to travel down his body like a clear oil slick, removing all our feeble attempts at securing I.V's and electrodes to get a heart tracing. The benzoin's sap-like consistency anchored our only diagnostic tool.

A garbage bag curtain hid the unfolding ice storm as inside we swirled around our most diaphoretic, nauseated, hypotensive, peripherally shut down patient.

I had been assessing a young man's knee when Jane burst into my office. She can get a bit dramatic near the end of her stints so I wasn't fazed at first. "Uhh...I think I've got an M.I in my office." M.I is medspeak for myocardial infarction, a.k.a 'heart attack', a.k.a 'a jammer'. I asked my patient to hold tight. I love cardiac stuff. It's a throwback to my old ER stomping ground that was in the heart (pun intended) of the silver tsunami which is the West Coast. Cardiac emergencies are interesting, challenging, emergent. Emergent is a nice change from the doldrums of most ER care which revolves around abdominal pain, back pain, flus, colds, headaches, lacerations, psyche, and the odd trauma.

I happily left the twisted knee and went into the trauma room. There, slumped on the stretcher was a very distressed Inuit man. He was clutching the center of his chest with one arm and failing around, grasping at air with the other. He was moaning loudly and the sweat was literally flying off him. His tan skin had somehow managed to take on a ghastly gray/green tinge and I could immediately see that we were in for the long haul with this chap.

No cardiac monitors, defibrillators, no I.V pumps. I was used to these constraints in settlements but cardiac problems are so rare that normally I don't notice it. I wheeled the EKG machine to the bedside as our only means of 'cardiac monitoring' . He was in v-tach. This was glaringly obvious the second I fired on the EKG with help from Jane, who was starting I.V's and trying desperately to have the leads stick to his chest which was as slippery as the frozen ground outside.

A heart beating 240 times a minute is more like a fluttering wing than a pumping muscle. When this happens oxygenated blood does not get to the right places. Where the blood is not perfusing the starved cells begin to die. One place that doesn't get the supply it needs is the heart in these situations. And in these cases, minutes mean muscle.

It was bad. Maybe a pressure palpable at around 65 systolic. I was scared and excited and intrigued all at the same time. I was loving it.

I hate to admit to the morbid love of real emergency situations but really it is such a charge.
At one point I remember looking at him, curled in the fetal position with his sweaty hair plastered to his face, a shiny gray, and thinking to myself, "he is going to crash. He is going to crash and we have no electricity to do anything. He is going to crash. Are we going to tube him? Is he maintaining an airway?"

He was gulping for air despite the 10L NRB mask on and the nasal prongs at 4L. Gulping! And we couldn't get an o2 sat because his fingertips were giving up no information. The sat monitor could not read how much oxygen his red blood cells were carrying around...his capillary blood had packed up and moved north.

More north than we were.

I called the doctor at the hospital which was an hour away by plane (the only way in and out of the community). As usual the security guard/answering service put me on hold for a horrifyingly long time. By this time Lawrence, our only other nurse, had taken over the duty of watching the EKG machines 2x2 inch screen for any changes while Jane worked continuously to dry off and re-tape the electrodes as they slipped off.

I hung up the phone and called the emergency line again, this time telling the security guard that I needed the MD on call toute suite. A harried doc came on the line and I apologized for raising the alarm but told him he needed to initiate a medevac for an extremely unstable cardiac patient and I needed some orders for the impending code that was going to happen. He asked me to fax the EKG and get amiodarone into the patient as soon as possible, well, as soon as he got the EKG and could confirm my v-tach diagnosis. To take care about the administration and set the pump to make sure he got the right dose. Pump! I laughed. "No pumps around here bud, I'll be giving that drug in a syringe drop by drop over 10 minutes once the loading dose is in!"


Our secretary was with the patients wife in the coffee room, trying to keep her calm so I was fiddling around with the ridiculous fax machine while trying to draw up the amiodarone and double check the dosing at the same time. Jane and Lawrence had their hands full still trying to get a basic set of vitals on the guy. Finally the janitor walked by and I managed to snag him into sorting out the fax.

In a few long minutes the doc called back and told me he'd initiated the medevac and had received the EKG. I thanked him and hung up the phone.

The loading dose of the drug went in and I shook my head at the set up we were dealing with. An impending blizzard outside, no way to properly monitor the patient, and no way to deal with him if he coded. I felt like my hands had been tied behind my back while the crisis crescendoed.

I held the 60cc syringe in my hand while watching the clock (the only real technology in the room) and dribbled in the maintenance dose.

Then lo he suddenly said--'the pain is gone'. He let go of his chest and turned his head to me in surprise.

The dregs of the amiodarone were still going in by my hand. I ran to the other side of the stretcher and happily informed him, indeed the pain was gone because he was in a sinus rhythm. I must have thought, thank God or someone.

I know that then I must have exhaled completely for the first time since seeing him floating in his own juices on that emerg stretcher from the 1950's.

The time had warped. Despite the freezing rain and the blowing snow, the fog and the ceiling the plane landed and he was scooped (infuriatingly slowly!!!) by the paramedic and med student.

And off they flew, 6h after he'd driven himself to us.

Suddenly realizing that it had been too long since I'd had a chance to pee, eat, or drink water, I endeavored to change that. In the process of trying to quickly saw in half one of my 4 day old muffins the chopping knife slipped and gashed my left index finger.

That was annoying. It started bleeding and bleeding, I thought--there is no way i am getting sutures today...so I applied pressure, steristrips and a bandage. And was still annoyed. And will continue to be as the deep cut on my right index finger from climbing has only been freed from bandaids for 24h. Ugh. Oh well, I realize how pathetic a cut finger is compared to a jelly heart.

But I thank him and bless him. He gave us a rare satisfaction. The feeling that we actually did something really important that day. We worked as a team and even with our limited resources we actually saved a life. We didn't just look in throats and ears and give out septra for U.T.I's all day.

It also made me thankful that I had spent those hellish nights in the viper pit in my old emerg department. That's what all those countless cardiac cases were preparing me for.

I do hope he does well, was such a nice, funny, man. He joked with me about wanting to eat berries and that he was getting ready to 'run out' and pick some before the medivac crew arrived.

The wind is rattling my windows still and the power just went out. Thankfully he got out before the storm really hit.


My next patient of the evening:

Pommer the Pommeranian

We got the call that there was a lady with a dog who had a broken leg. Apparently she had called the RCMP first but they directed her to the health center. I was on call so agreed to see the pooch. We're not really supposed to treat animals but as the nearest vet is 4h away by plane we usually bend the rules and help out if we can.

Pommer was a rust colored fur-ball of a puppy. An adorable 4 month old who had apparently been 'dropped' by the chubby, flat affected, 8 year old---er---since when did dogs break their legs from being dropped 3 feet above the ground?

Anyway, the dog seemed settled enough in the mothers arms but with even the slightest movement the yelps of pain elicited were so ear and heart piercing that we could hardly bear it. Our attempts at x-ray had been traumatizing for everyone involved. Thus the decision was made to try and medicate and splint the poor creature.

So I called Dr. P in Whitehorse, a vet who gives over-the-phone advice and he talked me through how to create a muzzle out of kling gauze (so as to not get bitten) and how to landmark for an intramuscular injection of demerol. And so the splint was made with the bendable metal we fashion finger splints, gauze, and kling. Did you know that dogs have radius' and ulnas? I had to laugh at the learning curve of the evening.

Let's hope the rest of the night is quiet. Uh-oh. I wrote the "Q" word. I wonder if the same jinx happens when you write it as when you utter it...

The, Like, Doctors of Like, Tomorrow, Like...

The title is probably all that is needed. But I'll elaborate anyway. I just spent the last 3h in a chem lab making estriadol. It was a pretty simple procedure since we were given the estrone needed to do so. But during the lab the two girls who I share the bench isle with became unbearable to me.

One said "thank God there are so many idiots in this class asking stupid questions". Whenever any student did ask a question the two of them would exchange eye rolls or snorts of superiority. That is, of course, between the compulsive checking and texting on their pink razor phones. Maybe they are day traders and premeds, so maybe I shouldn't judge.

Yet Brittney #1 thought it was HILARIOUS that she kept spilling her hexane all over the bench. Hexane stinks, its highly flammable, and extremely volatile which meant I was praying all afternoon (in a hexane vapor cloud) her bunsen burner wouldn't set me and the bench alight.

I didn't think it was hilarious. Nor do I enjoy the fact that one of these girls will likely be doing my moms knee replacement surgery in 10 years. It is such a whack system that forces people to become these uber-achieving-competitive-petty-sociopaths to get INTO medicine, then expects them to suddenly develop a compassionate, patient, and understanding personality of good doctors (whatever that means). And don't give me the "if they are surgeons they don't need to have good bedside manner" because that is a cop out and a load of bull.

Surgeons don't work in a vacuum so why should the rest of us be expected to play nice and be professional and they get off the hook?

But I digress. The bottom line is, after being surrounded by the medical/dental hopefuls for the past year I have developed some major doubts as to the quality of the masses attempting to become doctors. It's scary folks. There is an upside though. I have a nearly photographic memory for faces. And believe me, I have been amassing a composite of wannabeMD's, which, if I ever see them in the hospital, I will hit-the-floor-running-with-my-IV-pole-trailing-behind. Because really, I've seen how they handle things like H2S04 gas and I find it worrisome that some day they'll be making life and death decisions for us all. I must say though, I do wish I could be there the day they realize that sometimes medicine means putting your finger in someones bum.