It's been another good week here. Spring has taken off and it is colorful! Tulips, daffodils, grape hyacinth forsythia bushes and small violet pansies are everywhere. Even the yellow dandelions are a welcome sight. The trees are in bud and bloom; bud colors vary from green to yellow to red and blooms from white to fuschia to powder pink. If you have never seen a Magnolia in bloom (i.e. myself), I highly recommend it. They blooms start out as a bright pink, then unfurl to become a beautiful, large, pink blossom. If this color palette is fore-shadowing for the fall, I can tell you I am very much looking forward to experiencing that. Last weekend, I didn't take the time to describe the country side I was horse-back riding in. Central Pennsylvania has gently rolling, yet large, hills. You may have gotten that sense after the recount of my harrowing ride from several weekends ago. What I haven't discussed is how vividly green and inviting the farmland is. Driving through the country side here, brings to mind the scenery of English period pieces. I half expect to see an old English manor in the distance, or perhaps Mr. Darcy riding to Longbourn to declare his love to Elizabeth Bennett (a Jane Austen reference, if I just lost ya). Add to that picture an Amish horse and buggy (I have seen several already) and you've got yourself an idyllic setting.
I mentioned in a previous posting that I have to wake up early in the morning for work. Well, I've already had a few days when I hit snooze too often and ended waking up 30 minutes late (not good when you've allotted 45 min to get ready for work.) In order to combat this bad habit, I have decided to exploit one of my cat's habits. She has an automatic feeder that goes off at 5 o'clock in the morning. If it goes off and there is no feed in that slot, she comes and lets me know in no uncertain terms that she is hungry and would like to be fed. Normally I keep it stocked so that I don't get woken up prematurely. Now however, I have found it helpful to have a reliable alarm clock that physically wakes me up while purring, and who needs to be fed in order to turn off. Since employing this behavior, I have woken up on time, everyday.
I do a lot of standing and walking at my job. So much so, that I have purchased two pairs of compression stockings in the hopes of staving off future dysfunctional leg veins. I bought a light weight compression, as I don't have current problems, and man, do they make a difference! My legs and the bottoms of my feet aren't nearly as tired at the end of the day. I can tell that my overall energy is better too. I wore them every day last week except Wednesday, and I couldn't believe how tired I felt at the end of the day compared with the other four. They also keep me warm, which is nice since I'm in a cool, air conditioned environment all day.
I received a lovely complement this past week from one of the circulating nurses (the circulating nurse stays in the operating room during an operation, and runs the non-sterile side of the operation; a scrub nurse is "scrubbed in" meaning they are wearing sterile gown and gloves and managing the sterile instruments and field). We had been positioning a patient for the operation and she showed me a trick with one fo the pieces of bedding equipment. For the next case, I happened to use that piece of equipment again, this time using her trick. She looked at me and said, "Wow, you're a good learner." She was genuinely surprised at how quickly I caught on to, and used the information she had supplied me not just a few hours earlier. I had never thought about myself in those terms, I've always thought of myself as a "good student," but being in school for so many years, I developed a penchant and skill for learning. Speaking of learning, both surgeons are consistently letting me open and close for the cases. Opening entails making the initial incision, dissection down to the ribs, and opening into the chest cavity, while closing entails using different types of suture material and appropriate stitch/knot to close the multiple layers of muscle and skin. I'm getting more comfortable with the daily routine, am feeling like more of a professional and less like a student and am taking on more of the daily responsibilities like taking the call pager. I'm also writing notes and orders on patients, and so far I must say the "paperwork" part of my job (the one aspect I knew would be my least favorite) is quite manageable.
We look at a lot of chest x-rays and chest CT (aka CAT) scans everyday. Our patients are generally very sick, with either pneumonia, pleural effusions, emphysema or multiple problems, that I'm beginning to forget what a "normal" chest x-ray should look like. This has lead me to fully realize, you don't want the opportunity to be consulted by our service. The doctor's are very friendly, compassionate, empathetic and very good at what they do, but if you are sent to us, that means you're pretty sick. Which is my segue into a public service announcement about smoking: DON'T DO IT! I've never been a fan of smoking, but seeing first-hand the complications that arise from it (I'm not just talking about cancer), and treating those complications, makes me dislike it even more. I understand that it's thoroughly addictive (both chemically and behaviorally) and there is often a culture surrounding it, but wow, the quality of life that smoking leads to, is just...bad. I have patients who have more years in their pack-year smoking history than they are years-old, i.e. they've smoked more than one pack per day, for multiple years (such as a 54 year old with a 70 pack-year smoking history). Now, that's not the norm, but a pack a day is very normal for the patients I see. Their skin is dull and weathered, their teeth are yellow, they have raspy voices and nasty coughs, the whites of their eyes are grey and more often than not, they are dependent on oxygen in order to walk a single flight of steps or walk the hall to the bathroom. Those are just some of the "cosmetic" complications because usually smoking has also given them heart disease, lung disease, vascular disease (the blood vessels), and a myriad of other problems. Plus, it makes other chronic diseases (such as Type 2 diabetes) worse and harder to treat. Eighty five to 90% of lung cancer is caused by smoking and/or a known environmental carcinogen (i.e. second-hand smoke, asbestos). Not only that, it is the No. 1 cancer killer of both men and women in the United States. It kills more people in the U.S. every year than colon, breast, ovarian and prostate cancers combined. Yet, there are few fund raising events to raise awareness and money to research it. We don't need to do extensive research, we know why lung cancer occurs in the U.S.: it's smoking! For many of my patients, the experience of a complication from smoking is enough to make them (and sometimes their adult children) quit; there is a small handful who don't. Yet, even knowing what can happen, young people will take up the habit and smoke throughout their lifetime. To me that's a reflection of how addictive tobacco truly is (and how influential an environment is on a young person). Until someone has a life-altering experience, or simply becomes determined to quit for themselves once and for all, nicotine will hold it's grip on a them, no matter the amount of education and scare tactics used. So, the short of the long of it is, don't start; and if you do, try to find something in your life that is meaningful enough to motivate you to quit. Because trust me, a burst emphysema bleb, subsequent collapsed lung and prolonged air leak (leading to the prolonged use of a chest tube), is excruciatingly painful and not something you want to experience. Thanks for sticking through that with me. I've said my piece, preached to the choir and hope that my opinions haven't offended anyone.
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