Out with the old; In with the new!

Dearest Mustang,

You and I spent a great 10 years together.  I remember feeling like the luckiest gal on the block when my dad brought you home from the dealership on that crisp February morning in 2000.  Back then you were shiny and almost-new with a mere 6,000 miles.  I felt like the hottest thing in town. We turned a few heads, you and I!  I admit I may have broken a few speeding laws with you, but you always got me safely to where I needed to go, and for that I'll be forever grateful.  You were kind to me even after that fateful morning of the ACT when I hit a pickup truck and put a trailer hitch ball in your front bumper.  Sorry about that...

We've had a great relationship through college.  You've taken me to the beach for many spring breaks, but according to mom and dad brought me home from Auburn too few times.  We've been through 101,000 miles, a wreck, a few jumped curbs and 5 moves together.  We've been pulled over quite a few times, but still with NO speeding tickets (yes I'm proud).

And now, I hate to break the bad news, but I'm moving on to someone else.  Someone who gets 50 miles/gallon.  Someone whose paint isnt chipping off, whose radio display tells me what station I'm listening to, whose seatbelt retracts back in the holster, whose power steering doesn't leak.  Someone who's a little less "crazy teenager" and a little more "earth-friendly responsible adult".  Someone who has 4 doors and the ability to transport friends and groceries.  Someone named Prius.

Please, Mustang, don't be hurt or jealous.  We had good times together.  But sometimes, you just have to move on.

Love, Kacie

 

Lesson of the Day: Always Listen to Your Patients

Even if they are crazy ...

This Tuesday I was on call.  That means that I, along with my team, hung out in the Emergency Department and admitted all the patients in serious enough condition to stay in the hospital.  My assignment for the night was to admit a lady who we'll call Ms A.

Ms A came in at 6am that morning for a chief complaint of sudden blindness.  Her estranged husband (who just so happens to live in her back yard) brought her in.  When I strolled in the room he flashed me a toothless grin and told me his ex-wife wouldn't wake up yet.  I glanced over to the patient and realized she appeared quite sedated.  I'll later tell you why, but for now let's move on with the story ...

I had to get the story from the grinning ex who lived in the back yard since my patient was obtunded.  He told me that last Thursday she came to the hospital for outpatient excision of "skin cancers".  As I look over to her I notice she has multiple sutured lesions on her face.  After the surgery all was well and they sent her home.  Well a few hours later she started getting sick at her stomach and came back to the hospital.  Lo and behold, they did some blood work and she had pancreatitis!  So obviously she got admitted and underwent the standard treatment for pancreatitis.  While in the hospital, records indicated she had been a bit "hesitant" about going home, and at the time of discharge kept telling everyone she had a bad headache.  As some in our patient population seem to enjoy their stay and free meals in the hospital, I think this statement was ignored and she was sent home.  

A few hours later that night, around midnight, she suddenly gets very nauseated and begins vomiting.  She calls the ex from the backyard and out of the blue, she suddenly goes blind in both eyes!  Everything was completely black!  Now let me tell you friends, if you havent figured this out for yourself, sudden blindness is not a thing that usually happens.  And especially not in both eyes at once.  The story continued on per toothless ex, "well she just kept throwing up and saying she had this headache and couldnt see nothin!  Then about 30 minutes later all the sudden she could see again!  But she said it was real shadowy.  Then about another 30 minutes later she went blind again!  So a few hours later I decided to bring her in because I kept giving her Lortabs and they wouldnt work."

At this point, I had already been told by the ED staff that this lady was crazy.  Her ex had also reportedly told a nurse she was crazy.  And this story was crazy!  Blindness that got better and then came back again in a few hours and not deciding to go to the hospital for 5 hours afterward just wasn't coming all together for me.

But then the story gets more interesting ...

At this point, the ED staff decided to get a CT (cat scan) of her noggin.  Sometimes a special type of "mini-stroke" can present with blindness, though not necessarily in the way that this patient did.  Of course to no one's surprise, the CT came back normal.  They then called neurology because they didn't know what to do with this woman.  They suggested an MRI, because that usually gives you better pictures of the brain.

So off to the MRI Ms A goes.  She keeps mentioning she's nauseated (and oh by the way her sight is fully back now) and the nurse goes down to MRI to take her some nausea medicine.  As he hands it to her, Ms A stiffens her whole body, and then has a grand mal seizure.  The nurse witnessed the seizure, but others who saw it thought it was a pseudoseizure.  Pseudoseizures are non-epileptic psychological seizures (aka, the patient is faking it).  She was treated for a seizure regardless (hence the sedation I mentioned earlier) and was administered a test to see if she had a seizure or not.  And that test was normal.  Suspicions again grew.

While Ms A was knocked out from her medicines, we decided to sneak her into the MRI to actually see if anything was going on in her noggin.  MRI's take a while to get back, and so our team went upstairs for dinner.  It was interrupted by a call from the radiologist saying we better take a look at this MRI.  It looked like this:

See those white splotches at the bottom?  That's not normal.  And this is the area that controls your vision.

And then on top of that, add this picture to the same one

See that white spot in the middle popping out at you?  That's not normal either.  This is a picture from the internet, but her white spot was even bigger.

Uh oh.  We've got trouble. Now we all felt pretty terrible that we thought this lady was "malingering", or exaggerating/creating symptoms for personal gain/attention/sympathy.

After seeing the images and debating over what they meant/how they got there.  The top ideas were malignancy (especially that middle white spot), a stroke (either spot, but neither of them really screamed a stroke to the radiologists), or an interesting syndrome called Posterior Reversible Encephalopathy Syndrome, which she had all the symptoms for.  We wound up treating her for the latter, and then during her hospital course we wound up ruling out everything that we thought of.  She went home today stable, but still without answers as to what is going on in her brain.

Ill probably never know how things turn out for Ms A, but I did learn a valuable lesson from her.  Sometimes in the healthcare field it's pretty easy to become jaded and maybe even a touch cynical.  A lot of patients seek drugs, and a surprising number of them may exaggerate their symptoms, or even fake their symptoms for various reasons.  But just because a patient may be odd, or you are suspicious of their motives doesn't mean that they can't be very sick too.  If someone tells you they are sick or in pain, you can never ignore that and write it off as insignificant.  Not only did I learn what Posterior Reversible Encephalopahy Syndrome meant during the past few days, I also learned to truly listen to your patients, to not make judgments, and to not jump to conclusions.  A good lesson learned.

Ladies' Brunch!

Last Saturday I had some of my best girl friends from school over for brunch!  I kicked Stuart out of the house for the first time since we've been married and then the gals arrived!  It was so nice for us all to take a break from school and get together and have some gal time!  Here are some pictures from the day ...

Can't have a great brunch without great food!  Raspberry, mozzarella, and mint skewers.

Scrambled egg and ricotta crostinis

Pears and arugula wrapped in prosciutto!  Delish!

It's also crucial to have mimosas at a ladies brunch =)  Rebekah was the only one brave enough to open the champagne bottle!

Shannon and Rebekah

Liz and Priyal

Riah and Britni.  Riah made an amazing tomato pie that I forgot to get a picture of!

Greens and Garbage Disposals

I recently had some great friends over to the condo for a Saturday brunch.  We had so much fun and I will have to post some pictures later.  Well ... I just absolutely love cooking and hosting and take much pleasure in creating fun delicious dishes.  One such dish was going to be homemade roasted garlic hummus with kale chips.  Kale is a lovely leafy green that is packed full of nutrients.  I found a recipe for the kale chips online and after Stuart and I picked out a ginormous bunch of Kale at Winn-Dixie (Publix didn't have any ... I don't want to talk about it!) I started baking.  I soon discovered that baking a kale leaf turns it into a microscropically thin crunchy thing.  So thin, in fact, that just picking it up off the baking sheet made it crack.  So since the kale chips didn't work out, we resorted to pita chips and I decided to cook the kale another day.

Last night when I got home from work I decided to saute the kale to have alongside some leftover fish.  Now, while kale is nutritious and I would love to eat it on a regular basis, I haven't had much luck with it in the past.  No matter what I add in when I cook it it is always way too bitter.  I decided to try it again with a bit longer cooking time to hopefully cook out some of that flavor.  I also added in some apple cider vinegar because I thought that would brighten up the flavor a bit.

Well, 15 minutes later I put some kale on the plates and we chow down.  Well, we try at least... the kale is SO TOUGH that it is impossible to chew!  And on top of that, it was even more bitter than before.  Stuart wouldn't even eat it, and if you know Stuart that says a lot!  He hates it when things go to waste and has been known to cut mold off bread and still eat the loaf (yuck)!  Anyway, he politely and gently encouraged me to put the greens down the garbage disposal where something with sharper teeth than we have could digest it.

Grudgingly I made my way to the sink, turned the water on and put the kale down the drain.  A flip of the disposal switch and all of a sudden we hear horrifying noises, and water starts backing up in the sink.  My greens were even too tough for the garbage disposal's steel blades!  How embarrassing!!  20 minutes and a toilet plunger later, the kale and water made it safely down the drain.  My pride went with it ...

Who would have thought God's saving power would look like this?

Isaiah 53

A servant grew up before God—a scrawny seedling, a scrubby plant in a parched field.  There was nothing attractive about him, nothing to cause us to take a second look.  He was looked down on and passed over, a man who suffered, who knew pain firsthand.  One look at him and people turned away. 

We looked down on him, thought he was scum.  But the fact is, it was our pains he carried— our disfigurements, all the things wrong with us.  We thought he brought it on himself, that God was punishing him for his own failures.  But it was our sins that did that to him, that ripped and tore and crushed him—our sins!  He took the punishment, and that made us whole. Through his bruises we get healed.  We're all like sheep who've wandered off and gotten lost. We've all done our own thing, gone our own way.  And God has piled all our sins, everything we've done wrong, on him.

He was beaten, he was tortured, but he didn't say a word.  Like a lamb taken to be slaughtered and like a sheep being sheared, he took it all in silence.  Justice miscarried, and he was led off— and did anyone really know what was happening?

He died without a thought for his own welfare, beaten bloody for the sins of my people.  They buried him with the wicked, threw him in a grave with a rich man, Even though he'd never hurt a soul or said one word that wasn't true.

Still, it's what God had in mind all along, to crush him with pain.  The plan was that he give himself as an offering for sin so that he'd see life come from it—life, life, and more life. And God's plan will deeply prosper through him.  Out of that terrible travail of soul, he'll see that it's worth it and be glad he did it.  Through what he experienced, my righteous one, my servant, will make many "righteous ones," as he himself carries the burden of their sins.
 

Therefore I'll reward him extravagantly— the best of everything, the highest honors— because he looked death in the face and didn't flinch, because he embraced the company of the lowest.  He took on his own shoulders the sin of the many, he took up the cause of all the black sheep.

All you need is ...

Do you know what one of my favorite things in the world is?

Old couples in love.

After just finishing 2 weeks in the emergency room at South's hospital, a place which can make even the softest heart just a bit cynical, I am now working for 2 weeks in a clinic at a private Catholic hospital, Providence.  The clinic here is what I imagine Heaven to be a bit like: wonderful sweet patients (most of them) who take their medicines, who want to get better, and who are so appreciative of everything you do.  They bring homemade cookies and fresh veggies from their garden at every visit, and people bring you tuna steak for lunch (yes, seriously).

Now I have to say that I do love working at South too.  The patients there are just more challenging, to say the least.  Many of them are "non-compliant", a doctor term for "daggum it why won't this patient take their medicine and stop smoking!!!" and as a result of that they show you the "natural process of disease", meaning "what happens to a body when its owner doesn't take care of it."  It's obviously a great place for learning, but not such a great place for your morale if you're really wanting to make a difference. 

So with that said, sometimes a place like Providence can be a bit of a respite.

Well today I saw these two patients that I just have to tell you about.  Let's call them Mr and Mrs S.

Picture it:  I walk into room number 1.  There in the corner chair sits Mrs S.  She is all dolled up for the doctor's office today in her bright blue cardigan with embroidered flowers, dress pants, and the cutest shoes I have ever seen.  Seriously, I wanted to borrow her outfit.  Her teal green cane was propped up against the counter; she has kyphoscoliosis (a hump and curve to her back) and the cane helps her get around. Her makeup was perfectly applied and when I walked in the door she smiled up at me with eyes wrinkled from 81 years of grinning.  We chatted for a while - she wanted to know about medical school, where I was from and if I was married.  Then she decided to tell me about her cold.  She told me she had been sick for about a week with the crud.  She just couldn't seem to get over it and finally decided to come into the doctor since she had been through a couple episodes of pneumonia in the past.  With that in mind, I do my exam.  Everything sounds surprisingly good and I'm not suspicious of pneumonia.  I go present my findings to Dr Israel, my proctor, and move on to the next patient. 

I look at the new chart and realize it's the same last name.  Mr S, the husband, is in the next room for his yearly checkup.  I can't help but smile a little when I walk in the room and see him with the same hunch in his spine.  He straightens up immediately and I wonder if his hunching is just habit so that he can stoop to help his wife?  He's not quite so dressed up in a plaid shirt and khakis with his orthopedic shoes, but smiles just as big.  He wanted to know about medical school and where I was from.  He then got on the subject of his time in the marines and working at a local plant nearby.  Then he decided to tell me about why he was there.  He was doing pretty well, despite the aches and pains of old age he said, but made more of an effort to shift conversation to his wife.  He said she had really been sick for about a month and he just couldn't get her to come to the doctor.  He was worried about her and wanted to know if I thought she would get better fast.  I told him I thought she would do just fine but that she would probably need an antibiotic, to which he replied, "Oh goodness!  I just want her to feel better!"  He then told me they had been married for 58 years.  I asked him the secret to their success to which he replied, "just know each other, listen to each other, and don't get all bent out of shape if something goes wrong".

Visiting with both of them completely brightened an already great day.  It's always great to see people who love and care for each other - even after 58 years!  It's even better to go into a room hoping to teach a patient something to improve their life, and they wind up teaching you something to improve yours.

Day 5

The finale ...

We got up early and headed out for breakfast at a "fine" restaurant called Sears Fine Foods.  It is a local San Francisco fav, and we can see why!  They're famous for their plate of 18 Swedish pancakes.  All those carbs were tempting since we hiked about a mile uphill to get there, but instead Stu went for the French toast and I had the apple chicken sausage with eggs.  It was great!

After we got our nourishment we crossed the street for the cable car stop.  We were planning on taking the famous Powel-Hyde cable car down to Fisherman's Wharf.  Well, we stood there on the sidewalk, watching passers-by and eavesdropping on a few free-spirited college kids' convos, and finally started wondering why the cable car hadnt arrived?

Stuart got out the iPhone and conveniently found an automatically updating schedule.  It said the car was 8 minutes away.  Meanwhile, all these buses kept stopping by us with our destination posted on their placard.  Assuming this was a quicker travel alternative for the locals, we continued waiting.  Well, after about 20 minutes of the schedule updating with later and later times, we got a bit frustrated.  I walked up a bit closer to the street and all the sudden noticed this bright orange poster right below the cable car sign

Basically, the 2 days we were in town were the 2 days they were doing maintenence on the cable car.  Those buses that kept stopping for us and then leaving when we just stood there were the cable car-alternate buses!   There we go looking like tourists again ...

After that revelation we gave in and hopped on the next bus.  Fortunately it was a cheaper fare than the car; unfortunately it was not so exciting.  The "end of the line" for this bus just so happened to be Lombard Street - the (second most) curviest road in the world!  This is a one-block stretch of road that was made into switchbacks because the 27% grade is too steep for cars to descend!

Check out those curves!

As soon as we got close we saw flocks of tourists posing at the bottom and making the hike to the top.  We kind of felt bad for the people that actually live on that street, but then we got over it and joined everyone else at the top.  We broke a bit of a sweat on the way up, which was nothing new considering all the walking we had already done.  The view was worth it!

View from the top of the street

After the hike up, we made our way back down and over a few blocks to Fisherman's  Wharf.  The FW has been San Fran's fishing home for over 100 years.  There are several things they are famous for:

1) Dungeoness Crab - These have been farmed in the waters nearby for years.  They then sell them right there in the wharf - and make lunch out of them too!

2) Clam Chowder in bread bowls - you can buy these on the street side and just eat them on the sidewalk; however, we opted to dine inside the restaurant and enjoy the views from upstairs

3) Sea Lions - yes, sea lions in San Francisco!  These guys somehow migrated here to the docks in the 1990's and haven't left since.  About 15 of them originally set up shop, but now in the winter there are up to 500!  They just kind of loll around on the floating docks all day and bark at each other.  It's pretty hilarious!

Look!  They're hugging!

4) Scary men in fake bushes - this was one of my favorite parts of the day.  This guy sits on a crate, hides behind some fresh-plucked branches, and jumps out at unsuspecting pedestrians.  Fortunately I saw it before we got too close, so Stuart and I just decided to hang back and watch him jump out and yell Boo at everyone.

After soaking in the Wharf we walked up a few blocks around the "beach" (which is not quite as lovely as Gulf Shores I might say) to Ghiradelli Square to continue on with breaking our Lenten fast.  We enjoyed the largest ice cream sundaes you could ever dream of

Look at the smile on that face!  A little peanut butter goes a long way ...

My gold Rush Sundae with a chocolate chip cookie on the bottom

Finished!

And to walk off those extra 8 billion calories, we headed off for our last stop of the day: Chinatown!  San Francisco has the largest concentration of Chinese citizens in the country.  They originally immigrated to work in the Gold Rush; however, their population increased so rapidly that I guess it scared the locals.  They decided to limit Chinese immigration and even put a tax on them for working and competing with the Americans.  Anyway, eventually the Chinese just created their own community and have been there since.  And by "own community", you might as well just say "own world".  Walking in Chinatown is just what I imagine walking in China to be like.

Fish for sale on the sides of the street

 After walking around and taking in the sights, we got up a pretty good appetite!  We decided that we should eat like the locals and check out some place in Chinatown.  Thanks to our Urban Spoon aps we narrowed it down to a few choices, the favorite being Hong Kong Clay Pot - based on title alone.  After a few minutes of searching signs full of Chinese characters, we saw a small man standing outside the restaurant with menus in his hand.  We interrupted his conversation with the friendly fish salesman next to him and asked for a menu.  He seemed quite taken aback that we were interested in eating there, and showed us the way upstairs.

It was quite a quaint little restaurant, and we were one of two American parties sitting down to eat.  That, my friends, is the hallmark of a good Chinese restaurant:  that Chinese people are eating there.  The waitress quickly came over with a pot of (I think) green tea and handed us menus.  We poured over them and decided that we wanted to split some salted and spiced prawns and steamed garlic spinach with a starter of spring rolls.  Not knowing portion sizes, we were concerned that we wouldnt have enough food to last us for the uphill trek home.  So when the waitress returned we had this conversation:

Me: Ma'am, is this #48 shrimp enough for us to split?
Waitress: Ahhhh, no no, no vegetable
Me: Yes there's no vegetables in that dish I know, but would this be enough for us to split?
Waitress: Ahhhh no no, this one have skins and heads
Me: (To Stuart) What?!
Stuart: Excuse me?
Me: Ohh you have to peel your own shrimp
Waitress: Yes!  You no eat that.  You eat honey walnut shrimp.  Much better!
Stuart:  Ummm ... ok.  Well get honey walnut shrimp.  And some spinach please.

So our mothering Chinese waitress ordered our food for us, and the food pictured above is what we wound up with.  And it was delicious!  She must have known that creamy sweet shrimp would have been a great choice for us.  And you know what?  The garlic in that spinach put the garlic at The Stinking Rose to shame!

Super sketchy food = super delicious food

In summary, after many days of spaced-apart blogs of our trip, we had a super time and were a little sad about coming back.  But life must go on!  Stuart started back to work and I have started working in the ER.  Many, many disturbing stories to come from that I'm sure....