Friday, January 23, 2009

"I got no strings to hold me down"

Two weeks ago I got an email from Columbia…

Dear Kelly,

Happy New Year. I hope this email finds you well. The admissions committee is in the process of reviewing your application file and I was asked to see if you would be willing to take the biostatistics placement exam. It will help the committee in their decision-making process…

I nearly shat myself. My heart started racing. Biostatistics? Test? Now? Are you kidding me? It didn’t help that I read this email at 8 in the morning after a four night stretch at work. As tempted as I was to just shoot back and email saying, “NO!.” I knew that was essentially writing my own rejection letter. I did the next best thing and called the woman who sent me this email. Of course she wasn’t in the office, so I left a voicemail. Boy do I wish that she had the option to delete and re-record because I rambled and babbled and stumbled. I managed to leave her my number and the best times to reach me, but I hung up with a pit in my stomach.

Thankfully, I managed to fall asleep for a few hours that morning. I got up and went about my day (gym, grocery shopping, post office, shower, date with the firefighter). After a late night, I didn’t wake up until the 11 the next day. What’s waiting for me? A voicemail from the admissions woman. I had only missed her by twenty minutes; I quickly called her back. She picked right up. She sounded so happy and perky; I, on the other hand, sounded like a hoarse, stuffy nosed sick person. I apologized for my rambling message and she said, “ Well after reading your application it sounds like you have a very intense and exhausting job. No excuses necessary.” Phew! That made me feel better. I told her that I was glad we were able to speak in person. I had a few questions and felt that speaking was much more personal than email (bonus points?)

But onto the real issue at hand. What I wanted to know was if they wanted me to take the test because of a shortcoming on my transcript/performance, or if it was something they were asking all candidates to take? She quickly summarized why she had contacted me. She was a member of the admissions committee and they were in the middle of reviewing my application. They were very impressed with my undergraduate transcript (Ivy League, Magna Cum Laude), my letters of recommendation (two PhD’s well known researchers & the worlds best nurse- BSN, CCRN, MSW, NC, Reverend –I forget all of his other credentials), and my personal statement. However, what they were rather concerned about was my quantitative GRE score. My scores just didn’t match up with my other credentials. That being the case, they felt that they needed me to take a placement test to determine my quantitative (math) capabilities.

I took in a deep breath and said, “Sure. When would you like me to take the exam.” She said, “Great! Here’s the name of the woman you need to contact about the test. Best of luck, Kelly.”

I hung up and sat motionless in my bed. I hadn’t taken a statistics class since my sophomore year of college, but I did get an (A). When I contacted the exam woman in the afternoon, she said that the sooner the better. I looked at my calendar. This was a Wednesday, that Friday I was beginning a 5 night stretch. I told her that due to my work schedule the earliest I could take the exam was the following Thursday. And that was that. Thursday at 10am. I no sooner hung up from her and ran out to the store to buy a review book.

Over the next week I did nothing but work (and study), work-out (and study. I’m sure the other gym members were like who’s the nut on the treadmill reading a statistics book?), and “sleep”/have nightmares of linear regression models, T-scores, and Z-scores.

Before I knew it, Thursday had arrived. I got up early that morning and was at the gym by 5 (sans review book). After a good sweat and steamy shower I set out for 168th and Riverside Drive. Oh yeah, WAYYYY up there across town. Knowing that public transportation would take almost an hour, I opted for the cab (gasp!). What I didn’t account for was morning rush hour traffic. I left my apartment at 8:50. I caught a cab at 9:20. Absurd! My stomach was in knots, my heart racing. The cab driver asked me if I was okay- I guess my voice was shaking as I told him where I needed to go. He was sweet and dropped me off right at the door, wishing me good luck as pulled away. I made my way to the sixth floor, knocked on the door, and then- test time!

The woman’s chipper personality made me more at ease. She led me to a barren room, I said a quick Our Father and Hail Mary and began. Forty minutes later I emerged and handed in my exam. She asked me to sit outside as she graded it. I could hear her turning the pages, it seemed like an eternity. She emerged from her office, paused, then said, “Congratulations, Kelly! 20 out of 21.” My stomach flopped, my head buzzed, I felt all warm and tingly. It may have been just a test, but it was a sweet victory for me.

And now all I have to do is wait for their decision….

Four Foods on Friday 64

Here are this week’s four questions.
Let’s talk about things that might not be quite the usual fare.

#1. What’s the oddest thing you’ve ever made with bread?
A gingerbread house. We didn't have any graham cracker, nor molds to make gingerbread so I improvised. I toasted it, then sprayed it with shilack (did I spell that right?)

#2. What’s the oddest thing you’ve ever done with mac and cheese or pasta?

Dried Pasta Jewelry. Go here for instructions

#3. Is there a food you eat other then it is intended?
Sometimes I take boxed cake mix and add it to some canned pumpkin, stir and eat. It's (almost) guilt free. May I suggest you try it with Namaste brand spice variety

#4. What’s the weirdest food you’ve ever seen?
It's not weird, but my phobia is. You know those "eyes" on overripe potaotes- they freak me out.

(photo credit Food Boom)

Do you want to play? Check out Valmg's FFoF blog feature!

Friday, January 16, 2009

Four Foods on Friday 63

Here are this week’s four questions.

Let’s talk about Chinese food.

#1. Do you prefer to eat Chinese food in the restaurant or to have it delivered?
Delivered. Chinese restaunratns scare me. Cat foo yong.. any one?

#2. Do you prefer wonton or egg drop soup?
Neither, too much salt.

#3. What flavor fried rice is your favorite?
I'd say vegetable.

#4. Describe your favorite item on the Chinese food menu.
This is so lame, but my favorite is steamed veggies. Since I don't eat meat and the tofu isn't recognizable in most dishes, I stick to the green stuff (and the occasional carrot). =)

What about you? Go and check ou Valmg's FFoF blog feature.

Tuesday, January 13, 2009

One Final Prayer

My last two shifts were non stop, but they are two shifts that I will never forgot.

X was accepted as in international transfer five weeks post burn. Although I've seen many patients with his % burn survive, the fact that at five weeks out none of his wounds were closed was not favorable. When X finally arrived in New York at the beginning of December, he was in renal failure, maxed on dopamine and norepinepherine for his blood pressure, thrombocytopenic, in respiratory failure and ventilator dependent, and in septic shock. Additionally a MRI of his brain revealed an acute cerebellar infarct. He had six surgeries for debridment and skin grafting but none of them took as his body was invaded with fungus and bacteria. I took care of him the better half of the last two weeks and grew to know his family well. They halted their lives abroad and moved here to keep vigil at his side. They waited and prayed and waited and prayed and waited and waited and waited and prayed.

In the last two weeks, X grew sicker and sicker. He had showed some signs of improvement early on (return of some kidney function with oliguric output, improved ABG's, improved coagulation, fewer bacteria invading his wounds) but he took a turn for the worst...

Pseudomonas in the sputum, blood, and urine.
Acetinobacter in the sputum.
Candida on the skin and in the blood.
Pulmonary Edema
Acute Renal Failure
Collapsed Lung
20 kilos of fluid overload with edema making him unrecognizable

In those 25 hours of work I administered 8 units of blood, 8 units of FFP, 10 units of platelets but he remained thrombocytopenic.
The ventilator was on 100%FiO2 and he was still lethally acidotic.
He required continuous deep lavage suctioning that involved removing him from the ventilator and breaking PEEP causing his blood pressure to plummet.
He was so unstable we couldn't turn him to put him on dry sheets, yet he was putting out 11 liters a day in bed drainage (yes, we suction and measure this).
He was two days overdue for day #5 post-operative dressing (POD) change.
His eyes were dilated and minimally responsive.
He was maxed out on Dopamine, Levophed, Neosenepherine, and Epinephrine.

I arrived at work on Monday and was partially surprised to find X still alive. The three hours prior to my arrival his blood pressure was resting around 68/40, his heart rate tachycardic in the 110's, and his O2 sat around 73%. The attending physicians held a discussion with the family during the day and I thought they were leading in favor of DNR, but in a desperate twist of fate the father disagreed and said he wanted "every thing possible" to be done.

During the day, the family had kept vigil at the bedside, never more than three visitors at a time. In the middle of report from the day nurse, Xs alarms sounded, his O2 sat was 65%, he needed to suctioned. The day nurse (J) and I went in and prepared to suction. We no sooner finished when his heart rate began to plummet: 110-90-80-75-70-60-55......

J yelled to get some atropine began bagging the patient. I hopped up to begin compressions. In rolled the code cart and so began the code. His venous access lines ( a right internal jugular TLC, a left femoral TLC, and left femoral Aline) were a mass of "spaghetti" coming from the 13 pumps running on either side of his bed; however, when the atropine arrived J started pushing meds, I continued compressions ,and the fellow took over bagging. I felt ribs snap, I saw my artificial compression "V-tach" heart rate on the monitor, my triceps and deltoids tightening with every blow. And then it happened. The mother came running down the hall, stopped in the doorway, and yelled, "Stop! NO More! I'm his mother." We all looked up- all hands off the patient. At this point the attending physician was also in the doorway and he and the fellow clarified with the mother what stopping CPR would mean and verified that this indeed was her wish. With tears streaming down her face, she sobbed, "Yes. Yes." And with that we turned off the pumps and stepped back. I stood there holding the mother as we watched the agonal heart rhythm on the monitor...28, 23, 10, asystole. We checked- no pulse. And he was gone.

The monitor no sooner read asystole and the sister came running back in. She threw herself over her brother and let out a blood curdling scream. The crowds started to dissipate from the room and the fellow, J, and I began to comfort the family. After turning off the monitors and stocking the room with tissues, we all left and let the family grieve. I called the priest. It broke my heart as I watched the father pace frantically outside the room, refusing to set foot inside. After the priest left, I heard a noise coming from the room. I looked up from my paperwork and started walking towards the room...

Oh Dios de quién Único Hijo nos ha otorgado los beneficios de la vida eterna, concédenos la gracia que te pedimos mientras meditamos los Misterios del Mas Santo Rosario de la Bienaventurada Virgen María, debemos imitar lo que contienen y obtener lo que prometen, a través del mismo Cristo Nuestro Señor. Amen.

Over the last two weeks I'd listened to X's family chant prayers at his bedside, but suddenly I was moved. Not overly religious, but still connected to my Catholic roots, I stopped to think about what they were saying.

Let us pray. O God, whose only begotten Son, by His life, death, and resurrection, has purchased for us the rewards of eternal life, grant, we beseech Thee, that meditating upon these mysteries of the Most Holy Rosary of the Blessed Virgin Mary, we may imitate what they contain and obtain what they promise, through the same Christ Our Lord. Amen.

Jesus died at 33, their son didn't even make it to 30.

The post mortem care that followed was grueling. It took over 3 hours. Removing the dressings churned my stomach. X's skin was green with infection and textured with fungus. When all was said and done, I called the family in one last time to say good bye. As they kissed him their final goodbyes, I stopped the mother in the doorway and took her hand. I opened her clenched fist and placed something in it. She brought her hand closer to her face and opened her fingers--an ID band. She threw her hands up around my neck and sobbed, "Thank You. Thank You." I may not have been able to save her son, but I sure hope I can preserve his memory.

Friday, January 09, 2009

WEEK 62: Four Foods On Friday

And I've been out of the loop for over a month. Life has been quite busy and work, well, overwhelminng. But it's a new year and I'm trying to get back on track. Valmg's been in a funk too, so hop ov over to here meme, check it out, and leave her some love.

Here are this week’s four questions.
#1. Waffles. Do you usually eat frozen or homemade?
What do you consider waffles made at a restaurant? I guess they are "restauarnt" made- but those are the only times I eat waffles

#2. Eggs. Do you buy brown, white, or it doesn’t matter?

Whatever is on sale, but I always buy organic, cage free eggs.

#3. Oatmeal. Do you usually make instant or cooked?
Cooked. Call me a snob, but I'll forgo the oatmeal if I dont have time to cook it. Cooking tip- Old Fashioned Cooking oats are MUCH Better in cookies.

#4. Bacon. Share instructions or a recipe that you use bacon in.
1/2 lb. thick sliced bacon
2 tbsp. butter
1 c. onion, chopped
1/2 c. sweet red pepper, diced
1 c. sliced fresh mushrooms
1 bouillon cube in 1 cup hot water
Salt and pepper to taste
1 lb. pasta
10 oz. fresh, washed spinach (about 4 c.)
1 c. grated fresh Parmesan cheese
Cook bacon until crisp in skillet. Discard fat. Place bacon on paper towels. Add butter to same skillet (do not wash). Saute onions and peppers for 2 to 3 minutes. Add mushrooms, saute for 1 minute.
Over high heat, stir in broth. Bring to a boil. Lower heat and simmer for 2 minutes. Taste and add salt and pepper. In a large pot, cook, then drain pasta well. Return pasta to pasta pot.

Add the vegetable sauce and spinach. Toss over medium heat until spinach is wilted and most of the sauce is absorbed. Divide onto 6 plates. Top with crumbled bacon and Parmesan cheese.

Thursday, January 01, 2009

2k9 MEME

I got this MEME from O, who got it from All & Sundry. It's my last day off for the next five, so I figured what the hell-let's waste some time on the computer.

1. What did you do in 2008 that you’d never done before?
took the GRE's

2. Did you keep your new year’s resolutions, and will you make more for next year?
Is it a bad sign that I can't remember if I made one last year?

3. Did anyone close to you give birth?
two of the nurses that I work with, two of the girls I went to highschool with, and Anjali

4. Did anyone close to you die?
yes, one of my coworkers. RIP Tara. Miss you.

5. What countries did you visit?
St. Martin, St. Barts

6. What would you like to have in 2009 that you lacked in 2008?
Sleep and a social life; weird combination I know.

7. What dates from 2008 will remain etched upon your memory, and why?
December 19th- best Christmas party ever!
December 1st- I dischared the first pediatric trauma that I ever admitted
June 14th- I fractured my pelvis

8. What was your biggest achievement of the year?
Staying healthy

9. What was your biggest failure?
Not staying in touch with my friends becuase of my crazy schedule

10. Did you suffer illness or injury?
Fractured Pelvis

11. What was the best thing you bought?
My blackberry

12. Whose behavior merited celebration?
Amy: new job as a VP= all grown up

13. Whose behavior made you appalled and depressed?
The parents of my patient who pressed their child's face against the radiator. It made my blood boil.

14. Where did most of your money go?
Rent, rent, rent. Did I say rent?

15. What did you get really, really, really excited about?
The prospect of getting a permenant day position (too bad it was only a prospect).

16. What song will always remind you of 2008?
I don't know.

17. Compared to this time last year, are you:

a) happier or sadder? neither, I'm content
b) thinner or fatter? fatter and it's really stressing me out
c) richer or poorer?Richer. That's what happens when all you do is work and have no time to play!

18. What do you wish you’d done more of?
Stayed in touch with my friends, gone to church, slept (in no particular order)

19. What do you wish you’d done less of?
Stressing over the future

20. How did you spend Christmas?
At work. Hospitals never close.

21. Did you fall in love in 2008?
Someone won my heart over, but then broke it.

22. What was your favorite TV program?
The Biggest Looser (a guilty pleasure, I know).

23. Do you hate anyone now that you didn’t hate this time last year?

24. What was the best book you read?
Quantum Wellness

25. What was your greatest musical discovery?
Our tiny little bathroom has great acoustics for shower singining

26. What did you want and get?
a complement

27. What did you want and not get?
a permenant day position

28. What was your favorite film of this year?
Rachel at the Wedding

29. What did you do on your birthday, and how old were you?
I worked, but at least Dr. MAtt was there *cue the dreamy music*! I turned 24.

30. What one thing would have made your year immeasurably more satisfying?
Working days so I could see more of my friends and family, sleep more, and make dating easier

31. How would you describe your personal fashion concept in 2008?
Hospital issued 50/50 Cotton, Poly scrubs; gym clothes; a conglommerate of J.Crew, Gap, and Bloomingdales

32. What kept you sane?
Escapes to the suburbs to see the L's or my family, late night talks with Natasha or AMy, and Wednesday Night Dinner Club

33. Which celebrity/public figure did you fancy the most?
I can't decide if the numerous adoptions and procreations of Jolie-Pitts is admirable or insane

34. What political issue stirred you the most?
The shit show otherwise known as our health care system

35. Who did you miss?
My family, my sorority sisters, Sarah, Memegrl and family, Shestartedit and family

36. Who was the best new person you met?
Cheryl. I'd be lost without her friendship

37. Tell us a valuable life lesson you learned in 2008.
Life is best lived with a little spontaneity.

38. Quote a song lyric that sums up your year.
Don't get all worried but if you remember this post, I'd say these lyrics just about sum it up:

What's wrong with me?
Why do I feel like this?
I'm going crazy now

No more gas, in the red, can't even get it started
Nothing heard, nothing said, can't even speak about it
On my life, on my head, don't wanna think about it
Feels like I'm going insane, yeah
-Rihanna, Disturbia

9 things About Me for 2009

1. I like green grapes but red wine
2. I can't fall asleep with dirty dishes in the sink
3. I can wiggle my ears
4. I don't play any musical instruments
5. I haven't eaten meat in 8 1/2 years
6. When applying to college I was torn between architecture and nursing
7. I floss after I brush
8. I prefer flats to heels
9. I'd rather go to bed at 10pm and be up at 5am, than go to bed at 1am and sleep till noon.