austin

Haha,

I'm in austin. Nothing has changed, except for the new BME building.

austin still sucks.

Time's off

Something really freaky is going on. My computers (and the rest of the world) is an hour behind. I went back to Plano this weekend and found myself going to sleep earlier and waking up earlier even though I felt normal, but I didn't think anything of it. 

Then, I get to my apartment, and my computer says 10PM, while my alarm clock says 11PM? The same alarm clock that used to wake me up for school! How can it be an hour ahead? (Same thing with the oven/microwave/coffee maker.) 

All the appliances and myself are running an hour ahead. For example - I'm used to waking up at 7AM. Like clockwork. For the last 7 months. I thought I did today. I looked at my alarm clock and it says 7AM (like it should) except my phone says 6AM. And my computer says 6AM. wtf?

So either I'm an hour ahead or the rest of the world is an hour behind. We're no where near DST time-changing dates, so it can't be that. There's only one explanation for this - Aliens.*

Someone please throw some ideas out there. Especially explaining how my alarm clock, which I've been using to wake up (as recently as last week) is an hour ahead, randomly.

Maybe this is how stress interfaces with my life. Time synesthesia? If only I could see colors like Feynman. Ahh, screw him. (Yeah! I said it!)

This is kind of starting to freak me out.

*: I've ruled out a power short at exactly 11PM that would reset my clocks to 12AM, since Aliens are more likely. 

Browser wars, my ass

The next person to tell me that Firefox has brought them salvation is an ass. Firefox crashes on half of the streaming tv websites, Google Chrome messes up CSS rendering more than it should and Safari (until today) didn't work with gmail very well. Internet Explorer is the only stable, reliable browser, given you know how to use a computer. 

If you don't and have this pathological need for 200 extensions (which just slow down your browser) then go ahead and try something else. 

I use all four.

Also, it's valentine's day on Saturday and my roommate has his gf over and they're tickling each other like monkeys. Yeah, I said it. 

My day at BTGH-EC

The first thing you really notice is how much trouble you have to go through to get to Ben Taub (from Baylor). Down a ramp, then up a floor in an elevator. Having card access to Ben Taub rocks.

*Beep* [Light flashes green + almost imperceptible click of the door lock]. So satisfying. The next thing you notice is the old BCM logo plastered along the corridor. What a horrendously ugly logo.



Ugh. Are you srs? Yeah, they're serial. The new logo is awesome though - simple, with a great color scheme. Midst the quiet, the third thing you notice before you get to the emergency center is the smell. Faint hints of nausea, vomiting, sterility, and cleaning fluid, all mixed in one.

This is the first year they started this program, and I had the first shift evar - Midnight to 4AM. I had done ER shifts before (at Medical Center of Plano). 12 hour shifts, and I got to see almost nothing - a few drug overdoses, alcoholics, maybe a case of acute angina. 4 hours at a Level 1 facility is far far different. Three GSWs, a few stabbing victims. Ambulances were coming in almost every 30 minutes and a Code 3, almost every hour. Crazy! We had "heard" of Code 3 (full lights and sirens) in Plano, but I never got to see one.

Ben Taub runs at 150% capacity and to put things into perspective - it's a bit bigger than the ER at County General.* But man, Houston is so ghetto. In the 4 hours that I was there, there were 2 GSWs, a few stabbings, and one person that got run over (maliciously..).

More importantly, I got to start a few IVs. I feel sorry for my first IV patient though. I haven't treated patients in a long time and it's really something to hear "Ok, you watch this one, and the next one is yours." 10 minutes later, the nurse was handing me a chart to call a patient back to the IV area - NVD symptoms, and I was looking at her and I felt a little sorry for the short period of pain that was coming.

It's good to just stick in the lancet and get it over with. I was going slow, so she was squirming in pain the entire time. The nurse told me to stick it in there and flip the catheter forward. I have to admit, it was satisfying seeing that flash of blood** through the proximal portion of the lancet, indicating a good cannulation. Those NEJM videos really do no justice to the initial difficulty of starting an IV.

So many things can go wrong. Put on some gloves, take out the J-loop, flush it with saline, lay it on a piece of gauze, take out the 20 guage, unsheath the cap, loosen the catheter, lay it on a piece of gauze, take out an alcohol pad, identify a vein, rub the area with alcohol, wait for the vein to appear or be able to feel it, find a straight segment in the vein (or make one by pulling on the skin), insert the lancet along the straight segment, keep inserting until you see the flash of blood, push the lancet 1-2mm along the vein, flick the catheter forward, compress the vein proximally, affix the J loop to the vein, flush with saline to confirm a good cannulation --> ending steps.

It takes practice. The great thing about it is, there's a clinical/basic science reason to each one of these steps and you can think about it all you want, but until you really start doing the procedure, you have no idea what they *really* are.

The subsequent IVs were better and I was promised an arterial stick next time. Smaller and deeper vessels.

I also learned how to do an EKG and a quick interpretation of it. The attendings kick ass. A 20 minute explanation and she doesn't even know who I am. Which, if you think about it, is pretty cool, in that they're willing to teach anyone.

My next shift is Saturday early morning, midnight to 4am. Bring it.


*: If you don't know what I'm talking about, google it. Then watch all 15 seasons.
**: Serial-killer-ish. "Do no harm" becomes "Do more good than harm".