serendipti's Diaryland Diary

10:09 a.m. - Thursday, Jul. 07, 2005

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swallow in cantonese.

ouch. that last entry was a real debbie downer, people. I just re-read it and it is nice to no longer be in the frame of that day.
Don't mail me any zoloft just yet, much of it has passed. the great thing about being a chronblog again (chronic blogger....just made that up....shhutup, I think it is cool)is that you are all connected to peeps. So the arod and gracie had both emailed me after reading ayer's journal entry, and it is just nice to know that this forum allows you such intimate connection with people who love you. really. what a blessing.

so today is thursday morning, I am post-call (i.e. I spent last night in the hospital, hung out a bit in the morning, and then was allowed to go home for the rest of the day....desafortunadamente, thursday is lecture day in the afternoon at our school, so I get a few hours off before I head out). I bathed and bedecked myself so fine....kidding, just quoting a june poem....no, but I did bathe, and soak and soak in hot water, and now that I am clean and have some yummy smelling nivea on my face, life is good.
I was up working till about 130 am, because me and the intern had to put two NG tubes in. NasoGastric. go through your nostril to the stomach, and then you turn on suction and suck stuff out from the stomach. most of the time, there is some obstruction downstream, in the colon, and so there is all the backup (yes, it IS exactly like plumbing) and we suck it out before we go into surgery the next day. So we had this on 60ish asian man, and this 70ish white woman with a broken hip who had the BIGGEST abdominal hernia I have ever see (granted, I have not see hundreds, but since one of the residents also said this was the largest she has seen, I need to impress upon you the sheer basketball sized volume of the hernia).
So we start with the chinese man, who only speaks cantonese, who had earlier in the day, ripped out his NG tube. We go in and explain to him in short, bits and pieces sentences, that we need to put in the tube. he is nodding his head in agreement, but his daughter starts to get all agitated and is like, he doesn't want it. This touches off a protracted verbal battle between my resident and the patient's daughter, who has some very clear mental/emotional pathology. She is all histrionic and dramatic and emotional and is totally speaking on her father's behalf and has all this seemingly irrational anger and I watch my resident minute by minute increase her decible level and the frequency of her gesticulations, and as we go get the tubing and tape and stuff, my resident tells one of the nurses about the 'fucking NG tube' and I am like, uh-oh, she is going to blow, because the cantonese-english histrionic daughter is also starting to piss me off as well, and with no real responsibility or vested interest in getting this ng tube in, it is not a good sign that I am tempted to slap this woman as well. Her dad clearly was okay with this, but then she would tell him to say no, and then he would too, and my resident and I kept going in and out of the room getting things together and at one point I thought the daughter and my resident were going to come to blows so I intervene and was like, Miraj, let's get an interpreter, okay? Although I knew the majority of the problem was the daughter herself, I knew that communication barriers were making this whole situation escalate. So that was my einstein-light-bulb moment of the day. We ended up getting this dual phone thing that has interpreters at the other end of the line, and this woman (she is like in her 40s, her dad in his 60-70s.....her dad was smelling a lemon and giving me a thumbs up and pointing at the lemon and saying....china..china....i.e. in china, we use lemons to prevent vomiting....we don't need that tube up my nose that made me vomit earlier....) so anyway, I made sure to ask whether they spoke cantonese or mandarin (my resident was like, chinese....I was like, uh, I am pretty sure there are at least 2 main distinct languages in the country....i felt smart for a second....i never feel smart with anything having to do with medicine....only other stuff) and so we get this cantonese interpreter on the phone, and as her dad begins to say what I can clearly see are words of acquiescence and agreement, homey starts screaming and tried to grab the phone, and my resident is like, ma'am, step away from the phone....and she was like, they do not speak cantonese....and in my head, I was like, bitch, your dad has been talking to this interpreter now for like 3minutes, don't tell me they have not been speaking the same language....and then, much to our horror she grabs the phone from her father and proceeds to give a hamlet-magnitude soliloquy in cantonese and my resident at this point has simply resigned herself for this woman taking control of the room........long story short, we finally get his consent to do the procedure.
So there we are, trying to get the NG tube in, and dad starts to puke up a whole lot of brownish green fluid into the basin, and homegirl starts her histrionics, jumping up and down, crying and trying to pull the tube out of my residents hands (as it is still advanced down his esophagus)as one of the nurses tried to hold her arms down. Me and the resident are, this entire time, screaming the word for 'swallow' in cantonese at this poor man..(it was tri-syllabic, that is all I remember). the nurse is all, ma'am, please come with me, but she starts screaming and was like, don't touch me don't touch me, and this whole time, I am thinking of the 1000 different possible scenarios of how differently this could have been handled.
At last, we get the tube down, but it is not suctioning as well as it should.
In the meantime, we go over to our other patient with the biggest abdominal hernia I have ever seen, which she has had for 35 years. We had tried sticking the tube into her, but she ended up vomiting black liquid as well (less green in her, more black) and she also has a broken hip, so her leg was all contorted and we had a hard time sitting her up. She also weighs a lot a lot of pounds, and it is funny how you are just expected to hold one side of the sheet and pull, and move these patients sometimes, even if you are the kind of person who uses the 5 pound dumbells when you go to the gym once a month.
Anyway, so this lady did not want the bloody tube either, and she pulled hers out once we had it halfway down. We finally did hers.
In the meantime, we had gotten an xray done of our chinese guy, to see if the tube was place properly, cuz we had our doubts, and wouldn't you know it, me and Miraj go down to xray, and there is the NG tube, extending down the esophagus, and look, there is a nice little loop where it curls back up, bypassing the stomach entirely. We looked at each other in dread as expletives were exchanged. It was now past 1 am. At this point, any chance I got, I was sitting down, and when I had to stand, my hands clutched uterus, begging for it to stop its contractions. My cramps were awful the entire day (I would expect nothing less of day 1) and by 1 am, it was all I could do to stand up straight.....i had begun assuming a forward lean when I could not stand. My resident looked over at me, took pity on me, and was like, you know what, this is torture. I'll take care of it, you get to sleep.
there was not a peep of protest or argument from me. I had nothing left to give.
I get to my room, exhausted and achy and sore and yucky beyond anything....and guess what?
sleep doesn't come.
and there are few things more intolerable to me than this. and I had this wave of lonliness and that pathetic 'i'm all alone in the world' feeling that you get when you are putting the cherry on top of your self made pity-sundae.
and I thought of who I might call at 130am. And I realized the crappy part about getting older is how we try and squash the urge to make the 'i'm sad, cheer me up' 2 am phone call to friends. We just do it less and less. Partly because, I feel, the list of people we would want to call gets smaller and smaller. For one, all your friends who are couples are basically out. Cuz lets be honest, who wants to wake Niki AND Kevin up at 3am in DC? And then there are the people who you just know don't get enough sleep. Bhakti, your ass gets up at 4 am or some other such hour that God regularly forsakes...so I try and save only the 3am-mom-is-in-the-ER calls for you.....then Amy is on Burn, and I just didn;t want her to lose sleep....then Sheila is in some country far far away....and then there are all the other factors that have shrunk your goto list, and you certainly cannot call someone up who is going to need a 1 or 2 month update on your life to really understand where you are at right now.....it has to be someone who is 'present' in your life, or as 'present' you can be with geographical distance.....since it was 130am central standard time, I ruled out the east coasters and the midwesterners....that left california. I was able to come with the only 2 people who fit the bill in that moment....and wouldn't you know it??? neither answered.
And then I went to sleep, and I slept some of it off, and now I am fine.
My chief resident thinks I suck, and she made me present a patient even though my resident had told me he would present this time, and she was trying to embarrass me, and I came off as kind of fumbling and lame, and then she would ask me questions, and I kind of had a sarcastic and sort of bitter edge and would look her straight in the face, and kind of defiantly, when she made me repeat stuff, and I think it was because I was tired, but anyway, I might have made an enemy of the last person you want to make an enemy of. I made some sort of sarcastic remark about being thrilled to be on call....and this woman is this no-nonsense badass Austrian woman, and you know how the first thing that gets lost in translation is sarcasm, and so she caught me yesterday in one of my more sarcastic moods. Ooops. That will likely translate to nothing higher than a clinical 'pass' which, at the rate I am going, suits me plenty fine.
I don't know when I got to this 'i don't give a flying fuck' place that I am in, but saying 'I have arrived' is not painting it completely...its more like a, I have arrived, unpacked, put my belongings in their respective cabinets, have painted the walls to my liking, and am HERE TO STAY.
Okay, I have a dermatology test from 2 weeks ago that I need to take manana, so I have to go study.
I prolly should eat, but don't feel hungry at all.
bye, love.

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