Code status

Yesterday, I finished up my 2 weeks on the stroke service as part of my neurology rotation. On this team, we admitted and managed all patients presenting to the hospital with acute strokes. This last week has been one of the most emotionally difficult times I have experienced in medical school. The situations of some of our patients are profoundly sad and tragic. Imagine that you are partnered to a vibrant and beautiful 30 year old person, a caring partner and parent. Now, you hear them complaining of neck pain and a headache, so you offer your partner some sympathy and suggest ibuprofen or rest. Unbeknownst to you, your partner, or anyone - the blood flow through a major artery to the brain has slowed to a trickle and your partner's brain is dying. Some time later, you notice that they are slurring their speech or they seem to have weakness on their left side or their personality is now a little different from baseline - you take them to the hospital and are told that they are having a stroke. If you are lucky - your hospital will have a stroke service to admit and manage your partner; if not, hopefully they will be airlifted out to a hospital that does have a stroke team. If the stroke is identified early, a few very effective interventions are available. If stroke is severe or identified too late, not even the most heroic of measures can improve the final outcome.

I suppose I always knew strokes were bad news, but I wrongly assumed that the stroke population largely consisted of elderly men and women with serious risk factors (ie poorly controlled diabetes, history of blood clots, a bleeding disorder.) I learned this week that anyone can stroke. Granted strokes are tragic at any age - you are no more prepared to lose a partner at age 70 than you are at age 30. But really - 30 year olds with spouses and children and lives full of promise should not have strokes that result in clinical brain death, but they do.

So, in the past two weeks, I have seen patients and their families devastated by an event that often occurred without warning. In med school it is sometimes easy to lose perspective - you see the very sickest of patients and begin to think that that is the norm. I must remind myself that not every headache or neck-ache is a stroke. And there are things that you can do to make this situation more bearable should it ever occur - first, recognize it early. Should anyone you know ever experience slurred speech (sudden onset, not due to intoxication), or a one-sided weakness of face or body, or loss of sensation on one side of the face or body, or personality changes, take them to the ER for evaluation. Time is brain. And second, clarify your code status with someone that you would want to act as a surrogate decision-maker should you ever become incapacitated. It is not a fun discussion to have, but you need to talk about what kind of life saving measures you want undertaken if your chance of survival is low. Let your partner know how you feel about living with severe disability. The families of patients with severe strokes are the ones called upon for medical decision making - it is a terrible position to be in, to be faced with such important decisions while overcome with grief. It seems to provide some comfort of family members are able to act in accordance with the patient's wishes.

So, long post. And likely not an uplifting one. I am sorry - this has been a tough couple weeks, and I felt I needed to say this. I am also presenting a very simplified version of stroke neurology - strokes have varying etiologies and mechanisms and can affect various parts of brain and produce different signs and symptoms, but I will spare both you and I a painful neuroanatomy lecture. Also DNR/code status issues are much more complicated than the questions asked above. If you have more specific questions, please ask, I would be happy to discuss any and all topics in more detail.

My Very Own Jordana Paige!

So, this local yarn store was having a sale. I stopped by to pick up some yarn for a gift for a friend, and while there, Raul pointed out that the long coveted Jordana Paige knitting bags were on sale, too. So, as I mentioned in a previous post, we are on a total student budget, but really, these are Jordana Paige bags I'm talking about - on sale! Raul convinced me that I needed one, and we decided to forgo our weekly dinner date out, so I could get the bag. Have I mentioned that he's a keeper?

Here are gratuitous photos of my new bag:

View of bag interior - check out all the cool pockets and clippy things and a little zippered notions bag (what are notions? small knitting tools like stitch markers, tapestry needles, small scissors and such):


View of bag exterior:


Me with bag:


Happy Memorial Day weekend! And happy Mule Days to the family in Bishop - did any of you brave the parade? Unlike the majority of our fellow Americans, we're not driving to any destination this weekend. I have to go into the hospital for rounds Sunday morning, but I have Saturday and Monday off. I am currently doing a rotation in Neurology, and I am on the stroke team. Prior to this experience, I really did not have an adequate appreciation of how sudden and devastating strokes can be. It is also equally amazing how quickly some patients improve. Just over the course of this week, I have seen a couple people make miraculous recoveries - a patient may be unresponsive on admission, but a few days later, the swelling in their brain has had time to resolve and suddenly they are alert and talking. It is really quite inspiring.

Happy Birthday Big Dave

49 years ago today, my dad was born. What a milestone - happy birthday Dad! Being the knitting savant that I am (what I am really saying is that I am quite poor), I am knitting his gift. And given my schedule, I am, of course, not finished with it yet. Let me tell you, the size of his feet rival the number of his years. Here is a photo of his birthday present (these clogs are a favorite pattern o' mine, as you can probably tell):

Aerial view with women's size 11 (big feet run in the family, okay) Dansko clog for scale:

Side view, again with Dansko for scale:

I always think this pattern is hilarious. You knit up these giant clown-shoe-sized slippers then you throw them in the washer, and after a couple of hot water wash cycles, presto! You have a pair of super cute slipper clogs! You totally have to wear these slippers, Dad - I even knitted them in Angel colors for you. Although, I hadn't anticipated that they would require so much yarn, so slipper number #2 might have a slightly different color scheme. Uncle Rob is going to be so jealous of your super cool clogs. Don't worry though - I won't start knitting speedos anytime soon.

Baby Uggs

I made these for a classmate (my cellmate on the recently concluded Oto rotation, actually) who is due in 4 weeks.

Profile view:


Super up-close profile view (Greta's paws in the background for scale):


Full frontal:


Specs:

Pattern: Suede booties by Candi Jensen
Yarn: Soles and body of booties were done in Berroco Suede (in chocolate brown and tan colors) and fleece trim in Berroco Plush.
Needles - size 4 for the soles, size 5 for the body and trim.

These booties were a fun knit. The pattern is easy to follow, and I was able to knit up both in a total of about 5 hours. Super fast.

I finished Oto on Friday, and all in all, it was not that bad. The residents were nice, and they taught me how to do a thorough head and neck exam. I also learned the importance of providing your patients with adequate pain relief when you're manipulating a head/neck wound - the head and neck are heavily vascularized and innervated, and it seems that any repair of anything on the head/neck can be exquisitely painful. I saw several patients writhe in pain while they were being treated - it seems unnecessary to make someone endure something so painful when narcotics and other very good analgesics are available.

On a lighter note, I have a free weekend! I have some plants outside ready to go in the ground and a truckbed full of mulch. I see some gardening in my future.

Happy weekend!

Update

Updated photos of Glee. I am undecided as to whether to make the medium or large. This version (lifted from a blog that I lurk on occasion) was a medium and it turned out a little small. I took mine off the needles today and put it on scrap yarn to try it on and evaluate the fit, and I still have no idea. I guess I will compare the size to another raglan style shirt I have. I'll let you know.

Glee from the front:


Glee from the side:


Glee from the back:


Let me tell you, figuring out how to work the self-timer button on the camera was my big accomplishment for the day. Raul normally helps me out with all things relating to technology, but alas, he is still in Council Bluffs, IA finishing up his Family Med rotation. I also managed to master the crop photo feature, thus saving you from viewing my post-call visage. For those of you unawares of the horrors of call - I was in the hospital from 8am Sunday to 12pm today. It was a good time, for sure. I actually got 6 or so hours of sleep which is a good amount for a call night. We were busy during the day, though.

It's kind of funny - several of the surgical rotations have suture clinics for the students where you have the opportunity to practice your stitch technique on a pig's foot (previously removed from the pig, of course.) Not to toot my own horn, but I was feeling pretty good about doing a little simple interrupted and a little vertical mattress on the aforementioned pig's foot. I guess I had never really planned on putting those stitches into a living human, but that's what I did last night. A patient was involved in a bike vs. car, and he had some pretty gnarly facial lacerations. No brain injuries fortunately, but he did have a few broken bones. Here at the hosptial, if you have a serious facial lac, you call ENT (otolaryngology) to repair it. So, I found myself cleaning out and helping repair some serious facial lacs. The ENT resident said my stitch technique was pretty good (qualified, of course, with the "for a third year medical student.") Good thing for all those pigs feet. Only one more week left on Oto - I'm done on Friday. Hallelujah.

Happy Monday!

NB - It was my little b's 24th birthday yesterday. Happy birthday Ryan. It's funny how fast time goes. Seems like just yesterday, we were in the backyard playing tetherball. Sorry about never letting you win. Love you!