So I'm sitting here in the infants and children's area of the hospital while a tiny little infant screams while two nurses are placing an IV. She's been screaming for about 10 minutes now, and I'm starting to fell a bit uncomfortable. However, there are lots of nurses that are checking in on the patient, and everything seems to be in order. I am taking a break from the activities of the day to write a little for the blog. (There goes nurse #6 into the room...and there she goes again.)

Pediatric Surgery continues to go very well. I'm operating virtually every day, which is such a treat for an intern with little experience. The attendings are very patient and stress good technique, which I love. (Ahh, the crying just stopped.) Even office hours are supremely educational (Ooops, the crying has begun again.) and actually quite enjoyable. This is an optimal situation for me so early in my training.

It is important for me to recap this weekend's festivities, as brother Ryan Ricks came in for a weekend of fun and excitement here in Western Massachusetts. Thanks to Southwest Airlines for providing cheap airfare and The Boeing Corporation for paying his way.

Friday

Ryan arrived late on Thursday, but I was on call, so I couldn't entertain until Friday. That call night wasn't the worst ever but it seemed to last forever. Then I had a surgery at 0730 Friday morning followed by office hours until 12:30, so my post-call was a bit extended. However, a frozen margarita followed by beer and pizza at Pizzeria Uno's cured those woes instantly. (Nurse #7 just entered the crying baby's room. I didn't know there were so many nurses up here.) Ryan seems to be doing well. He still has the same girlfriend, of whom he speaks very highly. Her name is Katie, who (nurse #7 just left) is law school classmates with Katie Taylor of J.J. Pearce High School. (Remarkably, Katie Taylor is dating someone named Ryan...so both of them are dating Ryan's.) So that's all very nice. He is also beginning his masters work in aerospace engineering which is very exciting. It seems Ryan is trying to become all grown up.

So we finished pizza and went home to watch my previously recorded Stars game. They beat Calgary very nicely. We then took brief naps (in separate rooms mind you) in preparation for beer-drinking and baseball playoffs watching. Upon awaking we headed over to Springfield's "Ginger Blossom" which is a combined Chinese and Japanese restaurant. I had sushi which was very good. (Nurse #8 just entered, but the crying seems to have stopped again.) Then it was off to Brian O's were we joined Brian, Madeline, Dave, Tracie, and three cats for baseball watching. Brian is from Lake Tahoe, so he likes the Angels. Dave is from Chicago, so he likes the White
Sox. I'm from Dallas, so I just wanted to drink beer. And so we did along with other various activities. Then we went home and went to bed.

Saturday

I didn't watch too much college football, but my Aggies beat Oklahoma State 60-20 or something like that (Nurse #9 in), and Texas beat Colorado (Nurse #9 out) as well. So Texas is right on track for a possible national championship bid, and A&M is very underwhelming. Maybe we can beat Texas at Thanksgiving and spoil their bowl plans. We pretty much drank cocktails and watched TV all day. I think I took pictures of breakfast too, which was very good. It was fried egg on potato cakes with this interesting vegetable topping. Then 6PM rolled around, and it was time to party.

We headed over to a girl named Leia's house for an Oktoberfest party. There were three little kegs of beer along with a nice grill with bratwurst simmering in a nice pot of beer. There were other finger foods as well. We proceeded to make introductions with the hostess and guests and began the eating and drinking. I had my first experience with a drinking game called "flip the cup". It's a relay race where one drinks a shot of beer then places the cup on the table and flips it over without it falling sideways. I was quite adept, flipping the cup on my FIRST try in every game but one (of five or six). The drinking continued as more people arrived. Then another resident friend of mine arrived, let's call him Azad, who is from Azerbazhan. He brought a lovely Polish girl with him to the party and his appetite for Vodka. So after I had a few glasses of the nice spiced cider, I turned to the vodka. Yum. That stuff continued until it was time to head over to Dave's house.

Dave (mentioned above) is yet another buddy of mine here in the residency program with me. I actually met him the night before I interviewed here and was one of the reasons I ranked this program so highly. (Thank goodness it turns out that most of the other residents here are similar in personality.) We had Guinness at Dave's among other things and talked a lot in front of the fire. I had a small mishap walking down the stairs, but left the party with all limbs intact. That's a story for another day. So then Ryan went back to the party and Kayla and I went home. Fast forward to 2:30 AM when Kayla and I are at home asleep when I get a call from Ryan who is attempting to walk home and is lost. I laughed, then had to look up his location on Google Maps, because even I didn't know where he wandered off to. (Speak of the devil, Tracie from above just came by to say hello. She seem heard there was foul play at work with my "small mishap" but I assured her there was not. How funny. Also the little crying baby left the room, but it seems an IV was not placed. So now they have new nurses back in the room with the baby trying again. Needless to say, the baby is screaming again.) I found Ryan's location and directed him home. Fun evening.

Sunday

Nothing much doing on Sunday. We awoke to Kayla cooking some blueberry and pecan pancakes. We had leftover bratwurst (from another gathering) to go with, coffee, and orange juice. Kayla did a fantastic job on breakfast. Then we watched the Cowboys beat the Giants 16-13 in OT. It was a fun game to watch but frustrating, because we turned the ball over 4 times in the first half alone. However, the end result is what counts, and it was a win. The Astros won as well, which puts them up 3-1 in the NLCS over the Cardinals. Then we decided to go shopping.

We first stopped at Pier One to purchase one of these very large oval-looking chairs with a big pillow in the middle. Apparently this is called a Papasan chair. It's pretty cool and super comfortable. We also got the matching ottoman. Then we went into the mall for some power shopping. We stopped at DSW to hit the clearance rack. I didn't find anything. However, Ryan found two pairs of casual shoes, and I found a pair of shoes that didn't fit and one that did. They're called Ugg's. They are ULTRA comfortable. You put your foot in, and it feels like you lose your foot in fur. It's pretty sweet and it will be ultra warm in the winter. Then we went to Filenes so Kayla could purchase some makeup and such. Finally we stopped at New England Candles to buy one of their popular offerings.

Dinner was at Chilis. I had the country fried steak for the first time ever. It really wasn't all that bad. So good for Chilis. And I think that's it. I have pictures. Thanks to Ryan for flying all the way up here to spend the weekend. We all had a great time.

>>View the PICTURES<<

I know it seems I have abandon all of you to the abyss that is the Internet. I have been MIA, that is for sure. However, I am attempting to rectify this situation tonight. Let me update you on things these days, as I have a few moments here on call in the hospital.

Nathan Beach of www.nathanbeach.com is back in The United States after his jaunt in Europe. How lovely that he spent his honeymoon with Shelley over there. I received a nice thank-you card from Shelley and also one from Linda Beach. I thought that was swell. I actually still owe Nathan a thank-you card for my graduation present, but I haven't done that yet. Maybe when I am post call on Monday I can get to that. Or maybe I'll sleep all day.

I was in the Surgical ICU last month. It was month 2 of 3 for me in the ICU, so now I feel fairly confident in managing critically ill patients. At least I should be able to identify sick patients in regular hospital beds as I move forward in residency. And for all you lawyers out there, that doesn't mean I'm an expert. It simply means that I'm a first year surgical resident who has spent two months in the ICU and feel much better about managing sick patients than I did three months ago.

I also had to make a lot of difficult decisions this last month regarding end of life issues. I had several older patients who either had metastatic cancer or other life ending illnesses and had to "pull the plug" as it were on a few of them. What this means in more compassionate terms is that these patients were suffering, in pain, and would be dying in the immediate future yet family wanted to continue aggressive care. "Pulling the plug" really means we decide to provide comfort measures (adequate pain medicine and sedation) for the patient and remove life support machines (the ventilator, CPR if the patient's heart stops, drugs that artificially improve the heart's pumping performance, and other various life support). In these situations, the physician must always ask the patient directly how he or she wants to proceed, but often that is impossible because the patient is unconscious or incapacitated. Then the burden of decision-making falls to the family, who is instructed to relay what they think the patient "would have wanted" in this situation. However, often the family member feels guilty about ending a loved one's life, even if the patient would have wanted it that way. In addition, the family member will often interject his or her own feelings instead of what the patient would have wanted which makes things very difficult for everyone. Plus the patient is sometimes suffering, and it's hard for me to watch that happen here in the hospital. Anyway, I had many family meetings last month to provide as much objective information to family members so that informed decisions about end of life care could be made. In the end, I felt good about the decisions that were made as we took suffering away for several terminal patients. At the same time, I cried a few times last month (making sure no one was looking) when faced with the enormous emotional burden of these decisions. I sure picked an interesting job.

This month I'm doing pediatric surgery. It's absolutely incredible! It's really my first month of general surgery as a surgical resident. I received my $850 pair of surgical magnifying glasses (loupes as it were) which are very cool. I look forward to using them not only this month but also Nov and Dec on vascular surgery. The attendings on pedi. surgery are awesome. They are very concerned with technique, which is important for a young surgeon trying to learn the right way to do things. I couldn't be happier that my first true surgical experience is with this group of surgeons. And there goes the trauma pager...

...And I'm back. My call nights are going to be absolute hell. I am covering trauma and pediatric surgery, which means I don't sleep, and I am responsible for 20-50 patients on a given call night. Plus, here in MA we get non-stop trauma. NON-STOP. The problem is that 90% of these cases are non-operative trauma. This means we get the CT scans, X-Rays, lab tests, and all the other stuff only to admit the patient to the hospital and wait for them to heal. There rarely are surgical issues in these patients which makes this less appealing for a surgical resident. It's ok though, I will try and learn as much as possible from the experience. I'm here to learn right? Plus the more positive I am, the better I'll feel...even if I'm perpetually tired.

So that's what's up. I have a new camera which Kayla purchased for my graduation. It's the sweet, sweet Panasonic Lumix FX8 with 3x optical zoom. It's the coolest thing ever. I have several pictures of my dog so far and not much else. I also have a few hospital pictures which I will post with this entry. Look for them soon. I hope all of you are well.

Hmmm, I'm at the hospital, but I haven't slept. I'm just staring at the computer screen. It's creepy. People are looking at me funny.

I noticed that I managed to go an entire month without an entry. That's suboptimal on my part. Oh well.