A Day in the Life...

5:50 am - Alarm goes off.  Get up, get dressed, go downstairs.  Feed two impatient cats and one dog who always waits his turn.  Pour coffee and place travel mug in two ziplocked bags.  Hope to never have an in-backpack coffee spill again.  Eat last piece of toasted home-baked bread and remind myself to bake a couple more loaves tonight.  Throw Mojo bar, Cheese-Its, apple and string cheese in backpack.

6:15 am - Greet Clara and Jack who come downstairs.  Answer, as I do every morning that, yes, I do have to go to work so can't get them dressed, eat breakfast with them or walk them so school.  Feel a bit shitty about that and somewhat jealous of Andrew.

6:25 am - Walk to the hospital with Goose.  Enjoy exactly 17 minutes of peace and good conversation with our ex-stray.

6:45 am-  Dress in greens and see my first patient.  Unlucky man who broke his neck in a car accident.  Explain to him that I will have to put his breathing tube in while he is awake to avoid damaging his spinal cord.  Reassure him that it is not nearly as bad as it sounds.  Glad that it is not 8 years ago, when I was new at doing awake intubations and lacked the finesse that I will use today to back up my reasurances.

7:00 am - Set up my operating room, check my anesthesia machine, draw up drugs.  Check and double check everything.  A mild case of OCD is a prerequisite for this field.  Eat Mojo bar and drink coffee while doing all of this.

7:15am - Patient rolls into the room.  Numb his upper airway with tubes and jelly and aerosols and sprays.  Inject lidocaine through his neck and into his windpipe.  Use a shockingly large-bored needle to do this as it's got to have enough tenacity to poke through the cartilagenous tracheal rings.  Shutter as I do this as I've never gotten used to stabbing people's necks until their breath wooshes out at me.  Snake a fiberoptic bronchoscope through his nostril and his vocal cords.  Slide breathing tube over scope.  Finally, mercifully, put him to sleep.

10:00 am - Finely tune drugs, gasses and ventilator settings in order to take the man as close to death as he'll ever go (until he dies, of course) while keeping him comfortably asleep and his vital signs stable.  Wake him up as the bandages go on.  He remembers nothing of his intubation.  Silently praise amnestic drugs.

10:15 am - See second patient.  Three year old who needs his humerus fracture fixed.  Read the chart and realize that this is a suspected child abuse case.  Which explains the nurse who does not leave the child's side.  Automatically despise the mother.  Take a history from the mother and see her red-rimmed eyes and the regret and love contained in them.  Realize I want to hug the mother and tell her that only by God's grace have many of us not been in her shoes.  That love, exhaustion, anger and frustration are intimately entwined. 

10:30 am - Gently put the toddler to sleep, while stroking his cheeks and whispering in his ear, hoping to give him a moment's peace.

11:00 am - Answer page from recovery room.  The neck patient is having nausea.  I order more drugs and hope they help as I figure vomiting with a neck incision has got to be fairly miserable.

11:05 am - Answer page from pre-op.  Order versed (anti-anxiety medication) for my next patient after being told she is sobbing and disturbing the other patients.

noon:  Wake baby up.  Skeletal survey has been read by the radiologist, who calls in the room and reports his findings of multiple fractures in various states of healing in his ribs and legs.  Take him to recovery and ask the nurses to be very gentle since he probably hurts all over.

12:10 pm - Go to doctor's lounge to sign charts, eat apple, cheese and Cheese-Its.  Listen to news about health care reform.  Wonder how many hospitals will have to close due to Medicare cuts and how many physicians will be able to stay out of hospital employment situations.  Realize there is nothing I can do about it.

12:20 pm - See third patient.  36 year old for a D and C for a miscarriage.  Turn my name badge (with the small photo of my three children taped on it) over before I meet her.  She is a G4P0 (four pregancies, no children).  She looks sad and resigned.  The husband can't even look at me.  He has his hand on her belly.  They saw a heartbeat six weeks ago.  It was gone yesterday at her OB appointment.

12:25 pm - Place a long thin needle in the woman's back.  Wait for clear cerebrospinal fluid drip back out at me and then inject some numbing medicine.  Marvel that a single cc (or gram) of fluid can make a person completely numb for hours.  Sedate the woman after her spinal is in place.  (She couldn't really explain why she didn't just want to be put to sleep for the procedure.  She just preferred a spinal.)  Quietly discuss with obstetrician her odds of ever completing a pregancy.  They are slim, unless they do IVF with donor eggs.  Of course, who has the money for that in this recession?

1:30 pm - See fourth patient.  Post-partum tubal ligation.  A Medicaid (welfare) patient who just had her 6th child in the wee hours of the morning.   Ask her if she understands the permanence of the procedure.  She assures me that she does.  As a matter of fact, she wanted it done after her 5th baby, but got tired of waiting for her doctor who was attending to a delivery.  So she went home and got pregnant again.  I call the OR to encourage the nurses to hurry up and take her back.  I do NOT want her leaving again. 

1:35 pm - Realize that with the new Medicaid/Medicare cuts Obama just approved, I will get paid exactly $126 dollars for anesthetizing this woman.  After expenses, I will get well less than half.  Sigh.

3:00 pm - Finish the case and take her to recovery. 

3:15 pm - Use ultrasound to locate the brachial plexus, the network of nerves supplying sensory and motor function to the arm, in the neck of a man who just had shoulder surgery and is in exquisite pain.  Carefully deposit numbing medicine on these nerves and feel really good when I see his heart rate and respiratory rate slow.  He thanks me.

3:45 - Go perform a pre-operative evaluation on a patient who is having surgery the next day.  Enjoy talking to her and her family.  Take a history, listen to her heart and lungs, examine her airway, answer questions.

3:55 - Tell a nurse on the floor, who approaches me while I'm there, that, yes, I will do the anesthetic for her upcoming breast augmentation.  Call my secretary to schedule same. 

4:00 pm - Walk home.  Feel so thankful that I am not on call that night and that my day was short.  I rarely get out so early.  Talk to my mother and my sisters on the walk home.  Try to get my heart rate up because this will probably be the only exercise I get today.

4:20 pm - Walk in.  One dog, two cats, three children and a husband all compete for my attention immediately.  Try to make each feel that they have it, undivided, all at the same time.  Help with electricity project, math homework, go through school folders, get dough mixed up for bread.  Help Alice and Clara knead bread for me while enjoying the feel of their hands on mine.

4:50 pm - Drive the girls to ballet with Andrew.  It's only a thirty minute practice so we walk to the local Irish pub and share a Guiness.  Talk about our respective days.  I don't talk about my patients.  It would take too much time.  And he wouldn't fully understand.  You can't undertand the intensity of those situations without looking in the eyes of the people involved.  Plus, he needs to discuss life insurance, summer camps and the fourth grade trip to Baltimore.  I try to listen but my mind wanders to the three year old's mother.  Wish I had the whole beer for myself.

5:30 pm - Pick up girls.  Reassure them that they will do fine at the recital.  Drive home.  Bathe girls while Andrew finishes dinner.

6:00 pm - Eat black eyed peas served over jasmine rice with shredded cheddar, chopped onions and sour cream.  And lots of Texas Pete.  It's delicious.  Pop bread into the oven and feel thankful that I know how do something so tangible for my family that they absolutely relish.

7:00 pm - Finish dishes and then Clara reads for Andrew and Alice reads for me.  Alice is almost done with the last Bob book box and I'm proud of her.

7:30 pm - I read to both of them while Andrew does homework with Jack.  Or they model.  Or read books side by side.

8:30 pm - Put Jack to bed.  Discuss whichever topic he's chosen for the night. He always saves his "heavy" topics for the nighttime.   I used to think he was procrastinating lights out, but now I know he really needs to discuss issues he feels are important in the evenings with me.

8:45 pm - Shower.  Answer emails.  Try to study a bit for my recertification exam in anesthesiology.

9:45 pm - Read.  If I'm disciplined, I turn my light off at 11.  Say a prayer of thanks that I've been given such a full life.  And pray for strength as I muddle through it.