Spending this lovely evening budgeting our family finances for the next 2-3 years. Oh yah. Good thing my husband knows his way around an excel spreadsheet.
(If that sounded sexy somehow, it was unintentional.)
Thursday, June 7, 2012
Thursday, May 10, 2012
What does an anesthesiologist do? (Part One)
I've been thinking about this post since I started the anesthesia portion of my residency last July. In part, I've been wondering myself what my career will look like; what will I do everyday? Who will I care for? But also because most people don't even know how to spell anesthesiologist let alone know what they do at work (It's okay, I still have trouble with ophthalmologist.)
It is obvious to most people that surgery is not a benign process. It is painful for one and can be very risky depending on the situation. Yet, surgery is often necessary and can in fact, make people feel better. What is not so clear to most patients and lay-people is that anesthesia is no less risky than surgery. For some, the anesthetic is actually more dangerous than the procedure.
That's where I come in.
I could tell you that anesthesiologists are "peri-operative physicians" or that we are experts in physiology and resuscitation. Yes, we put people to sleep, but more so, we keep them alive. "Vigilance" is the motto of our professional association.
Admittedly, it is sometimes easy. A young, healthy guy having an appendectomy is a walk in the park. The chances of having an adverse reaction are quite low, almost negligible, but bad things can and do happen.
Perhaps a better way to explain is with an example:
I was recently caring for a middle-aged, basically healthy male who was having a simple spine surgery (a 2 level "foramenotomy"). I noticed right away that he had a healthy low resting heart rate in the 50s before anesthesia started. After inducing anesthesia and placing a breathing tube, his heart rate sank and rested in the mid 40s. I gave a little medicine to try to pick it up some. It didn't really change. I gave a little more. His blood pressure was still stable and his oxygen levels were fine, so I wasn't too concerned, but I was aware of the pattern emerging.
The next step was for the surgeons to place a fixation device on his head to keep his spine aligned for surgery. This is a "stimulating" process (read: painful), so I gave the patient a little fast acting pain medicine as the surgeon did his work. My eyes were fixated on the EKG because I was expecting his heart rate to increase if he felt any pain.
Instead, the numbers started to go down... 40...38...35
I said to the nurse, "Call my attending back in the room!"
35...32...28
"Get him here immediately!"
25...10...0
What? 0?
I felt on his neck for a carotid pulse. Nothing. I turn to the surgical resident, "Do you feel a pulse?" He puts his hand on the neck and says nothing."
"Call a code! He's got no pulse. I'm starting chest compressions!"
I immediately go into CPR mode and try to instruct others to do the same, but it's like the other 4 people in the room are stuck in mud. No one moves.
Two other anestheiologists fly in the room. "What's going on Sara?"
"He brad-ied down and went asystolic just as they were pinning him. He lost his pulse and I started CPR. He needs epi."
My attending says, "Wait, wait I think he's got complexes, hold your compressions."
I stop and sure enough, the patient's heart rate is back. We place an arterial line, draw labs and all looks to be normal. Our diagnosis: profound bradycardia (slow heart rate) and hypotension due to anesthesia and pain medicine in a patient with an slow heart rate at baseline.
There was no adverse outcome in this particular case, which is what makes it a good example. I spoke with the patient's wife after the successful surgery and recommended that he have a cardiac evaluation for his slow heart rate.
The thing that impressed me the most was my reaction time. I'd been watching his heart rate, his physiology all along. I know what the side effects of anesthesia drugs are and how they can effect even healthy patients. I was additionally impressed when the surgical resident said to me,
"You know, I saw his heart rate dropping, but I just kept assuming that the equipment was malfunctioning. I had no idea it was real until you were doing chest compressions."
And that's what an anesthesiologist does.
It is obvious to most people that surgery is not a benign process. It is painful for one and can be very risky depending on the situation. Yet, surgery is often necessary and can in fact, make people feel better. What is not so clear to most patients and lay-people is that anesthesia is no less risky than surgery. For some, the anesthetic is actually more dangerous than the procedure.
That's where I come in.
I could tell you that anesthesiologists are "peri-operative physicians" or that we are experts in physiology and resuscitation. Yes, we put people to sleep, but more so, we keep them alive. "Vigilance" is the motto of our professional association.
Admittedly, it is sometimes easy. A young, healthy guy having an appendectomy is a walk in the park. The chances of having an adverse reaction are quite low, almost negligible, but bad things can and do happen.
Perhaps a better way to explain is with an example:
I was recently caring for a middle-aged, basically healthy male who was having a simple spine surgery (a 2 level "foramenotomy"). I noticed right away that he had a healthy low resting heart rate in the 50s before anesthesia started. After inducing anesthesia and placing a breathing tube, his heart rate sank and rested in the mid 40s. I gave a little medicine to try to pick it up some. It didn't really change. I gave a little more. His blood pressure was still stable and his oxygen levels were fine, so I wasn't too concerned, but I was aware of the pattern emerging.
The next step was for the surgeons to place a fixation device on his head to keep his spine aligned for surgery. This is a "stimulating" process (read: painful), so I gave the patient a little fast acting pain medicine as the surgeon did his work. My eyes were fixated on the EKG because I was expecting his heart rate to increase if he felt any pain.
Instead, the numbers started to go down... 40...38...35
I said to the nurse, "Call my attending back in the room!"
35...32...28
"Get him here immediately!"
25...10...0
What? 0?
I felt on his neck for a carotid pulse. Nothing. I turn to the surgical resident, "Do you feel a pulse?" He puts his hand on the neck and says nothing."
"Call a code! He's got no pulse. I'm starting chest compressions!"
I immediately go into CPR mode and try to instruct others to do the same, but it's like the other 4 people in the room are stuck in mud. No one moves.
Two other anestheiologists fly in the room. "What's going on Sara?"
"He brad-ied down and went asystolic just as they were pinning him. He lost his pulse and I started CPR. He needs epi."
My attending says, "Wait, wait I think he's got complexes, hold your compressions."
I stop and sure enough, the patient's heart rate is back. We place an arterial line, draw labs and all looks to be normal. Our diagnosis: profound bradycardia (slow heart rate) and hypotension due to anesthesia and pain medicine in a patient with an slow heart rate at baseline.
There was no adverse outcome in this particular case, which is what makes it a good example. I spoke with the patient's wife after the successful surgery and recommended that he have a cardiac evaluation for his slow heart rate.
The thing that impressed me the most was my reaction time. I'd been watching his heart rate, his physiology all along. I know what the side effects of anesthesia drugs are and how they can effect even healthy patients. I was additionally impressed when the surgical resident said to me,
"You know, I saw his heart rate dropping, but I just kept assuming that the equipment was malfunctioning. I had no idea it was real until you were doing chest compressions."
And that's what an anesthesiologist does.
Thursday, April 19, 2012
My son is a genius
Ok, I know. I'm not the first parent ever to think that their child is perhaps the most gifted individual to ever toddle on two feet. But, since it's just you and me here in the space, I'm going to put down my completely unvarnished, unadulterated, incredibly biased praise for one Samuel Atticus Weisbrod for posterity so that when he goes on to cure cancer, solve the Israel/Palestine crisis, and fix the US political system before he's 30 years old I can say "I knew it when he was 18 months old." Also, you should stop now if people talking about how awesome their kid is makes you throw up a little in your mouth (seriously, this is where I would stop if this were someone else's blog). Don't say I didn't warn you.
And let me say now before I get to far into this that my measure of success as a parent has zero to do with his cognitive ability (as long as he can support himself as an adult) and everything to do with his enduring happiness and belief in himself. But let's let that go for one moment to bask in the brilliance of Samuel A.
So, from some quick online surveying it seems that the language milestones for 18 months include a vocabulary of 12 and 50 words and understanding around 200 words. In February we counted around 150 words that Sam speaks and by now I would estimate it is around 300. His vocabulary includes words like "triangle", "motorcycle", "helicopter," and "Target" (yes, the store. Sam has learned his very first brand).
Where Sam really excels is in his knowledge of birds. Tonight, at dinner Sam looks outside and says "chickadee." Sure enough, there were two little black-capped chickadees gathering nest materials on the ground outside the window. A minute passed with us looking at them and then they flew away. I told Sam "the chickadees flew away" and he said "flew away" (he often will immitate the last two words of a sentence, particularly if he doesn't know those words). I then asked him "What else flies?" I figured I'd be answering it myself but Sam processes for a minute and then says "Robin." Seriously. I was floored. I responded "yes! A robin flies. What else flies?" And Sam said "Cardinal." Now, I knew Sam knew those words and that he could identify those birds (once, when seeing a Cardinal, he made the beginning of it's call "Cheer Cheer Birdie") but to link that to the question "What else flies?" seems unbelievable. I then said "A plane flies." And his eyes widened. And then said "Does a helicopter fly?" and he broke in to a huge grin as he made the connection around things that fly. Awesome!
Sam is also in to nursery rhymes and can recite broken but recognizable and hilariously cute versions of "Bah Bah Black Sheep," "Row Row Row your boat", "the ABCs", "Ring around the Rosy", "Twinkle, Twinkle, Little Star," and "Rain Rain Go Away." When we pass the park on the way home he will occasionally say "Home again, home again, home again, pop!" (from the nursery rime Home Again, Home Again, Piggity Pop!). Sometimes the "home agains" will continue repeating which is pretty damn adorable. If you start him off counting with "1, 2, 3" he can count up to "10" (although he does miss numbers). That's crazy for an 18 month old, right?
He also understands the concepts of names. When asked what "Mom's" name is he says "Sara"and he does the same with "Dad" and "Kyle."
Unfortunately, when we start videoing Sam's emerging language development (mostly because it is super cute), all he wants to do is grab the camera. We'll have to keep working on it. I'll make it a goal for this weekend.
Ok, I should stop now. I know I'm going to look back at this post and regret it. I already do a little bit even though I haven't yet posted it yet so I went ahead and added the up front warnings. So if you read this far and now have to brush your teeth you have no one to blame but yourself.
And let me say now before I get to far into this that my measure of success as a parent has zero to do with his cognitive ability (as long as he can support himself as an adult) and everything to do with his enduring happiness and belief in himself. But let's let that go for one moment to bask in the brilliance of Samuel A.
So, from some quick online surveying it seems that the language milestones for 18 months include a vocabulary of 12 and 50 words and understanding around 200 words. In February we counted around 150 words that Sam speaks and by now I would estimate it is around 300. His vocabulary includes words like "triangle", "motorcycle", "helicopter," and "Target" (yes, the store. Sam has learned his very first brand).
Where Sam really excels is in his knowledge of birds. Tonight, at dinner Sam looks outside and says "chickadee." Sure enough, there were two little black-capped chickadees gathering nest materials on the ground outside the window. A minute passed with us looking at them and then they flew away. I told Sam "the chickadees flew away" and he said "flew away" (he often will immitate the last two words of a sentence, particularly if he doesn't know those words). I then asked him "What else flies?" I figured I'd be answering it myself but Sam processes for a minute and then says "Robin." Seriously. I was floored. I responded "yes! A robin flies. What else flies?" And Sam said "Cardinal." Now, I knew Sam knew those words and that he could identify those birds (once, when seeing a Cardinal, he made the beginning of it's call "Cheer Cheer Birdie") but to link that to the question "What else flies?" seems unbelievable. I then said "A plane flies." And his eyes widened. And then said "Does a helicopter fly?" and he broke in to a huge grin as he made the connection around things that fly. Awesome!
Sam is also in to nursery rhymes and can recite broken but recognizable and hilariously cute versions of "Bah Bah Black Sheep," "Row Row Row your boat", "the ABCs", "Ring around the Rosy", "Twinkle, Twinkle, Little Star," and "Rain Rain Go Away." When we pass the park on the way home he will occasionally say "Home again, home again, home again, pop!" (from the nursery rime Home Again, Home Again, Piggity Pop!). Sometimes the "home agains" will continue repeating which is pretty damn adorable. If you start him off counting with "1, 2, 3" he can count up to "10" (although he does miss numbers). That's crazy for an 18 month old, right?
He also understands the concepts of names. When asked what "Mom's" name is he says "Sara"and he does the same with "Dad" and "Kyle."
Unfortunately, when we start videoing Sam's emerging language development (mostly because it is super cute), all he wants to do is grab the camera. We'll have to keep working on it. I'll make it a goal for this weekend.
Ok, I should stop now. I know I'm going to look back at this post and regret it. I already do a little bit even though I haven't yet posted it yet so I went ahead and added the up front warnings. So if you read this far and now have to brush your teeth you have no one to blame but yourself.
Saturday, March 31, 2012
Trip to Bainbridge Island
As many people who have/have had a toddler can understand, it can be challenging to go outside the house for more than a few hours. As my sisters can attest on their recent visit, Sam naps for 3 hours smack in the middle of the day. So unless I head out the door first thing in the morning, it's hard to get any adventures of significant duration. Add to that, the weather in Seattle and well, let's just say that our family has not made any outings since we moved here last July.
Enter Bainbridge Island, an idyllic, artsy, well-to-do community of about 20,000 people.
We decided to go, no matter what. Despite Sam's mid-day nap, despite the awful weather, we were going. And you know what? I think in the end, we felt all the more "Seattle" for it.
We drove our car onto the ferry and enjoyed the scenery.
No, of course it didn't actually look like the above picture. That would be what it looks during the summer. My picture looked more like this:
We headed first to the most amazing playground we've ever been to. Again, it looked nothing like this picture today. The silver lining, though, was that we had it all to ourselves on a rainy Saturday morning at 10am. The big key was bringing two sets of clothes for Sam, including waterproof shell pants. I forgot Sam's rain boots, so we lined his shoes in extra sandwich bags that were in his diaper bag. Resourcefulness!
After the park, we went to a kids museum. Sam tired himself out pushing a kids
grocery cart around and pretending to drive this smart car:
While I don't exactly love the weather of the Pacific Northwest, I do appreciate how green everything is, even in the winter months. I think the keys to living here are being prepared for the bad weather (extra clothes, and rain shield for the stroller were key) and just getting out there no matter what.
Tuesday, March 27, 2012
Sister Visit in Seattle
Sam loved the Olympic Sculpture Garden:
Diana, Laura, Sara, Sam
Mommy and Sam watching the train from a hilltop
Sam and Mommy
Sam and Calder:
Strolling along the waterfront:
Diana, Mark, and Calder:
Laura and Remo:
Laura and Remo on the Ducktour!
Seattle as seen from Lake Union on our Duck Tour:
Friday, March 16, 2012
Video Updates
Kyle got a Strider bike for Sam. Here he's getting used to his new helmet. The video cuts off just before he points to the bike, still in the box, shouting, "Bike! Bike"
Sam loves the website Birdjam.com. It has all sorts of bird-sounds to learn. You'll notice Sam say "Please" as he rubs his chest with his hand. That was the sign they taught him in Daycare for please. He still uses it even though he can now say the word.
Getting ready to go to the park:
Playing on the bed with the kitties:
Fooling around at home:
Wednesday, March 14, 2012
Vocabulary in Bloom!
It is almost spring time... meaning, it will continue to rain more than it already has here in Seattle...
Actually, it's not THAT bad. No, strike that. The weather really stinks here. Clearly, I've reset my expectations (lowered them, it's the Gravelin way!) because a few weekends ago, we had a sunny 50-something degree day and I wanted to take my sweater off and bask in the sun. Anywhere else, it would have been an average day. If I had just been visiting, I would have said, "What is so special about today? Everyone should put their shirts back on." But instead I felt that it was a beacon of light (literally) amidst a cloud-filled season.
But despite the dreariness, our dafodills are popping up and the crocuses have already bloomed. Day-light savings has made our evenings so much brighter, that I can *almost* imagine what it was like last summer when the trees were green and we had copious raspberries in our yard.
All that said, I've been adapting and coping (i.e. drinking more coffee, generally moping around the house, and supplementing with Vitamin D) and trying to be aware of other things that are blossoming in this gloomy time such as:
Sam's vocabulary!
Kyle and I made a list for fun the other day and we tallied over 150 words that Sam can correctly use in context.
Among them:
Helmet ("elmut")
Apple sauce
Guitar ("tar")
Tractor
Triangle
Now, he may not say them right, but we generally know what he means. Additionally, we have noticed an onslought of compound words and phrases. It started last weekend when I was working late. I'd left my coffee mug in his room and he pointed to it, turned to Kyle and said, "Mama, home." (Yes, my heart broke a little when I heard this while I was still at work...)
He's also using more verbs and describing his needs:
"Pick"- for Mommy pick-up this thing that I just flung onto the floor
"Want" -self-explanatory and said in the general direction of so many things
"Out!"- This is my new alarm clock. Out! Out! Still haven't found the snooze button...
"Poop."- He's been trying to alert us after he goes #2, but let me tell you, there are still many false alarms.
"Wash"- When he wants to wash his hands in the sink in addition to grabbing and causing mahem with anything in the vicinity of the sink area.
And he's been playing games:
-"Nigh-nigh" said as he collapses into his crib and "hello!" said as he pops back up are his own version of peek-a-boo
- In response to "rain, rain" he'll say "go way" (I'm sure Seattle kids know this one before they can walk.)
Anyway, this word explosion has been so awesome. Everyday Kyle and I are smiling or laughing along with whatever word-concoction Sam creates. It's such a joy during a dreary time!
Actually, it's not THAT bad. No, strike that. The weather really stinks here. Clearly, I've reset my expectations (lowered them, it's the Gravelin way!) because a few weekends ago, we had a sunny 50-something degree day and I wanted to take my sweater off and bask in the sun. Anywhere else, it would have been an average day. If I had just been visiting, I would have said, "What is so special about today? Everyone should put their shirts back on." But instead I felt that it was a beacon of light (literally) amidst a cloud-filled season.
But despite the dreariness, our dafodills are popping up and the crocuses have already bloomed. Day-light savings has made our evenings so much brighter, that I can *almost* imagine what it was like last summer when the trees were green and we had copious raspberries in our yard.
All that said, I've been adapting and coping (i.e. drinking more coffee, generally moping around the house, and supplementing with Vitamin D) and trying to be aware of other things that are blossoming in this gloomy time such as:
Sam's vocabulary!
Kyle and I made a list for fun the other day and we tallied over 150 words that Sam can correctly use in context.
Among them:
Helmet ("elmut")
Apple sauce
Guitar ("tar")
Tractor
Triangle
Now, he may not say them right, but we generally know what he means. Additionally, we have noticed an onslought of compound words and phrases. It started last weekend when I was working late. I'd left my coffee mug in his room and he pointed to it, turned to Kyle and said, "Mama, home." (Yes, my heart broke a little when I heard this while I was still at work...)
He's also using more verbs and describing his needs:
"Pick"- for Mommy pick-up this thing that I just flung onto the floor
"Want" -self-explanatory and said in the general direction of so many things
"Out!"- This is my new alarm clock. Out! Out! Still haven't found the snooze button...
"Poop."- He's been trying to alert us after he goes #2, but let me tell you, there are still many false alarms.
"Wash"- When he wants to wash his hands in the sink in addition to grabbing and causing mahem with anything in the vicinity of the sink area.
And he's been playing games:
-"Nigh-nigh" said as he collapses into his crib and "hello!" said as he pops back up are his own version of peek-a-boo
- In response to "rain, rain" he'll say "go way" (I'm sure Seattle kids know this one before they can walk.)
Anyway, this word explosion has been so awesome. Everyday Kyle and I are smiling or laughing along with whatever word-concoction Sam creates. It's such a joy during a dreary time!
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