Would you like another martini?

ICU psychosis might be one of the more comic aspects of my job. Mostly because I'm slightly mean and it is actually hilarious to encounter these folks in their delirium.

Consider Mr. You-Better-Take-Me-Seriously. He, in his altered state, ardently believed that he deserved a cocktail and deserved it now. It probably was close to 5 o'clock but how would he have known that?....Anyways, he's screaming at every person who walks by that he "need a martini! On the rocks!"

ICU psychosis is a condition that some people develop as a result of constantly being woken up for procedures, having the lights on at all hours of the day, and soon losing track of whether it was 1 am or pm. Because we draw labs at midnight, tend to do baths at 3 am, and re-assessments at 4 am, you can imagine how much restful sleep one gets.

So we indulge Mr. You-Better-Take-Me-Seriously and give him an empty cup, telling him it's his martini just like he wanted. (And the funnier part is that going along with it often puts them at ease). He started sipping his empty glass, saying it "hits the spot". He was content and only then began to tell us tales that seemed to be a compilation of Vietnam war stories and vignettes about his house full of cats. It ended up being a fusion of war-ready felines and it was hilarious.

Usually we put patients on a sleep-wake cycle, which generally means that you aren't supposed to wake the patient up from 11 pm to 5 am to do baths etc. This is usually feasible, except when the patient is on the neurosurgery service and has to be woken up every hour for a neuro check. A neuro check consists of asking them simple questions like their name, where we are right now, and what's the year or who's the president. It takes one minute but you can probably guess that patients are ecstatic when you wake them up to ask them if they know their own name.

Little Miss Precious-Old-Lady was just that. Precious. And 79 years old. She was delightfully confused black woman who had ICU psychosis and waved to everyone walking by. She was restrained so it ended up looking like she was having a spastic hand cramp under the sheet because she couldn't lift her arm off the bed. But she wasn't phased by this. She looked at everyone who came up like she had known them for years and was so pleasantly surprised by their visit! One time I simply looked at her with a big smile and she said "I love you too dear!" We don't get that kind of affirmation from our patients often so I laughed out loud and told her I loved her too. Precious.

She wised up to the fact that we were asking her where she was every hour...and that she couldn't remember.
"Miss Precious, do you know where we are right now?"
"Yes"
"Where are we?"
"Here"
"Where's here?"
"This building"
"What kind of place is this?"
"A business"
This went on for a while as she cleverly tried to maneuver her way around her own dementia. You've got to give her points for trying.

All in all, you have to wonder what you would say if you were in the same spot. Would you tell your biggest secrets or talk about your family? Would you be pleasant or onery?

I think I would tell everyone I love them... just like I do when I have one too many. But I would be pleasant and I hope people would indugle me.

I think Little Miss Precious and I could be good friends. You've got to the love the old people in your life. Because even if they are confused, they have lots of love to give. So give it back, because one day we will all find ourselves in the same spot...probably asking for a cocktail.

Thoughts on Mortality

This one might be on the verge of morbid so you've been warned.

Working with trauma patients makes you realize how seemingly random life really is. There are people who get hit by a bus walking down the street or go to work one day and get shot by a crazy employee or stop to help someone by the side of the road and lose both their legs. It can get to you if you think about it long enough, because it makes you look for the situations that put you in danger. I'm driving up the Tollway and think "if I made one slight wrong turn of the wheel, I would be dead". And that's the reality.

Good things happen to good people. Bad things happen to bad people. Bad things happen to good people. And so on. There's no formula and, while you can calculate the risks to some extent, it's still out of our hands.

If you're like me and ponder such things, you are forced to decide what you think about these "spontaneous and unpredictable" events. Is it some kind of natural law of fate? Is it karma? Is there a God? How can He be good if He allows horrible things to happen?

Take the tragedies around the world lately. People were at home fast asleep in bed when suddenly their house crashed in on them. Here in America, we support financially and pray and do what we can but the truth is we don't want to dwell on that. We don't want to believe that such things could happen to us. It makes life too real. And most of the time, we prefer our ignorance induced by television and convenient distractions. I do it too, it's a natural reaction.

So I made my decision about this subject. And that's how I sleep at night. And go to work everyday. And drive on the Tollway.

"Who has understood the mind of the Lord, or instructed him as his counselor?" Isaiah 40:13
Everyone from Job to Isaiah to the Psalms has struggled with this question and the answer is that God is sovereign. He does what He pleases. And His ways are right and good.

I will never understand why bad things happen but I can rest because my Father knows. He planned it out and He works for the good of those who love Him, who are called according to his purpose. So as Jesus says "You must be ready" for we do not know the future. And I can trust that.

So for now, I do my best to help those people heal and I try and not take my health, my security, my comforts for granted. Because you never know.

Resuming said blog

Alright, I know I have slacked off for the past however many weeks but I have discovered the root of the problem.
I have writer's anxiety. I get anxious that people won't like my blog or that it won't be funny and I have decided to abandon such thoughts. I love to write and, while I will continue to write about the crazy things that happen to me at work, I am going to throw in random thoughts.

So here we go. Again.

Yesterday my patient told me his previous doctors told him he had "sleep acne". After a split second of rumination, I realized he meant "sleep apnea". I held in my amusement but it continued. I was about to give him a subcutaneous injection of insulin, which is standard protocol in the ICU. He freaked out at the sight of a needle, regardless of how tiny it was, and said he refused a shot. I tried to explain that it wouldn't hurt and we give it to everyone. But he resisted further when I told him it was insulin.

He started protesting that he wasn't diabetic and he didn't need insulin. He then stated that he was "not gonna get addicted to that stuff!" I was laughing so hard internally that I didn't even protest. Insulin is made by your body; that's like being addicted to water. I should have done some education there but I let it go.

2 units of insulin: not given, patient refused.

Unfortunately, this man did not have a permanent residence. He lived in a shelter and, surprisingly to me, had one of the most pleasant dispositions I have encountered as of late. It made me think about how much I complain and compare when I have so much to be thankful for in my life. I take my nice apartment and supportive parents and meaningful job for granted. In Ecclesiastes, Solomon talks about how there's nothing "under the sun" but to work hard and enjoy the blessings you have been given. I aim to be more grateful and enjoy the little moments in my life. Cliche, yes, but nonetheless true.

My patient's girlfriend was laying in the bed with him every time I walked in. Not usually allowed, but pick your battles. The next thing I hear is her yelling "You don't know me at all!" and storming out. Hope it works out.