Wednesday, January 9, 2008

A Typical Day

This is an old post written when my youngest (now 1yr 9 months) was tarrying in the womb. The only thing that changed since then is the amount of entropy in our system and add 1yr 9 mos to the kids ages. I've decided that, E equals MC squared might only be true for subatomic particles (Don't quote me on that, I don't remember much physics). Anyone with small children knows that with a much larger mass and a much slower velocity, you get infinite energy. So here's a typical day in the life:

I wake up at 5 a.m., check to see if the kids haven't thrown off their blankets during the night. I go downstairs, drink some water. If I'm not completely wasted from the last on-call, I put in a half hour on the trainer (I'm an avid cyclist, more often than not I'm putting on pounds instead of miles), shower, eat something, drink some more water, make sure the kids are still covered and at 6 a.m., I'm at the bus stop waiting for the bus to Beersheba.

I'm usually connected to an MP3 player playing jazz or hard rock. This is on purpose, to drown out the senseless flapping of gums into cellular phones around me on the bus. I'm still surprised that people have something to talk about at that hour and even more surprised that someone else actually cares to listen.

6:30, I'm at work. Check e-mail. At 7 a.m., the morning report. The docs who were on call the night before relate interesting cases. The day's work assignments are announced. Most days I'm in the OR, today I'll be in the intensive care unit.

8 a.m. morning rounds in the ICU. The cases are presented; plans for diagnosis of problems and treatment are discussed. The guys who were on call go home for a well-earned rest, and the rest of us start the day's routine: Physical examination of the patients, review the lab results, make changes in the nurses orders. Take a patient to the radiology suite for a CT scan (a logistic nightmare involving mechanical ventilation en route, making sure all the IV drips are working, etc...).

Back in the ICU. Report the results of the scan to the director of the ICU.

Time for coffee!!!

More tasks to perform, call and schedule an ultrasound to rule out deep vein thrombosis (sort of like clogged pipes) for a young trauma patient. Change all the IV lines for a patient that has been in the ICU for a few days. Review the chest x-rays for all the patients.


Write a transfer letter for one of the patients whose condition improved enough to be transferred back to the ward. A call from the OR, a patient after a thoracotomy (an operation in the chest cavity) is being brought up to the unit.

The patient arrives from the OR. The patient is very unstable, blood pressure is low and dropping, the anesthesiologist who brought the patient reports that the patient was unstable during the operation and there where changes on the ECG that showed myocardial ischemia. A big operation and a heart attack to boot, the patient's prognosis is grim.

Start an IV with a pressor to boost the blood pressure, the blood pressure responds very sluggishly. The patient goes into VT (ventricular tachycardia, a potentially fatal arrhythmia), start CPR, call for assistance, click out orders to the nurses to prepare a defibrillator and to draw up syringes with drugs for resuscitation. Place the paddles on the patient’s chest, "clear!" I shout. Make sure no one is in contact with the patient and I administer an electric shock. A few seconds later, rhythm returns to normal but the blood pressure is still low. By morning, this patient passes away, the damage to the heart muscle was too severe despite all our efforts.

Evening rounds, we report the patients' conditions to the doctors on call, answer all their questions. Call the wife to tell her the good news: I'll be home on time today (for a change).

Catch the bus. Don't forget to hook up to the MP3 player (i.e. anti-flapping-gums-device).

Home, greet the kids, prepare dinner. Slow down, this is what I've been waiting for all week, a quiet moment with the family. My 6-year-old daughter (turbo-charged model) is talking 5,000 words per minute, excitedly relating the events of the day.

My three-year-old son asks me to build a Lego car with him. After a couple of hours of sacred quality time, it's bath time. Time too precious to waste, I talk to my son, he tells me of the goings on at nursery school that day. While I dress our boy in pajamas, my wife bathes our daughter.

Story time. I read one of our favorites: Meir Shalev's "How the cave man invented entirely by chance Romanian kebab." I kid you not, it really is a children's book. At some point, I'm woken up by my son poking me in the ribs, "Daddy, wake up and finish the story!" Yet again, I fell asleep while reading a story aloud.

Finishing the story, I sing some lullabies, and my son falls asleep. Now I can shower. I go to my daughter's bedroom, she tells me more about her day, I kiss her good night. I go to our bedroom. It's 9 p.m. and I'm exhausted. My wife is reading a book. Slipping under the blanket, I look over at her, somewhat puzzled. "You look familiar, do I know you from somewhere?" We discuss the day's events, things that need to be done tomorrow. I ask her how she's feeling - she's 40 weeks pregnant.

The kid still doesn't want out. Apparently he's waiting for improvement in the weather. I turn out the light. We cuddle and fall asleep.

Five minutes later the alarm rings, incredible, it's 5 am...


Baila said...

Totally exhausting, I know. But it sounds like a really productive and rewarding day!

Lioness said...

This is why I saved your posts for today, I find the minutiae of other people's lives absolutely fascinating, and when they add a medical twist to the mixture, well, I'm easy.

I love that there is a book like that, love love love it! Must buy it when I visit Israel again, I'm bound to, at some point. My parents fell aslep whil reading to me all the time as well.

[How do you say "clear" in Hebrew?? I don't even know what we say in Portuguese!]

Unknown said...

We don't actually say "clear". We say "stand back" in Hebrew:
"l'hitrahek" (להתרחק).

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