That was a bit of a curious journal entry with the last update. I realize that I the things I end up writing about are fairly heavily influenced by sleep deprivation or the random mood that I am in. Do I sound like I am crazy at times? Maybe I am.

Right now, it is a lazy, hazy, daze of a Sunday afternoon. I slept in until 8:30am this morning before going to church. After the service, I washed my car, came home, ate brunch, did some chores, and now here I am. I love weekends.

The first set of photos is from the year end medicine BBQ early June of this year. I seem to have my eyes closed or partially closed in all of them. The second set of photos is from the medicine retreat from last week. I am visibly chubbier in June than now. This is despite the fact that I weigh more now than I did three months ago. I also run double the distance now than I did back then. I am such a narcissist.

Photos / Department of Medicine BBQ June 2006 (New Gallery)- go to section

- 84 New Photos

Photos / Department of Medicine Retreat Sept 2006 (New Gallery)- go to section

- 21 New Photos

My three weeks thus far on the intensive care unit has been an exciting experience. The adrenaline rushes, the need for decisiveness, and the ability to perform procedures have been amazing.

Often, I would be paged by a nurse in the middle of the night, with "come to bed XX right now" being the only message. I sprint down the hallway. I arrive in the ICU Bay. Everyone is gathered around the crashing patient. The show is mine to run. The challenge is mine to succeed at. The challenge is mine to fail at.

For every good thing of course, there is always a trade off - A Ying for every Yang.

The first trade off, is that all of the intensity, at the end of the day comes at a cost. The attentiveness and excitement during the day, produces fatigue and distractibility at home. I admit that I am heavily worn out. I still flog my poor body to go running after a long day in the ICU to try to keep in shape. However being in the ICU all the time regardless of what I do, still takes its toll on the body.

The second trade off, as I realized tonight, is the psychological aspect of it all.

For example, tonight I went to sleep early because of the fatigue. I was asleep for about half an hour and I suddenly woke up and was completely alert. I felt a deep pain and sadness that I normally do not feel. I felt as though I was inside the body and mind of one of the patients I have been caring for. She is a young lady who had a liver transplant. The operation took 16 hours and was mired by a long series of complications. A sizable portion of her new liver was damaged because of the complications. Her kidneys failed and she is now on continuous dialysis. We are supporting her blood pressure and lungs with various drugs and machinery. In the most basic terms, everything that could have gone wrong, short of death, had happened, and she is now barely alive.

The catch is that she is completely aware and awake. With great effort, she lightly squeezes my hands when I ask her to, but is unable to speak to me because of the tube passing through her vocal cords pumping air into her lungs. She can nod her head slightly to answer questions. From a functional perspective though, she is bed ridden and essentially unable to communicate. I awoke tonight seeing the world through her eyes. I felt such anguish and despair.

This second, psychological trade off, is that unless you stop caring about your patients, despite all the sedation and analgesia given, that there will be moments where the entire course of events stings with hopelessness and futility.

There is a counter balance to the emotional lows, is that sometimes, sometimes a miracle happens.

One of our patients had his only kidney removed because of cancer. During the operation he had a massive heart attack. We discharged him from the ICU in decent shape. He then had a massive clot go to his lungs on the regular hospital ward. His heart stopped. He was dead. We brought him back. We chilled his body for twenty four hours. He was comatose for a few days. We put him on dialysis. He began to wake up. Over the next two weeks his life-support medications were gradually weaned. His wife was always by his side. She decorated his entire room with pictures of their family. His family visited him all the time. We had difficulties weaning him off of the ventilator, and arranged for the surgeons to come and perform a tracheostomy on him today (cut a hole in his neck).

This morning, when the nurses were not watching, before he was to have his tracheostomy, he made a decision. He wrapped his hands around his breathing tube. He acted on his decision. He liberated himself from the ventilator. We though he would not be able to survive off of the ventilator. We were wrong. He did just fine and started talking to us. He is going to be discharged from the ICU now.

Back to sleep I go.

For me, each time that a month seems to pass by quickly, it seems to pass at an ever accelerating rate. September is more than half over.

On Saturday, there was the annual department of medicine retreat. The talks on international medicine were amazing, with some great stories being told by Gabe and Khurram (two of the residents in our program), and Dr Thompson. Gabe went to Nigeria to run clinics with Dr Thompson for two weeks. He put together an amazing slide show, complete with songs that he had recorded while he was in Nigeria. It was really touching to hear "Here I am to Worship" (one of my favorite P&W songs) sung all the way around the world by children in Africa. I had no idea that so many people in our program were Christian.

I went to Jon and Mel's wedding banquet in Toronto yesterday. Unfortunately, I was unable to go to the earlier actual ceremonies and the bigger banquet back home in Calgary. It was big and tasty Chinese wedding meal, with a couple of oddities that deviated from norm. For one, the abalone and scallop portions were enormous (tasty!). Next, with the chicken, they had crinkle-cut French fries instead shrimp chips. I am not sure how to assess this. The French fries offer more flavor, but its breaks tradition. Finally, there were was no lobster, but a double serving of fish instead. For myself, I have always like the steamed fish more, so it was not a big deal.

Before the wedding, I left London early to play Gran Turismo on the Highway 401. For the most part, the 401 is three lanes in each direction. Yet the majority of drivers drive in the middle lane, when they should be driving in the far right lane unless they are passing. (This is ignoring all the people who drive slowly in the left lane that we all loathe.) This however makes for some interesting driving for myself, hence the Gran Turismo comment. The fun comes in where you are trying to pass people while being in the left lane. You find that the drivers in the left lane are not driving any faster than the drivers in the middle lane. There is the occasional slow car in the right lane, but the right lane is essentially the most underutilized lane. So when a large opening appears on the right lane, I end up sliding from the left lane to the right lane, gunning it in the right lane, then sliding back into the left lane - threading through the middle lane cars both ways. Yeah, I am one of those bastards. I will keep doing it though until the slow drivers learn to drive in the right lane, or I die in a fiery mess of molten steel and burning rubber.

I arrived in Markham, and drove more sensibly down to the T&T. There, I managed to grab some sweet sustenance to stuff into my pie hole. Since the Chinese mid-autumn festival is coming up, they had some particularly tasty goods there. I bought a large box of moon cakes and a box of mini moon cakes, some assorted Chinese buns (freezer food when I am too lazy to cook), and a number of boxes of sweet, succulent Pocky.

Life on the ICU is going really well. Intubations, central lines, arterial lines are completely second nature now. The key is to ask the more senior guys for their tips and tricks for procedures. I then watch them to see what they do differently, and then ask myself, "why are they doing it differently than I do?" Wisdom calls, always be listening for her voice.

Anyway, I am going to go inhale some Pocky.

Links - go to section

- Jon & Mel's Wedding Website - Photo Albums (click here)

Photos / Jon & Mel's Wedding Banquet (New Gallery)- go to section

- 6 New Photos

Photos / Carmen's B-Day (New Gallery)- go to section

- 11 New Photos

Photos / Steve & Mona's Wedding Banquet (New Gallery)- go to section

- 18 New Photos