Walk the line

OB Anesthesia can offer a wide entertainment of cases and patients. For example, there are the uncomplicated “moms” who deliver smoothly without complication. There’s the “drug” mom who requests everything under the sun to be comfortable…. or the literal “druggy” mom who is able to tell you where they have the best IV access. Let’s not forget the “perfectionist” mom — who has everything planned out from conception to birth. There’s the “multips” who have been through the pregnancy process and are seasoned…. who for the most part are very cooperative and know what to do. The “teeny bopper” moms who often wince at just getting an IV — someone should tell these guys that pregnancy and birth isn’t just about the sex and then the baby. There’s the “IVF-ers” who tend to be very nervous about everything along the way, but they’re often the most appreciative of everything you do for them. And finally (maybe I covered them all, but I’m sure I haven’t), there’s the “I just want to be knocked out” mom who basically wants an elective c-section and general anesthesia so they don’t know or feel anything.

Of course, these are just my opinions of the populations I have come across; not true facts. And yes, I realize pregnancy can be a very nerve-racking process. These are just MY descriptors….

Came across an interesting OB anesthesia case. A pt who had an accreta. This was most likely due to her previous 4 c-sections… and she desired a hysterectomy.
Our plan: Multiple large bore PIVs. Arterial line. Type & crossed blood pre-op. Pre-op labs. Blood and fluid warmers. Belmont. Backup RIC and MAC lines available in the room. Peripheral phenylephrine with backup norepi if needed. Epidural anesthesia with backup emergent GA. Constant communication with the surgeons. SICU bed available if needed.
Outcome: Baby delivered and did beautifully. Roughly 1.5L EBL, 2.5L LR. Post hysterectomy ABG with stable Hb. A-line d/c’d. Pt back to OB Labor floor for a couple of hours of monitoring. No SICU bed needed.

Sometimes a full day’s plan helps ward off the evil. It’s nice when you get to deviate away from the “normal” OB anesthetic…and everything goes well. Even if it does seem like over kill.

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Walk the line

March 2, 2010

OB Anesthesia can offer a wide entertainment of cases and patients. For example, there is the “uncomplicated” mom who delivers smoothly without complication. There’s the “drug” mom who requests everything under the sun to be comfortable…. or the literal “druggy” mom who is able to tell you where they have the best IV access. Let’s not forget the “perfectionist” mom who has everything planned out from conception to birth. There’s the “multips” who have been through the pregnancy process and are seasoned…. who for the most part are very cooperative and know what to do. The “teeny bopper” moms who often wince at just getting an IV — someone should tell these guys that pregnancy and birth isn’t just about the intercourse and then the baby. There’s the “IVF-ers” who tend to be very nervous about everything along the way, but they’re often the most appreciative of everything you do for them. And finally (maybe I covered them all, but I’m sure I haven’t), there’s the “I just want to be knocked out” mom who basically wants an elective c-section and general anesthesia so they don’t know or feel anything.

Of course, these are just my opinions of the populations I have come across; not true facts. And yes, I realize pregnancy can be a very nerve-racking process. These are just MY descriptors….

Came across an interesting OB anesthesia case. A pt who had an accreta. This was most likely due to her previous 4 c-sections… and she desired a hysterectomy.

Our plan: Multiple large bore PIVs. Arterial line. Type & crossed blood pre-op. Pre-op labs. Blood and fluid warmers. Belmont. Backup RIC and MAC lines available in the room. Peripheral phenylephrine with backup norepi if needed. Epidural anesthesia with backup emergent GA. Constant communication with the surgeons. SICU bed available if needed.

Outcome: Baby delivered and did beautifully. Roughly 1.5L EBL, 2.5L LR. Post hysterectomy ABG with stable Hb. A-line d/c’d. Pt back to OB Labor floor for a couple of hours of monitoring. No SICU bed needed.

Sometimes a full day’s plan helps ward off the evil. It’s nice when you get to deviate away from the “normal” OB anesthetic…and everything goes well. Even if it does seem like over kill.

Spain – Barcelona, Seville, Madrid

Spain: what an awesome trip!! Barcelona, Seville, Madrid. I can’t say enough. This little blurb only touches on the schedule of the trip. After 870 or so pics… you see for yourself! You gotta log into Flickr to see them…b/c they’re privatized. 🙂

My Flickr Photos

Here’s the schedule:

– 2/19 (fri): Left Boston at 6:30pm (Spain is 6 hours ahead of Boston time).

– 2/20: (sat): arrive Madrid 7am –> Barcelona 9:30a. Toured Las Ramblas, Barcelona cathedral, St. Josep Mercat (food market), Cristopher Columbus statue, Picasso museum, Barca v Racing soccer game, dinner at a cool tapas restaurant where we met 2 British guys and just chatted “European” style (i.e. wasn’t rushed with the bill!)

– 2/21 (sun, rainy): Took the cable car from Port Vell to Montjuic. Toured Montjuic, Miramar. Tackled the Miro museum (oh yeah!). Lunch at Txaipela a tapas restaurant. Toured Casa Batllo (Gaudi work), walked to Casa Mila (but it was closed). Churros con chocolate at Farggi (a dessert chain with gelato). Walked Passeig de Gracia. Dinner @ Senyor Paralleda.

– 2/22 (mon): Visited Sagrada Familia. Toured an old Hospital in Barca – Hospital de la Santa Creu i Sant Pau. Took the bus from Sagrada Familia to Park Guell. Toured Casa Mila. Dinner at Taller de Tapas. Watched a concert at Palau Musica Catalana – a beautifully ornate music hall – where we saw The 12 Cellos. After the show, we developed a gelato craving… but by midnight, most of the gelato places were closed –> thank goodness for McDonald’s!

– 2/23 (tues): Toured the gothic quarters. Walked Las Ramblas again. Visited a cute chocolate store and Musica. Toured Gran Teatra La Liceu opera house — neither of us could stomach sitting through 5 hours of Wagner’s Tristan and Isolde. Toured various ancient Roman ruins located around Barcelona (almost like a fun treasure hunt!): Roman tombs, Roman columns, etc.). A little nap was needed — Siesta time, Spanish style! Went to a very cool Tapas restaurant and enjoyed tapas and cava! We continued with gelato for dessert. Actually first night to get home around 10pm (for the most part, Barca had a later dinner eating time…but the streets get quiet around 10-11p…just like Boston. Weekends people stay out til 6am…but not weekdays.).

– 2/24 (wed): Took an early morning flight from Barca to Seville. At the Barca airport, I was craving a Big Mac (haven’t had one in YEARS!)…and they serve Big Macs at 530a!!! Yeah, I was stoked! Upon arrival in Seville, we took a taxi to Santa Justa train station and checked our luggage at the Consigna (locker storage). We walked and toured the LARGEST gothic cathedral in the world. Toured Alcazar Palace. Viewed the Torre del Oro (Gold Tower), a watch tower. Toured the Plaza de Toros de Sevilla, a bull fight stadium (bullfights are scheduled from April to October). Toured the house that’s a replica of Pontius Pilot‘s – it was rather ornate! Enjoyed bocadillo (essentially a sandwich with frenchbread, softened with tomato rub, type of ham/jamon/meat/etc). Ate these all throughout our visit in Spain. Walked back through the maze that is Seville… stopped by for a dinner at a quaint restaurant. Had a tasty chorizo bocadilla. Everyone in southern spain (Barca, Seville) are extremely nice! Left for the train station and caught the Renfe to Madrid (715p-1030p). Upon arrival in Madrid (pouring rain!), took a cab to our hotel (Hotel Europa) — located in the center of Madrid (Puerta del Sol). Went to a cute restaurant La Casa del Abuelo specializing in cooked shrimp (which we enjoyed)…and yummy tinto vino dulce! After that, went to an awesome place called Museo del Jamon – a never-fail for late eats/tasty bocadillos/great company.

– 2/25 (tues): Breakfast at El Brilliante. Toured the Prado museum. Enjoyed a 3 course lunch (yeah, crazy great lunch deals for 10-13 euro: 2 courses + beverage (even wine!) + dessert). Toured the Reina Sofia museum. Dinner at the famous Botin (oldest restaurant in the world) to have their famous roast suckling pig and roast suckling lamb. Yeah, they were heavenly…the service, not that great. After the 8pm dinner, we walked around Plaza Mayor and grabbed dessert at Chocolateria San Gines for their specialty (chocolate con churros)…in my opinion, they have the best chocolate (I’m a dark chocolate lover!).

– 2/26 (wed): Enjoyed La Mallorquina‘s delicious pastries (napolitana and rosquillas were my fave)!! Toured Madrid’s Royal Palace. Toured another art museum, Thyssen-Bornemisza. Thank goodness I covered the top 3 art museums in Madrid — I saw more art in a week, than I had in a lifetime! After that, we took the #27 bus from the museum up through downtown Madrid to the Gate of Europe. From there, we took the metro back to Puerta del Sol and enjoyed delcious pig ears, patatas bravas, beef at a very cute restaurant who specializes in pig ears! It was fattier than I thought, but the flavor was just delicious!! After that, we went to a Flamenco show at Casa Patas. After the flamenco, we toured multiple plazas in Madrid. I was really impressed with how small old Madrid is…very walkable (the maps make old madrid appear larger and less walkable than it really is!).

-2/27 (sat): This was our relax/nothing-scheduled day. We had a relaxed shopping day! I got 2 pairs of cute shoes, a Euro hoodie, and a very stylish short leather coat! We walked all along Gran Via and Calle Hortaleza — Madrid Shopping!! After another 3 course lunch (all the while watching Free Willy playing on their tv!)…we headed back to plaza del sol and chilled out on our balcony while viewing the plaza. There was a demonstration that was started…coming down the street in front of our hotel. I’ve never seen a “protest/demonstration”…but it was rather tame, no violence…and it quickly filled up the plaza! For dinner, we had our eye on a Galitian-style dive that had been packed to the brim just about every night! It would start out filled with older men just chillaxin’ and socializing…then in the late night, it would be filled with younger people — everyone socializing, eating, drinking…having a great time. We arrived 2 hours before the Madrid soccer game. We ordered pulpo (octopus), patatas bravas, morcilla (blood sausage — the best seasoned that we had tried–it was delicious!), and calamares. We expected the pulpo to be better… but our faves were the morcilla and calamares. The entire time, we were never rushed or scooted out…even though the lil place was filling up fast with the “usuals”. We took our time with dinner…with wine and manchego cheese. It was a nice jovial crowd. After this, we opted to walk around a bit and then headed home to watch the Barca game.

– 2/28 (sun): Left Madrid at 1:30p and got back to Boston 3:30p.

We got roughly 4 -6 hours of sleep a night — but it really took its toll on us after a couple of days.  We must’ve walked at least 5 miles a day.  Spain was a wonderful time. If you love terrific food, wine, and company…then you can’t go wrong with Barcelona, Seville, or Madrid. If you’re short on time,… just do Barca and Madrid.

Token Tracker

Call Gods

I’m always amazed by the random behavior of calls — some are crazy busy, while others are extremely quiet.  Tonight, is an extremely quiet call for the main OR call team… but insanely busy for the acute pain service.  I have a feeling that the pager is going to go off a couple hundred more times before 7am.  Boo!

What’s in a consult?

February 15, 2010

I happily went into anesthesia for the acute patient care, procedures, pharmacological/physiological immediate impact of my decision-making…. and no clinic visits.

Today, I’m covering the acute pain service on call.  My pager just went off for a consult.  A patient who is about 3 weeks out from an abdominal procedure.  This patient has been on chronic pain meds as well.  Not only do I get a page from the secretary on the floor to come see this patient…the secretary gives me attitude.  This is definitely NOT what I bargained for when I made the decision to become a doctor.

So, if you’re going to order the consult let’s follow these simple steps:

1) The primary service ordering the consult should page and make direct contact with the consult service.

2) Have all the information ready: i.e. last surgery, type of surgery, previous/home meds, and reason for the consult.

3) Be polite — the consult service is happy to help, but it makes it difficult when you bark orders.  We’re all colleagues…let’s add some professionalism to the mix.

4) When the consult service makes recommendations, please follow them.  If you ‘re not going to do the recs, then don’t place the consult.  If you want a “curbside” opinion, say so.

5) Make sure you page the correct consult service.  For example, we have an acute pain service and a chronic pain service.  Unless this patient has had surgery in the last 5 days, it’s a chronic pain consult.

What’s in a consult?

I happily went into anesthesia for the acute patient care, procedures, pharmacological/physiological immediate impact of my decision-making…. and no clinic visits.

Today, I’m covering the acute pain service on call.  My pager just went off for a consult.  A patient who is about 3 weeks out from an abdominal procedure.  This patient has been on chronic pain meds as well.  Not only do I get a page from the secretary on the floor to come see this patient…the secretary gives me attitude.  This is definitely NOT what I bargained for when I made the decision to become a doctor.

So, if you’re going to order the consult let’s follow these simple steps:

1) The primary service ordering the consult should page and make direct contact with the consult service.

2) Have all the information ready: i.e. last surgery, type of surgery, previous/home meds, and reason for the consult.

3) Be polite — the consult service is happy to help, but it makes it difficult when you bark orders.  We’re all colleagues…let’s add some professionalism to the mix.

4) When the consult service makes recommendations, please follow them.  If you ‘re not going to do the recs, then don’t place the consult.  If you want a “curbside” opinion, say so.

5) Make sure you page the correct consult service.  For example, we have an acute pain service and a chronic pain service.  Unless this patient has had surgery in the last 5 days, it’s a chronic pain consult.