Shoe Money Tonight

Occasional ramblings by an anesthesiologist/mother (and sometimes her husband).

Friday, October 20, 2006

It's OCTOBER Gorramit! - Part V: The Scouring of the Shire

As ES1 pointed out yesterday, our power is back. It came back on at 5:25 PM yesterday.

There are many people in the area still without power, now over a week later. We're down to the nitty-gritty of repairs. What's left is the rough, difficult work that they're rushing through as fast as the can.

In order to restore power to our street, for example, two 50-foot branches had to be removed from the power lines. They cut them down and left the pieces on the ground. There's about a 20 foot section sitting in our back yard, on top of our phone and cable lines. I've already called the cable company to fix their wires; I can't touch the branch until then. Even afterwards, I'll have to find someone with a chainsaw to help me cut it up.

There's still a couple of huge branches on top of our roof, as well as the garage. I've cleared the driveway and the deck already. Kenmore cleared our street this morning. See pictures here.

All in all, however, we faired well. I've gotten the groceries and beer restocked. The house is clean. The laundry is done. Tonight I had a borderline-tartar-rare steak, while ES1 had a baked brie. Later on we will be opening up the 18-year old Macallan. Updates on any other celebratory activities will be available only to subscribers on our pay site.

There's nothing like a natural disaster to bring out the true nature of a person. Driving through our neighborhood during the immediate aftermath, the thing you saw most was extension cords. They were laid across every street, so that neighbors could run their sump pumps. People helped each other out. In many cases, the reactions were truly inspiring.

Other people's true nature was also on display. 3 people stole a transformer. Several stores were looted. Worst of all were crimes against crews attempting to restore power, many of whom were from out of state. People stole wire, tools, and GPS units hoping to sell them. A neighborhood nearly rioted because they heard their power would have to be disconnected temporarily for repairs. Rocks and bottles were thrown at crews. Some dirtbags even threw snowballs and rocks at National Guard troops who were delivering food.

In more civilized ages, during time of emergencies, looters were shot on sight. Those who would prey on their neighbors during time of need, or attack those trying to help, are simply beyond help. Entire neighborhoods had to wait on power because of a few subhuman creatures. Many in these neighborhoods will then assume that racism is behind their delay in power restoration. I have no tolerance for such nonsense.

In our neighborhood, however, things are slowly inching back to normal. I have no idea how were going to clear that huge log out of the back yard. We had no appreciable property damage, however, and no injuries. There's not a tree in these 4 counties that hasn't either lost a large number of branches or has been simply destroyed. It's a miracle how quickly we've been able to get back on our feet. All in all, life is good.

Especially because the Sabres are kicking ice. Again.

Thursday, October 19, 2006

Happy Happy Joy Joy

As of 5:30 pm eastern time today I have power again!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I have survived a week of living at home for the first time since I got married two and a half years ago. I was at work today when Peter paged me to tell me they were working in the backyard and that the wire was back up on our house. Not to long after that one of the nurses (who was also one of the few left without power) called his house to discover that his answering machine was on and he too had power. My aunt and uncle got their power today.

According to National Grid, everyone should have their power back on by Saturday night.

While I'm at work tomorrow, Peter will be moving our stuff back in and refilling the fridge with fresh groceries. With dinner we're going to drink our best bottle of wine and crack open the really good scotch.

Friday, October 13, 2006

It's OCTOBER Gorramit! - Part IV: The Escape

At about 10:00 our power gave out for good. With all the power lines down, it could be out until Tuesday. The power line is resting on top of our garage.

We packed some clothes, our laptops, a couple of DVDs, and our Airport Base Station and headed over to ES1's parents' house. It's a mile away from our house, and it has power. We left the answering machine plugged in so we could call up and see if the power's back.

2 saving graces:

1) Friendly neighbors have a generator - they allowed us to plug in our sump pump so our basement doesn't flood as this 1.5 feet of snow melts.

2) No temperatures below freezing - so no worries about pipes.

So, it looks like we're refugees for a few days. We felt like wimps leaving, but if the power line had fallen all the way, we couldn't get into the garage. It was now or possibly never.

It's OCTOBER Gorramit! - Part III

As promised here are some more pictures.

I love Kenmore. They just plowed our street. They've brought out tractors and flatbed trucks to clear trees off the roads.

Seriously, if the Kenmore DPW were in charge of Alderaan, they would've had the place back up and running by halfway through "Empire."

It's OCTOBER Gorramit! - Part II

Things have gotten steadily worse.

Through the night we lost power a few more times - almost 10 in all by now.

Last night I helped our neighbor saw, lift, and remove a 15 foot leaf covered branch which had impaled his fence. This morning I awoke to find 2 more of those in the same spot, hanging off his power lines. I used my handy-dandy reciprocating saw to cut it into small enough pieces that I could lift over the line. I then hauled 3 more 20-foot branches down to the curb to clear the driveway so ES1 could get to work. A quick look up into the tree showed that about 1/3 to 1/2 of the healthy branches are just gone.

Then, she tried to go to work. Kenmore Ave (a fairly major road for those who are not familiar with the area) is completely dark. Many streets are down to single car passage due to downed trees. Power lines are down all over the place. ES1 got about halfway there before she had to turn around. Many lines were hanging so low that they would almost touch her Jeep. The snow was so thick that others may have been on the ground without her seeing them.

She turned around, came home, and paged my brother who runs the ICU that she's rotating through now. She's feeling guilty that she didn't try hard enough to get in. If she ever starts to doubt her dedication, I need only mention this day.

There are 2 downed lines in our back yard. Since our neighbors have lights on, I'm guessing they're phone lines. When the sun rises I'll take a few more shots and post them. More than a foot of wet, heavy snow has fallen.300,000 homes are without power. There's a restriction on water usage because they're still restoring power to the water treatment plant which covers 2/3 of Erie County. The lightning is still going strong, and some of the flashes have been green.

On the bright side we're both home and we're both safe. Anything that's going to fall, for the most part here, already has. Our damage was relatively light. We have power, heat, water, cable, phone, DSL, plenty of food, and a well stocked liquor cabinet. We've both got a snow day together. The temperature's supposed to go up to 47 today, so within a few days all of this will be gone. For today, we're just gonna stay in.

Thursday, October 12, 2006

It's OCTOBER Gorramit!

I love snow.

I love thunderstorms.

I love the rare combination of the two.

I do, however, think that October 12th is just a little bit early for snow. The pictures from the last post of me grilling were taken on Saturday. On Sunday, ES1 & I went apple picking with the unofficially extended family (more on that later) in gorgeous weather which was in the 70s.

Of course what I really don't like is the fact that very heavy wet snow has been accumulating on trees, weighing down the branches which are still full of leaves. As a result, trees and branches are coming down all over the place. The very large tree in the back yard has been shedding some of its healthy branches all afternoon. We've already had a small hole punched in the side of the house. Power has gone out 3 times already, for 20 seconds at a time.

Granted, in a few days it will all have melted. As of right now, however, this is not fun.

Pictures here. And it's gotten worse since then.

Updated 8/16/07 to correct image links.

Wednesday, October 11, 2006

Mmm... Charcoal...

Okay, so there aren't all that many things I do (that I can mention on a blog) which are unabashedly manly. So when I do, I revel in it.

There is only one way to grill.

Updated 8/16/07 to correct image links.

Saturday, October 07, 2006

A note on Code Status

Back in June, I linked to Fat Doctor's post on advanced directives and why it is so important to have one. Feel free to click here and re-read her say on the topic.

I feel the need to expand on one section of that topic, because working in the ICU it is something that often comes up. The "code status" of a person.

First a brief history on codes and CPR. This info is taken from The ICU Book by Paul Marino (a must have for any resident working in an ICU rotation). In 1960 JAMA published an article titled "Closed-Chest Cardiac Massage." It was based on 5 (yes 5) case reports about acute cardiopulmonary arrest. It concluded that cardiac massage was proven to be effective. This was the birth of CPR. In 1993 the Journal of the American Board of Family Practice did a 30 year review of in-hospital CPR. Of the 19,955 patients in the study 15% survived.

After the resuscitation there is the possibility of multi-organ damage and the potential for poor neurologic recovery. The longer the arrest time/duration of CPR the greater the risk of permanent neurologic impairment.

Codes are not like what you see on the medical shows. They do not work most of the time. When the do work, it is rare that the person is completely as they were before the code.

When you discuss your "code status" in your advance directive terminology comes in. DNR means do not resuscitate - no drugs, no chest compressions, no shocks etc. DNI means do not intubate - no breathing tube, no machine breathing for you. You can be DNR but not DNI, a DNR/DNI, or DNI but not DNR.

To be DNR/DNI is simple. It is clearly spelled out what you, the patient, wants done.

DNR but not DNI isn't a real problem either. There are situations where intubation for a short time will allow support while treatment of the underlying problem (acute heart failure, pneumonia, etc) can occur.

From a treatment perspective, it is the last one DNI but not DNR that poses a severe problem. We can do every part of the resuscitation process except put in a breathing tube. In order to perform CPR/recuscitate a person the first step is securing the airway, i.e. intubation. No amount of chest compressions to move the blood through the body will do any good if the blood has no oxygen to carry. Even if a person is young enough to get a blood pressure and pulse back, their brain has been deprived of oxygen.

In my mind this is doing a patient harm. I in good conscience could not fill out the paperwork to make a patient DNI but not DNR. And to be honest, I view my colleagues who do so with much less respect as physicians.

Keep this in mind when you're making decisions for yourself, and if forced to for your families. It's a harsh reality, but one that needs to be faced.

Friday, October 06, 2006

so so tired.

It appears that my day Wednesday set the tone for the rest of the week. I left work almost an hour late on Thursday. There were two open hearts and they both came out after 5pm and about 15 minutes apart. Then today, I got an admission at 11 and the next time I had a free minute to do anything (pee, eat lunch, etc) it was 3:30. And then I just kept getting more stuff to do. At least I left work on time.

BTW, I think I have the greatest husband in the universe. I called him to tell him how bad the day was and he graciously agreed to do the grocery shopping for us. So when I came home, I had nothing to do but get into a nice bubble bath. I just hope tomorrows a little less hectic.

Wednesday, October 04, 2006

I Hate Wednesdays.

Well, not really. I'm always exhausted once the day is over. I leave the house at 5:45am and come home at 10pm. I go from work, to Wendy's for dinner and then to rehearsal from 7-9:30. I'm always so tired when I get home. This is one of those days where it's hard to recover if it gets started on the wrong foot. Like today's did.

I'm on an ICU rotation right now, covering surgery patients. It's never a good sign when you walk in and see a crash cart outside a room that was empty when you left and 2 surgery residents standing in front of the room. The patient had been coding off and on since 2am. Its now 6am, his epinephrine is going at 100cc/hr and his norepi is going almost as fast. Pink frothy secretions are coming up out of the ETT. The systolic pressure's in the 80s and the heart rate's in the 40s. So I was busy for an hour until the family decided not to prolong the inevitable. And you can guess how the day went from there.

Thanks. Venting over. We will now resume regular programming.

Random, Not at all (necessarily) Alchohol Induced Miscellany

1. Another heartwarming story from a place with a lot more good stuff going on then you'll ever hear reported on the news, courtesy of Op-For.

2. I don't know if it's the line itself, the voice with which it is spoken, or just how little sleep I've been getting in the last few months, but for some reason, every time I see the trailer for Employee of the Month, I wait for a certain line at the end which just cracks me up every time:

This is an '81 Honda - HOW DARE YOU?!?

It's probably the lack of sleep.