Another milestone

Originally written 4/18/2007:

I bought a plane ticket yesterday for a trip to Dallas. When I was traveling in college, I was short on money but had vast amounts of time. It seemed like no trip was complete without a layover in Atlanta or Chicago or Saint Louis.

For the last couple years when I've had a salary, however, I've noted that my subconcious mind has started to assign value to my time. Who wouldn't pay $10 more for a direct flight rather than sitting in a dull midwestern airport for a couple hours on a layover? But exactly how much is my time worth? How much more would I pay for a direct flight than a trip with a layover?

Various factors I might consider:

• $ = The difference in price between the direct and indirect flights (of course)
• L = Length of the layover (A forty-five minute layover is more tolerable than a 3 hour one.)
• t = Overall length of the trip in hours (The difference between a 10 and a 14 hour trip is not as great as the difference between a 2 and a 6 hour one.)
• c = Convenience of departing and arriving times (It's not fun to arrive at JFK at 10:00 PM the night before I have to work.)
• V = Length of the vacation or time off
• S = my salary in approximate dollars per hour

I spent a little time trying to devise a general formula, but it got tedious. All told, I was on the verge of paying $60 extra for a direct 3 1/2 hour flight rather than buy the $230 flight that took 7 hours. A little nudge from a fellow resident who only flies direct if she can help it was all it took.

More milestones and angina

Four miles in 28 minutes: Wednesday, June 5th, on treadmill.
Four miles at 1% grade: Done today, on treadmill, in under 32 minutes.

On Saturday I ran the big loop again in the park with Justin and Ezer, My time was right at 52 minutes, which is a full minute slower than my best time; then again, it was considerably warmer and very humid Saturday morning.

The last half-mile or so, leading up the hill to the corner of Central Park West and 110th Street, I really started pushing myself. Within 100 meters of the end, however, I started feeling chest tightness that radiated to the neck and nausea! The sensation stopped nearly immediately once I slowed my pace.

I know what exercising at 15-16 METS feels like, and I believe I was doing considerably more than that, given the grade of the hill and my speed. But still, the experience brought about a good deal of existential clarification when it comes to the concept of angina. I suspected that I was feeling a demand ischemia.

I mentioned this experience to one of the ICU Anesthesiologists, who scoffed at the idea that the pain was cardiac in origin. He mentioned chest wall tightness. I'm doubtful. Theoretically, if the heart rate were not limited by intrinisic properties, someone young like me might push his heart rate to the point where the organ demands more oxygen than can be delivered. This doesn't mean I have coronary artery disease. Just a heart that can beat faster, perhaps, than it should.

It's hard to imagine someone feeling the sensation I felt (but sustained and not relieved by rest) and not take himself immediately to the hospital! Scary!

And if you work for Aetna and happen to be reading this, my identity is obscured for a reason!

Open mouth; insert foot

Two, yea, three things of note happened whilst on call last night.

1. I finished a case around 2330 and crawled into bed at midnight. The pager was silent. I awoke at 0757, three minutes before my alarm was set to go off. I got more sleep on call than on any night for the preceeding two weeks. That's how a call should be!
2. While stopping by another first-year resident's operating room (for reasons that do not need discussed here), the surgeon asked for 4000 units of intravenous heparin. Because I was standing between the resident and the cart, I opened a syringe, drew up 10cc of the standard concentration of heparin (1000 units per cc) and was about to label it when the resident took it from me. "What's this?" he asked. "Heparin." "What concentration?" "The normal--1000 units per cc." "Then why did you give me 10cc's?" "Because the surgeon might ask you to give more later." Without a word, he then proceeded to open the cart's drawer, and pulled out another vial of heparin. "Was this what you used?" "Yes." At this point, he looked into the trash, rescued the empty vial from which I'd drawn up the syringe, and compared it to the one in the drawer. At this point, the surgeon asked if the heparin was in yet. Only then did he administer it!
3. I was talking to a patient whom I was originally going to take care of, but who was now going to have anesthesia administered by another resident. She'd requested that I take care of her (since she'd had me twice before) but it didn't work out. We were in the preoperative holding area, and she was going to have her surgery in an hour or two. Feeling a little bad, I gave the nearly-eighty-year-old's hand a squeeze and said, "If you're still around tomorrow, I'll come by and see you." The double entendre, unfortunately, was lost on no one!

Nessun Dorma

Can you get tired of the aria? (Probably. That's where the discipline of self-retraint comes in useful.) One of the anesthesia attendings showed me this youtube video of an amateur singing it. Quite good. See for yourself:

Paul Potts sings Nessun Dorma

His voice has a certain resonance, clarity, and intensity. And one of my favorite aspects of the video was watching the female judge's expressions and reactions. Note her nearly gasping for breath at the musical climax! The sweeping camera shots at the very end of the aria are a little cheesy, but still effective.