A good post call day

I'll have to write about the excitement at the end of my call night some other time. Today, however, was a good blogging day. I finished my shift a little after 0800 and went first thing up to the Marshall's in Marble Hill to look for a new shoulder bag since my old one, courtesy of my old violin teacher, Ms Morrow, is more than ten years old and showing its age.

At Marshall's I found several more good buys: new dress socks, a stove-top espresso maker for $9.99, a good-quality shoulder bag made by the makers of the Swiss Army Knife, athletic pants that are actually long enough without being wide enough in the waist to fit in two of me, and a pair of Timberland casual brown slip-on shoes.

I slept for a few hours at home before venturing out in the first winter storm, or Nor'easter, of the season. The mental image I have for Nor'easter is thick swirling flakes resulting in a gleaming blanket of freshly fallen snow. This, strangely, was not concordant with my experience of a slushy wintry mix that made the sidewalks slippery and produced a slurpee-like bog at the bus stop's curb. The most pleasing image from the "storm" was seeing small trees' spidery branches covered in a thin layer of clear ice.

After a little exercise at Columbia's fitness center, I met up with Lauren and Maurcio at 116th and Broadway, where we boarded the 1 Train to take us down to SoHo where we had hot chocolate at Jacques Torres. Mauricio and I had the "wicked" hot cocoa (spiced with chili pepper) and Lauren had the incredibly dainty espresso. I mentioned to her that I might feel annoyed if I'd ordered espresso and gotten the mere tablespoon's worth her cup held. Only then did I realize that she too was slightly annoyed with her portion size!

We wandered for an hour or so around SoHo and the West Village where we made stops at a cheese shop, the Magnolia Bakery, and the Chess Shop (see picture above) where Tyler, a friend of Lauren, was working. Only in NYC can you find a shop devoted to chess...and the rival Chess Emporium was just across the street! The Chess Shop, however, had a better atmosphere and a good-sized room with people playing chess for $2 an hour. It was the sort of place where one might pull out a pipe to smoke and was slightly run down, whereas the Chess Emporium seemed newer and more commercialized. The "Starbucks" of the chess world, if you will.

Mauricio came over for a light dinner of leftover zucchini soup, toasted turkey sandwiches, chips, and a Magnolia cupcake, and I got to spend the remainder of the evening tucked in bed reading and writing this post. Ah, the only thing lacking from the post-call day was a crossword puzzle...

4 8 15 16 23 42

Some numbers follow me in life. Take 113. My address growing up--113 Horseshoe Drive. Also the URL of this blog. It's one of my numbers. I also like 259, the number of the highway that runs north/south through my hometown of Kilgore, Texas.

One number that has recurred on multiple occasions is 352, so I'm officially embracing it as another one of my numbers. Its appearances are impressive:

• The prefix of my telephone number in the city where I went to medical school and internship
• My apartment number during internship
• My violin locker during undergrad at Baylor for four years

The violin locker has one of the more interesting stories. I was visiting campus with a friend of mine who was about to start grad school at Baylor. I took Jessica by the music building to show her my old stomping grounds, and eventually we wandered over to the music lockers. I knew, of course, which row my locker was on, but its exact location, five years after graduating in 2001, was lost to me. I pointed vaguely to a locker and said, "I think my locker was around here."

At this point, Jessica started laughing. I'd pointed to locker 352, but at that point she probably didn't know of 352's recurrences in my life. What she was laughing at was that there, next to the number, was a faded label with my name penciled in! After five years with surely at least two different occupants of the locker, no one had bothered changing my name on the locker. And now, a year and a half later as I remember the incident, it seems like there was something unusual within, perhaps a little plastic Mozart figurine or something of the sort.

So thus, the sequence begins: 113, 259, 352

Fun website

Are you a nerd? Do you like geography? Think you know the 50 states pretty well? Well, look no further. This website is for you.

Another OB story

Dr S, the chief of the obstetrical anesthesia division, has been promising to tell us the story about F.C., an interesting patient of his from several years back. He didn't have the time today to tell us the story, but instead related another interesting anecdote.

The day started normally with a couple epidurals for women in labor, overseeing a cesarian section, the usual. He was called to one of the labor rooms with another epidural request. When Dr S walked in, however, he noticed the patient lying stark naked in bed, in labor. A little unusual, perhaps, but nothing too remarkable. After all, patients are very frequently naked in the operating room, though we try to keep at least part of them covered when they're awake.

The vibe here was different. Dr S soon picked up on why when he looked up and saw the patient's husband sitting in the chair beside the bed...also completely naked. They were evidently the "crunchy granola types" and preferred the "natural approach." (Why they were in a top-tier medical institution requesting an epidural rather than squatting at home on the kitchen floor with a bucket of warm water, a pair of gleaming scissors, and some fresh clean towels, I cannot say.) After taking a moment to register the situation, Dr S regained his cool and explained the process, benefits, and risks of an epidural to the patient, who wished to proceed.

As if that weren't weird enough, the story doesn't end quite there. The patient then requested that Dr S remove his clothing before he placed the epidural. This was part of the" natural approach."

This led to a series of musings:

• Hospital policy does not explicitly require that one wear clothing while placing an epidural. It does require gloves, a hat, and mask, though. Would the family object to the hat and mask?
• What, if any, extra documentation would be required? "Patient identification confirmed. Risks, benefits, and alternatives discussed. Consent for epidural obtained. After proper hand hygiene and removing my clothes, the patient was placed in the sitting position. Sterile prep and drape..."
• Was the husband sitting on a towel?
• Where would one put one's pager?

In the end, and probably in part because of the multiple quandaries raised by the circumstances, Dr S told them no, he would remain fully clothed for the epidural.

Epidural hubris

So I just finished doing a combined-spinal/epidural on a woman who has had scoliosis of her back repaired. The usual risks of neuraxial analgesia--inadvertant dural puncture, headache, difficulty placing the catheter--are all greatly increased in patients with a history of back surgery.

This patient was in the hospital last week for induction of labor, but when the obstetrical anesthesia fellow wasn't able to place the epidural, the patient was sent home.

She came in tonight in spontaneous labor, and again requested an epidural. This time I was on duty. And can I say that--*boom*--one one attempt, the spinal was given and the epidural catheter threaded easily!

On this note of success, it's now time to hand off the primary pager to Todd, my co-resident who's been sleeping peacefully for the last few hours, and it's my turn to hit the sack.