Life in the PICU (Pediatric Intensive Care Unit)

I have been spending quite a bit of time in the past month in the PICU doing one of my clinical rotations for my residency.  I do not have much direct patient care interest, so the rotation is not one that I have been looking forward to all year.  After all, I am doing a residency in administration.  But the month has challenged me professionally and personally.  It takes someone with a special mind set to work in this environment for their career. 
The average length of stay in our PICU is just over two days.  We round on 25-30 patients a day.  So in seven days, I see about 50 different patients. 
Most are babies that come in with RSV (a respiratory virus) having trouble breathing and we help them while they fight off the virus.  The vast majority of them leave in good shape.  Seeing these babies on rounds has forced me to think a lot about having kids.  Before this month, I have not really challenged myself on the timing of having children,etc...  Seeing the kids in the ICU makes it look easy and glamorous.  Most of the kids are intubated, so they do not cry.  They just lay cuddled in their blankets.  It makes parenting look easy.  I only remember two kids in the past month that have been screaming as we round. 
Another set of kids that we see are asthmatics who have an episode so they get sent to the ICU for observation.  These kids also make it look easy to be a parent.  Most of them are well behaved at this point, because they are just happy to be able to breath again and are not complaining about the TV station or their siblings.  They just lay in bed happy that they do not struggle to breath.
However, the third set of kids we see is very sad.  These kids have a genetic disorder.  They have never lived a "normal" day in their life and they never will.  Some are adopted.  These kids make me realize just how awesome I have it.  I never spent a day in the ICU.  I never had to get treatments as a kid. And I have a "normal" future ahead of me.  These kids do not.  Very sad.
The fourth set of kids we see are cancer patients.  Once again very sad.  These kids were lucky enough to have a normal life for some time span.  However, these kids have had to fight like hell for parts of their young lives.  It is almost more sad to see these kids as they have "normal" parents.  Some of these kids know what they had and what they could have had.  Very sad again.  When I say "normal" I am referring to someone that I could see myself being in a similar situation as them.  Someone who is not totally different from me.  Someone who could have been my parents.  Example: not abusive, not a drug abuser, seem educated, etc...
Some days I go from seeing a child that came in sick, but is getting better where I get excited to start a family one of these days.  Then the next room I see a kid who used to play baseball and run track fighting against cancer.  And his neighbor has a random genetic disorder.  What if I have a child that is the latter of the two?  That would be horrible.  It would be horrible for any child to be the latter.  How horrible it must be for the parents.   Some kids I never see the parents.  Others, I see them EVERY single day.  Not every other, but everyday!  How amazing they must be to see their child laying in the bed.  I can only begin to imagine what they are going through. 
So it is crazy the thoughts you get as you round on all these different types of patients.  It forces me to think about all this stuff.  Happy thoughts and sad thoughts.
Being in the ICU daily, has also forced me to think more about death, the thing I am most scared of.  I have been lucky to not have had one patient who we round on die.  But some, it is evident that it isnt that far away.  But who knows the time of death.  Anyone of us could be gone tomorrow.  Being around the sickest of the sick just makes me think more deeply about it.  I try to look down the hallway to the kid who is getting better and had their entire life ahead of them.   It makes me appreciate life and my health.  That was the reason I wanted to be a hospital pharmacist nine years ago.  Working in a hospital keeps me grounded.  Should I really complain about the cold weather?  I bet PICU- bed 20 would love to be outside with cold hands.  I still complain, but just hopefully less. :)
I do want to mention my two favorite times during the rotation.  Two weeks ago.  We are rounding with a physician who comes across a bit "cold." Very nice guy, but he has been an attending for I am guessing over 20 years.  So things do not bother him.  He has kind of seen it all.  We are all standing in the hallway in the isolation pod, so there is a clear glass door.  As we are finishing with the last patient in the pod, he stops and says, "Wow, it's [insert name here :)]"  Of course, I had no idea who she was.  He walked out in front of us and said hello.  Her mom said, "she just wanted to come down and thank you." and at that moment the little girl gave him a big hug and thanked him.  He hugged back for a moment and they exchanged some quick words.  The girl was obviously shy.  The attending had the biggest smile on his face.  And I can count the number of times he smiled on two hands. She had been in the unit for some time and was finally being discharged from the floor and wanted to say thank you before she left for home.  Kind of cool to observe.
 And today...We are rounding on a patient in a big long hallway that stretches the length of the floor. We are in one corner.  We notice that there is a crowd of people down the hallway at the CTICU side of the unit (cardio-thoracic).  The fellow stops rounds and says..."I think that is [name]"  He quickly jogs down the hallway and goes up to the little girl and gives her a big hug.  I have no idea what was said.  I asked one of the team members who she was and she told me that the girl was in the unit for over a month and multiple times they had thought the girl was dead.  She had been on ECMO for a long time.  He came back to the group and told everyone her story.  She was blue one day when he rounded on her.  He couldn't believe the girl was walking and talking.  He had a huge grin on his face and said "that is why we do what we do."  Cool moment.
I will not forget these two moments.  I think as pharmacists we do not get to see this kind of interaction enough and we can tend to forget the big picture.  He do not get to see the sick patients come back walking and talking.  There are so many miracles that happen at Children's and all other hospitals across the US.  Like the fellow said, that is why we do it.  To better the lives of our patients. 
Although I enjoy those moments, I am not a one on one helper.  These practioners do amazing things for each and everyone of their patients. As much as I love seeing it, it isn't how I want to make my stamp on health care.  I enjoy making decisions that affect the care of hundreds of patients in the hospital.  I enjoy providing a safe environment so people who are way smarter than me can do what they do and help improve the lives of our patients.  It is what makes health care so complex and awesome at the same time.  Everyone matters.  If the housekeeper had not cleaned the room properly before one of those two patients got admitted. There could have been a bacteria growing that could have taken their life.  If the person caring the food trey does not wash their hands between patients, everyone is at risk. If a X-ray tech does not shoot the right film the first time, therapy could be delayed and crucial decisions and turning points could have been passed.  If the COO does not authorize the appropriate funds so the CNO can hire the appropriate number of nurses, patient care would be affected.  And of course, if the pharmacy director does not provide the proper clean room and work environment, the pharmacy technician cannot adequately prepare doses for the pharmacist to check.  I better throw in the surgeon too. :)  If the surgeon does not take the time to double check the limb to cut or make the appropriate wound closure, patients will be harmed.  Everyone plays a part.  I cannot imagine the number of decisions and steps in a patient's care that are done daily.  Some more crucial than others. 
To sum it all up, I am happy the month is over tomorrow and that I will be able to get back to a more administrative day than a purely clinical.  I did enjoy the experience in the ICU as it was good to be back on the floor interacting with the entire medical staff.  It was good to get the reminder of why I do what I do.  We work to improve the health of our patients.  

Surviving New York City's New Year's Eve Ball Drop

When Kristen and I decided that we were going to battle the NYC crowds and see the ball drop live, we searched and searched the internet for tips on how to make it as fun and stress-less as possible.  We didn't really find a good site that gave good advice (where to stand, how early to arrive, how it would all go down, etc...).  We were able to piece together various sites and got a little lucky in our adventure and ended up having an amazing time.  I wanted to blog about our experience for 1) memories and 2) in case anyone wants to take on the challenge.  I am going to write this as a story and try to insert advice/lessons learned.

Everyone knows how busy Times Square is.  There is Carson Daly and all sorts of other celebrities with about a million people in a very small area.  For anyone who has experienced crowds in NYC, you know that these events can create cattle herd like environments.  However, with adequate planning and direction, it is very manageable.  Here is a run down on our time.

We took the subway to Times Square about 1:00.  We were told that the cops start sectioning off the streets about 3ish.  This was true.  They sectioned off the streets starting at the ball working north.  We decided to camp out right next to Carson Daly's stage.  This put it right by the action.  Advice: 1) get to Times square about 2:30ish to pick out your spot.  Even if the cops do not get to your section until 4, it is nice to be ready for when they come.  2) Buy a folding "seat" when you arrive (see below).  This will give you something to sit on while you wait for the next 10 hours.  

When you get put into your section or what I will call pen, make sure to position yourself to be at the front of the pen. This way you will be able to see the celebrities as they walk by.  If you are claustrophobic, then stand in the back of the pen as there will be a lot more space.  I am not a big celebrity watcher, etc... but you get into it here, because it gives you something to do as you wait.

Now that we were positioned in our pen, right in front of Carson and in the front of the pen, we were set.  We to TS 11 hours early and probably got into our pen about 9 hours before midnight.

Once we got into our pen we hung out.  They counted down each hour to honor a new year in a foreign country.  It was also nice, because Carson was on stage fairly early in the afternoon to entertain us as well.  Probably the best advice I can give is to do this with someone that you like and that passes the time by fast.  11 hours of standing is crazy and can be brutal.  Luckily, Kristen and I had a good time hanging out, so the time went by fast.  Speaking of 11 hours early, how in the world do you prepare for such?  Remember folks, no bathrooms in the pens.  Do not drink all day long.  I had one glass of milk for bfast at 9am.  We went to the bathroom right about 2:30 before the cops came to section us off.  This was vital to our success.  Additionally, dress warm and bring an umbrella.  It snowed in Manhattan on New Years, but rained in TS due to the heat of the lights and people.  Crazy to think about.  Rewatch Rhianna at the Rockefeller, it was snowing pretty hard.  Watch Carson's show, all rain.  Furthermore, bring snacks in your jacket.  We had plenty of protein bars, etc... Do not even contemplate alcohol or any liquids.  The last thing you want is to have to go to the bathroom before the ball drops.  Once you are in the pen, you are not guaranteed to get back in if you leave for the restroom.

It was important that we got the front row, because about 8 oclock, they handed out tall hats and balloons that made it hard to see.

 From 6-12, there was entertainment over the mic, on the big screen TVs, celebrity watching, and listening to the performances.  It was hard to watch the big stage performances, because it faced another stage with cameras on it.  There wasn't a great place to watch it.  Our location in front of the Marriott Marquis was amazing.  Every celebrity walked by and we were at the bottom of the stairs where Carson's guest entered.  However, if we would have bee across the street, we would have been on TV multiple times when they brought Carson back on.  Toss up on my recommendation.  Better celeb watching on Marquis side, but TV on the other.

(Mayor Bloomberg)

The energy and excitement from being in TS was awesome.  We were on soo many different videos.  We did see ourselves on the Budweiser video screen.  Kind of exciting. After hours of enjoying the energy (and some moments of boredom).  The ball dropped.  It was amazing and worth the long wait.

Well, I think that about covers my story...
To view more of the pictures click here

Fighting Cancer

Well after some blog hibernation, I have finally decided to take the five minutes to blog.   I have a few topics that I want to blog in the future: 1) How to survive Times Square to watch the ball drop  2) My trip to California  3) My future plans after residency.  Stay tuned...

But, I want to take the time to spread the word about what my brother is doing.  I do not want to re-write what he says, so check out DetermiNation.