Catch up!!

Well my New Year’s resolution has not been very successful over the past few months.  To say the least, it has been a very busy few months.  Let’s start with the most important stuff.  As most of you already know, I asked the beautiful and awesome Kristen Thomas to marry me. Lucky me, she said yes.  This happened over Easter weekend.  It was the perfect weekend.  She had no idea.  I proposed to her on my front porch where we had our first date.  A few good stories from the day.  We got Greek lunch and were eating it on my porch.  A front was coming through, clouds came out, and the wind picked up.  This was unacceptable.  I was not going to let the weather stop my master plan.  So we sat outside like I planned.  The wind picked up and literally blew the lettuce off my plate.  Kristen then asked if I thought we should just go inside.  I stated that I didn’t want the lettuce anyways and that I thought we should stay outside.  However, since the wind picked up, the temp dropped.  I was done eating and she was cold.  Perfect, an easy way to get the ring.  So I went inside to get her sweater.  I closed the door, got my “speech” and the ring.  With the door closed, I turned on my video camera, so the moment could be captured on video.  I turned it on and left the door open this time.  After a few minutes of my heart pounding while Kristen finished eating, I finally said my deal and proposed.  To say the least, she was shocked, but she said yes!!  And I got it all on video!  What a great way we will be able to recreate the moment on our anniversaries. 

With that big life decision in place, we have been trying to lock in the next big decision.  Where in the world to live and work.  We can live anywhere in the country which is not good for two people who could be happy just about anywhere.  So we have spent the past few months interviewing from Ft. Myers, FL to Asheville, NC, to Mattoon, IL to Elmira, NY.  The interesting thing is that each of those places at some point we said, ok, lets go there. We start to make plans to finalize our choice and something came up and made it not ideal.  It is really amazing how many times we have said, let’s go here and we have not gone there.  However, through it all, we have gotten to meet a lot of great people and see a lot of great places.  I write this blog as I am flying to New York where I hope that we will be living.  I am not going to write more, because I believe in superstition and I don’t want to jinx our plan that we are excited for.

So hopefully when I post this blog, we will both have a job and a place to live.  I cannot wait for that weight to be off our shoulders. 

I have 23 days left of work at Nationwide.  Time has flown by.  The month of June will go extremely fast as I try to wrap things up at work and say goodbye to everyone in Columbus.  Lots going on in June.  Three day work week this week with a round of golf with Tony on Friday, followed by two days at the Memorial Tournament.  Go Tiger!! Kristen comes to town the second week of June with graduation that weekend.  This will be an awesome week as Kristen and I don’t get spend more than 3 days together very often.  Plus, all of my family is coming into town for graduation.  Patti, Tim, TJ, Hannah, and Brett have not met Kristen yet.  We will be having a cookout all day Sat. June 12^th, so if you are in Columbus, you are invited.  Followed by a weekend of work with my b-day weekend and work graduation party the final weekend of June.

The best thing about finishing residency is that I get to somewhat control when I start my next job.  The plan is to take July and August off.  Kristen doesn’t finish until the end of July.  This works out great as I will be able to spend sometime in Sullivan for the 4^th of July, followed by a week in Denver with Matt before Ben’s wedding at Keystone.  Finally, get some time to visit Hopeton in San Diego the second week of July.  Kristen has the last week of July off, so we will be moving to hopefully Elmira, NY.

We are trying to figure out how to spend our August.  We want to take advantage of the time we have off and fly somewhere that is not easy to fly to when we take vacations from work.  We are still in the process of trying to find the best place. We wanted to hike the Inca Trail in Peru, but we booked too late as all hiking permits have been sold.  We then thought about hiking Mt. Kilimanjaro.  We think there is a travel warning for Kenya, so I am not sure if this will work either.  So if you are ready this and have ideas as to where to spend four weeks in August, please let me know.  The hard part about August is that a lot of the places we want to go to, it is Winter (Argentina) or deadly hot (India and Egypt).  My plan for our trip is to blog everyday about our experiences.  I am not sure how real time I will be able to blog as I doubt they have wireless signal on the side of a mountain, nor do I want to carry a computer while hiking.  So that means that I will for the first time in my life try to write in a journal, yes pen and paper style. 

Trying to think what else I need to write about to catch everyone up.  Most of my time outside of residency has been traveling to find a place to live and work.  Lots and lots of stories there, but I don’t want to bore everyone with the ups and downs.  The good news is, I am excited to hopefully be flying to a place where we will both have great jobs and be living in the Finger Lakes.  Google it.  Beautiful place.  A bit more slow pace, which I cannot wait for.

Hopefully within the week, I can blog about confirmation on a job and maybe even a place to live!!!!!!

All electronic devices need to be shut off as we are approaching LaGuardia.  Bye for now!

Airplane thoughts

Well tomorrow marks the final countdown until the end of my residency. T-100 day!!!  What does that mean?  Well that means I have to staff 8 more weekend days! I have less than 100 days to find a job, hopefully to start in September!  I need 60 days off from residency before I enter the real world.  :) However the bulk of my remaining work lies in the next 40 days. I have to finish my Master's project and present it at the end of April. I am very excited to get it done as it has turned into a very time consuming activity which is preventing me from other fun things at work. I also have another clinical rotation in April. All in all: I have a very very busy 40 days. However, I am highly anticipating my trip to Paris which conveniently falls the day after I present my Master's project!!!  Additionally, Kristen and I are trying find a place to start our careers in the next 40 days so I am very excited to explorer the possibilities.

All of these To Do's have me typing about them on my iPhone as I fly over Illinois back from Vegas. I am usually asleep before the plane is at top altitude. Vegas was a blast. It was Ben's bachelor party!  We watched more basketball in our days than I have in months. It was great. Vegas is nuts during march madness.

It was really cool flying here on Thursday. We flew right over Sullivan. I could see the high school, wyman lake, lake Shelbyville, etc...  It was a clear day. How ironic though that I had a window seat and that I was paying attention and that we actually tracked over the big town of Sullivan. I wonder what the 2010 census will be for Sullivan. What's the odds on over/under of 4400 people?  I didn't see the odds while I was in Vegas. :)

Damn that reminds me, I forgot to put $20 down on Illinois winning the NIT!  I did put $20 on OSU after Kansas got upset yesterday.

Not sure what to title this blog as it is probably the most random one to date.

Well my thumbs are starting to hurt from typing on this little screen. Maybe I can grab a 45 minute nap.

Car wash!!

Today was a great day...After months of getting in a salt encrusted car everyday, I was finally able to get my car washed!!  This usually takes me hours and hours after a harsh winter as the car needs a complete wash down, wax, carpet shampoo, floor mat cleaning, etc...  However, I finally got smart and decided to pay to get it washed.  I am usually against this for a few reasons.  1st: no one washes it good enough to my liking, 2nd the extra cost isnt worth it.  But after thinking about it, I realized that this was only true once I clean my car routinely.  After three months of no cleaning, it was most definitely worth the $35 to have it cleaned and waxed.  They did everything for me (except shampoo the carpet, but that would have cost me an extra $100 and all I need to do is the front floor board).  Have you ever gone camping for 3 or 4 days and you finally get to come home to shave and shower?  Well that is how I feel now that I got to clean my car.  And I got new floor mats with a gift certificate too.  Also, Mother Nature, I went ahead a packed away my ice scrappers so Columbus cannot have any more snow until I move. 

So within 25 minutes tonight, I got my car washed and waxed while eating a Chipotle burrito.  This was way better than spending 2-3 hours in the car wash parking lot doing it myself.  I do look forward to the day when I can wash it by hand again.    

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. 

Healthcare workers need to step up...

http://www.timesfreepress.com/news/2010/jan/18/smokers-need-not-apply-job/

I came across this article yesterday and it had amazing timing.  Walking into work yesterday, I was thinking about how unhealthy our society is.  The New England Journal of Medicine just published an article stating 1 out of 3 people are obese!  We have a huge obesity problem with the children in the Columbus area.  I was trying to think about how this all became about.  It just became the norm to be an overweight person.  As I walked into the hospital thinking this, I walk right by the parents of sick children smoking in the parl across the street from the hospital.  I wondered how poor of role models we are for our children.  We smoke and we are overweight.

As I walk into the hospital, I realize that we are not good role models in health care either.  Society cannot control parents, but we can control who are children look to in a hospital and in our schools.  It got me thinking.  Should we higher people in a hospital who smoke?  Even more out there, should we hire people who are obese?  These are very iffy topics of discussion, but it got me thinking.  If you were a child and you came into a hospital you see that the people who are supposed to be making you healthier are not even healthy themselves.  It makes no sense.  Health is not just about having a good heart or having healthy bones.  It is well rounded.  Study after study has indicated that smoking leads to many of these health problems.  Maybe we should ban smokers from working in a health care study.  I don't think it is too far off from reality.  However, where do you stop?  Can you really deny employment to someone who does something legal in their spare time at home?  I am not a fan of having the government control our lives, but I am a fan of providing role models for our children.  If you want to work in health care, then you should be a healthy person.  Do you take golf lessons from someone who cannot play golf?  Or take baking advice from someone who always burns the meal?  Of course not, you only take advice from someone who walks the walk.  We (people in health care) need to be healthier role models for our children.  We cannot accept the norm of having obese people treating our children.  I do not know where the line is.  I do not know if I could ever set the line.  This is a very sensitive topic and could have many unknown ramifications.  It is just a thought outside of the box.  I do however agree with the article.  When you become a health care worker, you are committed to the health of the community and the patients it deserves.

Disclosure:  All ramifications of such harsh decisions have not been fully investigated, so I would not support such an idea at the moment.  I do think it makes for interesting debate on how healthcare workers need to step up and walk the walk of a healthy lifestyle (whether that be smoking, drugs, obesity, etc...).

And an interesting facebook status related to the story: "Pregnant woman in hospial with chili dog in one hand and pack of Newports in her back pocket telling the nurse that ppl are trying to hurt her baby...."