Tuesday, March 17, 2009: St. Patrick's Day, Tyler's Birthday, No IV day.

I woke up this morning to the faint odor of staleness. In my half-stupor, I began feeling the sheets and pillowcases around me that were tinged with my iv fluid that was supposed to be going into my heart. On closer inspection, the iv tubing had accidentally been pulled off and 30 ml/hr was dripping all over the bed. I used to practice being blind when I was little, so that I would know how to do something in the dark. 

I am drifting off to sleep as I try to stay awake long enough to make my entry. The world does not have enough places of recognizable reward. So I talk to our wonderful Lord Jesus. There were many times that I spent, giving my sufferings over to Christ. 

1. God woke me up with the wetness of life, an astounding sense of humor upheld.

2.God woke me up this morning with a large sense of fateful people just spontaneously and erratically

3. God woke me up this morning with my iv disengaged from my PICC line. Praise to the Lord.

Miracles, Education and Inspiration

March 16, 2009

Today, I contemplate all those who have helped me. To my beloved father who awaits me in Heaven. To my Mother Renee who has always been there for me, and who continues to give me advice. Others who have believed in me: my son, husband, and little daughter. Professionally and personally, my years at Stanford University School of Medicine were by far the best professional years of my life. Here, I loved going to work every day as an anesthesiology doctor in training (residency). I was treated as a person with a brilliant brain (albeit up for question by some), in sharp contrast to over-rigors I suffered at LAC-USC Medical Center. Here, several Attendings believed in me while my peers seemed over concerned with my life.  

As I begin another route, another path to physical wholeness, I must pause and thank Dr. Nabil Rashad, Dr. Thanga, Dr. Steve Haddy, and Dr. Vladimir Zelman. You helped me take my assigned ICU cases into the ORs, making me cemented in caring for the critically ill. Thank you for all the ICU patients I had to take into the ORs...the old lady with a stroke, the young man who is now paraplegic from inflicted gunshot wounds. I had to analyze their iv lines, central lines, arterial lines, and take the patient off the ventilator. I had to squeeze the AmbuBag over and over again after trachestomy after tracheostomy after tracheostomy. Perhaps my peers were trying to make my life difficult; this I felt was true.

 A single parent through medical school, internship, residency, and Critical Care Fellowship, I eagerly sponged up my guts to make it through, one day at a time. Not many people know this of me, but I left a full scholarship spot in medical school, trading it for a better chance for my son to live better. What a compliment it is, to have our children give us new perspectives in life. 

My child was crying every night I was a single parent in medical school. My decision was easy. I wanted it all. A family, a profession, and success in spite of obstacles. Thank you to an elder medical student who took me by the hand, and off we drug ourselves to the Dean of the School of Medicine. She helped me acquire a letter of recommendation and official transcripts of my classes already taken. Sealed, stamped, and ready to carry. I left Oklahoma the next day.

Off from Tulsa, Oklahoma we got into my red 3-cylinder Chevy Sprint, together with a few clothes and many medical school books. I left an entire 2-bedroom apartment full of furniture and all my personal effects: antique photos, canopy bed, towels, everything. Thank you to the unforgettable Medical School wives, who helped box up my apartment up and put things in storage. Thank you to the best buddy truck driver who not only picked up my boxes, but also brought them to me in California. And sent me my first dozen roses, for my graduation from USC Medical School. I had always joked that I received more roses from my patients, than from men. As a single parent, I was too busy putting whatever leftover energy of the day that I had, back into my child. Sure, I failed at many things. Sure, I made mistakes that I am sorry for. And sure, I learned a lot. And helped the sick. I saw the door to Heaven, so this confirms that my past life must be okay with God, that He forgives me for my sins of comission or omission, such that I will be ready to go to Him when my Time is again at hand.

Thank you to the nurse midwife that talked me into going into Anesthesiology. God was watching out for me when I was accepted to the only programs I selected: USC Anesthesiology Residency, a transfer to Stanford University School of Medicine for completion of Anesthesiology first, and then acceptance into their prestigious position as one of the Critical Care Fellows. Had I known that Stanford Anesthesiology and Critical Care would be, in reflection, the best professional years of my life, one would think that I would have enjoyed it more, taken more chances, accepted more dances.

But I remembered that my father used to always tell me, "I just LOVE going to work every day! I can't believe that I actually get paid to do what I enjoy! I can't wait to get to work every morning!" Stanford Anesthesiology program, thank you for teaching me innumerable lessons. Believe me, I loved going to work every day, and the Hospital and its ICU were my home shelter of love and acceptance. I was so well trained that any Attending Physician had to go through me or another Critical Care Fellow to admit a patient to the ICU, and my Attending Anesthesiologists would always back me up, even if that really mad Attending decided to raise the bar a little harder and go tell my Attending his/her problem with me. Thank you, Drs. Rosenthal, Pearle, Mihm, and Feeley. To Jocelyn, Maria, and the nurse that got killed on the Life Flight helicopter in bad weather: you all helped me retain my sense of peer friendships and unconditional love. You kept me going on, from day to day.

Almost 3 years after the car accident, my iv PICC line is churning at 29 cc/hr. At the newest hospitalization 2 weeks ago (I think the total is now 25 hospitalizations since the car accident), for 5 days Dr. Cannom was able to save my PICC line as Neurologist Dr Verapamil (not his real name, but I believe the drug gave me back the lacking cerebral perfusion pressure to allow tiny, single-file, red blood cells to carry oxygen and nutrients to the master computer center of the body, the human midbrain) made a new diagnosis: that of Basilar-type migraine. It is only the beginning of this miracle of cerebral perfusion. 

Walk with me and see what I can do. If I can do things, you can also strive to do them. Do not take, "No" for an answer. Make things happen in your own life, as I have. Be the miracle. Feel your body shivering as you get up out of bed and trust in the Lord, knowing that you should have died 5 times in the last 3 years.

Whereas before, I could not get out of bed without taking iv ondansetron, now I can get up slowly and carefully balance on my cane.  I can walk! Whereas before, I would have to wait an hour for the iv ondansetron to take effect, now I can brush my teeth when I first wake up in the morning. From being bedridden to being in a wheelchair, to walking with a cane, the Lord has indeed given me the miracle of a walking life.

I can not end this entry without thanking my husband for sticking with me. The words I have to say to him? They are too personal to list here, and he already knows the joy I have in being a family together. I also thank all of my caregivers for their love and patience with me. Even though food disappears out of the refrigerator, toilet paper is missing in bulks of 10 at a time, and a set-aside-to-do-the-dishes ring disappears. It is hard to find a consciencious, caring, actively working caregiver to feed the sick, change the sheets, and help me walk from place to place. 

I probably have not been the best patient in the world, but understand that I fought for myself whenever I thought it was necessary, and I used every bit of my medical training to keep myself alive. With God's Blessings, I go now to take my usual 3-4 or 5 hour nap of the day. I envision my brain as it heals itself unto this deep sleep.

If God permits, I will awaken to the sound of the birds outside my window seat, and my eyes will open to watch the baby hummingbirds flitter outside the leaded glass window. For now, that is all that I ask. Once I wake up, I will give thanks to God for another morning, for another evening. I give thanks simultaneously as my orbital muscles contract so that my eyelids go from a closed, to an opened status. I will ask Him for my assignment for the day, and I will carry out my day for Him, with Him, and in Our Lord Jesus Christ.

Whatever lies before me now, you will be able to live through with me as I attempt to share my blessings and my Faith in God. As I am now tired, I will start tomorrow to carry you with me as I walk in my shoes of thunder. Never a dull moment. 

You will start out tomorrow by carrying my 5 lb CADD pump for me. I'll tell you the rules of the game in the morning. In the meantime, may I leave you with this parting thought: there are many of you that are not able to keep up with a medical diagnosis, or a special or rare abnormality that the doctors have never seen nor read about, perhaps because it is rare. You can still question the doctor's plan regarding your body, you can make your own deviations with your doctor's consent so that your health care is tailor-made, and you do have some control over your life, your shoes, your clothing, and your money. In the meantime, I'm putting in another bag of iv fluid, and another 9 Volt battery. I will listen to the hum, drum and drip, drop 30 times a minute, as D5NS courses from my left antecubital area into my right superior vena cava. I will listen to it all day and all night, 24/7.

My advice for the day (check with your doctor first): Be the Best Person You Can Be. 

Just one day at a time. Take a long shower. Start afresh and walk through life with me. Say one prayer for me. Say one for someone else you know. Prayer really does work. This is not a cliche. I should have been dead by now. The least you can do is to pray for your children, every day. God will protect them and save them from harm.

God wants to use my life for your inspiration, for your nightly peace, and for your future inspiration. 

Another PICC line infection

After going to Chicago, seeing old friends, and then the famous camping out at a neighbor's back yard and sleeping in a child's teepee a couple of nights ago, I have had an awakening. Listening to lectures on the brachial plexus, listening to 'doctor talk'.....it re-awakened a different part of my brain. Everyone says I look much better. I still need help keeping my balance, remembering which of my 32 medications to take and when to take them. Most importantly, it looks like I may have a neurogenic bladder and I have an appointment with a urologist tomorrow. Hopefully, I won't pee in my pants before then. I met a lot of my neighbors, ministered about God with a very Godly man, was inspired by how inspiring my 'story' was to new friends, and was at so much peace to see children and families having such a great time together. I loved singing to the Eagles on guitar by several gentlemen who knew how to play. What follows is a synopsis to catch you up to today. It will be peacemeal, just so you know, since my thoughts go back and forth over this last month.

"Went to a garden party......

You can't please everybody

You might as well please yourself"      Ricky Nelson

The single Mom in me, the disabled Mom in me, and to the physician in me. I'm going to start taking better care of myself. At the suggestion of the manager/owner of a local store, I started taking some homeopathic mushrooms to boost my natural killer (NK) cell activity by up to 300%, consolidated calcium with Vitamin D and magnesium (I'm constantly hypomagnesemic), something for imbalance in my system, a natural product for constipation. My new motto, since the Chicago trip, is "Simplify life and maximize health". Really, I just don't want to have a PICC line infection every 3 months. I'll run out of veins.

Oh, boy. Important things to catch up on: bout of cystitis (bladder infection) a month or so ago where I was peeing not only in my pants (hello 80 year old group ;-) ) , but more. I was passing blood and blood clots through my urine (how do you spell P-A-I-N) so much that I have another story for you.

4 weeks ago, my caregiver dropped off a sample of urine at my primary care physician (PCP) that looked cloudy. They do the dipstick test, checking for blood, white blood cells that fight infection, nitrite that the bacteria produce. Needless to say, it was positive, otherwise I would not have sent it in. (I had all the symptoms of a urinary tract infection (UTI: frequent peeing, pain during peeing, feeling like you need to pee after you just did it. In my book, antibiotics and pyridium anesthetic for the urinary tract, go together. So if your doctor tells you that you have a UTI, make sure and ask if you could also have pyridium for the pain. By the time I got to the doctors' office, we had a second sample that looked like pure blood. The nurses were questioning whether I was on my period, it looked so bloody. Since I feel I have a history of not being 'believed', it's a sensitive point for me. I turned to any one who questioned me about the origin of the blood, and I said, "I know the difference between my orifices. The bloody sample came from my urethra, not my v.......a."  I love my PCP's office. They call me if I haven't been in for a week, and I call them to say, "Hi" whenever we're not in a crisis together. But I can't help it. Boh. I'll be glad when everyone believes me the first time. It's so cute to see the different things that need to be talked about. The Origin of the Pee.  On to other things, quickly.

3 weeks ago, I was admitted to a well known heart institute. My presenting symptoms were altered mental status (AMS) and increased nausea/vomiting. Harbingers of more badness to come, with my peripherally-inserted central catheter (PICC) line about to become royally infected. I never wait until I'm fully septic (bacteria in the blood), otherwise I'd be half-dead in someone else's Intensive Care Unit (ICU).(I used to help run 3 types of ICUs: surgery/trauma, cardiothoracic, and neurosurgical. I am not searching for repeated visits to the hospital, especially the ICU. :-). I know my body and its presenting symptoms. For example, my lungs never wheeze when I get asthma attacks. 

2 weeks ago, I was discharged from the hospital after a 6 day stay. I was sent home on intravenous (iv) antibiotics after the 'Grandfathers' of Cardiology and Vascular Surgery waited for the antibiotics to start killing the bacteria. I was sent home on 14 days of iv daptomycin (I get 'red man's syndrome' as each drop of vancomycin goes in, so the precious Infectious Disease doctor removed my need to have a red face, low blood pressure, the feeling as if large ants were crawling on my head, and a need for premedication that makes one drowsy.

1 week ago, we ventured out as a family and went on a plane to Chicago, where we used to go every year before our car accident. (The car occupants were me, my daughter, and our puppy whom we still have). We were there for six days. I awakened.

I'll let you know about Chicago tomorrow. Today's Labor Day anyhoo. Happy to catch up with you and I hope you're enjoying your Holiday vacation. Either by playing or working (which some people have to do to make money). Keep your head up to the Heavens.

Yours in Christ,

Dr. Margaret 

Ran away from home at 16 years of age and moved in with my then boyfriend. Went to school and got my Cosmetology License so I would never have to work for minimum wage again. When I was 19, I had a baby and took off work/school for 10 beautiful months. Received my Real Estate license, and caravaned around Ridgenorth, looking at all the beautiful indoor decor. Went back to college and after 5 years, I was Pre-Med and graduated Cum Laude with a Bachelor's in Arts in Biology from California State University, Northridge.  I won 1 of 3 Outstanding Student Awards, amongst other memorable events. Thank you, Skottie, for talking me into being Pre-Med. I'll tell you about that story tomorrow.

What am I posting, she asks. 

In second grade, one of my first memories was that of the dying Jesus on the Cross. It was a very large statue that displayed much detail. I could see and feel the crown of thorns on the head of Our Lord, and I could feel His Sufferings for me. I accepted Jesus Christ and while my life has fallen short of some successes, He has always been with me to provide comfort.

First of all, I am 48 years old. Raised 6 kids starting at 13 years old. Patting my brother's back meant that I, as the second eldest, grew up caring for people. Babies. Precious little ones.  I ran away at 16 years old, because by then I thought I knew everything. I knew how to bake an entire Thanksgiving Dinner, make 35 double-decker lunch sandwiches for 7 kids to eat one sandwich per day, and do laundry for 9 people.

I was an excellent student in high school, when I developed as a person and made many stupid mistakes. Just like all of us. Went to an Alternative School so I could have an ID to show the LAPD. The ID gave me permission, so that I could either go to school, or not go to school. Thankfully, my father was praying for us daily. Our Angels protected us as my best friend got shot in the head and was found dead in the bushes. Everyone in the high school went to her funeral, and I still think of her and all the life that she has subsequently missed.

I graduated high school at 16 years old by taking the California Proficiency Exam, then graduated first Cosmetology and then Real Estate school. Ran away at 16 but my ex-husband made me go back to school, and for this I am still grateful.

I was a battered wife for 9 years, and bore a much-loved son. Once in medical school, my ex-husband left with our child, and there was no "Amber Alert" then. I was blessed and deeply touched, yes even endebted to other Christians who taught me so much about life. They know who they are. Medical School was an enlightening time in many respects, and ever so gradually, I looked forward to seeing a life of some kind ahead of me. There were very close friends who understood me and helped me develop my character. I knew God was with me. I broke medical school in half so I could be nearer my family, to help me raise my son. Left an apartment full of furniture, and the medical school wives so kindly boxed everything up and mailed it to me. Thank you to all the Tulsa, OK groups of people I know. At the time, I could not have been in a better place. Alas, I left and drove back to CA in one day's notice. Once in CA, I tried calling two local medical schools.

One medical school said, "No." We don't have any positions opened for a medical student to transfer. The other medical school Dean said, "You did what? I have to meet you." Thank God, I could continue medical school and obtain my MD. During this time, I met a nurse practitioner while delivering babies, and she counseled me very much. I was a single parent with a young child, and she wanted me to pick a Residency program that would 'give me a good life' ... so God arranged a meeting or two, and I was accepted into a prestigious program, that of Anesthesiology residency..

I was handed ICU after ICU patient as a beginner, and learned from the beginning of my training how to provide anesthesia for the critically ill receiving tracheostomy or other surgical procedures. I became so adept at caring for the critically ill, so eventually, I became very good at it. Touche. God kept His watch over me as Critical Care became my specialty, with both Stanford University Medical School and the University of Pennsylvania ICU experiences that could fill a book alone.

Do not ever think that God has forgotten or forsaken you. He will never leave us, even to the end of the earth. Are you surprised that you got into a car accident today? God knew this car accident would occur when you opened your eyes in the morning. If you have given your life to Christ, and dedicate your efforts unto the Christian faith, you will have all the hope that you need: hope for forgiveness, hope for sufferings, hope for healing and for faith in God to keep your life on track.

Forgetting

Somehow, I wrote a full essay here, only to have it disappear and become unused. I therefore am writing this in one sitting, and fast. I'm almost too tired to write. It is hard to make my fingers do what my b rain wants them to do, and Iconstantly misspell and do typographical errrors. 

One of my parameters that we watch: how well I can type. I used to type almost as fast as Richard, now the Chief, Department of Anesthesiology, Stanford University Medical Center. And one of the 3 smartest men I have ever met: the two others  are Dr. Shadrad and my husband. 

Now, I have lost my time to write here in this journal of sorts. I must get sleep so the little one can get up in the morning and attend the Vacation Bible School. I hope she sees many of her friends from last year. There was somebody I knew who hardly got to wake up every School Year unless he had a stomach ache. No one seemed to know what affect a single parents' perceived 'constantly moving' would have in the future. It is a syndrome. It is a serious issue.

I believe that Disablled people, as I do, start having trouble with poor or extremely different types of forgetfulness. If you  remind me to write about this topic later, please do so. I may forget. Just refer to "Forgetfulneds" and "What happened on the last day of fourth grade?"

I can see some of you shaking your heads, wringing your hands in discomfort, and denying you are forgetful. Some of you have to be fired first, or lose money and become broke. You gamble it away instead of purchasing presents for your friends or family and taking zero chances that you will lose the money you worked so hard for. You will  then come to know it on your own. Other people see it, but you deny it and/or cover it up.  Everyone is afraid of being forgetful because of all the negative social connotations. (Remind me to tell you about fourth grade, of what happened to me on the last day of class).

I'm just too tired. Going to watch my favorite "Private Investigator" show. Maybe I'l learn some hints. I am attending a Mediation meeting tomorrow morning. I am the Complaintant and the other side is our local city association member, I think. Please pray that the meeting goes well to our advantage.

If we win (we are representing ourselves), we will have made some big strides for the Disabled population in our city. Talk to you later.

Disblogged, MD

Welcome back to our "Disblogged" blog pages! Please see the following for more information about what it is like to be different, specifically Disabled. Realize that the person writing this has a traumatic brain injury (TBI) also. No one told me how to prepare for a Disability, nor that I should ever prepare for it. I barely prepared for College...

Some could say that I beat the odds and 'made it to the top' of my field.  

My mother is first-generation American, from Mexico; my father is also first-generation, with Spain ancestry.  We were raised to speak English. After their divorce, my father was a single parent of 7 kids during the 70's. He must've been more cool than I thought at the time, but my fondest memory of him will always be with me. He would let us eat a double-decker ice cream cone while it was snowing at nighttime in Big Bear.  Flake after different flake of snow falling on my head and ice cream. Cool.

I went to the Alternative Schoool at Granada Hills High, and had a special pass saying I could be off campus any time of the day. Even the LAPD recognized this pass.

I got kicked out of Catholic High School, but not before one of my best friends there had been shot in the head and was murdered. She reportedly had been 'thumbing' a ride and got picked up by someone on a motorcycle. Later, I got kicked out because Annajo gave me orange juice to drink, and eventually, she had me drink a fifth of vodka that it was spiked with. By the time we got to school for a 50's party, I was seeing double. Needless to say, I got kicked out of school. But that did not mean that my life would be a failure, nor that I would not learn from it. I did learn that  authority meant authority, and that all rules were not meant to be broken.

I was pleased to go the Alternative School, where attending class was elective, and I think I received straight 'A's. Met some of the most memorable people there.

My first job was at McDonald's, when I was 16 years old. One of my best high school friends got shot in the head and I ran away from home every weekend. Finally, at 16, I ran away and married my boyfriend, who was 27. At 18, I got married. By 19 years old, I earned my Cosmetology and Real Estate Licenses. By 1985,  I learned phlebotomy (drawing blood from someone's arm) while a freshman at Cal State University, Northridge. (Thanks, Scarlet, for taking me by the hand and having Rich not only add me on to the class, but employ me as a teacher after that.) And I graduated Cum Laud, going immediately to medical school.

I'll tell you about medical school later. 

Eventually, I was Chief of the Department of Anesthesiology in Pennsylvania. I was at a Veteran's Hospital, which is where my love for medicine had begun while I was undergraduate. My Mentor on Life and Medicine was Lois, whose image I desired to emulate: tough on the outside, smart, and caring. Thought I would serve the Veteran's until retirement.

That changed. Then I got in the motor vehicle accident (MVA) and things really changed.

The Disabled do not seem to be noticed. When was the last time you smiled at someone in a wheelchair? I think that human nature and society teach us to find the disfigured and the Disabled as something to be avoided.

It's human nature: you look at me as you see me going in to the same door you are. You are walking fast to get ahead of me, and I am plodding behind you, slowly, and in a walker. One quick glance tells you I am disabled, so you put your eyes down to prevent my eye contact.