Welcome to Vegas....Daddy's in trouble!

So we went to Las Vegas this weekend. I wanted to use a slot machine strictly for the purposes of life experiences, but Steph said no. Well, technically she said I could do whatever I wanted, but her tone was very suspect; she then proceeded to give me condescending looks and read quotes about how gambling leads people down to hell, and how she's never gambled, not once, and how she doesn't understand why I would ever want to gamble, etc. etc. You get the point. I did, too, so I didn't get end up experiencing that particular life experience.

After Stephanie spent about thirty minutes talking about gamblers who ended up selling their toddler children in order to play poker one last time, Braeden saw a Vegas advertisement billboard and piped up from the backseat: "Welcome to Vegas....Daddy's in trouble!" We decided that should be Vegas' new slogan.

We actually went to Vegas because it was (apparently) only an hour longer a drive than to Salt Lake, but in the right direction towards Texas, and Steph would be able to pick me up from the airport so I could drive her home. We hadn't really anticipated traffic jams delaying her an extra two hours, nor her family having to drive her down due to some health concerns preventing Steph from driving....but in the end, I got to see my in-laws and it was very enjoyable!

I am becoming quite technologically savvy with a new phone (Galaxy S III) that has transformed my previous phone exasperation into something akin to shock and awe for how much technology has advanced in the phone department over the last five years....I can actually call somebody without even touching the keys! All I have to do is have the contact info up, and then as I make the motion of bringing my phone to my ear...VOILA! It calls them!

Driving home, Braeden and Emerson thought it was hilarious to keep unbuckling themselves from their carseats at random intervals....I finally stopped the car, unbuckled Braeden, and unleashed a major spanking meant to sharpen his memory a bit. When I walked around and opened the opposite door next to Emerson, Emerson looked up at me and said, clear as a bell, "Uh-oh!" All of us laughed so hard that the lesson of not unbuckling oneself was as wasted as toilet paper down a toilet....but it was very funny.

I am now thoroughly enjoying hanging out with my goofy kids and hilarious wife again! I have SO much more fun when they're around....otherwise I have no one whom I can tease and bother.

How to Fix Dehydration In 8 Hours, Costing Only $1500: Welcome to a Teaching Hospital

0700

Chief Resident Doc: Well, aren't you going to hook up the Vigileo?

Me: What would be his indication for a Vigileo?

Doc: To see his preload since his intravascular space might be dry.

Me: Do you mean to see the stroke volume variance? (It's a predictor of fluid volume responsiveness in patients who are mechanically ventilated and not in a significant dysrhythmia)

Doc: Yes.

Me: But he's not intubated so the number is pretty much obsolete.

Doc: Yeah but it's still good to see it.

Me: Okay. If you want me to hook it up, no problem. Are you going to do an ultrasound to see his IVC?

Doc: Probably not.

Me: Okay.

I spend 20 minutes getting the equipment set up, calibrated, and functioning while trying to figure out how to make a positional arterial line provide a good waveform.

0900

ROUNDS

Attending: What's his fluid volume status?

Me: He's up 5 liters since yesterday but clinically looks very dry. He's tachycardic, systolic BP is running about 15 points below his baseline, and when he stands up his heart rate jumps by over 30 points and puts him into SVT accompanied by nausea and dizziness. Urine output last night was marginal and concentrated. I think his insensible loss during surgery yesterday evening might have been greater than estimated.

Attending: Why are we using a vigileo?

Me: The chief resident requested it to observe the SVV.

Attending: Did you know that we can't use those numbers because we're not controlling his tidal volumes?

Me: Yes.

Attending: You can unhook it. You can take out the arterial line, too. We're going to do an ultrasound (US) to view his IVC filling.

Me: Okay, will do.

1100-1300

LATER, AFTER US DETERMINES THE PATIENT IS MOST LIKELY DEHYDRATED

PA: Can you hook up the Cheetah?

Me: Yes. Why does he need the Cheetah?

PA: We want to see his SVI.

Me: I haven't unhooked the Vigileo yet, you can see it on that.

PA: Yes, but it's different.

Me: How is it different?

PA: It's calculated differently.

Me: (internal sigh) All right. I'll hook up the Cheetah.

PA: We're going to do a fluid volume challenge to see his responsiveness.

Me: Didn't you already determine that he was dehydrated using the US?

PA: Yes, but this is more accurate.

Me: More accurate than the ultrasound?

PA: Yes.

Me: Okay.

I spend another 20 minutes finding the machine, including all the wiring that never seems to be with it, and attaching it to the patient. The numbers are literally exactly the same as the Vigileo and correlate with postural changes of the patient (meaning when I raise his legs, his SVI significantly increases in both machines). PA does the same test without following the official bolus test protocol of the Cheetah's programming.

1300

PA: Let's give him some fluid. I think he's dry.

Me: I just nod.

Bringing the Bottom Up

Some lessons I just want to skip. How does one face the truth about himself...about how he thinks, how he acts, even how he feels, and then have the faith to make those changes before those changes force themselves into his life? It's like he's just a shell of the self he thought he was, now riddled with cracks and holes that threaten to eventually collapse. The problem is, he doesn't really know what's inside the shell...is it enough to mold a new self? Or does he have to start from scratch?

After years of insecurity cloaked in a very transparent coating of self-assuredness and boastful selfishness, I suddenly feel the desire to wreck everyone's expectations of me, simply so I can reset my relationships and have a new beginning in life. Maybe my goals in life no longer include higher education; maybe I don't want to be rich. Maybe I don't want to be a spiritual giant, or an athlete, or better in any way than anybody else. Maybe I don't even want to strive for those things. Maybe, just maybe, I want to be good at a few very simple, essential things; I want to get up in the morning and be satisfied with what I have become, with who I am. I want to be satisfied with the progress I can make without crushing the backs of those around me in my efforts to stomp my way to the top. Leadership takes a back seat to simply hoping that my peers will enjoy me working at their side. Excellence falls away to the sheer cliff of consistency, the persistence that keeps patients and people and problems from disaster. Degrees become papers on a wall, the background to the satisfaction of having learned or mastered some new concept or skill that day in a relevant part of my life. Perfection crumbles, leaving a framework on which I can use my mistakes to design the strongest aspects of myself. Praise becomes an opportunity to show appreciation, or give proper credit; to pay it forward, instead of greedily slurping up the results of chance, circumstance, and a little involvement.

So, I'm bringing the bottom up. Life is always long enough to fall in love with it, and if there's one thing that I know is worth it, it's falling in love.