Call me fickle, but I'm writing at Luminousheart.vox.com again. I wish I could be like normal people who just write on one blog for years.

Going to bed at 10 am.

I'm post-call again this morning, for the second time in four days. Since I'm going on vacation during the second half of the month, they have to cram in my requisite number of calls (five this month) into the rest of the time that I am here. We had a busy morning, including an emergent intubation in the ICU (which I got, yay!), so I was at work for 26 hours! (I love to complain about how many hours I work, can't you tell?) We all have our idiosyncrasies; one of the female senior residents loves comparing her looks to other girls. She's in her late thirties but looks younger. She is half Asian but dyes her hair platinum blond religiously. This morning she saw me and grabbed my shirt. "OH MY GOD, Sel, you look SOOOOOO EXHAUSTED." You might think she was concerned that I had a rough night on call or was being too overworked, but no, you could see it in her face: she looked happy, perhaps even thrilled that I looked so horrible. We had a morning conference with the chairman after that and I kept catching her catching sneak peeks at me. (Thinking to myself: Okay already, I know I look horrible; is it that shocking?)

I had a busy but satisfying call. One of my patients was only 16 years old and recently immigrated from Central America so she didn't speak a word of English. I was able to use my Spanish but more importantly, I was able to play a huge role as she was scared to tears about the upcoming operation. I was more connected to her than the surgical team was, which confirmed my understanding that an anesthesiologist does have power to impact patient's lives... no matter how our role is belittled by other physicians (especially surgeons).

The only unfortunate thing about being on call last night was that I missed Chris's birthday. He complained about it a lot, but more like a little child whining rather than really angry (I hope). I probably should have made more of an effort to switch my schedule (ie, trade call nights with someone else), and for that I feel guilty. I did, however, take him out to dinner the night before since I knew I wouldn't be there yesterday. That was nice. On the whole, however, something seems off about him ever since yesterday morning. When we talked on the phone he seemed distant and upset about something. He keeps denying that anything's wrong, but my intuition is usually right. I'm guessing that it's something that he doesn't want to admit to me, so maybe it involves money.

The Return of the Shopaholic

Two young men with jaw fractures after being struck by baseball hats, one young man newly blind and riddled with skull deformities after a gun shot wound to the temple: these were some of the wild and wooley characters making up my weekend call at the House of Doom. It was steadily busy for at least twelve hours without respite... but for the first time, I really enjoyed my call. I'm telling you, this anesthesia thing is growing on me. The only thing I missed was the first major snowfall of the season. I looked out longingly from the second floor hospital windows. When I left for home this morning, the snow turned to rain, and now there are sheets of treacherous black ice on the roads.

If there's one human behavior that has changed completely because of my work, it is my driving. Since my resolution to change last month, I have consistently remained a safe and boring driver. No longer am I the fastest driver on the roads as I used to be. In the operating room I don't see the ones who have died from car accidents-- those are for the emergency medicine residents to handle. But of those victims who have survived-- I see the worst of them, because they inevitably need surgery. And what I have seen has scarred me for life. I wouldn't say I'm now afraid of driving, but what I feel is close to that.

I slept for a few hours this morning after I got home. Then realized that I only have a dress for Saturday, and nothing else. (Thanks for reminding me, Lara, by asking if I had accessories yet!) So off I went shopping for a strapless bra at Victoria's Secret, bought eye shadow at Chanel (the saleswoman knew me by name though I hadn't visited since September; I was impressed), and engaged in a several hour quest for the perfect shoes. I ultimately settled on a lacy pair from Ann Taylor:

Not sure if these are "perfect." The material and color are similar to the top of my dress. But are these shoes too "black" for the dress? I have a back-up pair of pearly-colored shoes at home if a lighter color is the way to go.

For the sake of my bank account, I'll skip the search for new jewelry.

A new month (Or: a chance for a clean slate)

It's currently 18F/ negative 7C. With the wind chill, it feels more like 5F/negative 15C. The weather wasn't much better during the day. Despite that, we went off to search for our Christmas tree. Chris talked me out of going to a rural farm to pick out the tree. So we copped out and went to the local Mahoney's where they sold pre-cut trees. It wasn't a disappointing experience however, as they do try and recreate the farm look. There were endless rows of trees standing up tied to little poles to simulate the look of trees still rooted into the ground, and there were so many shapes and sizes to choose from. However, we were in danger of frostbite and in a sore mood from an argument earlier this morning so we quickly picked a cheaper and thinner tree than last year's beautiful fir. However, now that it's sitting in our living room, over six feet tall and adorned with lights and ornaments, one can't really tell a difference.

I'm on call tomorrow so this is the end of my weekend. I'm already looking forward to coming home Monday morning and going to sleep.

I've decided that it isn't possible to make up for a sleep deficit with only one good night of sleep. I slept for at least 10 hours last night but was still fatigued all day today and these tired, baggy eyes looked back at me through the mirror. (In fact, I now hate looking in the mirror as all I ever look is horrible these days and I can't figure out why!!) What I'm feeling no doubt is a chronic state of sleep deprivation. I'll be using my upcoming vacation to fully recuperate.

I only had one case today and the paramedic student needed one more intubation to graduate. Despite what I wrote yesterday about my selfish greediness because I still enjoy doing all these things myself, my sense of moral duty compelled me to offer him this intubation so he could graduate and go forth into the world. After all-- if I get into a life-threatening accident on the highway I would want the paramedics to be able to intubate me. Or if Chris or a family member had a cardiac arrest, I'd want the paramedics who rushed to our house, be able to intubate. I was mortified when the paramedic student told me he was only required to get 10 successful intubations to graduate. It took me at least 50 successful ones to feel really comfortable. It's November 30th, the end of the month, and the last day of this NaBloPoMo. So after tonight I will no longer feel compelled to write every day. It was a fun exercise while it lasted, but now I won't have to write sub-par stuff and can go back to writing only when I really have something meaningful to say.

Despite the long work hours, fatigue, and the worn, increasingly unattractive face that is my reflection in the mirror...

I'm starting to really like this practice of anesthesia. I no longer daydream about returning to internal medicine. That is progress. Even an intubation still excites me. I have now done approximately 102 successful intubations (remember when I couldn't even get my first one?). Sometimes I still get critiqued on my technique though. I think I still need so much more practice and experience. I admit that I feel selfish about intubations. I want to do them all the time. However, I often get medical students or other residents doing an anesthesia elective and they ask to join me on my cases, and they want to do my intubations. Even a paramedic student today asked if he could take my intubation. I don't know how to assert myself so I give it all up to them. I remember how I felt as a medical student when I wasn't given much of an opportunity to try intubating so I try to be generous to everyone now. But on Monday night when I was on call and had to intubate someone emergently in the ICU, I couldn't get it despite trying twice. My senior resident had to try. She got it easily. I think this means I still need the practice. Besides giving up my intubations to the med students, it's also tough to pay attention to what's going on in the case and try to teach a student at the same time, particularly this early on when I'm still learning the ropes too. Truthfully, my heart sinks everytime a student comes up to me and asks if they can join me on my case. I feel ashamed for having this feeling because a good resident should want to teach.

The only thing worse than having an overly long day at work,

is having an overly long day at work and coming home to find multiple piles of dog poop all over the cream-colored carpet in the bedroom.

Who says dogs can't have human emotions? My chihuahua is capable of a highly evolved form of emotion: GUILT.

I instantly knew something was up when I walked into the bedroom and found neither dog in sight. Usually, they are highly visible and come to greet me when I come home. This time they were hiding under the bed. It wasn't a matter of If they'd done something, it was a matter of WHERE they'd done it. I found my answer on the floor.

The funny thing is, I don't even punish them. I just say "bad! bad!" and they know.

I guess it could be worse. I could be a mother and come home after a long day at work and have to feed and bathe a HUMAN baby. That's got to be a lot harder.