Golden hour

ER- a place where every minute counts. And more so in a pediatric ER, where sometimes the only thing important in helping a child get better is to get an IV line in him. There are times when you feel very comfortable examining children regardless of how small they are, even at the nth hour. But sometimes, it affects you deeply in mind and emotion, in ways you don't understand. And you wonder if you are the only one who's uneasy...and ashamed to admit.

Time in the ER goes fast. It was 15 mins that I had stepped in for my ER shift, and I was giving the third combi- neb to this very tight 2 year old boy, who's heaving chest made me nervous. I thought to myself, he will need to be admitted. I glanced over to his dad standing near the window, who clearly looked impatient and frustrated. His child had already got 3 treatments in the clinic before he was sent here, but his distress persisted. Sometimes, talking to the parent is the toughest part. They seem to want quick results. "Why hasn't my child improved? ". It was the 4th time he was asking me that question. As if responding to my cues, he walked over to me and took the mask from my hand and sat down next to his child. I told him, mustering up a straight face, that, if he doesn't improve with this, we will have to admit him. He didn't look at me. He pursed his lips, continuing to look at his child who was breathing in the white fumes of albuterol. I stood there for few seconds and then taking the chart, I went up to the station and scribbled orders for magnesium sulfate. The nurse came up to me and said that she will prepare a bed and get a monitor ready. I gave her a half smile. The nurse knew my thoughts already.

As I was to pick another chart to see a new patient, the overhead speaker screamed "pediatric trauma alert". I saw my attending rush to the trauma station. I dropped the chart back into the rack, and hurried towards the trauma area, picking up some blue gloves on the way. I caught up with my attending who told me that this was a 8 month old baby who had been flung in the air. That's all we knew. Well, when you hear such things, you imagine the worst, you anticipate the worst, and you...pray! The patient hadn't arrived yet and I went to the trauma cart and started picking torniquet, IV cath, alcohol pads , syringes and all the things I thought I would require. I put them all in my coat's pocket and walked to the trauma nurse to get the full story. Apparently, there was an altercation between the baby's mother and her ex-boyfriend. The mother was holding the baby and he had gripped the baby by his ankles and flung him across the room. It was a distance of 5 ft. We didn't know what injuries the baby had sustained. In a minute, we saw the EMS bring in a stretcher with the baby strapped and with a C-collar. There was a woman, I guessed, the mother, with some abrasions on her face, walking along with the stretcher. The trauma surgeons had already started cutting his clothes. As they were clearing his spine, I took a quick glance over his entire body and heaved a sigh of relief. He was awake, looked alert, a little stunned perhaps, and had no obvious signs of external injuries. But I knew I couldn't relax, as we didn't know whether he had passed out the instant, the incident happened. I quickly took his right arm and tied the torniquet just above the elbow, scrubbed some alcohol on his antecubital area. I couldn't see a vein. I patted the area a couple of times. I still couldn't see a vein. He was a chunky baby. I released the torniquet and reapplied to his wrist. As I scrubbed the back of his hand, I felt enormous pressure building in me. I couldn't see a vein there. Every passing second was pounding. I had to get the IV cath in. I knew I had no time. I held his hand flexed, removed the cap of the needle and slid it through the skin, blindly. No blood. I retracted the needle half-way and glided it in another direction. No blood. The baby had started crying by then. I took a deep breath and retracted the needle again and changed its path just slightly, and I saw a line of red blood in the cath. I slid the cath completely in, retracted the needle and released the torniquet the same time. A few drops of blood stained the sheet, as I stabilized the cath with a tape. But it wasn't over yet. When I tried flushing with saline, I met resistance. I peeled the tape out and manipulated the cath and put the tape back on. This time the saline went through easily and I screwed the tube of the IV fluid bag to the port of the cath. I took the arm board and wrapped the arm and the board together with a kling so that the cath doesn't kink, when the baby moves. As I removed my blue gloves, I noticed that the baby had stopped crying and was moving vigorously. "baby, you did good", I thought to myself.

The trauma team ruled out any injury and we planned to observe the baby in our ER. It seemed like forever, but only 15 min had passed by. I rushed back to see my patient who would've been done with his nebulization by now. He was lying quietly on the bed with a monitor attached to his body. From a distance of 6 feet I tried to figure if his breathing had improved. I couldn't really tell, his chest moved the same way. I asked the nurse to give magnesium sulfate and walked over to his dad to tell him our next plan of action. He looked defeated. But I was hopeful that his son would turn a corner soon. I rotated the monitor so that it could face me, while I sit in the nurses station. I knew I had to look out for dropping BP. I sat down and resumed writing orders for him. He would need another bolus of saline. The rack for new charts was empty. I was happy, as there was enough on my mind already, to be concerned by another disease, another patient, another parent.

Another 15 minutes passed by. The 8 month old baby seemed very active and happy and was now drinking milk from his bottle. He was so oblivious to what had just happened to him, something he will never remember ever and I was happy for him. I saw the asthmatic boy talking to his dad. He was sitting up and pointing at the TV and saying something about spongebob. I smiled, he had certainly turned a corner. I went over to him and listened to his lungs. I could hear breath sounds, unlike before. His chest was still heaving slightly but not as bad as before. I called the floor resident and gave a sign out on him and proceeded with clearing him for admission.

The long hand of the clock struck 12. That hour was over. There was a new chart in the rack. My next new patient.

Writing right

I, somehow, am not able to do this. Blogging. I have always liked writing, have written a lot in my diary and have immensely admired good writing. Yet, it gets so difficult for me to pen my thoughts. The little events of everyday life, I give so much a thought to, just fade away without getting down in print. I wish I could just write down all that I think about, because in some way, my thoughts mean so much to me.
Now, my mind is blank again, not knowing how to continue. I will put this much of writing in print. I think its all about making attempt.To keep trying.

Haikus

1.I see you and me,
whose reflection do i see,
in your eyes so pretty.

2.Words seep, water like
in the brown mess of mind-pot
a person regrows.

3.Seated close on sand,
holding hands and gazing eyes,
dream eternal love.

Sunshine through the clouds

Land of a million dreams,
do I need, do I need?
or is it just a safe yard
that I seek.

Is it the ambition that's a driving force,
or is it something that I am yet to unfold.

Treading on uncertain paths,
picking dreams from an unknown cart,
do I care, do I care?

Alls well that ends well,
and so in hope I dwell,

With faith in me,
sunshine through the clouds
I can see.

American Dream

So what is this 'American Dream'? The person who coined the phrase, James Truslow Adam said "The American Dream is that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement... It is not a dream of motor cars and high wages merely, but a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position."

Mighty words. It makes me feel dignified, ambitious, capable of achieving the ultimate and deserving of the best. And the best feeling is that of empowerment, which after thinking hard enough, I realise that I haven't felt such an emotion with such magnitude, before. Not that I have encountered any discrimination or prejudice against me. Infact I have most often been rewarded, and I believe it is for my hardwork and good results! :)
But I guess there more often is a flavour of favouring probably for the wrong reasons ,present in most places like background music to lyrics. People who benefit deny it and people who suffer complain. At the same time I wonder , will they ,those very people who complain, stand up against unfairness if they themselves were being favoured. Is integrity there in us? It sure is a Right to fight for what one believes in, but isn't it equally important that he stands up for what he believes in, too!

I was reading an article on American culture and view by J. LaVelle Ingram, and understood why each american is the way he is. Their time sense is futuristic, and so, they plan. They plan everything with the idea to reap success in whatever they do. And their success is their own which describes another american quality- an individualistic attitude. Its about surviving for themselves, being self sufficient. If a son does not financially support his parents later on, its okay, he is not being heartless or selfish. His individual wishes, needs and aspirations are his priority and thats because IT IS the core system he has been brought up with. It is appropriate to move away and function independently of family or any bounding group. No obligations. And so, a college kid decides his subjects, a young daughter moves out into her own apartment. Wishes respected. No questions asked.

For americans, doing is much more logical than being. In the sense, what you do matters much more than what you are because the former leads to achievement and accomplishment. And that talks a lot about your status and good lifestyle.
In the USA, they believe that human nature is generally good and one will not deceive someone to profit himself. They believe in the good that there is, and strive to bring out the best in another. They swear by fairness and respect for others. And this is something I have witnessed and vouch for. Something very admirable. Thats probably the sole reason why the entire american society functions with such ease and miniscule chaos. And this attitude goes to say that they are very optimistic people and therefore there really is no need for enforcement of rigid laws to prevent people from doing wrong. Liberty rules because people live up to their best selves.

These aspects of USA, I have, quite clearly noticed in a few days of being here. I was quite apprehensive, sceptical and critical about America before coming here. Mostly fed in the negative by many who have had experienced a slice of it. But now I understand the principles of an american life. The author suggests "...the immigrant does not have to decide to adopt American worldviews to live in America (assimilation); nor does one have to hold rigidly to the culture of origin (rejection). Rather, it is simply a more effective living strategy to recognize the cultural differences and consciously negotiate them."
And I agree.

My Day, today!

Tring tring...uh mh...I switch on my cell to look at the time -9:36. Tring tringgggg... I swagger to the phone in the opposite room.I could see that the number belonged to my aunt. "uh..ehhllo?"

"Hello, good morning...got up now? hmm, so what else is happening? hows cooking- yeah I know..its so boring to cook for oneself...blah blah". She trailed off saying other things to which I could barely manage a "uh-ya" in a very hoarse voice.


Every night, I plegde to get up early, something that never happens despite the blaring alarm kept close to my ear. I have an exam next month on the 16th. I havent yet started studying. And I plan to do that every day. Its weird, once you are out of college, you just can't get yourself to studying. Studying sincerely and dedicatedly, I mean. And especially when you are at home. And being home alone makes it worst.


I have been home alone for 3 weeks now. Mum's left to the great US of A. In a way, its a good way to be independent, doing things on your own like cooking. Especially when I intend to fly to USA for my further studies( ha ha..."further studies" sounds so cliched!). But certainly, studies just dont happen, hmm... among other things!


But so far the day has been good. I have managed to do things I intended to. Posted the long due documents to the Ecfmg office in USA. I posted it via registered post, cost me rupees 56 for 70 gm envelope. The post office in my area has nice people. The girl who helped me was around 25-27yrs, and was wearing a pink striped shirt and black corduroy pants. Pleasing and polite. I was happy to see a fresh & young face in the insipid post office. Sometimes I wish I could be an invisible 'lakshmi bai" and scrub the place clean....that will be like a job well done.


Then I moved on to the beauty parlour. Its called Complexions and has classy red interiors with old english pop numbers playing in the background. What I like about this place is that there are never more than just one customer. Heh heh. So you get ample attention and I feel like a queen with all the pampering! This time too, I was the only one, come to trim my long wavy tresses. I loved them for the way they were...wavy!Waves suit me. Sometimes I picturise myself on the beach, wearing a clinging white crush kurti and my wavy damp hair swaying in the moist wind like the rising tides , a few curls clinging to my shoulders and back...hmmm!!!:):)

My hair was growing a little too unruly and had lost a little bounce. So there I was ,watching as the lady sprayed, from a couple of shiny bottles, some fluid onto my hair. Just for that moment when my hair was damp with the fluid, I liked it the best. It looked glamourous!!...I looked glamourous! heh heh....I wandered off to the beach again...


Sooner, all the chop chop and curl- curl and blow drying left me with bouncy hair, a lot shorter than before. But it felt good, lighter on the crown and I loved the way the curls bounced as I moved( read jerked) my head. I thought I would definitely be good for a shampoo ad! and probably the best place for that would be the beach...and me in a white crush kurti! ;) yeah...


I bought a few things on my way back home- Cup noodles, Goodday biscuits, Garnier fortifying conditioner for rough unruly hair & an Apricot scrub. Missed out on bread.

Lunch was yesterday's veg jafrezi gravy bought from outside with home cooked freshly made chappatis. The chappatis came out good. My hands, you see! ;)



Now done with the routine checking of gmail and orkut, I thought I'd write something while waiting for the maid to come and clean up the mess at home.

A few haikus

1. Blocks of blue on wheels,

connects places and people,

also thoughts in sync.

2. A man and woman,

is friendship not possible,

not all eat apple.

3. Parle G and tea,

a union too strong to break,

dip-dip and bliss-bliss.

4. A man sits in train,

eats biscuit like a small child,

wipes crumbs off his grey moustache.