A few days ago, I picked up this app: Animoog, which is made by the venerable Moog music (worth the 99c and is worth the 29.99 which it will go up to at the end of the month – it is currently sitting at #1 in sales in the app store). I spent a few hours playing with it.

Last night I made this in Garageband:

It is only 8 seconds long because I didn’t want to work with larger set until I figure out how everything works. It’s has five layers here: two of me playing the tabla (duet bwahaha), the ‘smart guitar’ (acoustic) playing the A minor chord, ‘smart bass’ Cello in A minor, and the drum machine doing a high hat and shaker (quiet, complex).

As I was working with this, I went downstairs to change the diapers around, noted the humidifier was full and fixed that. After that, I stood up and looked at the guitar, turned around and looked at all the instructional stuff relating to the guitar and wondered ‘why can’t I play the guitar?’

And then it made me wonder why I haven’t done a lot of things. Why haven’t I lost all the weight I want to lose? Why don’t I know more languages or read more books?

Going back to school made me realize I’m capable enough to do a lot of things and simply haven’t put the time in for anything else. I don’t want to roll into my forties being in the same situation… obviously, I’ll likely be an RT by then, but should that be my end goal forever and ever? No.

I’m not saying I’m going to succeed in doing anything above, but at least I’m mindful of what I’m capable of doing and the resources I have at my disposal.

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An update to the previous post about teaching Nora to read – she can read. No, not every single word or sentences but last night I gave her blocks with animal names on it that she’s never worked with before and I asked her to sound out the letters and figure out what the words are.

She did it. And she begged to keep going, but it was too close to bed time and she was getting a little feisty.

And that’s it: she was ready, but she needed to get over her mental block of relying solely on memorization. She can do it, and it’s clear she’s very proud of it, too.

Now the ‘problem’ is that this was she started all this by wanting learn her numbers, but now she has zero interest in that.

Next step is to bring up the chalkboard. When she gets on a roll, it’s like a torrent and the chalkboard is the fastest way to keep up with her.

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iOS 5.0 is very nice. I installed it on both my ipod and ipad. On the ipod, the feature set doesn’t bring the same sort of across the board improvement than what was brought to the ipad.

In sum, iOS5 has made me love my iPad even more (if that were possible) and convinced me to stick with android phones.

Steve Jobs said that the iPad was conceived before the iPhone, and I believe that the trickle down of ideas still continues. The iPad and the interface works so perfectly but on such a small device, android shines.

The Galaxy Nexus S is coming to Verizon, and it’ll likely be discounted by the time we’re able to upgrade, so that’s where I’m headed.

I didn’t think much of it at the time, but I was the only ‘rt’ in the room during an endoscopy (I think this was by accident, actually). Before the procedure started, I told the doctor that I was a student; after that, nobody seemed to notice or care that I was managing a few minor things.

Generally speaking, I work independently of oversight. I appreciate that everyone has that sort of confidence in me. I’m glad I earned it.

I’m only noting these things because as a career it’s actually fairly interesting. Of course, some days are better than others, but as a whole I’m enjoy everything. I know this is specific from hospital to hospital and there’s no guarantee that I’ll enjoy this working somewhere else, but for the time being I like what I’m doing.

I also noted that in the system I’m listed as a ‘non-staff RRT‘. No pressure or anything of course…

By the way, I think iOS5 will match Android’s ‘smartness’, for which I’m rather excited. That’s neither here nor there.

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Aside from Lisa’s problem, which is a major problem indeed, I’ve hit a bit of a roadblock at the hospital, namely the fellow student there.

I’ve more or less complained about her to Lisa nonstop since maybe the second week of these clinicals, and I’m frustrated beyond belief. It all came to a head two weeks ago: she was charting a patient, and she walks up to the preceptor and says “what do you do if the medication isn’t listed? Atropine isn’t on the list.” The preceptor simply said “Atrovent”.

My eyes went wide when I heard this for a bunch of reasons:

1) You don’t know what you’ve been giving to the patients for over a month?!
2) We had two separate classes on pharmacology and most importantly:
3) Atropine and Atrovent differ greatly on how they affect a patient.

Atrovent (ipratropium bromide) works to reduce airway swelling by blocking m3 receptors. It helps make it easier to breath. It’s like anti-depressants for your lungs. It’s fairly safe. It’s actually derived from Atropine. However…

Atropine is an old medication and crosses the blood-brain barrier. What’s that mean? It means it has funny effects on people, most notably causing hallucinations and excitability in the elderly. Yeah, and it really isn’t used for the purpose of treating asthma and COPD anymore.

On that subject, we see a crapton of COPD patients. Atrovent is indicated for COPD. We’ve been there for almost two months when that quote was uttered. Seriously? I read the same textbook she did. Atrovent gets pages upon pages, Atropine gets maybe half a page. C’mon now!

It’s been downhill from there. I was there last Friday, and something happened on the day she came in when I wasn’t there. Any time she was discussed, there was tension. I don’t know what happened, I don’t want to know. But I fear that she’s going to hold me back going forward. Heck, I know this is a fact now. When I’m there by myself, I’m granted a lot of leeway. I’m trusted to do a good job. I go out of my way to follow people around, ask questions, take notes and volunteer for every job that comes my way.

That’s how you learn, right? Right?

I ticks me off that she doesn’t have any other job other than being a student and lives so close to the hospital. Me? I drive 200 miles, pay $17 in tolls and $40 in gas a week only for her to still be confused about breath sounds. I have another job and have two kids – lady, I don’t get to study until after 8.00pm and that’s assuming I don’t take any ‘down time’ (which I do, for my sanity). You should be running rings around me!

It’s not fair, I tells you.

Basically, the amniotic fluid somehow enters the bloodstream and creates a bunch of little thrombi (blood clots). Since the thrombi put a tremendous amount of strain on clotting factors, at a certain point the blood simply stops clotting. On top of this, the blood clots are still there, so when they get dislodged, they can go *anywhere* (the brain, the lungs, the heart).

So, there are two problems here: the fact that there were so many clots and that it has to be diagnosed in the first place. It happens so infrequently that it’s unlikely that a general practitioner will see it in their lifetime.

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As I’ve been going through this program, I’ve come to appreciate having a sister going through med school in India. Specifically, her school is a level three critical care hospital; this is the highest level and they see the hardest cases that lower level hospitals refuse to take. I can mention a concern and she’ll have in depth knowledge on the subject… except, ironically, respiratory, for which she has not done a rotation yet, so I end up briefing her on a variety of subjects.

Also, more importantly, India is coming up as a first world country but many of the patients still are of third world poverty, so they use a number of old school methods that we don’t see here in the U.S. There’s a science behind it that gives me a better understanding of how the machines work.

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Obviously I’m at a different stage in my life, but had I given it some deep thought ten-twelve years ago, I probably would’ve enjoyed being a doctor. I can’t believe how much I’ve enjoyed this program thus far. Last night, I had an unexpected day off and I found myself wishing that the syllabus were available so I could start studying. All of it is incredibly fascinating. Jaya and I have had some incredibly interesting conversations about our clinical adventures.

Another time, another life…

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Let it be known that Lisa is killing it with the running. I’ve only run once, but she’s taken the Google Tracks / spreadsheet thing to a whole new level. Kudos to her!

For example, one patient I saw came in anoxic (without oxygen, or not breathing) and was put on a ventilator. His situation was that he had shortness of breath and chest pains the night before, and slept through them, and passed out the next day (lesson one: chest pains, don’t mess around!).

I sat in on the EEG to study his brain function. I asked the tech a myriad of questions, all of which she was happy to answer. I bugged the ICU doctor on his diagnosis and prognosis, and asked everyone who touched his chart all sorts of follow up questions.

I have to say I learned quite a bit that day in a way that I never have learned anything before.

In case you were wondering, yes, his brain was not functioning. But, even with almost no brain function, it’s surprising how much he responded to commands and outside stimuli. I guess I assumed that if the brain lost oxygen you’d stop everything; that is not the case. He responded to suctioning as you’d expect (body tremors, tearing up). He periodically opened his eyes – but the gaze was fixed only on one spot on the wall, and his pupils did not respond to light changes. He responded to pain with decerebrate posturing and periodically bit on down on the endotracheal tube until he was red in the face.

I can now understand why the Schiavo family was so insistent that she wasn’t dead. Had I not been there to see the EEG, I would’ve thought the same of him. The brain is a funny thing.

All that said, it’s hard to disconnect from the clinical side and see the personal side while in the hospital. I think, as a rule, the hospital is built to be a sad place where the frequency of miracles to tragedies is 1:100. That makes sense, of course, but our textbooks always present it as “this is how this works, and what will happen when it works”, where in reality it’s “this is what is supposed to happen, but…”

I have hope for a few people in ICU. We’ll see where they are once I’m back on rotation.

For many of my fellow students, they’re already working in hospitals, and some have been for decades. In their case, they’re Respiratory Techs or Nurses Aides or something of that nature. In essence, they have clinical experience. I’m one of the few odd people out.

To that end, I’ve been putting in a lot of effort in this first week. I can’t skate by; I have to do twice the work of nearly all my peers. These courses aren’t been graded on a curve, but I’m pretending that it is.

That being said, trying to strike a balance between work, family, school and sanity is proving hard. I’ve yet to figure out how to get workouts scheduled in between all this. I’ve been absolutely flooded at work so studying there is proving to be difficult. Everything starts after the kids go to bed.

I wonder how my parents did it… they did it at roughly the same age I was, and I don’t remember very much of it at all.

Only problem was that I couldn’t very well quit work to follow this path, so my journey started with DCCC’s program (full time), then onto West Chester University’s program (full time), onto CCP’s program and going so far as to speak to the dean of the program at Gwynedd-Mercy (to be honest, if I could have quit and gone there, I would have – I spent a good 50 minutes talking to him).

It led me to Independence University’s program, which is online. The program is two years, but it’s the only part time program in the area (there are accredited part time programs in other states, just not PA).

Note: even though there are nine hospitals in the immediate surrounding area, they belong to one of three networks: Mercy, Crozer-Chester or Main Line Health. Because of this, they have very specific contracts with the aforementioned colleges.

Back on point, while joining Independence was a fairly easy task (there was a rather informal interview and then the Wonderlic), there was no avoiding the fact that any RT program requires clinical hours (960 to be exact).

I interviewed last week at a hospital in Hamilton, NJ (right outside of Trenton) and they accepted me. Since then, I’ve been filling out reams of paperwork and my advisor has been calling me non-stop. The full weight of it didn’t really hit me until Nora asked me about going back to school. Hence, the cryptic blog entry.

The hospital is 54 miles one way, which is about 1hr 10min one way not during rush hour. After graduating I have to sit for the CRT and RRT examinations.

Interestingly and oddly, Independence University was originally called California College of Health Sciences and was the same program that my dad did to become an RT (back then, it was a correspondence course). For those curious, it’s not only accredited but comes under Title IV, so no high interest private loans for me (thankfully). It does have professors, and there’s a fairly decent course load. Each student is assigned an advisor who apparently calls once a week. Exams are proctored. Even though it’s online, I’ve been very impressed by how the whole thing is run (and a little intimidated).

There’s a lot of reasons I’m pursuing this outside of the family business – it’s neither exotic nor prestigious, but I will say this: for years, (seven, at this point), I’ve almost constantly dwelt on how going to law school was a mistake (and I knew this before I even went – I remember the conversations with Lisa clearly) and I should’ve stayed in D.C. and tried to get work on the Hill; since making this decision, I haven’t had those regrets. I’m really looking forward to this next chapter.

Also, I’m really happy that I made this decision before I turned 30. Truth be told, I felt rather rudderless. The family business kept me busy enough, certainly, but I was thought if I was going to do what I was doing, there was no need to waste money and go to college. While there’s a solid amount of growth in the respiratory field, there are a lot of RT factories and a bachelor’s degree gives me a ‘step up’ if I ever decide to work outside of a hospital within RT. The more I think about it, the more excited I get.

Finally, thank you for the supportive comments, I appreciate them.