SI -- WEEK THIRTY THREE

It was another good week here in the Stoecker household! I had a week of lectures covering everything from how to treat symptoms of menopause to pediatric hospice. One of the most helpful things we reviewed was the conversions between all the different narcotics and how to appropriately prescribe them (there is a method to decide how much to prescribe for baseline pain control vs breakthrough pain.. you don't just pull numbers out of the air!).

We also practiced "end-of-life" and "code-status" discussions with a small group of students. A palliative care doctor worked through a few fictitious scenarios with us as we role-played these conversations. I thought she was really helpful as she shared with us how she phrases some of these difficult topics. I have to ask every patient I admit to the hospital what they want listed as their "code status" - meaning, would they want us to attempt resuscitation? Or would they like us to allow natural death? The physician working with us shared the numbers on the effectiveness of these efforts - super helpful to hear so that I can pass them along to patients the next time they ask! (What % of people is CPR effective? 15% if you include accidents like near-drowinings and electrocutions. ~5% when you look at people with serious, chronic medical conditions.. and that whole 5% don't make it home from the hospital... I've always thought it was powerful to know that >90% of physicians report they select DNAR - do not attempt resuscitation. Just something to think about!)

We also had a small group Code simulation. UNMC has an awesome simulation lab that was built solely to train students/residents. [If you have some time to waste, you can see the "clinical skills labs" in the virtual tour of the campus here] We've used the lab for various training scenarios and tests throughout our program. This week, we were put in groups of 4 M.D. students with 2 PharmD students. We then had to work our way through 2 different code scenarios with the ($150,000) mannequin. This robot talks & blinks.. his chest rises when he breathes.. you can feel pulses in at least 4 spots.. he measures if chest compressions are adequate -- he really is quite advanced! I was nominated by my group to "lead" the first code. This is something we've all been trained to do during our Advanced Cardiac Life Support classes.. but we're pretty comfortable taking orders from a more experienced physician and standing in the background instead of taking lead!  Even though the scenario is fake.. it is still a little nerve racking to be running the show. So what does it look like to "run a code"? It means you're the person deciding when to start chest compressions, when to give medications, when to hold chest compressions to check for a pulse, and when to "shock" the patient -- any/all of those decisions. It's all an algorithm but, it can still be challenging to lead. For me, the most difficult part is keeping track of time. It helps to delegate a "recorder" - someone to keep track of when you started the resuscitation and when each dose of medication was given. But it can still be tricky because the timing feels so different from reality - does that make sense? After we saved the patient (yay us!) we "debriefed" and watched a recording of the code with 2 camera angles to critique what we could have done differently:

I'm there in the green with my hand on the "patient's" femoral pulse while I bark
out orders and make the boys do the tiring part - the compressions ;)

Finally, how did we spend Valentine's Day?! First, we had a lazy morning in bed (it's not often we both have Saturday off work!). Then I danced around the house to this jam while I made us french toast for breakfast. T and I went for practical gifts this year: I bought him a few money belt options for our trip to Europe and, for me, he remembered that I had be seriously considering stepping up my skincare game with a Clarisonic. I had decided it against it a few months ago because it's spendy.. but T was sneaky and surprised me with one anyway! I'm a total rule-follower -- so it was a painful 24 hours to wait before using it (it's what the instructions recommended!). I never thought I'd be a diva about skincare but ever since I started working long shifts/overnights I care more and more about how my skin looks au natural!

Then we spent our afternoon in Lincoln celebrating a 6th birthday with T's family:

We ended the evening by staying in and ordering Chinese take-out.. can you tell we don't make much of a fuss about holidays?

Tomorrow, I don't have to work thanks to President's Day! That's the bonus to having a month of lectures - we actually have holidays off! Ironically, T has to work (don't banks close for all holidays?!). I decided to book any/all "annual" appointments I could think of (doctor, eye exam, etc) so that I can quit being a hypocrite when I tell all my patients to make these same appointments :) Have a great week!

xo,
Krista