On Up to Seattle

Well, I've made it quite a round trip from Colorado, to the North Rim of the Grand Canyon, to Seattle, and all the way back here to West Virginia!

After spending Mother's Day with my Grandma in Boulder, I drove down to Glenwood Springs to fly fish some. I love fly fishing, but I'm terrible at it. I walked into this fly shop and the guys told me what to buy and where to fish. I didn't catch a thing. Oh well... the beautiful scenery and calm mountain air was good enough.

My rusty steed and I then headed south to the North Rim of the Grand Canyon and I got there just as the sun was setting. You haven't lived until you've seen the sun set on the Grand Canyon. The next morning I woke up to find the same site to the East and just as breath taking. On to the Redwood Forests!

That took me up toward Salt Lake where I hung a left onto Interstate 80. Now, I thought this would be a pretty boring part of my drive, but let me tell you, it wasn't. Western Utah is by far the strangest place I've been. The ground is white as snow; apparently it's entirely salt. People find these black rocks to write illegible messages in the salt. It's completely absurd. As far as the eye can see in any direction there's nothing but salt. No plants. No animals. No hills. No people. No nothing. Wild.

Oh yeah, in the middle of all of this I came upon a huge, manmade thing. As I'm heading down the road, barely speeding, I'm inspecting this giant contraption and thinking... "Well, is it artwork? Yeah sure... must be." Then I almost hit the guy in front of me who had almost stopped because of the... um... artwork. Fortunately, I didn't hit him, but I was inclined to stop barely speeding.

I finally made it to the Redwood Forests in northwestern California. Those trees are absolutely beautiful. I was kindof filled with mixed emotions though. While those trees were enormous, big enough to drive through, bigger than any tree I've ever seen, the stumps left from the loggers were even bigger. They were larger than my imagination. Interestingly, they had sprouts coming from them. They are the 800 or 1000 year old trees, cut down in their glory, only to spring forth new sprouts from their roots. The sprouts aren't very big yet... but wait another 800 years!

I went to Seattle next to visit me sister for the next few days. That'll have to be next time... perhaps tomorrow. I'm going to bed now. For all of you who are board studying, best of luck!

Mike

Life and Death in the Southern United States

Lord, make me an instrument of your peace,

Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
where there is sadness, joy;

O Divine Master, grant that I may not so much seek to be consoled as to console;
to be understood as to understand;
to be loved as to love.

For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life.

-The Prayer of St Francis of Assisi-


I was riding down US Route 47A on a beautiful Sunday morning when a young girl stepped out to wave me down. When I asked what was the matter, she said "are you a doctor?" "No, but I am a medical student." She pointed down the road a few meters and said, "go there."

I saw the truck first, then the old man thrown out of the truck. There was a small croud of people around him trying to hold him still. He was conscious, but clearly completely unaware of his surroundings. I asked the guy next to me to try to maintain his c-spine and we waited. The others had already called an air-medic for transport.

That's when things started to go really bad. He stopped breathing and the two people feeling for pulses, stopped feeling them. He vomited blood. I tried to clear the vomit and start CPR. Airway. Breathing. Circulation. Those become so confused when you're staring down at somebody who needs them. I started to do compressions, then mouth-to-mouth, then compressions, then he'd throw up blood. Somebody said later that lasted just 8 minutes. There was no greater eternity when I had no idea what I was doing. 8 minutes.

That's when the air-medics landed. You would think that I'd remember them landing, but I don't. She handed me a BVM so I could stop with the mouth-to-mouth; I have never loved a person more. I continued with the airway, another guy took over the compressions, and the air-medic tried to put in some lines. She had trouble with the lines because apparently his humeri and his femurs were broken. All of them. I hadn't even noticed.

We continued until they attempted to put in an endotracheal tube. They tried twice and then switched to a combitube, a tube that will enter both the esophagus and the trachea. By this time, something like 20 minutes had passed since he stopped breathing and stopped having a pulse. There was blood coming from his ears. The EKG on him said asystole. That's not a shockable rhythm. Shit.

The air-medic called it. I guess they can call it in this state. That was it. He was dead on the side of the road. I'm kneeling beside of him like a vulture, covered in his blood from my mouth to my shirt to my jeans. My knees burned as I stood up. I didn't know what to do. While once he was alive, now he is dead. I asked for an alcohol whipe for my face.

After I got cleaned up and changed my clothes, the flight nurse came over to say thank you. We hugged afterwards. I don't know if that's standard procedure, but it was nice.

Now, what do I do about my obvious pathogen exposure in my obviously immunocompromised state. Yikes. I've gotta say I normally wouldn't care, but I just stopped a round of temazolamide yesterday. So, I went to the local ER and called my own oncologist. The ER had a Physician's Assistant on duty who really didn't know what the deal was and my Loyola oncologist was in a conference. So I had to wait about 2.5 hours for my oncologist to give me a call and say it's not worth taking the drugs.

I don't know whether I did the right thing with this patient. I'm writing this as I'm trying to work them out. Did I get his airway open; there were times when it wasn't open enough. Did I do compressions right; sometimes I just lost count. I didn't maintain his c-spine when I was trying to clear his airway. I can't stop thinking about it right now, as much as I try. I guess I have to go back to that original conversation with the young girl. "Are you a doctor?" "No, but I'm a medical student."

I'm not a doctor.

Continuing the trip...

Hi all,

My road trip has gone spectacularly so far. I went up across South Dakota and Wyoming, which I had mentioned before, but which was far more amazing than I can describe here. I can just say it's breathtaking... other than that you have to see for your self. Next I spent some time in Boulder and Colorado Springs. That was amazing because I got to see my family and even my new cousin... the future Dr. Shea. Then, my mom & her kin got up and went down to Santa Fe with me, which is where I am now!

In the future, I fly back to Chicago for a few days around 5/10 and then back out to Boulder. I'll then traverse the country westward and arrive in Seattle for a few days around 5/20. On 5/23 I'll go back to other direction to arrive in West Virginia and spend the memorial day week on a lake. I'll head back up to Chicago around the 4th of June.

In GBM news... we finally got the call from MD Anderson to tell us that my tumor is V3 negative. I actually took quite a bit of relief knowing this because it means I don't have the most aggressive of tumors. However, that result means that I'm not able to have the viral vaccine. That may seem disappionting, but I'm actually quite pleased with it. We'll wait until we think about it some more to decide whether to have to surgery in June...

Most importantly, congrats to all who finished their finals and are entering boards study time!

I'll try to post more later...

Mike