Sneak Shot

One afternoon, a deer quietly wandered in our yard near the front door. They are usually timid creatures and are easily spooked by just about any motion or noise.

Hiding behind the curtain, I sneaked to get a photo of the deer. However, I think it sensed that she’s being watched, so she quickly moved away, but not after I was able to take some shots.

The deer disappeared probably muttering “Those pesky nosy neighbors!”

What’s funny is I did not know that I was also being sneak up on. And she was able to take some shots too.

Am I also timid and easily spooked? I could have turn around and gave my deer-in-the-headlights look.

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(*photos of me sneaking a photo were taken by my wife)

Unburdened

It has been rough going for us in the past few weeks. Our work group is limping with regards to our coverage of clinic duties and hospital calls.

One partner is on maternal leave. There were sickness in our ranks as well for two of my partners went down with flu at the same time and they were incapacitated for a day or so, and we scrambled to cover for them. Then another partner underwent surgery and have limitations on doing procedures that we have to switch around our rotations. And with recent spring break season, there’s always one of us that is out of town for a vacation that has long been scheduled.

But life goes on and we managed.

I am in-charge of the ICU for almost two weeks now. It is awfully busy and I am in a lot of stress to say the least. My wife have noted that I’m in a foul mood in the past few days. Perhaps I’m becoming a grumpy old man. Or perhaps it’s male menopause, if that’s even a thing. I still blog though, partly to de-stress.

Then a couple of days ago I received an e-mail from our group’s Risk Manager forwarding a letter from the hospital’s Guest Relations Office.

When the hospital’s Guest Relations Office is involved, it is mostly to pacify disgruntled patients and families and to hear their grievances. And when Risk Management contacts a doctor, that’s not a good sign, as most of the time it means a patient is complaining or worse yet, filing a lawsuit.

This is at the heels of a recent local news of a patient that sued a doctor and the jury awarded the complainant several million of dollars for damages. The compensation was so steep that most medical doctors could not earn that amount of money even in their whole lifetime. As a physician it bring shivers down my spine. I am not saying that the doctor in that case is not at fault, but this is just the reality of the world we lived in.

The e-mail I received said that the call came from the family of a patient that I took care in the ICU. It was an elderly woman who became severely ill and died under my care. She was one among the recent strings of our hospital fatalities.

I am already under a lot of pressure from the ICU’s workload and I don’t need any more bad news or added stress.

But as I continue to read the letter, my yoke was suddenly lightened. In fact my burden was lifted and turned into joy.

The letter said that the patient’s daughter reached out to the hospital’s Guest Relations Office and recommended that her experience be forwarded to the appropriate leadership body. And it named me specifically.

What the patient’s daughter wanted was that me and two of my residents “be recognized for our hospitality, warmth, and kindness.” She shared, “they were wonderful in explaining my mother’s circumstances. I cannot even find the right words to express what they did for me. It was so heart-warming.”

God knew I badly needed some encouragement. And I am so grateful He provided me one.

(*photo from the web)

Old Man

I had another birthday. If you don’t know it yet, my son and I share the same birth date. But as he is turning into a young man, I am growing into an old man.

We did not have a big celebration though, and in fact during our birthday, we drove more than 100 miles to my daughter’s university to watch her perform during a competition of their school’s top music students. So we just had our birthday dinner at my daughter’s university’s cafeteria. But we still grab an ice cream treat from there.

Even though we did not have a party or a fancy celebration, the best part of my birthday is that we spent it together as a family. I know as our children gets older and they go to college or move out and have their own lives, gathering together can get more and more infrequent.

It’s getting warmer in our part of the world, so we can spend more time outdoors again. And last night, my son and I played some basketball in our driveway hoops, perhaps inspired by all these NCAA March Madness. I know the NCAA basketball championship is all set between Virginia and Texas Tech tomorrow.

We spent many summers playing in our driveway hoops. It is here that I taught my son how to dribble the ball, how to drive into the basket and do a lay-up, how to do jump shots and some other fundamentals. Maybe I taught him more than just basketball here, like how to whole-heartedly compete and yet staying gracious in win or defeat.

photo taken 9 years ago when my son was 7 years old

But this time it is different. My son is now taller, even taller than me maybe by half an inch, and he is way more muscular and agile.

When we played one-on-one, it did not take me long to realize that I cannot compete against him anymore. I was just no match to his quickness and strength. He kept on blowing by me when he drives to the basket, he jumped higher to get the rebounds, and I can’t even reach his pull-up jumpers.

I tried all the ‘old man’ tricks I know, which in our language is called ‘gulang,’ but it was still a no contest. I was clearly overmatched. And every time he blows by me or make a basket, he lovingly teased me, “Come on old man!”

In spite of that, I can say that I could still run, jump and play basketball. Or at least a semblance of playing basketball.

Last night was a ‘passing of the torch’ moment for me.

I humbly accepted defeat. Not necessarily from my son, but from father time.


No Bird’s Nest

It’s spring time and all the snow are gone, but I have not put away our Christmas lights at our front door. Well, it is still cold. That’s my excuse.

Then this morning, we have noticed a lot of bird activity in our Christmas light topiaries. When we peaked, we found that a bird was trying to build a nest in our topiary.

It was flying back and forth with some small twigs in its beak. However, it sensed that we were watching through the glass, that it stopped working and dropped the twig from its beak.

It eventually flew away and abandoned building the nest in our topiary altogether. Perhaps that is a good thing as I don’t think it would be a safe place for a bird’s nest anyway.

Needless to say, it forced me to finally put away our Christmas topiary lights.

Buwang

(This piece may be a parody, my aim though is not to ridicule those people with mental illness, but perhaps give an insight to their sad plight.)

Isip ko’y wala na sa akin,

Ako’y buwang sa ‘yong paningin,

Ako ngayo’y nag-iisa,

Sa loob ng isang selda.

Sa ilalim ng puting ilaw,

At dilaw na gown,

Nagwawala’t sumisigaw,

Sa dilaw na buwan.

Ayokong mabuhay sa hawla,

Ngunit ‘di na ako lalaya pa,

Ulirat ko ay lumayas na,

Lumipad papuntang buwan.

Sa ilalim ng puting ilaw,

At dilaw na gown,

Nagwawala’t sumisigaw,

Sa dilaw na buwan.

Itong kanta pinapaabot ko sa buwan,

Ang takbo nitong utak ko ay nasa kalawakan,

Hindi na bumabalik dito sa akin,

Walang nagmamahal,

Wala rin namang mamahalin,

Pakinggan aking iyak at damdamin,

Sa loob ng Mandaluyong na damdamin.

Sa ilalim ng puting ilaw,

At dilaw na gown,

Nagwawala’t sumisigaw,

Sa dilaw na buwan.

image from the web

(*Inspired by the song “Buwan” by Juan Karlos. This piece can also be sang to that same tune; composed at 2 AM, crazed by the moonlight.

Wind Farm

It is officially spring time, and not too long from now our farmers would be busy working on their fields.

Since it is still too early for planting season here in Iowa, here’s the only grown farm that we are harvesting right now.

These “plants” are really humongous by the way. A wind turbine has 3 blades that are 116 feet long that are affixed atop of a 212-foot tower for a total height of 328 feet. The blades sweep a vertical airspace of just under an acre.

Iowa is a national leader in wind power. Here it is by the number:

We are 1st in share of wind energy used.

2nd in installed wind capacity.

3rd in number of wind turbines installed.

In 2016, 37% of Iowa’s total power is from the wind. That equals to 1.85 million home here were powered by the wind. There are more than 4000 wind turbines in Iowa (there’s about 30 wind turbines in this photo if you look closely).

With continued expansion and addition of wind turbines, a power company in Iowa projects that by the year 2021, wind-energy capacity will equal customers’ energy needs. Iowa can be totally powered by the wind.

Maybe the proverb of “when you sow the wind, reap the whirlwind,” can be a positive thing sometimes.

(*photo taken on my way to one of our outreach clinics)

Deer at Dusk

Iowa is one of the top five states in the US with the highest deer collision rate. According to one estimate from an insurance company, 1 in 73 drivers in Iowa have reported hitting a deer from July 2017 to June 2018. Oh deer!

Autumn has the highest risk of collisions with deer because that’s when the herd is mostly on the move, though it can happen any time of the year. And dawn and dusk are the most dangerous time of the day as deer are more active during these times.

One day last week, it was dusk and we were on our way home. In one lonely stretch of a country road I spotted a herd of deer standing at the side of the road. I believe they were planning on crossing the road. But it seems they were waiting for our car to be just close enough, and then they would dart off across the road when I have no time to hit the brakes. They can be that crazy, you know. They are also notorious to stop at the middle of the road with their proverbial “deer in the headlights” look.

However, I outsmarted them. I slowed down as I approached where they were standing and even came to a full stop just in case they still would jump right in front of our car. Since there was no other car on the road except us, it was safe for me to stop (even gave a chance for my wife to take photos).

I think I disppointed them, so they turned around instead of pouncing at my poor car.

Scat you rascals! I will not be one of the insurance’s statistics.

More than Tylenol

It was the height of flu season. I was working that weekend, and I was in the hospital for 36 hours straight. We had several patients in the hospital that had complications from the flu. There were five on ventilators due to respiratory failure from Influenza A in our ICU. Two of them were on ECMO.

ECMO is short for extracorporeal membrane oxygen or also known as ECLS, extracorporeal life support. It is an intervention to provide adequate amount of gas exchange or perfusion in patients whose heart and lungs have failed to sustain life. It is done by placing a large bore catheter in the patient’s central vein or artery, where the blood was sucked out from the body, then ran through a machine to bathe it with oxygen, then flow it back to the body.

Saturday morning, I got a call from another hospital for a woman in her 40’s who had Influenza A and who was rapidly deteriorating. She went into respiratory failure and was placed on ventilator. They want to transfer her to our hospital for possible ECMO.

We rarely have two ECMO patients at the same time in our ICU. Even one patient on ECMO makes us busy, so two was really demanding. But a third one at the same time? That never happened before.

I made some phone calls to verify if we have a machine for a third patient and if we have enough resources and staff to handle a third ECMO. After confirming, I was given the green light to accept the patient.

Additional ICU and ECMO staff were called to come in. I called the interventional cardiologist-on-duty who would assist us to put the Avalon catheter, a dual-lumen catheter half as big as a garden hose that goes from the jugular vein and through the heart. The cardiologist in turn called the cath lab to prepare for the arrival of this patient.

Avalon catheter in correct position (image from web)

The patient was flown in via helicopter to our hospital and went straight to the cath lab where me, my ICU and ECMO team, as well as the cardiologist and his cath lab team were waiting.

We were ready for the challenge and eager to make it happen.

While we were doing all this, our patient’s oxygen saturation was only in the 70-80% (below 90% is perilous) despite maximum ventilator support, so we knew we needed to work fast.

However problem struck. Working for more than an hour, we had difficulty placing the Avalon catheter in good position. We tried different approaches with different instruments, but cannot get the ECMO flow going.

I called my other partners over the phone and I probably disturbed their quiet Saturday afternoon off, but I needed some opinion of what else we could do.

After deliberation, we decided that we cannot sustain this patient on ECMO. Perhaps it was her vascular anatomy, or perhaps there was a big clot in her vein. Whatever the reason, we could not proceed.

I went out to the cath lab’s waiting room, and gave the sad news to the patient’s family that we couldn’t do the ECMO. All I could say was that we tried and gave our best, but it was unsuccessful.

I felt that we betrayed this patient and her family. After I thought I moved heaven and earth to get this patient to our hospital, only to end up like this was really deflating.

The worse part was, I knew that without ECMO, this patient had little to no chance of surviving and possibly could be dead in a few hours.

We transferred the patient to the ICU, but we left the big neck catheter in place even though it was not hooked to the machine. We have to wait for the heparin (anticoagualant) we gave when we attempted to start the ECMO, to wear off before we can pull the catheter out.

After about half an hour in the ICU, I was informed that the blood test showed that the heparin had worn off and I can remove the catheter with less risk of bleeding.

When I pulled the Avalon catheter out, I applied direct pressure in the patient’s neck to control the bleeding. I did this for 30 minutes. I was alone in the room with the patient most of that time, with the nurse intermittently coming in and out of the room to adjust the IV pumps or to check on the patient.

All along while I was holding pressure, I was watching the monitor which showed that the patient’s oxygen saturation was staying in the low 80%. I thought death was imminent.

During the time when I was alone with the patient, I felt helpless and defeated. I failed her. We failed her.

Then a thought came to me: I don’t save lives. It was not up to me. Only a higher power determines who will live or die. That’s when I fervently prayed.

With my hands on the patient’s jugular holding pressure, I turned my thoughts to heaven: “God I am nothing, but an instrument of Your healing hand. I failed. But You never fail. I don’t know this patient personally, but I am personally praying for her. Please heal her in my behalf, and let me witness Your awesome power. Amen.”

How many times have we prayed for a sick loved one? But do we really believe God would heal them? Do we add the phrase, “if it is Thy will,” so we wouldn’t get disappointed?

As a doctor, sometimes, I put more faith to the medical intervention than God’s healing. Like when I was bedridden earlier this year due to a bad viral infection, it seemed I had more faith in the Tylenol that I took than in God to take away my fever.

After 30 minutes of holding pressure the bleeding stopped. I left the room and went to see other patients, especially the new ICU admission, a young man in his 20’s who had a bad asthma attack, so bad we had to place him on a ventilator.

As I was busy attending to other patients, I was just waiting to be called back to that particular patient if she goes to cardiac arrest or expires.

More than an hour later, I went back to the room of our failed ECMO patient. I looked at the monitor and her oxygen saturation was 100%. I was amazed! The respiratory therapist told me that she even titrated down the oxygen level on the ventilator to almost half as the patient was really doing good.

I had no other explanation but one: God heard my prayer.

I went down to my call room to be alone. With tears welling in my eyes, I uttered a prayer of thanks. Never would I doubt the power of God again.

He healed my unbelief.

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Mark 9: 23 -24: Jesus said to him, “If you can believe, all things are possible to him who believes.” Immediately the father of the child cried out and said with tears, “Lord, I believe; help my unbelief!”

*Post Note: Our failed ECMO patient survived. She even did better than the two patients we had on ECMO.

Six Pack

We are still in the midst of winter. Due to very cold weather, I have not gone out for a run for almost a month now. I even have not gone to the gym for several weeks as well, due to consecutive snow storms we had that piled up the snow and ice on our streets making driving a little tricky, especially when its dark.

But I have not been totally inactive even though I have not run or went to the gym. Because lately, I discovered my wife’s exercise videos and I was working out following them here at the comfort of our home. It’s better than not doing anything at all.

Since Jane Fonda produced those workout videos in the 1980’s, there’s a lot of them available. Are you picturing me doing them in my leotards? Sorry to disappoint you, but I am not donning those. Maybe pajamas, but not leotards.

I will not say that they are less intensive than running or doing cardio and lifting weights in the gym. In fact, I find my wife’s workout videos challenging.

One particular workout video series she has is the “Hip Hop Abs.” Yes, they are mostly dance moves, Hip Hop in particular. But if you do it for 30-45 minutes, it is really exhausting. Maybe even more exhausting than running 3 miles.

I also find it challenging since my feet have no rhythm at all. I can’t dance. I have two left feet!

My wife just laughs, for I lack the grace and coordination. But she let me do my thing and even joins me at times, exercising with those workout videos.

I think this Hip Hop Abs is really effective, as I feel the burn in my abdominal muscles and core muscles when I do them. Maybe if I do it long enough I’ll develop those muscular abs just like the workout video instructor. Or maybe I’ll do them until it is warm enough that I can run outside again.

Perhaps some people think that it is a waste of time working out or going to the gym, for there are more important things to do in life.

I remember a quote by Robert Mugabe, former Prime Minister of Zimbabwe. He said, “No girl will choose six pack over six cars….so stop going to the gym and go to work.”

Of course there’s truth to that. But I tend to disagree. What if you can strike a balance and get the best of those two worlds? What if you have both?

Just so you know, I don’t have six cars. I don’t have six pack either. But I’m working on it.

To be clear, I’m not referring to a six pack of beer.