swine flu

I'd been complaining for weeks about the peds ED. I love kids but, damn. How can one not get frustrated when your board says cough, tos, cough, no come nada, fiebre and on and on. So, I decided I didn't care that we had our lovely DG Holiday Party the night before I had to work at 7. I stayed late and allowed the 4th years to accomplish the waste-the-interns mission. And then, of course, I showed up to work to get the sickest patient I have ever seen.

The only history was that she'd had a fever and muscle aches for a few days. That morning, she had had some vomiting and diarrhea. And at around noon, her stepdad found her passed out on the bathroom floor. By the time she arrived at the hospital, she was breathing agonally and vomiting blood. We intubated her, started giving her blood for her hemoglobin of 5, started antibiotics, started lines all within a few minutes of her arrival. By the time her parents arrived, she was coding. There was nothing we could have done to save her.

This case doesn't bother me because I wish we had done something different, because I fully believe that there was nothing we could have done; she was too sick when she arrived. However, this case bothers me because I really want to know what she had and I can't wait for the autopsy results to come back. Some of her blood culture results came back, which were positive for e. coli. I just think that this is bizarre. She was a young, healthy girl. Why would she get a gram negative sepsis without any preceding symptoms of UTI? I think that maybe she had H1N1 and that she got ARDS and DIC from the H1N1 and then seeded her blood from her gut, which was obviously bleeding by the time she got to the ER and by the time we took the cultures. I want to be able to explain this, and I think that this is a plausible explanation.

H1N1 has taken quite a few young, healthy people this year. It is much more virulent than the typical seasonal influenza. In fact, young healthy people don't have immunity to it because the last time a similar strain was seen was around 30 years ago. People under 30 don't have immunity.

I also think this case is interesting because it is completely parallel to Brittany Murphy's case, who also recently died after a few days of flu-like illness. The cause of her death is, as well, unknown. People are trying to pin it down to drugs, but the only hard facts are that she had a flu-like syndrome and that she went into cardiopulmonary failure and shock and died very quickly.

I will have to leave it as a theory at this point.

Bishop Christmas Crush

We planned to avoid the snowy weather by driving South and avoiding the high elevation passes that were sure to delay us as we headed cross-country on a time limit. We left immediately after Joel's final and had to make it to my interview in Las Vegas less than 2 days later. Murphy's law held true, and just about everything possible went wrong. The giant red pickle van lost power only about 100 miles south of the cities. Was it broken? Was it out of gas? Was something frozen? We didn't know. The gas gauge was broken and it was -20; our calculated mileage was around 8mpg. We gambled optimistically and kept going. We then hit snow and ice storms through Kansas, Oklahoma, New Mexico and Arizona, stressing a bit as we saw about 30 cars in the ditch. We stopped at a truck stop to shower, I changed into my suit in the van, Joel de-Rocco-haired me with a tape roller as I rolled into my interview only 5 minutes late and on a few hours of quality van sleep. Maybe in retrospect, we might have planned it a bit differently. But, we made it, safe and happy, to Bishop, CA. We joined Team Minnesota in the Bishop Christmas Crush!!

Danette on "The Hulk," a super-classic 4 star boulder problem at the Happies that is really sweet. But hard.




Mike on Red Rum, his proj.











Lynn at the optimal angle to photograph Joel in the silly furry hat Danielle gave him on the problem next to Red Rum. I forgot what its called.











Trinh on The Cave Problem, V6. I loved this problem, and worked on it my entire time in Bishop, but never sent it. I've got some unfinished business; all the more reason to make a return trip to this beautiful place.

Joel, getting the butt spot on Kyle as he tries The Mandala, V12, his proj.















Alex flashing High Plains Drifter, V7, on her first day in Bishop.

Interview Trips

I heard someone refer to residency interview trips as our victory lap around the country for doing well in medical school. I suppose you could say that . . . the interviews were mostly relaxed and low-key and I did get to visit some really cool places and mix a bit of business and pleasure. Here is Lisa, one of the British girls I climbed with during my one-day stop in Hueco. She is proving that short people can indeed do the first move on Babyface, though maybe not the second.

This is Hueco, the cutie pie little pup that George, one of the guys staying at the Rock Ranch this season, adopted. He has the exact same shape, pencil tail and giant bat ears as Rocco when he was a baby. Awww.

My first look at the amazingly majestic Yosemite Valley. Someday, someday, I will climb these granite behemoths. First, I've got some work to do on my weak sauce crack climbing skills.










The boulders, too, were awesome. I didn't actually see anybody bouldering at the Camp Four boulders, which kind of surprised me because there were a lot of tents. So, I had to boulder sans-pad on the short ones so as not to re-break myself. But, I'll be back . . . mwahaha.







I think this may be the first time ever in my life that I've taken a picture of a rainbow and it has actually showed up in the picture. This is Yosemite Falls, which I hiked up to when I got bored of bouldering by myself with no crash pad. It is absolutely beautiful and gives you some amazing views of the valley, especially Half Dome.



Portland, Maine is a really, really cute and picturesque little city. Really, with all the cobbles and tranquility, its hard to imagine a crime being committed there. Which makes it probably not the ideal place to train for Emergency Medicine. However, I think it would be a fun place to live. The residents all have Maine Medical Center biking jerseys and go on long rides twice a week. They pride themselves on being the happiest residents in the nation. It would be a fun group of people to train with.

I mean, really, is this even real? It looks like a painting. Or a postcard. I think my mom would paint a lot more if she lived in Maine.

Winter at Sandstone

It was a sunny, snowy November day at Sandstone. About 25 degrees. Climbing weather, right? I did boulder with my socks on and my wingers were just a bit chilly, but we had a great time. I was afraid the little Rocco man would fall through the thin ice, though. He really did not understand about the ice, even when it was cracking.



Shirtless on the river boulder, Joel tries voraciously to prove that Minnesota really is seasonless in its incredible climbability.











Me, with my 4 toplayer, two bottom layers and socks in my climbing shoes. A little more of a freeze baby. Or a seasonal realist, see it as you will.