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Thursday, May 26, 2011
Yesterday I did four c-sections and three epidurals. The first epidural was on a patient 'Flaca'. She was barely 100 pounds soaking wet before the pregnancy. Her hips were like a boys', very narrow. I couldn't help but notice as I put in the epidural. It was not easy. I had to go paramedian approach to get in. (it is the way you try when it is not going in the regular way).
Flaca had medical problems. Two autoimmune diseases, one of them, with the potential to shorten her lifespan. And she was just a kid.
Her midwife was not the greatest, and made her push for two hours. The kid came down sideways.
A cesarean section was called. The epidural worked well. I simply switched up the medicine I put into it. But she tore. On the inside. It was a complex uterine repair that nearly doubled the time in surgery.
Flaca was not doing well. She had lost a lot of blood, was pale, and kind of twitching. Hemodynamically stable, for I kept up. But energetically, not.
Since I had time, I did Reiki and Diksha on her. I got her some warm blankets from the warmer. I covered her arms, and also wrapped one 'babushka style' on her head. As I wrapped, I rested my hands on her head. With Diksha she calmed. I felt her energy calm.
I prayed. I said, 'she needs to be here for this baby, help her please.' I didn't want her disease to progress early in the child's life. As I did Karuna Reiki (R), I felt her calm. This was hands-off, but my working in her aura had a feel, energetically. I did a lot. And prayed.
I checked on her this morning. Out of all the mother/baby sets I worked with yesterday, she had the most genuine love for her son. And was touching him and nursing him with true affection. I think she is going to be okay.
The photo above is from the Blue Angels flight team. One day, our trained Doctors with Reiki are going to go into danger zones and do their missions. Just like I did mine last night.
Tuesday, May 24, 2011
"Why don't you like your job, mommy?"
"Because mommy likes to know when her day starts and when her day ends. In the OR, you never know."
This was an actual conversation I had over breakfast yesterday. I had a 'late start', first case to begin at almost eleven a.m.
There was a phone call. I was in my pajamas. "When can you come in?" I gave my best estimate-sixty to ninety minutes. (From pajama, to breakfast, to lunches packed, to kid to school, through traffic--the worst time of day for it--to work). "That's not going to help me."
Okay then, start another room.
Then my boss calls. Apparently, even though you check TWICE to make sure of the start time, 'you are responsible' for any coverage before that is added on. Another doc was called in.. I got there ten minutes after him. But I had to sit in shame for two hours until I started my case. Unpaid.
That is the nature of the OR. Remember how I said it is like a server navigating a busy kitchen? This is Hell's Kitchen, the OR. And unless you are trained on it from early on, you are not going to make it, not going to fit in. From the scrub tech, to OR nurse, to surgeons and anesthesia...it is rife with conflict.
And why, exactly was not one but TWO anesthesiologists' mornings radically disrupted?
A cardiac surgeon had a VATS (video-assisted thoracic surgery) scheduled at 3:45 p.m. and wanted to move it up. No emergency. No saving a life. He just didn't want to wait until his scheduled time for add-on. All add-ons are to be scheduled on a first-come, first-serve basis in the OR to be done at the end of the day following scheduled ones. Any bumping (cutting in line) is a direct surgeon-to-surgeon agreement.
This was bullshit. The charge OR nurse wanted to look good. And the surgeon saw the gap in the schedule, and went for it. Ego. Pure, unadulterated ego.
I kid you not. Patients DIE from this. The poor woman, in the rush, there was trouble putting in the double-lumen tube. Safety last. Ego first.
Sunday, May 22, 2011
From where I sit, I have the interaction with many surgeons and nurses and perfusionists.
All of them are needed to do neurosurgery (with cell saver) or cardiac surgery.
The differences between these two groups of people are striking. BOTH do very delicate work at saving lives.
What are the jokes about them in the hospital?
1. What is a neurosurgeon? Someone who takes a patient who is doing this (decerebrate posturing) and turns them into someone who does that (decorticate posturing). In lay terms, it is someone who works with hopelessly damaged people and raises their function significantly but they are still pretty messed up.
2. A man was sitting in coach on an flight, when the flight attendant from first class came in, looking very worried, and asked if there was a cardiac anesthesiologist aboard the plane. The gentleman sitting next to him said he was, got up, went into first class, and came back five minutes later. Dying with curiosity, the passenger asked his neighbor what was the big emergency. "It was a cardiac surgeon. He needed to have his seat adjusted."
Neurosurgeons are focused, quiet, incredibly intense people who for the most part love their work above everything else. They play classical music often, and do not like to be disturbed. Every now and then, they ask, "is everything going okay with my patient?" and I reassure them that they are doing well. Sometimes blood loss can be massive. Everyone is prepared for it The most picky thing, besides having everything the way they like it, is when the patient wakes up from anesthesia, the surgeon wants to have them really awake so they can make sure that everything moves and works. That the patient follows commands.
When asked why he does not yell, one of my neurosurgeons looked at me with surprise, then the look changed to disdain, and said, 'anger is counterproductive.'
That is a neurosurgeon for you. Sometimes more angel than human. Not always with the best bedside manner (emotional support). I tell the patients 'you go to them for their skills, not their personality' when they have that bewildered look after they talk with their surgeon. Neurosurgeons are really, really smart.
Cardiovascular surgeons are the last of the 'old boys school' for the most part. There are notable exceptions, which I will discuss later. They are emotional, angry titans who split sternums and work on some really sick people. Some contain it better than others. But most hate to have a woman in their OR. Every group I know in private practice has some woman cardiac anesthesiologist who is better at transesophageal echo than ANYBODY they work with, but they tolerate her, make fun of her skills (why doesn't she say anything USEFUL?), and abuse her verbally. They don't trust her. In academics, it is different. Women are tolerated more. But at most centers for surgery, abuse is the norm.
I have seen patients die from pride of the surgeon and the anesthesiologist and the rest of the team.
Pride is an element in the heart room. Ego reigns. Dominance, aggression, control, continuity. There is NO COMPASSION. Not for anyone. When a case goes bad, the doctors are in for twelve hours, straight, with no breaks. It is barbaric. It has to stop. And for the most part, it is...the cardiologists are advancing catheter-based technology, and the patients prefer a small leg puncture over any opening of the chest. What is left are very complex patients, at high risk, for very little pay. Medicare pays a surgeon one fee in the hundreds of dollars for pre-op, six hours of surgery, all hospital care, and one follow-up visit. The only way for a practice to succeed is to do high volume of cases efficiently. Some work at three different hospitals in one day.
The exceptions are the cardiovascular surgeons of VERY high ideals. Most were trained under the giant, Dr. Norman Shumway at Stanford. They are gentleman of the highest sense. I never would have gone in the field if it weren't for one I worked with during medical school. Dr. Mehmet Oz is another that comes to mind. Another, is a catholic of very deep faith, I have known for years. The rest are Indian, Vietnamese, and don't have that attitude like the caucasians. (Some patients are flying to India for their cardiac surgeries now. The care is excellent, it is affordable, and the insurance company throws in a nice hotel, too.)
Verify your heart surgeons' lineage. There is a hospital in the area that is exclusively run by a group of Shumway's. Watch the surgeons' support team in the office. Is everybody walking on eggshells? Is it very 'old school' with the big library mahogany in the office? Is it an older surgeon? Does the surgeon also work on pediatric hearts? (most that do have better skills, but they can still be cruel. I know one. He was a piece of work.)
As Scotty on Star Trek once said, 'they still do this?! This is BARBARIC! Get out of the way and let me work!"If you are sick, your energy body and regular body need the best healing available. Go for it, and seek the very best.
Saturday, May 21, 2011
Last night, a bunch of nurses and myself had a 'circle' without it being official: we shared our intuition about a patient to move forward as a group and make sure the newborn was tested for illicit substances.
One nurse was upset. After the delivery, the baby nurse did not see any reason to 'bag' the urine.
She shared. I said, yes, the vibe in that room is that of abuser. Someone else said, 'The father smells' (he had gone out to party that the baby was coming but didn't realize it was going to be that night the baby would come.). I shared data from the epidural placement, her not flinching to the local injection (which hurts a LOT), and how the last time I saw a mom like this the husband had a record for assault on her last summer. The ward clerk got online to the local court system, and pulled up not one but two cases of arrest on the mother for drug charges. The baby nurse was shown this data, and the bag was tubed over in less than a minute and placed on the child.
The group worked together, using very little data, to solve a problem. We each have had experiences with 'the drug parent' archtypes. It was through sharing our individual perceptions that this was a success in leading to possible intervention for the newborn.
Did I use my Reiki? I do not know. At this point, everything is working together seamlessly, unconsciously, and effective as all heck. The questions I ask colleagues are close to home, almost like a lawyer--who planned a surprise birthday party recently, who has a left-handed son, etc. Through claircognizance I automatically 'know', and base my questions from there. It is not spooky or scary. Just uncanny.
I know that Development Circle is a strange concept to understand. I thought this was an excellent example of how we work together using intuition and our perception, to help patients in our care.
Wednesday, May 18, 2011
Lately I have been having new insights. I go for my Karuna Master class this weekend. Karuna has a different way of looking at things. Before a class, you go though a cleanse. Mine seems to be an awareness expansion.
Last night I went to Circle. It is a psychic development class that is ongoing. Sometimes I get upset because some people tend to 'hog the spotlight' and class is only once a month. Yesterday, I saw it fresh. And true. Everyone there has to keep going for some reason. Instead of 'just to go' or 'to develop my skills', everyone there is looking for instruction for how to live their life. For mediumship from the Other Side directed to them. Last month I gave messages to others. None for me. Last night, the same. But I was also feeling calm, light, and at peace. I did my thing, and gave consolation to others. I realized not everyone gets messages for them all the time. But the ones that need it most, get. It was a beautiful circle.
Today, in the OR, I got 'exploding veins lady'. Frustrated, the preop nurses passed the i.v. on to me. It was hard since we were to work on one side and an arm had to be free of BP cuff and i.v. I tried. Every time I got it, I got in, but with flow, the i.v. blew. Finally, one on the right finger (on the side of work but just to 'get her to sleep'). It blew before induction! So I had to try, try, try. The patient was excellent. I finally got it on the right foot. It ran. But I didn't take it for granted! LOL
The next one was pro-basketball player height, football player build, and assaulted people last time they got morphine. Great. A real self-destruct case, with life expectancy less than 5-10 years although this patient was five years younger than me.
The last? Eight years older than me, but with severe cerebral palsy and institutionalized.
What if these patients were an efficient way of paying off Karma?
Not MINE, silly! Them.
What if, like they had a debt to repay (for their past, assuming reincarnation is valid), AND...
they wanted to 'pay it off quick.'?
Makes a lot of sense, doesn't it? Being trapped in a body, failing, falling apart, with issues to the MAX?
Maybe what we think 'healing' may not be viewed the same way from The Other Side. Does this not make sense, if Life is a class and we are the lesson?
Everyone wants an easy life. But if this were so, why would we struggle? There must be a reason. I am not sure exactly what it is. But I am thinking... : )
I hope you are too.
Namaste and Peace.
Wednesday, May 11, 2011
Standard Monitor Used in Critical Care and the Operating Room
The monitor was the last great paradigm shift, Kevin Tremper, MD, said in the Rovenstein Lecture of 2010. He reviewed the invention of the pulse oximeter (blue line, with 100) and it's rapid acceptance and role in improved patient safety.
He also paralleled the changes in technology in aviation to the changes in technology in anesthesia. One of the newer developments in aviation is to 'fly by wire'...this means that there are no wires connected to the controls. Just a computer. And it interprets every move the pilot makes and adjusts it perfectly. Tremper said that Sully overrided the computer in landing on the Hudson River. But a whole new age of monitoring perioperative data and using it as a resource for clinical research is the wave of the future.
I have seen this done. Intraoperative monitoring with 'Quality Assurance' turns the operating room into a place where administrators set limits on where they want vital signs to change from baseline. And without the anesthesiologist knowing it, triggers are set and the anesthesia provider can be 'counseled' about their care. The chair of the department has an app on the cell phone and can see every case's monitor data remotely. It puts the anesthesiologist in a daunting position of defensively annotating the automated record to document everything to explain variation in the hemodynamics during each case. There is a little clock in the computer, and promptness is needed.
Sometimes, in a very unstable case, we don't chart, traditionally. In a horrible trauma, we take care of the patient first, pile the used bags of blood products and i.v. fluids on the floor, and the code drugs as appropriate, and chart at the end. Sometimes it takes more than one to do anesthesia for such a case.
The next wave after that is the use of 'subtle methods' in the operating suite. Yesterday, with a slow surgeon, working on a difficult case, I had time to think. Boredom does arise in such cases, with the finger re-implant with a microscope in the middle of the night being one of the hardest cases to stay alert.
While the surgeon went on and on, and on and on, I did Deeksha, Chakra balancing, Reiki, and Karuna Reiki on the patient. The striking thing about Karuna is claircognizance. You 'just know' what is going on. This patient had female problems. I picked up who had abused her, around what age, and why the fertility problems were present--rage. When I found out the patient's religion, a very strict and conservative one at the end when I filled out the face sheet, everything fit together: super sensitive to anesthesia drugs, pressure to have a family, and anger/betrayal at the head of the family of origin.
Instead of treating symptoms, I was able to take an energetic read on the chakras, interpret it, and offer treatment. No monitors were needed at all. One of my colleagues I did anesthesia for asked me what it was I did. Why she 'had no pain', and only took two pain pills because her husband was worried about her. I told her 'I zapped' and 'gave her the works'. She believes.
I hope others will, too.
Have a great day,
Thursday, May 5, 2011
At lunch yesterday I sat next to my boss. I am always uncomfortable around him, but my discomfort increased when another doc, who is Chief of Medical Staff, came to talk to my boss about an issue that is controversial: propofol conscious sedation. In my heart of hearts, I wished that this issue would just go away. I am woken up in the middle of the night to 'just give propofol. It will only take a minute.' when I am on my OB shifts.
It isn't right. Not to leave OB. And not to do a pre-op assessment, formulate an anesthesia plan, and oversee the recovery of the patient. I feel like a 'hit and run' and I don't like it. When I say 'no--call the OR person on call', they call me back 'he won't come in.'. It is a nightmare.
It was especially bad. These docs called a non-emergency an emergency, pressured me, and I was tied up for much longer than ten minutes doing their 'conscious sedation.'.
On my way to the car, I ran into my boss, and told him what happened. I had to walk with him all the way to the surgicenter. He asked me to write it up. I didn't know how, not in the current system. But I did spend an hour writing and collecting pertinent documents for my boss. That hour from seven to eight is LONG, especially without coffee! LOL
I am not sure what the purpose was of this. But, aside from giving 'ammunition' to the boss, I made a scared patient happy. The RN in the procedure room was near tears, when she saw me touch the patient, stroke her hair, and wake her up. The patient said, 'I don't know what happened,' and I smiled and said, 'that's because I did my job.' This does not happen in that part of the hospital. And politics aside, I think I was meant for her. Sometimes I get 'sent' by spirit to do certain patient's cases. I never know until afterward.
The 'wake you up epidural'...my bleary eyes took in that the patient was enormous. BMI over 40--super obese. I was like, 'God help me' when I saw her. Family was extra nice...and extra fat.
It was a primip, so I explained everything carefully as I worked. It went in. SCARY went in. Like nothing. All the way to the hub, practically, but placement was perfect, she had no complaints. I got sleep and she delivered uneventfully.
There was a symbol on the base of the patient's neck that had meaning to me. I had been guided to put her hair up in the cap for sterility. I saw the tattoo but did not remark on it. It was a busy one, the kind that is used to cover up another one of someone's name. The patient shared she was 'jumpy' when someone worked on her back for the tattoo. I felt a spirit vibe I did not understand. And when I came round the front to examine her airway after the procedure, I saw that there was a dark spirit in her.
WHAT? A DARK SPIRIT?? What is this, Halloween?
I am dead serious. With my psychic development classes I have learned there are people, who through no fault of their own, harbor these entities. You can see it. In the eyes. There is no light in them. Just dark, sucking vacuum energy.
I don't get it. Morbid obese parturient with spiritual twist and a dark entity that did not give me a hard time. When I can't get an epidural in, there are usually some negative entities in the lower chakras that make needle placement difficult. It 'won't go in'. This was my first dark entity on OB. Very strange.
I wonder when I will figure it out.
Tuesday, May 3, 2011
There is nothing like a Karuna cleanse to make you feel like you are on the Twilight Zone! : )
Every Reiki class has some form of 'cleanse' associated with it. For me, my cleanses are always BEFORE instead of AFTER the course. For others, it is after. Typical Reiki cleanses included physical (cold/flu symptoms, other illnesses), emotional (irritability, crying), and functional (sense of time off, might sleep through class instead of waking up on time).
My cleanses were annoying. There would be traffic annoyances. I'd hit every light. I'd have to repeat tasks, they'd take twice or three times to complete. And the clutter! Just piled up in my house kinda scary.
The Karuna cleanse is of a different nature. Karuna is 'multi-dimensional' energy. It is not of the earth plane. Therefore 3 dimensional and time get majorly distorted as the practitioner is cleansed to accommodate the energy of a higher frequency. Some of my classmates saw walls come towards them and go back, many dropped things and were clumsy (pouring missed, trying to set things down would go past the point of intent). A lot were irritable, mad at others for every little thing.
For me, I think the 'mean and nasty' was part of the cleanse. I was shocked to my core, but realized I had to let go of my desires for the piece of furniture and whatever else it was at work. Spirit was more trustworthy, and in the big picture, my heart's desires didn't amount to much. Also, the clutter improved and there was a greater clarity in solving problems, including the clutter.
I also noticed a lack of desire to 'help someone' by doing Reiki on them in my clinical practice. I realized that everything was happening at the proper place and time, as is best for all involved. Instead I focused on loving-kindness for my patient. Only when the case was extraordinary (advanced cancer, perhaps), did I consciously 'do my thing'.
Since then, the clutter has become more streamlined, and there is an effortlessness to trying to get things done. Getting to a film at a local Film Festival seemed like we were going to be late for sure. But as it worked out, we got in, great seats, great parking, food, and got an autographed poster from the director!
There is only one more class to go, Karuna Master. Then I can teach!
Have a good day, Namaste,