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It's beginning to look a lot like Christmas. Depression hits hard this time of year and suicides and idiotic drunk behavior abounds. Even more depressing are the tragedies that befall families when they gather together.

Take for example, Grandpa Henry who had decided that his city slicker grandchildren would love to have a tree house at grandpa's home when they visited beautiful arborous Knoxville, Tennessee. Grandpa Henry was busy cutting away smaller branches from this fabulous fort he was creating when the branch he was standing on gave way and he came plummeting to the ground by the grace of gravity. On his way down he was cushioned by multiple large branches that were to buttress his darlings' refuge. These branches caused multple bruises, but may have contributed to the devestating spinal cord injury or it may have been the hard ground below, I don't know.

What I do know, is that Grandpa Henry has suffered a devastating C5-C6 distraction injury (upper spinal cord injury) and upon transfer to our trauma bay was guppy breathing. Once you take out the nerve supply to the diaphragm, breathing becomes quite difficult. He was able to move only his right arm from the shoulder and the rest of him was as floppy as a marienet with cut strings. So Grandpa got intubated and a CT scan of his cervical spine confirmed his findings and got added to the list of educational Cspine films I have in the back of mind to show interns.

In my ICU Grandpa started developing neurogenic shock. His nerve supply that maintains the tone to his blood vessels became shot with his injury and just like his arms and legs, his blood vessels have become floppy and so his blood pressure began falling. So we started him on blood pressure medications, vasopressors.

Now don't be fooled, meanwhile the ICU is hopping... Grandpa Henery is so NOT my only patient. We actually have a young man who was in a motor cycle accident and ruptured his colon in his accident, another gentleman has had to have his colon transplanted and turned into a bladder conduit due to radiation cystitis and is having a difficult postoperative course, yet another gentleman is the Jehovah's Witness who would consent to surgery for his hip but not to blood transfusions.

So Jehovah (which is probably a very rude and sacriligious way to view him) had lost about a liter of blood in surgery and postoperatively his hematocrit was 16.6 (hematocrit is a percentage of red blood cells in your circulating plasma - normal is 40, our transfusion trigger is 24). His anesthesiologist for the case was very concerned about this critical hematocrit and despite Jehovah's vitals being near normal (BP 107/51 and HR 90), he demanded that the patient be placed under my care in the ICU.

Frustrated, cause really what can I offer a man who's primary need is a blood transfusion?, I gave up a highly needed ICU bed for Jehovah. As Jehovah was wheeled into the ICU our nursing staff explained to him why he was surrounded by patients with tubes and geegaws - his doctors were afraid he'd die from his severe anemia. He requested the paperwork to get his transfusion. Great. I was so glad that I got to do admission and discharge paperwork for a transfusion that he could have got intraoperatively or in recovery in addition to taking care of 30 other critically ill patients.

So I ignore poor Jehovah for the rest of the night, I've got so many other problems/patients, and my shift has been over since 6pm and its now 11pm. But who can keep track of time when Mr. Henton has become unresponsive and needs to be intubated, and Grandpa Henry needs a central line for his vasopressors, and we have to set the Motorcycle Kid up for an exploratory laparotomy?

I finally trudge home at midnight and thank Allah that I've moved literally 3 minutes from the hospital. I shower, prepare my Morbidity and Mortality presentations and lay down when Shanon calls me and tells me she needs another central line in Grandpa Henry, can I come in early and help. Sure, I'm on my way...

I'm finishing up my central line and suturing it in place, when Jo - a crotechety nurse who openly scorns the 'kid' residents comes ambling up to the bedside. "Miss Emma (don't ask me why she calls me Emma), are you 'here'? (asking if I was taking over Shanon's shift as the resident responsible for all concerns of the ICU patients)".

"What can I do for you, Jo?" I ask very politely, looking up from my needle work. To be quite honest, Jo scares me just a little and I'm quite in awe that she trusts me with her patients. "My little man, who got all the blood last night, has low blood pressure. His systolic is in the 70s"

Aware that Jehovah ran low blood pressures his entire hospital stay, I ask for a more precise number: "What is his mean pressure?" I locate my blade and nick the end of the of the suture.

"Why would you ask that? Its low" Jo replies tartly.

"I'll be right there Jo"

"Thank you"

I place a sterile dressing over the precious central line and walk over to Jehovah. Indeed his systolic blood pressure is 77 and his mean is 53. I place my hand on Jehovah's shoulder to make sure he is rousable (confusion and lethargy being some of the earliest manifestations of poor blood circulation to the brain)- "Good morning sir"

Jehovah woke right up. He looks me up and down.

"How are you feeling sir."

"Just fine."

"You look a lot better than when you came in last night." He had been as white as corpse for the lack of a more appropriate similie.

"You are a Muslim" he accuses in return.

"Yes sir, I am" I respond with amusement. Apparently enough blood is circulating through his brain for him to percieve what many in East Tennessee don't. (Remind me to tell you about the respiratory therapist who thought I was 'protestant')

"You believe in Allah" he further accuses.

"Yes sir. Allah is another name for God."

"God states Himself that His only name is Yahweh. It says so right in the Bible."

"Yes sir."

"Than why do you worship Allah?"

I recycle his blood pressure and it reads: 107/73.

"Jo, your patient's blood pressure is cured" I call out.

I now have one more strategy to treat hypotension...

and the day continued as before...

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im not an anethesiologist, but i found this to be hilariouSSSS

someone posted this in their journal

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3/17/08

Reminder:
Please register soon if you have not done so already.
dashtprofessionalevents.com

***Single Muslim professionals from all over the United States are encouraged to attend!***

The Mughal Era was one of the most fascinating and culturally rich periods of South Asian history. The elegance, grace and exquisite creativity of the Mughal culture permeated every facet of society and brought new perspective to existing culture of the time. Influences from that era persist even today.

With the Mughal theme in mind, Dasht Professional Events has organized a Single Muslim Professionals Matrimonial Event to take place in Central New Jersey on Friday, April 18, 2008. All Muslim professionals (single or divorced) who are looking for that "special someone" for matrimonial purposes are encouraged to attend.

VENUE:
Hilton Garden Inn Edison/Raritan Center
50 Raritan Center Parkway
Edison, NJ 08837
(Longwood Hall)
Visit hiltongardeninn.com for location information and directions.

DATE:
Friday, April 18, 2008

TIME:
6:30PM sharp to 10:30PM

AGE RANGE:
25 to 42

COST:
$95 per person (see dashtprofessionalevents.com for details)

EVENT DRESS CODE: *Semi formal or formal attire required* (see dasprofessionalevents.com for details)

There will be a thorough screening process of candidates prior to the event and unique ideas will be utilized at the event to ensure maximum communication between the sexes. All effort will be made to ensure that you get your money?s worth.

The event will include light ambience music, halal appetizers, instrumental performance, dance performance, Urdu/Farsi poetry reading, live raffle, prizes and more.

You will be required to bring your photo ID to the event. The Organizing Team reserves the right to determine candidate eligibility for this event. The Organizing Team is only responsible for the event cost; you must make your own arrangements if you plan to stay overnight at this or another location. Registration fee strictly covers cost of the event itself and excludes transportation/overnight stay, outfit, etc. All payments (including special discounts and rates) are non-refundable unless the event is cancelled for any reason.

Plan ahead and RSVP soon! Limited seating. RSVP deadline is April 5, 2008.

Please contact [email protected] if you have questions.

DISCLAIMER AND CODE OF CONDUCT: Participation in this event is strictly on a voluntary basis. Event organizers and representatives are in no way legally responsible for the behavior and actions of event attendees. This is a Muslim singles? matrimonial event and, as such, all attendees are expected to conduct themselves in a professional, courteous and respectful manner. Event organizers and representatives have the authority and reserve the right, at their discretion, to ask any attendee to leave the event if the attendee is disruptive or conducts himself/herself in a manner that is deemed inappropriate; event organizers and representatives will determine what constitutes ?inappropriate? behavior/action. Any contact information exchanged between attendees is the sole responsibility of the attendees; event organizers and representatives are in no way legally responsible for the outcome of any social, professional and/or any type of interpersonal exchanges at or after the event. Event organizers and representatives wish everyone the best and hope that the attendees find their respective matches insh?allah.