Ignorance would be bliss.

2 months ago or so, when I was going through the whole sudden, significant spike in blood pressure crisis (by the way, it apparently resolved itself within 2 weeks, my BP is now back down to normal) my GP ran my blood and urine. Bloods were normal, but he said I had microalbumin in my urine. He said it warranted further investigation, but believed my multivitamins may have somehow given a false positive.

Anyways, I decided to do my own Chemstrip dipstick urine at the clinic last week. No microalbumin or albumin, but:

Sample had the highest readable specific gravity of the strip. Pretty sure I'm not dehydrated, either.
Positive for occult blood at a moderate level.
Positive for bilirubin.

I don't have any symptoms. I'm sure if I thought long and hard about it, I could think some up... like the weird morning stomachaches, but I know they're all really benign (I'm pretty darn sure I get those stomachaches because I often eat right before bed). I'm afraid I'm becoming a hypochondriac or something, but I definitely wasn't hallucinating the results on the strip... I even had a coworker double-check them. Who knows? I'm not worrying about it yet, but it's on the back of my mind.



As I take my patient back from the waiting room, I can see she is struggling to choke back tears. Her husband hovers behind her with anxiety-brimmed eyes.

I speak quietly and move quickly. I tend to walk too fast.

Once we're in the quiet of the exam room, the tears begin to flow. I know why she's here, so I'm not surprised, but I never quite know what to do in these situations at first. Do I offer a hug? A hand on the shoulder? Nothing at all?

"I'm sorry. I just... I'm sorry," she says.

I get down to her level and offer a kleenex. "No, no don't worry."

My heart is breaking. For her and her husband, who is as vulnerable and anxious as I've ever seen any man, standing in the corner like an injured animal.

I take her vital signs and ask a few questions. I hate a few of the questions I have to ask. She keeps apologizing for crying. I keep trying to reassure her. The husband adds on to many of her answers and asks more questions than she does; he's so concerned about his wife that I'm simultaneously heart-warmed and heart-broken.

The absolute joy of their first pregnancy was shattered by an ultrasound a week ago. At 10 weeks gestation, her OB GYN diagnosed their baby with anencephaly. It's a cruel death sentence: the neural tube of the fetus fails to close, leaving them without major portions of the cerebrum and head. Those who make it to term are often stillborn, and those who survive birth die within days. When it's diagnosed early in pregnancy, therapeutic abortion is often recommended. And that's what brought my patient in.

The D&E is awful and unreal. The room is heavy with pain and silence save the patient's whimpers. When it's all over, the doctor leaves the room with the tissues to go make sure she's got everything and I return to tend to my patient. I check her vitals, fetch her water, and let her recover.

Once she's dressed I do her discharge, and she hugs me. I feel relieved, and we just stand there holding each other for a while. She sounds better. She's not crying anymore, and I catch a sad smile. I'd like to think that although devastated, she left the office in recovery. There's the crisis, and then there's the recovery.


Fun with avalanche rescue.

I know I haven't written in a while. This weekend I was up in the mountains for an avalanche rescue training. I'll write a full post soon, but in the meanwhile check out this classic shot of myself with one of the avalanche rescue dogs.

Great animals. They have a program in which they drop these dogs, their handlers, and another avalanche rescue technician into slide zones by helicopter if they suspect people may have been buried. As with any avalanche, recovery is much more common than rescue, but the dogs are very successful and greatly reduce the time and personnel needed to find a buried victim. It's also safer for the rescuers, considering with this method you only need 2 people and a dog on the ground in a potentially dangerous area as opposed to 20-30 or more needed for probe line recoveries.