MI's and Nursemaid elbows ...

... "So, Mr. Johnson, how's the chest pain, now?"

"Better, buckshot, better".

He was still ashen. I glanced over at the blood pressure monitor and it read 90/54. That's not too good. It was 130/80 before we gave him the sublingual nitroglyerin.

I looked at his EKG tracing that the lab tech just handed me. Something wasn't right. I couldn't put my finger on it but he definitely was NOT having an acute inferior or lateral wall myocardial infarction. There were no "tombstones" in the limb leads and V2-V6 looked normal as well.

Mr Johnson looked up at me and forced a wan smile. "Better, bucksot".

I smiled back. I don't know why he had chosen 'buckshot' as my nickname but it was congenial and sincere and seemed to make him feel better.

I felt my phone vibrate in my front pants pocket. I removed it and saw that Laura was calling me from her mobile. While I'll let other family members and friends go to voicemail, I always answer when she calls.

"Hey," I said as I turned my back on Mr. Johnson and the ekg tech and the RN who was getting a repeat BP reading, "Can I call you back in, oh, 10 minutes?"

Instead of the usual "sure thing, babe", Laura replied "Actually, no - Peter hurt his wrist or elbow somehow."

I started to feel as ashen as Mr. Johnson.

"Whaddya mean? did he fall? Is he bleeding, is he all right?". I gave the RN and Mr. Johnson a 'just a minute' index finger wave and stepped outside the surgical room.

I felt sick. My stomach was hollow, like when you take the first drop on a roller coaster.

Laura was talking quickly. "I have an appointment at the Saint Paul clinic at 11," it was 9:15am, "we are at art class and I was sitting on the floor and he came up behind me to give me a hug and he started to fall and he grabbed on to me but he jerked a little. He screamed but instead of shrugging it off after a few minutes, he's still whining and holding his arm funny. You know that's not like him."

My mind raced. Differntial diagnoses cycled through my mind. Fracture, dislocation, muscle or tendon tear. Thoughts grew deeper - Pathological fracture due to a carcinoma?

The RN came out into the hallway.

"Um, Dr. C, his BP is dropping - it's 80/40. We need you."

Shit. I have to triage, fast.

To the nurse - "ok". To Laura - "Um ... I'd take him to the ER; if there is a fracture or something, then they can do more than they can do at the clinic."

"Really?" pause. "OK."

I was worried about Peter but I knew that Laura's maternal instincts were kicking into overdrive. Mamma bear was going to take care of baby bear, no matter what. I trusted her to do the right thing.

"Love you," we said simultaneously.

Click. I slipped my phone back into my pocket.

I went back to Mr. Johnson's room. Still ashen, still hypotensive.

I picked up the EKG tracing again. I couldn't give him any more nitroglycerin with his blood pressure that low. He was defintely having a heart attack by clincal presentation, but the EKG wasn't telling me where.

Wait. V1 looked funny. The 'R' and 'S' spikes were reversed. That's it, he was having a posterior wall infarction.

It's rare type of heart attack that usually is fairly harmless as far as heart damage goes ... unless your right coronary artery is dominant or is the main supplier of blood to the back wall of the heart. Then it could be fatal because doctors do what I just did - treating it like a "normal heart attack". Instead of pushing fluids, I gave him nitroglycerin, causing his blood pressure to bottom out because his left ventricle fails to fill in time with blood - this makes the posterior wall becomes floppy and ineffective. The blood pressure continues to drop and the ventricle fibrillates and stops.

He needs fluids. Now.

I grabbed a liter of saline from the medicine closet and handed to the RN. "We need to hang this. Open it wide".

She was wide-eyed. "But he'll go into heart failure. Shouldn't we start a pressor like dopamine?"

I had to put on my 'hard-ass doctor look' I save for just the occasion. "No," pause for emphasis, "that will kill him. Hang the fluid."

She did. Within 10 minutes, the nitro had worn off and over half a liter was infused into Mr. Johnson's circulatory sysytem. His blood pressure had climbed to 97/60. He went from ashen to pale and he had stopped clutching his chest.

"Let's call 911 and get him to the ER with a stat Cardiology consult." He was doing better but wasn't out of the woods.

"What going on, buckshot?" Mr. Johnson looked a little worried.

"You were having a heart attack but it's going to be ok. We figured it out and stopped it from getting worse ... for now. We have to get you to the hospital to get is all settled down."

"I had faith in you, buckshot. Thank you." He was holding my hand firmly but gently. "Let my wife know what's going on - she'll like you, you're a handsome devil, buckshot."

"You're welcome, Mr. Johnson." Sometimes, I like my job.

I had to go back to my regular schedule of various ailments and personalities. Mrs. Franklin was getting a chest xray to rule out a possible pneumonina and Ms. Rodriguez was waiting in my other exam room - she thinks she has bugs in her rectum - last week it was people breaking into her apartment to rearrange her furniture. All the appointments were full for the rest of the morning.

Finally, at lunch I had time to plop down into my office chair and catch my breath. The RN from earlier poked her head in. "Just thought you'd want to know. Mr. Johnson had a 95% occlused right coronary artery. They were able to angioplasty and stent him open. The wife just called from the hospital, he's doing fine."

Yep, sometimes, things work out okay.

Then I had the sudden realization - "Shit!" - as I remembered Peter and Laura.

Laura picked up her mobile on the 2nd ring. I could hear Peter playing in the background.

"So? How is he?"

"He's great. He had a ... nursemaid's elbow? I think that's what it's called. Anyway, the people at Children's ER were great. He was seen by a Nurse Practicioner and a resident; the NP just popped the elbow back into place and He's been fine since. He yelped a little, but I go him ice cream on the way home. He's playing on the cube since we got home and is no worse for wear."

I was relieved. It's a relatively common injury in toddlers and with Peter being as active as he is, I'm not surprised. He'll be fine.

I'll be fine. Laura hung up and I got back to my charts.

Barely a minute later another one of the RN's poked her head into my office.

"Dr. C - we have another walk-in chest pain. She doesn't look too good."

I grabbed my stethoscope, took a swig of diet coke and raced down the hall ...

sometimes ...

... after seeing some of my patients, I'll go wash my hands.

Not to use universal precautions to lower the risk of spreading or contracting a communicable disease, but rather to "wash away the crazies".

Work ...

... is seriously getting in the way of my hobbies.

Gotta go play the Powerball ...

Well, it was better than Titanic's maiden voyage...

Let's start out by stating that lake water in Minnesota on May 1st is ... chilly, to say the least.

I wasn't going to let that stop my maiden row in my new single. I had the day off and the planets were aligned just right, allowing me a few hours to get out on the water for the first time this year. (Plus, I had an "ok" from the missus.)

I had thought about this all winter. I had scoped out the lakes near my work and had chosen Lake Josephine for a few reasons - a sandy swimming area I could lauch from, it was 2 miles from my work, and my boss has a house right on the lake with a nice dock (for possible launching and storage of my boat!? - all I have to do is ask him). However, it's the wrong shape and locale for optimal rowing. It wasn't long and thin and protected like Lake Hosmer at Craftsbury, it was more round and open. But, hey, we can't all be lucky enough to live in "God's Country" in Vermont.

But I digress.

The air temperature this morning was in the low 50's at best. And it was windy:



Which sucked.

Because when I got to the Lake, it was choppy.



There were 6 to 12 inch waves lapping the shoreline and the chop looked treacherous especially to a newbie like me. Out for the first time of the year. In a 'tippy' boat (only 12 inches at its widest point). With water temperatures in the 40's. Nice conditions for hypothermia.

I was bummed. I had bought this boat half a year ago and trekked it halfway across the country, only to be stopped by some wind. And bone-chilling water.

Fuck.


I lumbered back to my car and called my wife to leave a message that I was just going to the YMCA to slog away on the erg instead and will be back around noon.

As I hung up my iphone, a thought hit me - this is Minnesota, for gosh sakes! There are 9,999 more lakes for me to try. (actually, 11,842 more lakes)

Also, my iphone has google maps and a GPS built in. So, thanks to Jobs and Woz, within minutes I was following the turn by turn directions to Owasso Lake less than a mile away.

I pulled up to the beach area which was in a nice little protected cove. The cove was only about 100m wide but 400m long. It's not a big space - it's not uncommon for one stroke to carry you 10m or more, so I'd only get 20 strokes or so and then I'd have to turn around. But I didn't care. Most importantly, the water was calmer:




Jackpot! The wait was over.

Unfortunately, I was flying solo, so I wasn't able to take any pictures of me rowing. But I did get to row.

And it was fun.

It was a little touchy at first. I haven't rowed on the water in 6 months and haven't been in a single for close to 8 months. So after I almost flipped just getting into the the boat, I was able to take a few tentative strokes and it all came back to me. So far, so good.

So I got cocky and took a couple of good pulls on the oars and ... I almost ended up in the drink.

Humbled again by this sport, I went back to the basics and did some drills and I felt much more stable.

Finally, after about 30 minutes I was able to put together 10 or so good strokes and the boat set up, took up some speed and for a brief few seconds carved a nice straight line over Lake Owasso.

Awesome.

It was better than the feeling of driving a golf ball to within inches of the cup, or hitting a baseball over the center fielder's head or smashing a racquetball into the back of your opponent (I never said I was an good at these sports!).


I'm not ready for Ole Muddy just yet, but give me a few months. I could imagine myself rounding Pike Island and gliding back downstream.

Then I almost ran into a bouy ...

Google Maps says it's only 1159 miles ...

... however, try that with a 27 foot long boat strapped to the top of your car:

(That's my mom and dad at the bow and stern, respectively, by the way. You can click on any photos to make them bigger.)


I finally was able to make the trek back East to pick up my new/used sculling single.

I've been rowing and sculling for the past 4 or 5 years on the Mississippi River out of the Minnesota Boat Club and ... well, I'm addicted.

Or crazy.

Maybe a combination of the two.

I drove 1100 plus miles from Minnesota to Pennsylvania to see my family for Easter; but mainly I had to drop off parts of an indoor sculling machine I sold to a guy in New Jersey and to pick up the shell from another guy in New Jersey, who just happens to know the first guy - small world, huh?.

So, on the Tuesday after Easter, my dad and I braved the rain and traffic in 40 degree weather to make the 140 mile round trip to the Jersey Shore from Philly. The gentleman (a lawyer who started rowing when he went to Penn for undergrad) I bought the boat from was great (well, almost - I'll get to that) and accommodating and everything went fairly smoothly. He rows out of a brand spanking new, multimillion dollar boat house in Ventnor, NJ.

The boat house was an impressive structure that's the home for rowing teams for several high schools and one college, as well as 40 or so private rowers. There were 3 or 4 bays and the boats were stacked 5 or 6 high. Thank god the boat bays were wide enough that I was able to squeeze my CRV into one and load the single on top of my car - out of the pouring rain and almost freezing temperatures! It was such a miserable day, I didn't stick around to take any photos. Plus, it's always a good idea to get the hell out of New Jersey - did ever notice that all the toll roads, bridges and tunnels charge you to get out of Jersey but they don't charge you to get into Jersey? Apropos.

==========================

So, a few days later, my brother and I were getting the boat ready to take the long trip back to Minnesota. We tried to put the cover on the boat (also sold to me (cheap) by the lawyer from Penn) and:



It looked a little funny. The skeg (the black fin looking thing) wasn't lining up with the neat Velcro hole. Also:



It was 10 fucking inches too short!

The bum sold me a cover that didn't fit. And he swore he measured it and promised me that it'd be fine.

After I left a hasty and rather terse message on Ivy League Lawyer's voicemail, we decided to just cut a new hole for the skeg and then duct tape the shit out everything. There is no way that I was going to transport the boat without some sort of covering!

(the guy ended up returning my call - he was apologetic and is willing to refund and/or pay to get the cover altered ... but screw it, I'm returning his shitty cover and I'm going to have a newer more weather-resistant cover custom made. By the way - the cover is needed - look at all the dead bugs stuck to the boat rack. Ewwww)

==========================

Anyway ... The road trip was fun. My brother, Eric, is one helluva great guy and agreed to be my co-pilot on both legs of the journey. He's also the head duct-taper and structural engineer on the whole project - I think we could have driven through an F5 tornado and the boat wouldn't have budged from the top of the car.

It was also fun to stop at divey-motels and eat in greasy-spoon diners along the way. We ate a Texas roadhouse/steakhouse in Elkhart, IN and I felt like something was looking over my shoulder the entire meal:

==========================

The Mississippi River is still fast and high and I don't plan on going out in a single on Ole Muddy until later this summer. I'll still mostly row in a double in the morning for now; but I'm going to be taking my new/used single to a lake near my work one or two days a week for the next few months so we can get acquainted with each other.

But, hopefully, by late summer/early fall, I'll be skimming across the placid waters.


Hmmm ... I still need to re-christen the shell. Maybe "1159 miles"? ...

My soundtrack (part two) ...

... While it is going to be summertime soon (hopefully), and the "The Natural" is one of my quintessential summer movies (and soundtracks), I think I found my new anthem.

I stumbled upon it while listening to my brother's ipod while we drove halfway across the country.

So the next time I need to feel heroic or need to be inspired, I'll just turn the volume up to "11" on my ipod, plop my ear buds in and play Aaron Copland's "Fanfare for the Common Man".

(give it a minute or two to load, then turn up the volume on your speakers, etc).

Something about it just gives me goosebumps ...

Waiting ...

... for spring!

Where the hell are you? I made snowmen yesterday with Peter in the front yard and I may light a fire in my living room fireplace tonight while I work on charts for work.

This is April - that is not right. I'm getting sick of wearing sweaters. And snowboots. And wool hats.





Even my bonsai's are confused; this poor maple and cotoneaster are trying to push out new leaves but the occasional snowstorm and freezing temps are holding them back.

I hear birds chirping every morning. The dock at the boat club has been in for a week and the river has thawed. The yuppie down the street emerged from the Starbuck's last month and didn't see his shadow, so there shouldn't be 6 more weeks of winter.

Mother Nature - wake up!