Monday, Monday
So good to me.
Monday, Monday
It was all I hoped it would be.

Oh Monday morning
Monday morning couldn’t guarantee
That Monday evening
You would still be here with me.

Monday, Monday
Can’t trust that day.
Monday, Monday
Sometimes it just turns out that way.

On Monday morning
You gave me no warning
Of what was to be.
On Monday, Monday
How could you leave
And not take me?

Every other day
Every other day
Every other day
Of the week is fine, yeah.

But whenever Monday comes
But whenever Monday comes
You can find me crying
All of the time.

Monday, Monday
So good to me.
Monday, Monday
It was all I hoped it would be.
Oh Monday morning,
Monday morning couldn’t guarantee
That Monday evening
You would still be here with me.

Every other day
Every other day
Every other day
Of the week is fine, yeah.

But whenever Monday comes
But whenever Monday comes
You can find me crying
All of the time.

Monday, Monday,
Can’t trust that day.
Monday, Monday,
Just turns out that way.

Oh, Monday, Monday,
Don’t go away.
Oh, Monday, Monday
It’s here to stay
Monday, Monday
Oh, don’t go away

By Wilson Phillips

It is one of those Mondays. Maybe you don’t remember the Momma’s and the Papas but I seem to recall hearing this in the distant past some Monday. Just turns out that way, Mondays do. This Monday was not a day of crying but for going to school; Nurse Anesthesia school didactic and its here to stay.

Cardiac risk factors in the non-cardiac surgery patient are the topic of discussion today. This is a little complex for me so we turn to the ACC/AHA guidelines for a little help. I was able to find this document without too much trouble this afternoon. Here is the question, “do we go ahead with this ankle fracture surgical repair in this 55 year old Hispanic woman with a history of diabetes and hypertension and recent MI.” Oh, she had a myocardial infarction 4 months ago and currently has intermittent angina. Her blood pressure this morning is 165/90 and her medications include metoprolol, isordil, metformin and aspirin. She is able to climb two flights of stairs without getting too short of breath.

So what do you think? Are we ready to go to the operating room to fix her broken ankle? OK, we do this case being a little nervous with her potential to re-infarct again. Blood pressure and heart rate are well controlled during the anesthetic using opiods and short acting beta blockers. Cool, case one down.

The next case is an Armenian gentleman aged 54 who is scheduled for a fem-pop bypass graft (he has vascular disease even at this age), a heavy smoker for the past 30 years and a family history significant for coronary disease in both parents and an older brother. During the history he tells you that he is not able to climb one flight of stairs because his legs hurt too much so he can’t comment on whether or not he gets short of breath. No cardiologist has seen him. Do we take him to surgery today?

The ACC/AHA guidelines for Cardiac Risk in the non cardiac surgical patient can help with these kinds of decisions. Now maybe you thought this was all fun and games but when your butt is on the line and you have this guy’s future and health in your hands it makes you think twice, maybe more than twice.

As a student we are thrown into these situations and we have a clinical supervisor breathing down our necks asking us questions while we are trying to get organized and straight in our heads if we even want to take this guy to the OR. “So little grasshopper, why didn’t you call me last night with this information you worthless piece of student dog meat”. Oh No Mr. Bill!

Some of us are not getting very much sleep mulling all these things over trying to figure these things out, finishing up the anesthesia plan of care for the next days and studying for exams. This is not to mention that some of us have husbands, wives and children that need a little, I mean little attention once and a while. Maybe it’s the worry about how to keep our patients safe that bothers me the most. Even after all the study and diligence to make sure that every base is covered, there maybe just maybe something that will get overlooked that could make a difference. It keeps me thinking late at night.

Sometimes I wake up at 2:30 in the morning with my mind ruminating on the case that was a little difficult that last day. Wondering why I missed a couple of important points that my clinical instructor was “pimping” me about. I knew that stuff, why did I blank when he asked me all those questions. Maybe it was because I was trying to do something in the OR and my mind could not jump rope and chew gum at the same time, who knows.

All in all I am having a great time. Everyone is kind and understanding for the most part and it’s usually just me that is making life really tough. We are our own worst critics.

OK, did you think about our Armenian fellow. He is not going to surgery today. This is based on the ACC/AHA guidelines. He has intermediate risk factors and is scheduled for a high cardiovascular risk surgery and needs cardiology consult. Seems reasonable now while I am sitting at the desk with all of the data in front of me but in the heat of the moment it’s not so clear sometimes. I guess that’s why we are in training and have seasoned clinical anesthesia around to make sure we don’t fall in the ditch.

There are those that live for the weekend. Right now, this weekend, has been a rejuvenation time for me. The first two weeks of clinical rotations are done and the fatigue of those two weeks melted away today with a little bicycle ride through Sierra Madre down to South Pasadena and around back to Monrovia. The stress faded with the bright clear skies and cold breezes of this mornings ride. This is good. So, I live for the weekend too.

What is it with the Traffic Police? These last two weeks it has been bicycle ticket hell along the San Gabriel mountain range. Yesterday, the City of Monrovia passed out over 50 traffic tickets to bicyclists. Yes, over 50 tickets for failing to stop at signs and such. These tickets go on your driver’s license and carry the same weight as a moving violation in a car! Insurance rates will increase and the whole nine yards. Traffic School anyone?

Evidently what has happened is that a few concerned citizens have complained to the local City Council concerning the bicycle ‘gangs’ in their neighborhoods. There is a racing club based in Montrose that have very fast rides through the streets from Pasadena to Duarte and the locals are tired of them running stop lights. What happens in these large very fast groups is that a cyclist will get dropped from the lead group and will hurry through stop signs and lights to catch up. It’s easier in the main group because of the draft advantage not to mention the shame of getting dropped by the lead group.

The little bicycle group I ride with would never be called a racing club. We might get tickets for loitering but not for speeding. This morning as we rounded a small side street going out of Monrovia, a Traffic Cop, pulled up along side of us with all his lights flashing and yelled at us to “stop blowing through stop signs”. We looked at him like he was a little crazy. Really, he had an extremely rude attitude; it was amazing how angry he was. We waved and were on our way without any additional incident. Later on we heard the news at the rest stop that several of the riders were stopped and given tickets. These people are out of control, really.

Several of us are talking about going down to the City Council and local Police Station to complain about the harassment. These Traffic guys are going out of their way to make it difficult for the cyclists. Another tack is to talk to the local coffee shops and restaurants that we haunt to let them know that if this keeps up we will take our business to another city and local. Lets see if that raises any eyebrows at the local City Council.

In the end no one wins here. Going through some of these hillside communities is going to be slow going but that is the way it is for now. It must be stated that safety is the number one concern for every bicycle rider and we know that we share the road with pedestrians and motor vehicles. Being polite and courteous is the best attitude to keep safe. Obeying the traffic rules is the best policy even in large cycling groups. No one is contesting this but the harassment is a little too much right now from the local constables.

This is the end of week two of our clinical rotations at LAC-USC. I have to tell you that I am tired. Maybe this weekend I will have more imagination or wit to be readable but for now what is left is what you get. The progress that all of the students have made this past two weeks has been really wonderful. My feeling is that all of the preparation and study is paying off. The physicians and staff that we have worked with in this short time here at the County Hospital have really been wonderful and ingratiating. Personally, I feel very grateful to be afforded this opportunity and to be exposed to this group of people.

Today I had the opportunity to go to the Women’s and Children’s Hospital and was assigned to the GYN OR. The two cases that were in the room today were both hopeful and tragic. The first case was a young woman that wanted to have her tubaligation reversed so that she may have a chance at having children with her new husband. The second OR case was another young woman that is going back for her second laparoscopic surgery for ovarian cancer. Two women with two terribly different situations.

I came home today thinking about how we can touch another life. What is it that becomes important to others in our interactions? The important point of what I did today was in the facility of the anesthetic induction and skill during anesthesia. What I agonized most over was how these women were feeling and the outcomes of their surgeries. I found myself talking to both of them while they were sedated coaching them and telling them that they were going to be fine. Hoping more than knowing, praying more than comprehending the enormity of the outcomes of these operations over which I had no control. What I did have control of I managed with the utmost of passion. These women were safe during surgery and came through their anesthetic extremly well. I have had great teachers.

Now, if God would only listen to me for a little while.

Recently, a project I have been working on has taken off. The web site at metaltiger.org is flying after a lot of work. The Kittyhawk is skyward once again. For right now the site is being mirrored from this site to that one; check it out anyway. I am sure that you will enjoy the very simple layout in WordPress.