That Time I (Almost) Killed a Man with a Tube Up His Urethra

Every doctor remembers their first code. Maybe they remember sprinting there, shoving people out of the way. Or maybe they remember being pressed against the wall, watching everyone else who seemed so competent and in control while they felt useless. Some people say their first code was when they realized how little they actually know, while others say it was the first time they felt like a real doctor.

All I know is that my first arrest was the first time I ever had to say the sentence, "He peed everywhere and then stopped breathing."

Sunday night, 1 am: Day 1 of my week of nights. Trauma Ward calls, saying Mr M needs a Foley catheter because he hasn't passed urine since 5 pm. Grumble grumble, I wanted to sleep, but fine. Bladder scanner shows something in the neighborhood of 800 mLs. I try a 16 Fr, no dice. Try again with a 14 Fr. This time it drains, but the patient starts urinating with such force and gusto that the catheter actually flies out before I have a chance to anchor it. The patient probably voided all 800 mLs all over the bed, destroying my meticulously arranged sterile field. As I walked off to wash my hands and get ready to start again I realize that Mr M isn't speaking anymore, just making grunting sounds.

Me: "Mr M? MR M? CAN YOU HEAR ME? ARE YOU ALL RIGHT?"

Nothing. I felt for a pulse. Nothing.

Me: "CRAP. Okay call the arrest bleep, I'll start CPR." I started compressing his chest, feeling his actual ribs break under my inexperienced hands. The nurses ran around, taking the bed apart and putting him on O2.

Anesthetist arrives.

Anesthetist: "What happened?"
Me: "Umm I was catheterizing him and peed everywhere then he just stopped breathing."
Anesthetist: "What's his medical history?"
Me: "Broken hip. Right side. I think."
Anesthetist: "MEDICAL history!?"
Me: "Oh, ah. Hmm..."
Anesthetist: "Why the FUCK doesn't he have IV access?"
Me: "He does...in the left foot."
Anesthetist: "WHAT?! WHY ON EARTH?!"
Me: "...He has difficult access and that's where I put it..."

At this point I think the anesthetist was ready to murder me because he very rudely pointed out two allegedly excellent veins in the dorsum of the hand. He and the medical reg both tried to cannulate Mr M at that point (and both veins blew. Ahem).

Fortunately the anesthetist was as competent as he was furious at me. Mr M woke up, transferred to HDU. Diagnosis: vasovagal asystole 2/2 micturition. Wash hands, walk away.

Wednesday night, 2 am: I've now been on nights for a few days and am getting the hang of things. Nothing can touch me, for I am the Super Intern. Until I get a bleep from Trauma. Mr M is back, he is now post-op, and in urinary retention. Can I please come place a catheter?

Feeling a tad traumatized, I decided to ring the Medical Reg who was present during the arrest and who can advise on the safest measures.

Me: "Uh, hi. This is Caitlin, from the other night. Mr M needs a catheter again..."
MR: "You're taking the piss."
Me: "I wish I was. Any advice?"
MR: "Put him on O2 before you start, keep him talking, bring the crash trolley with you. Maybe pull the bed out from the wall as well."

In my head at this point I can hear a prosecutor demanding the maximum sentence for criminal negligence. I can hear my own lawyer demanding to know why I thought catheterizing for a second time was a wise move. I can hear my career falling down around my ears.

In the end I brought three nurses and another doctor with me, all to keep Mr M talking and to monitor his vitals the whole way. At one point he stopped talking (probably to breathe) and my stomach dropped. I glared at him and just said (quite sharply), "keep talking!" and proceeded. Urine flashback, catheter anchored, documented.

And thus ends the story of my first code. Here's hoping I can afford a good lawyer someday.

From artizans.com. Scarily accurate. 

xoCaitlinK

How I'm Upping My Skincare Game Now That I'm A Grown-up (or something)

Hello at last! It feels like it's been forever as I've been fighting off jet lag that seems to have hit me pretty hard this week. I'm back in Ireland for the long haul and over the last two days have slept something like thirty hours. It's bizarre but my friends are remarkably understanding and for that I have to thank them.

Traveling, stress, and caffeine are well-known enemies of the perfect complexion and over the last month or so I've been doing battle with all three. While I was home in Seattle last week I stopped in to H-Mart, an Asian megastore, to see what kinds of therapies our lovely Asian friends could recommend. While I was there I stocked up on all my favourite Asian foods, candies, and teas to bring back to Dublin and then popped into Amore, a sort of Korean version of Sephora. I've heard of their luxury line Amore Pacific (available at Sephora and here) but never actually played with any of their products before. The shop was an adorable little place with about a million different girly and colorful products just waiting for me to play with.

I've been wanting to play around with Asian skincare products for awhile, at least since my first order with Kollection K, but didn't know where to start and I wasn't willing to risk ordering something online that could potentially be irritating or just not the best choice for me. Luckily, a lovely skincare consultant in Amore (who, incidentally, had fabulous skin herself) had useful advice. She examined my skin using a strange bit of paper and some blue lights and then fed the results into a computer which spit out my skin analysis. It was bizarre and kind of gimmicky but surprisingly more accurate than the Dermalogica skin mapping analysis that I had last fall. As I suspected my skin is actually very dehydrated, causing it to overproduce sebum in the T-zone. This explains why my skin has always been the obnoxious combination of dry and oily at the same time and why I've had difficulties finding the right balance of products in the past.

The new regimen. Thanks, Laneige!

I left the shop with a few products from a company called Laneige (literally "the snow" in France). See more about the brand and please enjoy the poorly translated story. It very much reminds me of this scene from Zoolander

 and yet I'm still a sucker enough to buy into the marketing. The products from Laneige didn't come cheap (each product was around $30) but the packages are a good size and I expect I won't run out for at least 6 months, maybe even a year for the Yogurt Peeling Mask!

So far I've used the Water Sleeping Pack twice and the Gel Cream almost every day. I haven't had a chance to try the Yogurt Peeling Mask but when I do I'll be sure to report back. The Water Sleeping Pack is a very cool overnight mask that I use on nights when I skip my retinol product. It leaves a weird sticky feeling behind (it is quite a bit heavier than your standard night cream) but I always wake up the next morning with plump, moisturized skin. The Gel Cream is also fabulous and is quite like my old favourite, Chanel Hydramax Gel Creme, but at a fraction of the cost. The only downside is that it lacks SPF. Otherwise it keeps my skin feeling hydrated but never oily and makeup glides on like a dream.

Water Sleeping Pack - ultra fancy night cream, basically

Sidebar: I also left with approximately a zillion sheet masks. They were $1 each!

I look forward to scaring neighborhood children with these

Now that I've got my anti-aging and moisture game on lock I've been exploring a few new avenues for the last of my skin troubles. The most important thing with starting new products is to take them one at a time in case something causes breakouts or rashes. I tend to be a bit impulsive and in my life I don't think I've ever added one product at a time. I'm trying so hard to resist the urge to jumpstart my new skincare obsession NOW, so why don't I share my woes first?

Problem 1: Congestion. I have a few closed comedones on my forehead that bug me. The skin there isn't covered with red cystic acne but it's not exactly smooth. Hours spent on r/skincareaddiction lead me to believe I most likely need an AHA or BHA exfoliating product. I'm a little reluctant to dive in with a chemical exfoliant when I'm using a retinol, though. I've had no adverse effects from my current anti-aging product (La Roche Posay Redermic R) and I don't want to tempt fate by irritating the crap out of my skin. Thoughts? Recommendations? American ladies are partial to Stridex pads in the red box but we can't get those in this part of the world.

Problem 2: Makeup Removal. Ugh. I love Benefit's They're Real mascara (it is my one true ride-or-die eye makeup I think) but it is such a bitch to take off at night. It's not waterproof but seems to be highly resistant to all my efforts to gently remove it. Almost every night I'm convinced I'm pulling out several eyelashes at once plus likely damaging my delicate skin around the eyes. I tried coconut oil but kept getting that in my eyes. I'm tempted to try a micellar water. Bioderma is the makeup industry gold standard but difficult to access in Dublin. I saw several good options at Boots though, including this Garnier one which was on offer and a few by La Roche Posay, Avene, Vichy, and L'Oreal. The number of options is slightly overwhelming and they all seem pretty much the same. Probably by this time tomorrow I'll have purchased the Garnier one.

(Update: I did! It was 6 euros and they had 3 for 2 on skincare. I do what I want. Also I got Avene Cleanance K, an AHA/BHA product, and La Roche Posay's Physiologic Toner)

Can't wait to try these out. Updates to follow

How often do you update your skincare regimen? Do you gradually introduce products or go for it at once like me?

xo Caitlin

Le Geek, C'est Chic

It's that time of year again. Students will know exactly what I mean - finals season! I've been spending a lot of quality time in the library with my nose in a book and my eyes watering from staring at my laptop screen for hours on end. Fortunately I have my beautiful classmates keeping my company and I'm psyched to share their beauty tips with you. Obviously these tips aren't just for library geeks, anyone working long hours or night shifts can probably pick up a new idea or two.

Your Face

As an out and proud Eye Rubber/Face Toucher/Lip Biter I've pretty much nailed my library beauty routine. I need something that takes five minutes in the morning, requires minimal touchups, and makes me look pulled-together enough that if I run into my ex on my way home I don't have to turn and run (again).

I start with BB cream to even things out a bit. I don't like a full foundation look for the library, in part because I want my skin to breathe and in part because I think library beauty should be effortless. No one wants to be that chick who spent longer getting ready than actually studying. So BB cream it is. I also leave my dark circles alone, they are badges of honour! I earned them and they make me look tough! But if you aren't as twisted as I am you might want to cover them up. I like YSL Touche Eclat because it cancels out the blue shades without looking cakey or orange.

I keep my eye makeup minimal. I know I'll be rubbing my eyes when I get tired so I like products with serious lasting power. I use Bobbi Brown's gel eyeliner with Benefit They're Real mascara. I also swipe a little bit of Benefit Eye Bright in my inner corners and waterlines to look more awake. I love the eyeliner and mascara here because they stay all day and don't flake into my eyes.

For cheeks and lips I like to go with a bright and colorful stain product. You can really use anything you like here, I alternate between Benefit's Benetint, Revlon Balm Stains, and NARS lip pencils depending on my mood. I find that having a colour on my lips keeps me from biting them when I'm concentrating. Also it makes me look a little more awake and healthy! That's super crucial for library vampires. The only product I toss into my purse is the lip product so I can reapply after lunch or coffee - see above re: potential scary run-ins.

In this photo I actually skipped the blush altogether because I felt like the lip colour was pretty bright on its own! I put a tiny bit of navy eyeliner at the corner of my eyes and lashings of mascara. The whole look takes no time at all but makes me look pulled-together and lasts all day. It's not exactly revolutionary to wear red lipstick, but around my friends a bright lip is definitely A Statement and I'm all about making statements without having to actually put in effort.

NARS Matte Velvet Lip Pencil in Dragon Girl, Benefit's They're Real Mascara. 

Your Hair

It's tempting to throw my hands up in defeat and put my hair into yet another ponytail. But a gym-ready ponytail with bright lipstick is defeatist. And that's not for us! Put on Eye of the Tiger and get your comb out, girl.

The goal here is something that will keep my hair off my face, look cute enough for humans to see, and will not give me a headache after 10 hours or so. Enter: magnificent braiding. It takes me less than five minutes to work a braid into my hair in some way and yet people give me credit for it like I'm some kind of genius. It's perfectly simple! I actually take my inspiration from vintage Lauren Conrad on The Hills - remember her pretty little side braids? In this photo I did two French braids right at the hairline, ending in tiny elastics at the nape of the neck. This basically creates the same effect as a headband would but is comfortable for hours on end and looks somewhat bohemian and deliberate. To give hair a little more grip I like to spray it with surf spray or hairspray before and after the braiding magic happens so it'll hold better. As the day goes on the braids will naturally loosen but I think this adds to the subtle IDGAF vibe and I like it.

I don't know how I look more tan in this photo than the other one. iPhone cameras are weird. 

Your Clothes

Again, the temptation is to put on sweatpants, a sports bra, and a T-shirt from your high school drama club. Resist! Unless that's your thing, in which case, why are you even here? (JOKES. Please stay) I am all about comfort and refuse to buy into the idea that comfort and cuteness are mutually exclusive. Now your outfit will vary depending on the weather and the ambient temperature of your actual study or workspace. Our school kindly keeps the library at approximately the same temperature as the surface of the sun while it is typically mid-40s F outside. That means layers layers layers. I like a pair of boyfriend jeans, comfy plimsolls, a loose top, and an optional cardigan. The whole look is effortless and just as comfortable as sweats but also transitions to dinner or the pub easily. Click through to see product info.

Library Time by callmecate. Alternative outfit: scrubs.

How do you stay cute when your instinct is to hibernate? Weigh in below. Also as I edited this post I realized that I rapidly switch between first person and second person in the narrative. If any English teachers are reading this (or, God forbid, my former English teachers) I apologize, sincerely. I haz all the dumbs from studying too much. In medicine 99% of my writing is abbreviated anyway.

xo Caitlin

Keep On Hangin' On...

We've all been there. Work is piling up, deadlines are coming, errands to run, the bag of salad you purchased is starting to look dodgy and you don't even remember your last shower.

I like to think of myself as something of a pro at handling stress. I have no qualifications to back up my dubious title but there are plenty of others on the Internet with even less expertise than me, so I figure I might as well chime in. 

1. Get Help. If you think you aren't coping well and find yourself unable to deal then please don't suffer in silence! Talk it out. Call a friend, your grandmother, your dad, call your plumber if you have to. Just stop being a hero. If you are really struggling go to your doctor, if your anxiety is preventing you from being productive you might benefit from pharmacological or psychological intervention. 
2. Work Hard, Play Hard. Not just a motto for vanilla OkCupid profiles anymore, guys! When you need to work just put your head down and do it. Learn to recognize the need for a break. There's nothing worse than sitting down to work and 4 hours later finding yourself deep in a Wikipedia k-hole reading about the plight of Aboriginals in colonial Australia (not that that's ever happened to me...). If you need a break just acknowledge it and unplug completely. For me that means walking away from my computer, putting down my cell phone, and reading something by Jilly Cooper. If I don't disconnect completely my brain won't recharge and then I'm vulnerable to distraction again. Other options for disconnecting that are slightly less fun but pretty emotionally rewarding are doing laundry, tidying the kitchen, or throwing away all that nasty-ass food you bought when you vowed to be healthy last week which has now gone off because you keep eating cereal for dinner instead. It'll only take about 10 minutes but it's surprisingly more meditative and easier than actually learning to meditate. Note to self: must learn to meditate. 
   
3. Exercise Exercise Exercise. Ugh I know, how obnoxious am I? Look, we all hate exercising. People who claim to love it are lying to themselves and to each other. But the endorphin high afterward and the pure sensory pleasure of a well-deserved shower makes it totally worthwhile. It's hard to find the time to work out, especially when you're being pulled a million directions. Lately I am relying on a Pilates DVD (mine is by Gaiam and it's only okay so I won't link you to it, lest you find the instructor's voice grating and then question my taste forevermore). I also get a kick out of doing 15 minute HIIT sessions on my balcony. I pick three or four tough exercises (burpees, squat jumps, pushups... anything that sucks) and then do a 30 seconds on, 30 seconds off routine in a circuit. By the fifth circuit I'm completely spent and I always wake up the next day satisfyingly sore. The HIIT routine really saves me on days when I just can't drive forty minutes round trip to the gym plus work out for an hour. It also serves as a nice break from work while still feeling productive. 
4. Don't Be "That Guy." You know who I mean. The guy who works all day then collapses into bed at night for days and weeks and months on end, before eventually waking up at age 60 ready for his nervous breakdown. Put something between work and sleep. It can be exercise if that's your thing, or cooking, or home brewing, or reading. I am reluctant to use the word "hobby" because it conjures up images of crappy DIY Pinterest fails, but cultivating an interest outside of work will not only prolong your life but can give you something tangible to link you to the world. Working or studying nonstop can be very isolating so finding a hobby you can share with others (even if the "others" are just YouTube people) will keep you grounded and give you some perspective. 
5. Indulge. Whatever that means to you, now is the time to do it. In general I try to limit my intake of sweets to the weekends but today an almighty migraine was looming around 2 pm. My friend texted asking if I felt like running out for coffee at that exact moment and I gratefully accepted. I entered the cafe planning to order a sensible black Americano but felt the siren call of the pastry cabinet. The tempting array of muffins, cakes, and tarts called to me. "You want us, Caitlin. You need us. Get outside us." I gave in. I ordered the Maple Pecan Bar and savored every delicious bite. I certainly won't be making a habit of afternoon pastry time and I confess that I felt a brief twinge as I considered the number of burpees it would take to work it off. Within moments, though, I found myself not caring as my teeth sank into the chocolate-y, maple nectar of the Gods. Other indulgences include the nights I treat myself to an extra-long shower or spend five extra minutes in the morning to actually style my hair instead of sighing and putting it in a ponytail. Those brief moments of self-care rapidly become the best part of my week and I thank my sun and stars that I still feel alive and human. 
6. For God's Sake, Take A Shower. Showers take 10 minutes. Just do it. You're losing friends. 
7. Indulge (again!). You know what comes with stress? Rage. Road rage. Roommate rage. Frustration. Anger. Don't bottle it in, that will give you wrinkles. Instead just allow yourself to get mad. Try not to get mad verbally towards your loved ones, but by all means take twenty minutes to beat the shit out of a punching bag or a piece of hanging meat. It'll make you feel better and you may surprise yourself how much aggression you're holding onto. I love the high that comes after a good boxing training session; I leave the gym with excessive swagger and pray that someone, anyone, will attack me so I can practice my new moves on them. 

Rocky Balboa ain't got nothing on me

Perhaps just as important as a list of things to do is a list of things to avoid. Everyone has different ways of procrastinating and different websites that keep them distracted. If you use Chrome definitely install the extension called Stay Focused. It blocks all the fun websites during working hours that you set and prevents you from whiling away the hours looking at pictures of cats. I also avoid reading anything too navel-gazing or depressing when I'm stressed, I feel like the misery of others makes me emotionally labile and generally droopy.

I think I'll leave the list at 7 because 7 is the most magical number and I find myself growing tired. I started this post expecting to write a lot about the benefits of lavender essential oils etc. but found the words taking me in a completely different direction. I'm sorry for anyone who suffers from tension headaches who came here looking for a cure. Try playing Jimmy Buffett songs and wearing shorts in your house so you can pretend you're wasting away in Margaritaville, I guess.

What are your stress-busting tips? 

Catch you on the flip-flop,

xo Caitlin