doctors & mechanics
Apr. 18th, 2006 10:21 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
iridiumtoday i woke early, showered, put on presentable normal-people clothes, and went to the hospital with my dad. and then, of course, switched out of the presentable normal-people clothes into scrubs, so that i could come watch his cases.
this morning was two nasal/sinus surgeries, ambulatory, with the ENT surgeon being the old family friend that my dad's sailed with for years and years. for the first one, correcting a deviated septum + turbinatectomy, he used the scope, with the video up on a big monitor; the second one was simpler, and he did that one without the scope. i got very woozy during the first, at the bit where he was removing most of the cartilage plates out of the septum. had to sit down on the floor. the OR nurse was wonderfully sweet, went and got me gingerale and a wheelchair to sit in, and after a few minutes my head cleared again and everything was fine. as before, the strongest impression i left with was "we do this, and it makes things better?!? the human body (and all bodies) are...such amazing complicated mostly-functional systems. wow." also, i'm still pretty sure i don't want to be a surgeon. it's fascinating, but it seems to require a very particular sort of self-confidence, and beyond that, it's very much a craft-skill: cutting, patching, taping, stitching, stapling, yanking, screwing or wiring things together. and so much of the craft-skill seems impossibly crude, compared to the cost of doing things wrong, and compared to the elegance of the body itself. (something new, a further articulation: i don't see myself being incapable of doing surgery, or of doing it well. but i'm pretty sure it's not what i want to be doing most or all of the time.)
i met with both patients before and after the surgery, sat in on the pre-anaesthesia interview and talked with them a little as they come back awake. the second patient was a sweet, delicate old woman, an artist. the surgeries, as always, were pretty gruesome, cartilage and squishy bloody sinus-bits getting pulled out one by one, but both people upon waking smiled, and were already able to breathe more easily, and were feeling woozy but pretty much all good.
from there, my dad stepped in to start the anaesthesia for a patient with a very badly broken ankle, since the scheduled doctor was stuck in traffic. i only got to see the beginning of that one (the prep, opening up the ankle, and the start of the bone-setting) but that was pretty neat -- a crooked fracture and some seriously torn ligaments, and the surgeon was putting in a seven-screw plate.
the afternoon was a colonoscopy on a dignified old-Charleston-family lady, and the placement of a feeding tube into the stomach of a brain-damaged patient. that last was sad, and difficult...there was hassle and trouble with paperwork, difficulty with the equipment in the room and with the procedure, and his situation was not a good one. but it worked out as well as it could, and he'll at least be more comfortable.
the useful conclusion, from this and from my time standing in with my grandfather in the clinic, is that the practice of medicine still fascinates me, and it still feels very much like a good, right direction for me to go. selah.
---------------------
...and then i came home and called the mechanic.
the short form is that the oil leaks i've been seeing over the past several months may be partly due to old gaskets, but that the root problem is internal blow-by. the good solution to this problem is to either overhauling the engine or putting in a 'new' rebuilt one. his take was it makes more sense to put in a new engine, because after labor costs at his shop and the machine shop, overhauling the current engine costs more, and a factory-rebuilt engine comes with a 100,000mi/3yr warranty.
my options were, if i planned to keep Matilda, to
a) not do anything, keep putting oil in, and pray i don't get stranded somewhere unfortunate
b) replace the oil pan gasket & rear main oil seal, which would cost a big pile of money and probably just result in an oil leak showing up somewhere else. also praying not to get stranded.
c) rebuild/replace the engine, which costs a really big pile of money, but in theory gives me a shiny new entirely-working reliable engine.
the larger perspective options were:
a) fix Matilda
b) get another new/used car
c) not have a car.
...there are no choices that are not painful. but in the end...well, right now, i can (kinda) afford to fix Matilda properly. i was hoping to save that money, but i hadn't yet decided what i'd be saving for, or where i'd put it, or anything. and this roadtrip has been time spent travelling, living, learning, joyous, difficult...but always intensely interesting, always full. and travelling in this particular car has made it so that even the time spent behind the wheel is wide-eyed laughing beautiful life; it lends another dimension, a little more soul. and, dammit, i'm only halfway around! there's miles and miles to go!
more practically, putting in a rebuilt, under-warranty engine would mean she should run well for at least a few more years with minimal maintenance...and if i want to sell her, i'm a hell of a lot more likely to be able to do it when she's got a new engine, as opposed to wonky rings, blow-by, and a multitude of oil leaks.
so, a little unexpectedly, it's still worth it. there was a little question, but not much. my mother put it together before i did, said, "Look, it seems pretty clear that what you really want is to fix this car." and my dad said, "I think you're making the right decision, given the situation. But in the future...don't ever give your car a name." *laugh*
(since i started making the plans for this roadtrip, i've been saying "10,000 miles or as far as the car will take me," and saying that if she died on the road i'd just ditch, ship everything back in boxes, and fly home. but...i failed to consider exactly how attached i am to this vehicle, and more importantly, that driving all over lovely twisty highways and having a ridiculously powerfully good time would make it that much harder to just let Waltzing Matilda go, especially to such a rough and ungraceful end.)
more details, for my own notes and for other car-geeks: what the mechanic said was that the rings that seal the pistons had probably gotten slightly warped, if the car spent a lot of time sitting...which is likely, given that in 18 years it had 38k miles on it. in any case, when the fuel combusts in the chamber, most of the pressure is put into moving the piston, but some of it blows back past the rings. minor blow-by is normal, and the excess pressure is relieved by the PCV valve, but the PCV valve can only handle so much pressure before some of it is shunted back into the engine. thus, the internal pressure of the engine increases enough to force oil out of anywhere it can come out. he measured the blow-by on the engine, and could see it coming out on both sides of the valve. so while the gaskets were clearly 20 yrs old and disintegrating, putting in new gaskets would be only a temporary fix, and he said that he was seeing leaking from the timing cover gasket, which is new.
he didn't speak specifically about the cause of the intermittent front-end vibration, but he did say that the PCV valve was working, and that cleaning the solenoids in the throttle body would very likely fix the over-rev problem i've been seeing for the past couple of years.
and now the day is done. time for sleeping, soon. tomorrow is another full day.
this morning was two nasal/sinus surgeries, ambulatory, with the ENT surgeon being the old family friend that my dad's sailed with for years and years. for the first one, correcting a deviated septum + turbinatectomy, he used the scope, with the video up on a big monitor; the second one was simpler, and he did that one without the scope. i got very woozy during the first, at the bit where he was removing most of the cartilage plates out of the septum. had to sit down on the floor. the OR nurse was wonderfully sweet, went and got me gingerale and a wheelchair to sit in, and after a few minutes my head cleared again and everything was fine. as before, the strongest impression i left with was "we do this, and it makes things better?!? the human body (and all bodies) are...such amazing complicated mostly-functional systems. wow." also, i'm still pretty sure i don't want to be a surgeon. it's fascinating, but it seems to require a very particular sort of self-confidence, and beyond that, it's very much a craft-skill: cutting, patching, taping, stitching, stapling, yanking, screwing or wiring things together. and so much of the craft-skill seems impossibly crude, compared to the cost of doing things wrong, and compared to the elegance of the body itself. (something new, a further articulation: i don't see myself being incapable of doing surgery, or of doing it well. but i'm pretty sure it's not what i want to be doing most or all of the time.)
i met with both patients before and after the surgery, sat in on the pre-anaesthesia interview and talked with them a little as they come back awake. the second patient was a sweet, delicate old woman, an artist. the surgeries, as always, were pretty gruesome, cartilage and squishy bloody sinus-bits getting pulled out one by one, but both people upon waking smiled, and were already able to breathe more easily, and were feeling woozy but pretty much all good.
from there, my dad stepped in to start the anaesthesia for a patient with a very badly broken ankle, since the scheduled doctor was stuck in traffic. i only got to see the beginning of that one (the prep, opening up the ankle, and the start of the bone-setting) but that was pretty neat -- a crooked fracture and some seriously torn ligaments, and the surgeon was putting in a seven-screw plate.
the afternoon was a colonoscopy on a dignified old-Charleston-family lady, and the placement of a feeding tube into the stomach of a brain-damaged patient. that last was sad, and difficult...there was hassle and trouble with paperwork, difficulty with the equipment in the room and with the procedure, and his situation was not a good one. but it worked out as well as it could, and he'll at least be more comfortable.
the useful conclusion, from this and from my time standing in with my grandfather in the clinic, is that the practice of medicine still fascinates me, and it still feels very much like a good, right direction for me to go. selah.
---------------------
...and then i came home and called the mechanic.
the short form is that the oil leaks i've been seeing over the past several months may be partly due to old gaskets, but that the root problem is internal blow-by. the good solution to this problem is to either overhauling the engine or putting in a 'new' rebuilt one. his take was it makes more sense to put in a new engine, because after labor costs at his shop and the machine shop, overhauling the current engine costs more, and a factory-rebuilt engine comes with a 100,000mi/3yr warranty.
my options were, if i planned to keep Matilda, to
a) not do anything, keep putting oil in, and pray i don't get stranded somewhere unfortunate
b) replace the oil pan gasket & rear main oil seal, which would cost a big pile of money and probably just result in an oil leak showing up somewhere else. also praying not to get stranded.
c) rebuild/replace the engine, which costs a really big pile of money, but in theory gives me a shiny new entirely-working reliable engine.
the larger perspective options were:
a) fix Matilda
b) get another new/used car
c) not have a car.
...there are no choices that are not painful. but in the end...well, right now, i can (kinda) afford to fix Matilda properly. i was hoping to save that money, but i hadn't yet decided what i'd be saving for, or where i'd put it, or anything. and this roadtrip has been time spent travelling, living, learning, joyous, difficult...but always intensely interesting, always full. and travelling in this particular car has made it so that even the time spent behind the wheel is wide-eyed laughing beautiful life; it lends another dimension, a little more soul. and, dammit, i'm only halfway around! there's miles and miles to go!
more practically, putting in a rebuilt, under-warranty engine would mean she should run well for at least a few more years with minimal maintenance...and if i want to sell her, i'm a hell of a lot more likely to be able to do it when she's got a new engine, as opposed to wonky rings, blow-by, and a multitude of oil leaks.
so, a little unexpectedly, it's still worth it. there was a little question, but not much. my mother put it together before i did, said, "Look, it seems pretty clear that what you really want is to fix this car." and my dad said, "I think you're making the right decision, given the situation. But in the future...don't ever give your car a name." *laugh*
(since i started making the plans for this roadtrip, i've been saying "10,000 miles or as far as the car will take me," and saying that if she died on the road i'd just ditch, ship everything back in boxes, and fly home. but...i failed to consider exactly how attached i am to this vehicle, and more importantly, that driving all over lovely twisty highways and having a ridiculously powerfully good time would make it that much harder to just let Waltzing Matilda go, especially to such a rough and ungraceful end.)
more details, for my own notes and for other car-geeks: what the mechanic said was that the rings that seal the pistons had probably gotten slightly warped, if the car spent a lot of time sitting...which is likely, given that in 18 years it had 38k miles on it. in any case, when the fuel combusts in the chamber, most of the pressure is put into moving the piston, but some of it blows back past the rings. minor blow-by is normal, and the excess pressure is relieved by the PCV valve, but the PCV valve can only handle so much pressure before some of it is shunted back into the engine. thus, the internal pressure of the engine increases enough to force oil out of anywhere it can come out. he measured the blow-by on the engine, and could see it coming out on both sides of the valve. so while the gaskets were clearly 20 yrs old and disintegrating, putting in new gaskets would be only a temporary fix, and he said that he was seeing leaking from the timing cover gasket, which is new.
he didn't speak specifically about the cause of the intermittent front-end vibration, but he did say that the PCV valve was working, and that cleaning the solenoids in the throttle body would very likely fix the over-rev problem i've been seeing for the past couple of years.
and now the day is done. time for sleeping, soon. tomorrow is another full day.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2006-04-19 03:20 am (UTC)At least you no know what you're dealing with.
no subject
Date: 2006-04-19 03:36 am (UTC)yep. he's ordering the engine from atlanta, should be in on monday, car will hopefully be ready by wednesday.
i may borrow a car and drive up to GA/NC this weekend anyway.
no subject
Date: 2006-04-19 03:23 am (UTC)And for what it's worth, I always named my cars.
no subject
Date: 2006-04-19 03:41 am (UTC)*smile* i've named both of the cars i've driven regularly, and they were both Crown Vic wagons. and on the flip side, my mother never named the big old VW Vanagon that they had for years and years, and she was as bad about hanging on to it and doing continual repairs as i am with Matilda. she finally sold it, after "trying" to for several/many years, after finding exactly the right person, someone who'd take care of it and be just as attached as she was.
no subject
Date: 2006-04-19 04:21 am (UTC)The NG tube (or naso-gastric tube) is the one that goes through the nose and down into the esophagus. Used for short-term, temporary non-oral feeding as opposed to a PEG that folks can keep for years.
If you're talking management of swallowing disorders, you're in MY world, honey. ;-)
no subject
Date: 2006-04-20 05:44 am (UTC)no subject
Date: 2006-04-20 02:13 pm (UTC)I think that every medical school student should have an NG inserted and kept in for 3 days while they stay in a hospital bed with all the trappings therein. It oughta be part of the required training.
no subject
Date: 2006-04-20 05:30 pm (UTC)I think that every medical school student should have an NG inserted and kept in for 3 days while they stay in a hospital bed with all the trappings therein. It oughta be part of the required training.
*shudder* you're probably right, and spending my five days in Grady Memorial (Atlanta) certainly gave me a new perspective on it. that said, i *loathe* having to put anything up my nose, and being stuck in a hospital bed, while sometimes necessary, also seems to be generally bad for overall healthiness. without large quantities of painkillers/sedatives, i would go absolutely nuts; even with them, being stuck in the hospital bed was Not Fun.
no subject
Date: 2006-04-21 01:27 pm (UTC)Exactly my point. If prospective doctors were given the chance to see it from the other side, they might think twice about keeping patients admitted as long as they do, or think twice about running certain tests or blood-draws or meds at all hours, or bringing in a group of curious strangers to poke and prod like the patient is an exhibition.
Doctors are only human, but unfortunately, they often forget that their patients are too.
no subject
Date: 2006-04-22 01:07 am (UTC)bringing in a group of curious strangers to poke and prod like the patient is an exhibition.
remind me to tell you my Florence Nightingale story sometime. :)
no subject
Date: 2006-04-22 03:28 am (UTC)no subject
Date: 2006-04-28 12:21 am (UTC)right.
...just about ready to get back on the road here. i'm packing up, loading the car tonight, and then heading to NC tomorrow...
no subject
Date: 2006-04-19 04:12 am (UTC)no subject
Date: 2006-04-20 05:46 am (UTC)i'll be glad to have Matilda back and running and shiny, and the money side of things has i think just been too much of a roller-coaster, and i've just gone blank on it. *shrug*
med school...*sigh* still very intimidating, and it's very hard to figure out where to call, or what to say or ask, or how to set up a visit and what i want to look at. head's not been very clear at all for awhile.
no subject
Date: 2006-04-19 04:16 am (UTC)But I sure as hell wasn't going to perform a procedure on a patient that I didn't know how it felt if possible. ;-)
no subject
Date: 2006-04-20 05:49 am (UTC)no subject
Date: 2006-04-19 04:20 am (UTC)Do you have to bring the engine back to NC to get replaced?
presumably this is a mechanic you trust.
no subject
Date: 2006-04-19 01:30 pm (UTC)no subject
Date: 2006-04-20 05:54 am (UTC)no subject
Date: 2006-04-20 05:52 am (UTC)and yeah, this is a mechanic i trust. it's a big shop in charleston that's well-known for doing very good, reliable work, and the owner of the shop is the mechanic that i've been dealing with for Matilda. they're the people i took Matilda to for the post-shipping inspection, and have gone out of their way to explain to me what the problem is when something is broken, and have gone out of their way to charge me less, on occasion.
no subject
Date: 2006-04-19 02:04 pm (UTC)It's amazing how much damage slamming on the brakes can do, if your car's nose happens to go underneath the other car's bumper. He was old enough ('97, 170K miles, about 140K of which I put on him) that he was pronounced a total loss.
snif.
Good luck to you and to Matilda.
no subject
Date: 2006-04-20 05:58 am (UTC)but it sounds like he had a good long run with you, at least.
Good luck to you and to Matilda.
...one good thing -- Matilda's a tank. i should go out and check with a magnet sometime, but i'm pretty sure her bumpers are steel, welded to the frame. so if her front end caught on someone else's bumper, it's a good bet that they'd lose.
(which reminds me --
and...thank you. i can use all the good luck i can get. :)
no subject
Date: 2006-04-19 04:39 pm (UTC)& name whatever you want--i'm still bummed over the last car i lost, & miss it, & get jealous when i see other people driving one just like it, & there was never any naming involved. when you love things you just love them. :)
no subject
Date: 2006-04-20 06:04 am (UTC)not sure. anaesthesia is definitely appealing, for several reasons, but i'm wary of that because it's also what i know best, and what i've seen the most of. (my dad's an anaesthesiologist, and his father was as well.) i'm leaving that question open until i've had a chance to see more of other specialties.
& name whatever you want--i'm still bummed over the last car i lost, & miss it, & get jealous when i see other people driving one just like it, & there was never any naming involved. when you love things you just love them. :)
well understood. *smile* and really, i'm not likely to avoid naming or getting attached to houses or cars...but at least at present i have trouble coming up with a car that i'd enjoy quite as much as Matilda, that would suit me as well. an old mercedes wagon converted to biodiesel, maybe, or the right sort of pickup, or one of the old curvy Monte Carlos...but i suspect that if/when i need to get a 'new' car, i'm gonna have to go with something that's at least a little bit practical.
no subject
Date: 2006-04-20 07:25 am (UTC)no subject
Date: 2006-04-24 12:52 pm (UTC)no subject
Date: 2006-04-27 04:32 am (UTC)i have an...ambivalent fondness for saturns. among other associations, i was in a really nasty accident in