Tuesday, June 27, 2017

Estoy casi al fin.

There's always a moment of of subconscious pause each morning when you pick up your list. What was the damage done overnight? Breath held waiting for the result, is released in one of two ways 1) relief  2) sigh. This summer is proving to be full of trauma. Drug deals gone bad. Hate crimes. And then of course the typical array of motor vehicle collisions and people falling down. My held breath tends to be released with a sigh every morning. Six new names. Seven new names. Only three new names!!  It's even more difficult in my position when the ICUs unload their patients to the floors overnight to make room for all the new admits. My job, to pick up where the ICU left off for those patients. Sigh. It's like Westchester turns into a Trauma factory during the summer. They just keep coming in, and its all I can do to keep them going out at the same rate. If I don't, we drown. It can be stressful. Take today for instance. Two of my discharges were ready to go when I saw them at 6am. But we rounded, then morning report, then rounding with one attending (during which they reminded me they were ready to go), then I had a case, then rounding with the second attending (they were still waiting) and I finally got to sit down at a computer and my co-resident texted me, "Is there clinic today?" I was already 10 minutes late, and clinic was clear across campus. I walked there at the typical brisk pace of someone with somewhere to be... my head hung down. I try so hard, I don't let a minute be wasted. All my notes written by the time morning report is finished. Morning orders in by the time of rounds. Consults called. Dressings changed. Touch base with social work, case management and physical therapy. (Make sure they take care of your patients first ;) While anesthesia is intubating get through as much paperwork as possible on the OR computer. But, you just can't physically do it all. Clinic will take minimum three hours and your lovely patients who were ready to go at 6am, were fully dressed by 9am, will still be sitting there at 4pm, just waiting.  And they look at you like, "why?" FAIL.

Believe it or not, my chief actually helped me out today. Took care of the easy discharges. Then inbetween patients over at clinic, I was able to log on and complete the work for a few others.  And then after all that... at the end of the day... the list is still just as long. Sigh.


Much Love.

Sunday, June 18, 2017

Estoy lista.

I'm ready for the residency year to end. Programs all around are having their graduation banquets. Ours is this coming Friday. For those ending residency, we celebrate and congratulate. For myself, I'm so ready to not be an intern anymore. I had internship under wraps two years ago. Now having spent a year on repeat, I can perform these duties blindfolded and one arm tied behind my back. So thankful I had short reprieves with new rotations, like plastics and pediatrics. But trauma this month, provides no educational benefit for an intern, evenmoreso second time around. Zero. However, it has sharpened by prioritizing which lends itself to efficiency. I have a feeling that I cause borderline annoyance of ancillary staff and our allied health. To the social worker: I'm asking every 30-60 minutes, can I? can I? is everything set up? can I finally discharge? To the seasoned NP who goes to check labs and reorder: Already checked them, it's taken care of. And just like that they're thrown off their routine. Not that anyone has actually said anything, it's just a feeling. Probably born from the fact that I even annoy myself.


Here's a few pictures from my cousins wedding out in Illinois!
Our Stoller cousins had a wide age range. Luke, three months older than myself, was in between Carrie and I growing up in the Gridley school system. We were on the tail end of the Stoller cousins. As we've all grown and moved away, very few of us made it for his wedding. I'm sure Luke didn't take it personally, but it made me extra glad that I could be there.
Above: we grabbed a Stoller cousin selfie in front of the Illinois State Capitol building as the wedding was in Springfield, IL. (Troy & Carrie Blunier, Jeff & Cynde Stoller, Chelli and me)

Stoller table at the reception. Lucas and Megan are both pharmacists. They had pill bottles filled with personalized M&Ms for all the guests. Made it look like everyone was popping pills all evening long.


Lucas and Megan Stoller 

Lucas and Megan Stoller


Much Love.

Friday, June 9, 2017

Estoy viajando otra vez.

I left the hospital early today. Wanted to give myself extra time due to reported construction around the airport. It wasn't early enough. I pulled up to my apartment with 7 minutes to the arrival of my train. The train station is a 10 minute walk. I ignored that last fact, changed, grabbed my already prepared bag and was out the door with 4 minutes to the arrival of my train. I set off half running half walking, which turned into just straight running by the last half mile, I was at under 2 minutes. Seeing my hurried state a lady rolled down her window and yelled at me if I wanted a ride. I grabbed the offer. She asked me when my train was, and when I told her, she cracked up laughing. And laughed the whole short minute drive up to the stairway that led into the station. I made my train.

Sometimes you just got to go for the impossible. Who knows what will happen.

Heading to Illinois for my cousin's wedding. Gonna be a good time. Best part is the list back at the hospital is nice and neat. We've worked hard and cleaned it up over the past week and a half. It would have been even nicer, but we were gifted a patient just yesterday. A real gem. Working on her plan today I called multiple services for a consult and without fail, when discussing the case, they would stop me and say... "so....Why is she admitted?" (With extra emphasis on the 'why' and extra inflexion at the end). To myself, I ask the same question.  In response to them, I deliver a well practiced story. They sigh. I sigh. We all sigh. And then move on. If I dig enough, I think I'll actually be able to find something that will justify her being our patient. In the meantime, she has some of the worst drug-seeking behavior I've seen yet. Like I said, a real gem. She's borderline buying herself a Psych consult already. I have no doubt it will be paid in full by Monday.

Much Love.

Sunday, June 4, 2017

Estoy ajustandome a trabajar de nuevo.

Adjusting back to the grind. I knew I was ready to go back. Even before leaving for Argentina, when I returned to New York from Illinois, I knew I could have handled returning to work at that point as well. Which was encouraging, and in a way freeing. I could go to Argentina without the stress of knowing I had to be ready to go to work when I returned. I was already ready, and therefore had the freedom to simply enjoy traveling.

Kind of sounds like I just talked in a circle and actually didn't say anything...

Point being, I'm back to work. Returning, I am on the trauma team. Trauma hits its high season in June. I was the first one to hit the floor June 1st and was handed a list of 50 patients. It's simply impossible to know 50 patients in 90 minutes, all their stories, injuries, histories, numbers and plans, but you hit the floor running and you try anyways. I'm pretty confident to say that I would not have been able to handle this month very well prior to vacation. As is, each day has gotten better. Long hours and little sleep, but that par for the course. Each day you know the patients better which makes handling the million questions and issues that arise much more efficiently. Due to end of the year scheduling issues they put me on 24 my first weekend back. Thankfully I had the time to work throughout the night so that by morning I had all of my work already done. It was a blessing in disguise, because the PA assigned to assist the trauma team for the following day... actually things run smoother when he doesn't try to help.

I've also found so many changes at Westchester during my absence. It had been 4 months since I had set foot at the Chester. Many Attendings are different, many left some new. Some of the teams have changed responsibilities. My co-residents have had changes in their social lives. There's been changes to how a few of the orders go into the computer and a few of the protocols of patient care. That and everywhere I turn someone is commenting about "where have you been?!?!" In a way, it's nice to have one's absence noticed.

And every day, I miss Argentina, and traveling. Seeing something new everyday. New people, new experiences, forming memories, and being a part of this World that is so much bigger than this small corner of New York, this hospital and these patients. I look forward to being able to travel again when next able. But now it's back to the task at hand. Every day learning something new, solving this issue or answering that question, and ultimately becoming the best surgeon I am capable of.

Much Love.


Here's a few videos from the trip.





Wednesday, May 31, 2017

The Great South American Road Trip (Argentina/Chile)

We had few plans in place when we left. Really it was merely more than an idea. An idea to see Patagonia...ALL of it. From Buenos Aires to the tip, to the End of the World. We started off  May 13th from NYC landing in Buenos Aires on the 14th, and with an open schedule and lots of flexibility, we did just as we had set out to do, ending 6300 km (3780 miles) later in Ushuaia on the 28th. I praise God for the opportunity to see a new part of his creation, thank Him for the friends willing to travel the world with me, and will treasure the memories forever.

As always, pictures never can capture what was real, but I offer a few below should you like to see a glimpse into our trip.
 at the Market Puerto de Frutas

  at the Market Puerto de Frutas. Notice the cup the lady is holding. It's her mate cup, rarely do you see an Argentinian out and about without one. (mate = a hot herbal tea)

  at the Market Puerto de Frutas

 While in Buenos Aires we were able to stay with some friends. Juan, Marla & Thiago.

 Exploring Buenos Aires. Quick trip to El Caminito.

 Exploring Buenos Aires. El Ateneo is an old theater transformed into a book store and cafe. 

 Exploring Buenos Aires. La Recoleta

 Exploring Buenos Aires. La Recoleta.

Exploring Buenos Aires. La Recoleta
 
 Exploring Buenos Aires. La Recoleta. Perhaps the only spot to have flowers, that of Eva Peron.

 Exploring Buenos Aires.. La Recoleta. 

 Exploring Buenos Aires. La Recoleta. A place to sit. A story to share.

 Exploring Buenos Aires. Teatro Colon (Columbus Theater) and the Obelisk.

 Exploring Buenos Aires. Due to construction of both the Congress building and the Congress Plaza this was really the closest we could get. 

Exploring Buenos Aires. Looking down July 9th Avenue towards the Obelisk. 

 Exploring Buenos Aires. Stopping at Cafe Tortoni.

 Exploring Buenos Aires. Looking down Diagonal Roque Saenz Pena towards the Obelisk from Plaza de Mayo.

 Exploring Buenos Aires. Three clocks on one corner of Plaza de Mayo?

 Exploring Buenos Aires. Plaza de Mayo with the Casa Rosada (Pink House) to the right. 

 Exploring Buenos Aires. I didn't actually succeed in getting a good picture of the Casa Rosada, but this is a good one of us, so it shall suffice :)

 Exploring Buenos Aires. Puente de la Mujer.

 Exploring Buenos Aires. Puente de la Mujer.

 Exploring Buenos Aires. Puente de la Mujer.

 Exploring Buenos Aires. Puente de la Mujer.

 Exploring Buenos Aires. Puente de la Mujer.

 Sunrise over Rio de la Plata.

 Heading South from Buenos Aires, into the Pampas, surrounded by estancias and their herds of Argentine beef. 

 
 Stopping in Tandil.

 Mar del Plata at sunset. 

 Mar del Plata at sunrise.

As we left from Mar del Plata heading West the Pampas continued as did the estancias.

Stopping outside of Neuquen to see the world's largest dinosaur, Argentinosaurus Huinculensis.
 
 Stopping outside of Neuquen to see the world's largest dinosaur, Argentinosaurus Huinculensis.
 
 Stopping often for photo opportunities.

 Farther West and the Pampas rose to the Meseta Patagonica, and beyond that... the Andes Mountains.

 Guest book at our hostel in San Martin de los Andes, El Andaluz. 

 Enjoying San Martin. Chocolate? yes, please.

 Twilight futbol game on the shores of Lago Lacar in San Martin. 

 Leaving San Martin de los Andes we took the Route of Seven Lakes. Lake Lacar.

 Route of Seven Lakes. Lake Lacar looking back over San Martin de los Andes.

 Route of Seven Lakes. Lake Melinquina.

 Route of Seven Lakes. Lake Melinquina.

 Route of Seven Lakes.

 Route of Seven Lakes. Getting that perfect angle on Lake Faulkner.

 Route of Seven Lakes. Lake Faulkner.

Route of Seven Lakes. Lake Traful.

 Route of Seven Lakes. Friends joined us at Lake Traful.

 Route of Seven Lakes. Lake Traful.

 Route of Seven Lakes. Lake Traful.

Route of Seven Lakes. Lake Traful.
 
 Route of Seven Lakes.

 Route of Seven Lakes.

Route of Seven Lakes.

 Bariloche on Lake Nahuel Huapi

 Bariloche

 Bariloche

 Sunset over Lake Nahuel Huapi from our penthouse hostel in Bariloche.

Continuing along Route 40 South from Bariloche.

 Stopping in Esquel for some lunch. We were pretty sure this group of ladies over my shoulder were having a book club meeting. 

 Back on the East Coast in Comodoro Rivadavia. Nightly roadtrip planning.

 The Face of Patagonia. The Guanaco.

 Mt. Fitz Roy looming large in the distance as we approached the West once again.

 Welcome to the North end of Glacier National Park.
 Arrived at El Chalten with enough time for our first trek of the trip. Up to Eagle's Viewpoint and then over to Condor's Viewpoint.

 It was good that we hiked that night, because clouds kept Fitz Roy hidden from view during our hike the following day.

 Fall Colors on our hike.

 Looking down over El Chalten with Fitz Roy in the background. 

 Sunrise as we started our trek to Laguna de los Tres. 

  Sunrise as we started our trek to Laguna de los Tres. 

 Lake Capri on our way to Laguna de los Tres. 

 on our way to Laguna de los Tres.

 At Laguna de los Tres. Fitz Roy hidden by clouds.

 Turning to head back down from Laguna de los Tres.

  Turning to head back down from Laguna de los Tres.

 Hiking Fitz Roy

 Hiking Fitz Roy.

 Stopping to refill my water in the mountain springs.

 The Glacier, Perito Moreno, at the South End of Glacier National Park.

 Panoramic of the Glacier, Perito Moreno, at the South End of Glacier National Park.

Looking towards Lake Argentino at the South End of Glacier National Park.

 Sunrise at Torres National Park in Chile, view from our cabin.

 Puerto Natales, Chile.

 Puerto Natales, Chile. We never could figure out why the flying people?!?!

Flat tire on our way back to Torres.

 So back to Puerto Natales for a mechanic.

 Home from Puerto Natales, take two. Loved that they had "suggested" speeds.

 Viewpoint over Rio Serrano. Are cabin is there in the center.

 Rainy mornings in the cabin. We tried to be serious for a photo.

 Rain stopped for our first hike of Torres. Milky turquoise of Lake Pehoe.

 Milky turquoise of Lake Pehoe with the horns trying to peak through the clouds.

 Salto Grande waterfall.

 Los cuernos (the horns) with the sunlight breaking through.

 Looking out over Lake Grey towards Grey glacier (notice small icebergs to the right!).

 Sunrise over the towers as we start our hike.

 Los Torres del Paine.

 At the base of the towers. Los Torres del Paine.

 Los Torres del Paine


 
 Hike back from the Towers.

 Our three shadows as we hike back from the Towers.

 Unexpected sheep crossing in Chile.

 :)

 Ferry across the Strait of Magellan to Tierra del Fuego.

 Heading out to Beagle Channel from Ushuaia.

 Looking back towards Ushaia at sunrise from the Beagle Channel.

 Isla Alicia

 Beagle Channel looking towards Argentina.

 Telienka was the name of our boat.


 



 The lighthouse "Les Eclaireurs"

 Stopping on Isla Bridges for a quick trek and lesson on the natives, the Yamana.

 From Isla Bridges looking towards Argentina.

 From Isla Bridges looking towards Chile, cushion plants that grow 1mm a year.

 Isla Bridges

 Make it to the End of the World. Check.

 Ushuaia

 You see Estados Unidos? United States 10,548 km away.

Flying home, one last look at Ushuaia surrounded by the Andes.


Hasta el proximo, con mucho amor, buenas noches.
Until next time, with much love, good night.