Tuesday, July 17, 2018

Estoy parte de un terremoto.

The World Cup is over. The majority of those around me missed it. France won, in case you missed it as well.

A month ago, when the first games were underway, I’d excitedly ask random people in the hospital their opinion. You know, pass the time while waiting for the trauma to role through the doors, or the CT scan to finish on a patient, etc. The general response I received was, “Is the US playing?” No. “Oh, well, then I don’t care.”
Their response so strikingly American, and it makes me sad. The whole world cares about the World Cup! We all live in this world together, share the same sun, the same moon and stars, why not care together as well.

An American soccer player publicly expressed his support for Mexico during the World Cup and received quite a bit of backlash for his support. Also makes me so sad. If we can’t support our neighbors in something as meaningless as a game... how can we claim being neighbors at all?

I did not get to watch any of the games myself, but I did have the app open on my phone waiting for the updates. When all of Mexico jumped during their first match against Germany, registering seismic activity on the Richter scale, I jumped with them.

Common sense 101 on relationships teaches us to find common ground. Show interest in what someone else cares about. Find similar interests you can relate with each other. It’s all building up and out from there. When the whole world comes together around a single issue, I want to be a part. I want to share in their joy and sadness. I want to build a relationship.

Much Love.

Wednesday, July 11, 2018

Estoy siéndome como una esponja.

A sponge, is how I can describe it. You must be a sponge to survive. Soak up the sleep when the opportunity presents itself. I feel like I am barely able to soak it up in time for my next call; when I’m wrung out dry once again.

When discussions were afloat about scheduling changes for this year, especially concerning night float, hot topic was who would present the following morning at morning report. When a night float was in existence the senior resident presented all events from overnight the following morning. All ex-patriots of that position expressed utmost importance for that role to remain in the charge of the pgy3, or ER senior on call. Having stood next to multiple of my seniors as they stood up to present I knew what it would entail, that does not however, make it any easier.

It’s like standing up in front of a firing squad. Nothing to hide behind. And no where to run. Every decision made over night, whether you actually made it or not, is your responsibility, and up for target practice. And you’re standing there, awake for 26+ hours at that point, ready to take it like a champ... or not. Taking responsibility of the surgical service of a large academic hospital is like conducting an enormous orchestra, so enormous it overflows into 5, or 16 or 22 different rooms, and yet you have to somehow figure out to keep everyone on time to the same beat, in key, and of course alive. Sound nigh impossible? Kind of, yea. But you’ll be asked about it the next morning, and so you try your best anyways.

So when the intern texts with another concern or question you respond immediately no matter how minuscule the issue, because you yourself can not physically be on the floor addressing every single Tylenol renewal the nurses need, and are therefore reliant on your intern escalating anything and everything out of their scope. Especially now, at the beginning of the year, an intern going rouge, off on their own beat, is the last thing you need.

Some morning reports are less painful than others. A strong and dependable on call team helps. A chief resident who is willing to help, and/or do cases overnight helps. And having some time in the morning to gather your notes and try to decipher your scribbles from overnight and remember what actually happened also helps. But whether you have those helps or no, you’re still wrung dry.

Here’s to surviving yet another senior call at the Chester.
Much Love.

Sunday, July 8, 2018

Estoy tratando entender.


He was brought in with the appropriately appointed guards. Two of them, like always, one for each side. The presenting story was an assault. He had been pushed down a flight of steps and landed on the throat. He felt his neck was swollen and that his voice was sounding on the side of duck-ish. Trauma was activated and the patient was seen and assessed. Incidental finding of metallic objects in his stomach on Xray imaging.

Yes, please tell me you had a question mark floating after that last sentence. But it’s true. Razor blade will be wrapped in plastic or rubber and swallowed. Relatively harmless to the inmate, but once discovered, a ticket out. “Vacation”

As much as I have learned in this life, I’m still a small-town girl from the mid-west at the root. From time to time, I’m met with a new encounter that I am not able to empathize or relate to. Is that a good thing? Bad thing? Whether I understand their reasons or not, I can at least control how I respond to them. For whatever the reasons, covered in rubber or bare razor, it’s unsafe to leave sitting in one’s stomach.

I hope that I continue to learn from this world, improve my ability to form relationships based on common ground, and then eventually build on that relation.

Meanwhile, down the hallway, she was recovered and ready for discharge. She would suffer pseudoseizures when it was time to leave. Eventually we had to just let her go out the door and voila, pseudoseizure spontaneously resolved.

Sometimes I wonder, and I ask again, my inability to empathize or relate at times… is it a good thing? A bad thing? 

Much Love.

Wednesday, July 4, 2018

Estoy practicando respirar

It’s true poetic justice when your own human weakness proves your own vincibility. I had just about made it. Made it out of my month of trauma, my month of long hours and no sleep. I had kept it up, thought I could get away with it. Started believing my own invincibility. Believed it to the point that I ignored the sore throat that had started gnawing throughout the day last Friday. Believed it, until I woke up June 30th undeniably sick. Beyond the help of gummy vitamins.

I still go to work. We are residents, it’s what we do. It’s not an uncommon site to see a resident who is sicker than their patients. Plus, July 1... Had to be there for that. All hands on deck for the new interns.

I should have taken a hint when my intern asked to have July 1st off without giving a reason. I said no. He had gone to the chief residents and asked them not once, but twice. He had again been told no, twice. I had both emailed a list of expectations, and spoke to him on the phone how July 1st was to play out. Efforts which proved to be in vain, when I showed up to the 4th floor residents lounge July 1 ready to meet with him and round, instead was told by the night intern that my intern had yet to show up for the day, nor had he gotten any sign out on our patients. I’ll summarize and say we had a rough start. Nice welcome to being a senior surgical resident for me. *Note sarcasim* Got to teach him the importance of 1) being where you’re supposed to be   2) when you’re supposed to be there, and.  3) prepared to do what needs to be done.

July 1 was followed by July 2 and the start of our program’s new call schedule. No longer will we be having months of night float. We’ve switched to a 24 hour call schedule and I was up first for 24hr senior call. By this time, the virus that had started blossoming a few days prior had taken up residency in my lungs making me feel like I couldn’t breathe and my voice was half gollum, half squeaky  church mouse.

I didn’t even try to be productive when I finally got home from call. I went to bed with no plan to get out of it again until work the next day if possible. My lungs still feel like they don’t want to breathe, but I make’um anyways. Hopefully a little bit better each day. And my intern will be just fine as well. You could see that he knew he had messed up. I can work with that.  We’re all going to be just fine.

Much Love.


Saturday, June 30, 2018

Estoy avanzando.

Contact information was sent out for all residents in preparation for the start of a new year. My name was listed under PGY 3 Categorical. I paused for a moment of spontaneous unexpected elation. They tell me, the year will be the same as PGY2, especially now that we no longer will be rotating at St. Vinny's. They tell me it's nothing special, and not to get excited. What they don't understand or fail to realize is what it took for that PGY 3 to follow my name. Nothing short of a miracle, and I reserve the right to be elated, thankful, and at peace.

I'm starting PGY3 on a brand new service. I mentioned the major renovation our program has been going through before, and tomorrow is the day everything drops. July 1st everything new. I will be senior on the minimally invasive service for the next three months. It'll just be me and one intern. Being just two residents on a team, lends for an easy rounding schedule. Took me a whole two minutes to make it up and send my intern the schedule and the email welcoming him to the service and outlining some of my expectations. We'll see how it goes.

Here's a few pictures from our graduation party a week ago.
 Back row: Dr. Savino (Director of Surgery), Dr. Latifi (Chief of Surgery), Dr. Con (Program Director)
Front row: Graduating Chief residents: Min Li Xu D (Vascular Surgery fellowship), Artem Dyatlov MD (Starting practice in PA), Seungwhan Pee MD (Surgical Critical Care fellowship), Rachelle Lodescar MD (Burn fellowship)

 Chief residents with a handful of our Attendings

 K. Dzeba, one of our new Chief Residents, Monica and me

 Me, Ansab and Danny PGY2 going on PGY3

 All the PGY2s able to be at the party. Me, Clara, Danny, Ansab

Another of our new Chiefs Dr. Bronstein, Monica and me

Much Love.

Friday, June 22, 2018

Estoy manteniendo la respiración.

Last week of June. Prelim residents have left, moved on to their respective categorical residency orientations. Chief residents have likewise bid their adieus. Those of us remaining buckle down for a rough week, the past couple of days spent battening down the hatches in preparation. I feel like everyone is holding their breath, or maybe that's just me. Still counting down the days. 8!

Tonight is our program's graduation party. Despite how difficult the year has been for everyone, the low morale is slowly being addressed. I am encouraged to notice residents and attendings alike are excited and anticipatory for the evening's festivities. Take this in comparison to December's Christmas party... which no one went to.

I think everyone, in general, is looking forward to what a new year can offer. A theoretical fresh start. We kept waiting for someone else to make a change, make it better. No more waiting, we'll make it better ourselves.

Here's a few pictures from Dr. Babu's party a couple weekends ago.
 
 The newly completed Tappan Zee Bridge (I guess officially now the Governor Mario M. Cuomo Bridge) next to the old Tappan Zee being taken down piece by piece.


 Sunset on the Hudson. Tarrytown, NY

  Sunset on the Hudson. Tarrytown, NY

Christiana (and son Rokimi), me, Alexandra, Niu
 
 One of our graduating Chiefs, Artem, with his wife and twin girls

 End of the Year Party at Dr. Babu's with the Vascular team.

 End of the Year Party at Dr. Babu's with the Vascular team.

Much Love.

Saturday, June 16, 2018

Estoy lista para futbol.

We had a trauma come to us as a transfer from an outside hospital. Activated as a level one trauma as she had been intubated at the outside hospital. Intubated for combativeness. The trauma bay is a highly protocoled area, for both the patient's safety and the safety of the health care workers involved. Patient's, often intoxicated or drugged, blood coming from somewhere, but refusing to lay still or cooperate, often combative, and they get tubed. There is no patience in this setting for deviation from the protocols set in place for everyone's safety. A patient gets intubated and sedated, the trauma exam can then be completed isolating source of bleeding, and various injuries. This particular patient had avulsed half of her forehead, the laceration extending from her scalp in mid-forehead down to her left temple cutting her left eyebrow in half. We repaired her face before extubation, approximating muscle to muscle, dermis to dermis and eyebrow to eyebrow, etc. I worked with my Attending, one of the new ones, we all like her. But unfortunately, the rumors were already spreading of her moving on. I asked her about them. She looked at me surprised. Unfortunately, she could not negate the rumors, but wondered at their origin, as she had not yet even told many of her fellow attendings, and definitely none of us residents. I had been the first to even ask her about the subject. So sad to know yet another attending is leaving. I am so ready for this high turnover rate to slow down and stop.

Our daily lives on the trauma team have not gotten any better this past week. June continues to prove to be a very high trauma volume month. Thankfully I have multiple co-residents that have made themselves available and are willing to help if I ask, which I have from time to time. Our long hours have not gone unnoticed, and I've been told multiple times "I want you to leave the hospital at 6pm tonight" or "You have to be physically out of the hospital by 8pm tonight." That's all well and good. Unfortunately, they are only words. The same attending who tells me to leave at 6pm, also stands by and watches as I take the new incoming trauma at 5:45pm and with it any hope of leaving any time soon goes out the window. gone with the wind. Sigh. As hard as I try, I can't perform magic. Starting next month, our program rotations are undergoing a major renovation. Starting July1st, what is currently managed by our three person team will be taken over by two different teams and a total of 9 residents. I feel this is the main reason why words are not backed up with action. The change is in place, just not for another 14 days. Just 14 more days!

One good thing about being so busy is that my caffeine intake has reduced. Simply because I don't have the time to go and get any. I definitely could use it. On Wednesday's we dress up for our M&M, Grand Rounds and education hours. The other Wednesday I didn't have time to change afterwards, and one of the nurses in the ED has called me "ballerina shoes" ever since. You never know what's going to get spilled or splashed around in the trauma bay, and I think she was more worried I'd ruin my shoes than anything else. I didn't share her worry myself, they're just shoes. Whether I'm wearing danskos or ballerina shoes is not going to alter my ability to put in a chest tube if needed.

Much Love.