Prospero Año y Felicidad

I realized today that my Merry Christmas post did not publish last week. A thousand apologies for that.  But to make up for it, you get two posts today!  Feliz Navidad AND Prospero Año y Felicidad! Honestly, I didn't plan for it to be like that ;) (you can Click to go to the other post.)

I've been getting everything ready to move back to NY this afternoon. I'm expecting an intense night at the hospital tonight. There's been ambulances lined up at the hospital all afternoon. I'm only expecting it to get worse. We'll see how it goes. 

As for the End of Another Year. 2014. It passed.  It is a blur in my mind. Anything over 6 months ago seems like a different lifetime. Sometimes I'm amazed.  I don't understand why God blessed me with this opportunity. And I don't understand for what end it will all come to. Perhaps 2015 will shed some more light on that subject.

It is very clear that I, of myself, do not possess the love required to fulfill the role that I am currently attempting to fill. Daily requiring me to draw on the unending fountain of love that is Jesus. Sometimes I miss. I confess, I've kicked a chair. Slammed the phone down in its cradle multiple times. Wanted to throw the pager up against the wall countless times. Been caught muttering/venting under my breath going up the stairs when I had thought I was alone in the stairwell. But each of those times I've missed the fountain He's come after and drawn me back.

I finally came to the first patient that I stopped on just this past week. I won't go into details as to the work that had been put into the care of this patient. But in the end the patient and patient's family spat in my face, refusing to recognize anything that had been done for them. Refusing to accept any of their options.  And refusing to work with us in any way, shape or form. I finally got to the point that I politely excused myself.  I went and washed my face.  And my hands. I was done. I let someone else take over.
1 patient in 6 months....that's kind of acceptable no? yes? no?

I wonder if Jesus ever got that same sour feeling after dealing with those most unpleasant.  It probably made him sad more so than sour.  Sad that he couldn't help. Sad that they were so angry.  Why are they so angry?

I could not do this on my own, and am thankful that each day I step into the hospital, I am not alone. I marvel that so many of my colleagues are attempting to make it on their own, relying on their own strength.  But then again it does not surprise me to hear of the reliance on drugs those same residents possess. They joke that each residency has its 'drug of choice.' And now and again you hear of another resident that has OD'ed somewhere. It makes me want to love my co-residents even more.

Wanted to end 2014 with one more thing. My favorite song of 2014. I love the pictures that it gives. 'radiant diamonds bursting inside that we cannot contain' and then 'blazing wile fire'. I think that was the one that caught my attention the most. A wild fire is typically synonymous with destruction, perhaps to the point of loss of life. I was struck that they would choose such a topic to associate with God's love. And yet it is true, God's love exists beyond destruction, beyond loss, beyond darkness. It is unending and forever.  That even amidst destruction, loss and darkness you can hear nature itself singing His name. There is only one thing I actually know. I know that I love Jesus. and pray that my hallelujahs may somehow, someday be multiplied.

Multiplied by NEEDTOBREATHE.

Your love is like radiant diamonds
Bursting inside us we cannot contain
Your love will surely come find us
Like blazing wild fires singing Your name.

God of mercy sweet love of mine
I have surrendered to Your design
May this offering stretch across the skies
And these Halleluiahs be multiplied.

Much Love.
Psalm 113:3 From the rising of the sun unto the going down of the same the Lord's name is to be praised.

Feliz Navidad

Merry Christmas!

The holiday held many new firsts for me this year.  For example, I got to find out what it means to be away from any family for Christmas.

And I had an epiphany!

December 25, 2014 was like any other day. What does that mean? Well... it depends on what every other day is like?

In other words, do you live every day like it's Christmas Day?

Take the opportunity to daily love someone unexpecting, a patient, a child, the elderly lady passing through the door behind you.  Be sure to recognize and forgive all frustrations. Stop to focus on what's most important. Give without counting.
What is Christmas Day to you?

I wish you all a lifetime full of Christmas Days.

Merry Christmas!

Much Love.

Estoy descansando.

I am so thankful to be sitting. My feet extended in front of me on the foot rest. I'm resting.  I'm so thankful to be able to rest for this quiet short moment.

This week at the hospital, my intern counterpart was on her week of nights.  So the job that is typically done by two interns was left to me.  I went into the week, knowing it was going to be intense, with a goal for the week of 25 discharges.  That number had already been reached by Tuesday.  A 'discharge' isn't just a pat on the back and good-bye. From the perspective of the care provider, a 'discharge' is potentially a mountain of work. Coordination between consulting services, providing proper follow-up information, providing correct discharge medications, putting in discharge orders on time, and of course the discharge summary and paperwork. A discharge could take 15min (no consults, no medications, short hospital stay), but that is a rarity. Every single day this week I was at the hospital until late finishing up all my discharges from the day. Finally drag myself home at the end of the day feeling like I'd just spent the day skiing or something. Legs stiff. Feet hurting. Utterly exhausted. To get up in a few too short hours to go and do it all again.
 
By the end of the week, a 24 hour period away from it all, is potentially life-saving.  At the minimum sanity-saving. Which is why I'm so thankful to be sitting still right now.

I'm sorry to sound like I'm whining.  Perhaps I am.  Feel sorry for meeeeee. pitty meeeee. waaaaa. But please don't. It's just exhaustion speaking. And the disappointment that I couldn't be with my friends last night.  This is the process of residency.  This is the job.  These are the sacrifices that have been made, and will continue to be made.

I managed to get a few cases in this week.  Not as many as in previous weeks.  My seniors were all interns at one point in time.  No one said anything but one look at the floor list, and they knew what it ment.  Except for those few cases, most days they didn't even think about assigning me any OR time.  Friday, the 4th year assigned me to a Plastics case, and did so specifically as a reward (without actually saying it like that).  I like the reconstruction cases I've done with plastics, and I like the Plastics attending at St. Vinny's.  We don't necessarily have to work with him, but we like too.  And I couldn't even make the case. He saw me on the floor after the case was already over, and called me out on it.  "You were supposed to scrub with me! Things busy on the floor?" And he understood.  He might be the only Attending that would ever understand, accept, and forgive that.  And I hope I never have to abuse that fact again.

I get to go to church this weekend!!!!! I start my week of nights next week.  So I'm off Sunday day and will be able to make it to church. Just have to leave after to get back in time to get to work on time Sunday night.

Estoy comiendo dulce navideño.

You'll find residents that really like their months at St. Vincent's.  You'll also find residents that more or less dread their months at St. Vincent's.  I would consider myself as part of the first group.  However, that being said, I can understand the dread.  For example, I am dreading what I'm going to find waiting for me when I go in tomorrow morning. St. Vincent's has an oddly nice way of kicking you while you're down.  If such kicking could ever be considered 'nice'?

There's no trick to handling the type of work that kicks you while you're down.  You just can't stop.  You can't give up. Because if you paused for a second, you'd be buried so quickly and deeply, well.....good luck digging yourself out of that one. And you can't get discouraged.  No one ever recognizes the progress made.  No one ever says 'good job' or 'well done.' But that doesn't mean progress wasn't made, that you didn't do a good job.  It just means that such progress is expected, and that a 'job well done' is the level of performance you should already be performing at.  It should be the normal.  And therefore 'normal' isn't recognized. I don't know if I quite agree with that mentality.  Jury's still out....but it's leaning towards the disagree.  In the meantime, I continue to daily encourage. With a little help from my friends. :)

Much Love.

Estoy reafirmada.

My first day back at Bridgeport went about 95.7% better than my previous first day. I got many smiles and "welcome back's" from nurses and attendings alike. And they remembered my name! It is so reaffirming to find out that you are remembered by name and welcomed back with a smile.

As always, Bridgeport is busy, busy, busy. The other intern with me this month is M. Bravo. Did I ever show you a picture?  I can't remember so just in case...

  

 Dzeba, myself and Bravo.  W.O.W. = Women Of Westchester

 We work with efficiency.  Efficiency spelled with an A.  A for A Team. ;)  

Or as Dzeba would say, We keep it Poppington!

.....Yes, we are responsible adults ;)

Getting used to my new team at Bridgeport. First time I've worked with this particular Chief Resident. He's much more serious with tendency towards micro-management. Method of working with definite pros and cons, but as interns, not really our position to comment on either, and so we just deal.  Perhaps an eye roll here or there when we are called to the lounge to run the list yet again, but it is what it is. So we go, run the list, and keep our chief happy. Hence why efficiency with an 'A' is necessary in order to get the job done and on time despite regular interruptions. 

Much Love.

Estoy agradecida.

My neighbor knocked on my door the other night.  Inquisitively I opened the door.  He was standing there with a pizza box and one question. "Do you like pizza?" Now that, is the easiest question I've been asked in a long time! Yes, I like pizza!  He had gotten the day's extras from the nearby pizza shop in addition to his order and was hoping to share with his neighbors.

November has been perhaps the fastest month of residency yet. Don't have a lot to say about the last bit of the month of November. It wasn't the most pleasant of experiences due to some tension amongst team members. I initially tried to sooth things over, which I quickly realized was making things worse. So I kept my head down, and rode the storm. And it calmed down on it's own time. By the last few days of the rotation the laughing and smiles had increased again, not to it's previous level, but it was at least on an upward trend.

I'm not naive to think that with billions of people in this world and as many individual personalities, that all will necessarily like me. There will be those that revile me, and say all manner of evil against me falsely. I'm not to be surprised when it happens. I'm not to retaliate when it happens.  I'm to check myself, my position and the intentions of my actions.  And I am to love. Love as Jesus would love though unrequited.

That's easy to say, even easy to put into words. Much harder to put into action. Hard to not doubt everything you've worked for. Hard to walk unashamed. Love does make it possible to do so, not easy, but possible.

I start at Bridgeport tomorrow for the month of December. It was an interesting month last time I was there, and it is bound to be yet another interesting month.

Estoy pequeña.

Was able to make it into the city last Saturday evening. I was meeting up with Amy H. as she had made the trip East with a collection of international students from ISU. They were spending their time handing out Thanksgiving dinners, etc around Brooklyn and Manhattan. They were very gracious to let me join them for the evening.

Had to capture the 'selfie stick'. They really enjoyed the ability to take fun group pictures. And I enjoyed watching them.  I may have jumped in on one of them ;)

 

Much Love.

Estoy distraída.

I haven't gotten a whole bunch done today.  I've sat here in front of my computer.  Good intentions to be productive, but then my eyes stray up.  And I see the sun shining outside the window.  Such a beautiful clear autumn day.  Now the shadows are starting to stretch.  I've had to reach and turn on the lamp beside me.  And I'm torn. Between watching until the last light has moved on, or diverting my gaze back down to the computer screen and accepting the inevitable.

I'm trying to do the later, but my eyes keep looking up.  Time is going so fast.


I mentioned before that I have opportunity on this rotation to see more of my patients!  A definite plus.  However, as a result of that I'm getting comments from both patients and their family members.  Things like,  I'm the first person they see in the mornings and the last in the evenings.  When do I sleep?  First of all, I know that to be a lie, because I just came off night shift and know that both their nurses and nurses' aide have interrupted them at least a couple times through the night. I'm neither the first nor the last.  And second of all, would they rather I not do my job? Not communicate the plan with them? Not make sure they are okay?  I'm socially adept enough, to know that they are pointing it out from geniality. Because we then laugh together, and I make some joking quip in return.  But inside I wish they wouldn't comment on it. Perhaps it's yet another default I have, but this job, this residency, this path I'm walking isn't a joke to me.  I want to see them first thing in the morning and last thing in the evening. To wake them up, and then tuck them in, figuratively.

Another part of the intern job is to look after the students.  We have both medical students and PA students on our team, four currently.  Makes for quite a sight when I round in the mornings. Like I've got four tag-a-longs shuffling behind as I move from room to room.  They're pretty great all in all. I mean, they get to sit there and listen as my chief makes sure to point out every detail that I haven't performed to perfection. Yet they still tag-a-long with happy smiles on their faces.  :)

I discharged a patient to rehab this past week.  I'm half expecting her to be back when I get there in the morning.  She had an acute surgical problem, which had been addressed during her hospitalization.  However, watching her recover it became apparent to me that her acute problem had actually occurred in the first place from an underlying chronic psychological issue, which due to her acute problem can not be currently addressed. And unfortunately, her chronic issue is bound to land her back in the hospital right quickly.  Only question is when.

Much Love.

Estoy feliz.

I'm really happy to be back on days.  I mean...I knew I was struggling, especially towards the end of the month, while on night float.  But, with the renewed ease that a smile comes, makes me realize that I may have just been flat out depressed last month and in denial about it. I get to see all of the night nurses when I start and then again as I am leaving.  They at least act like they're sad I'm no longer with them.  Whether it's an act or not, it makes me feel like I must have done something right.  And for the most part I miss them too.

In general, ACS is not one of the more hectic services. There's time to actually talk to my patients.  Get to know them.  And I'm able to make it to the OR. It's pretty amazing.  Our team is actually a few members larger than it has been the past couple of months.  For one reason there is a resident rotating on our service  from another residency program specifically for all of the transplant cases.  Due to the nature of the service combined with the larger size of the team, those most senior are treating it almost as a vacation month.  They take turns having a day off.  Then the rest of them will text me mid-afternoon, once their last case has finished, to let me know that they are headed home and to call if I need anything. And then you should see the rounding schedule for the weekends and holidays this month. There's two people assigned for each day. Me and then one of them. I guess it's a good thing they all feel comfortable enough letting the intern run the service.  But then again that just comes as part of the "intern" job description in the first place.

I was changing the wound vac on a patient's abdomen the other day. He had his eyes squeezed shut against the pain caused by the process.  I intermittently will get some conversation going to distract myself just as much as to distract him.  I asked him what he plans on doing once he is discharged. And without missing a single beat or even opening his eyes he immediately responded, "Go to IHOP!"  I couldn't help myself. I cracked up laughing. Not only for the pure randomness of his response, but also for the fact that it was one he had obviously been planning probably for some time already. Upon further conversation I learned he's going to get lots and lots of pancakes.  That he loves pancakes. 

Much Love.

Estoy andando lentamente.

Done with night float! Sunday night was too much. Glad to be done with that rotation.  First rotation so far that I am happy to move on from. Ended at 6am this morning. And my next rotation started immediately. 6am and the chief of Acute Care Surgery (my next rotation) was waiting outside of the conference room. He smiled and asked "are you ready?" This is the same chief that I worked with while at Bridgeport. Nothing's changed.

The other night I pulled a muscle using a stapler.  I'd like to be able to blame it on the stapler, but that almost makes the situation even more sad.  I hang my head at the sad sad shape.

I had finally made an eye appointment for myself last week.  And then slept through the appointment.  I had happened to wake up just after the appointed time and called asking if it was okay if I was a little late.  To which I got a big New York 'No'.  I rolled me eyes on the phone to their response, silly me...thinking I was in the MidWest or something. So I just fell asleep again. Will just have to figure it out later.

Much Love.

Estoy cuidando por los higados, y sus receptores.

This is a story about a liver.  Just one liver, and three people.  I am not one of those three people.  The role I play in this story is rather insignificant.  In fact if they were to make this story into a movie my role would be what they call a ‘cameo appearance.’  Well…I guess one would have to first be famous or important for it to be a ‘cameo,’ so not even that.  Just ‘appearance’ then.  An appearance that would get credited as ‘random hospital resident’ or ‘H&P taker.’  But now I’ve jumped all the way to the credits of the story and only talked about myself….not the best start for this liver’s story.

The story starts with a death.  The death of Person A.  This was the liver’s first human, the one who had grown and nurtured him since birth.  We don’t know how Person A met their doom, but it is of little consequence to this story since the liver is our center piece.  Not the human.  Unbeknownst to the liver, prior to death, Person A, had signed the papers donating him. And this is where Person B comes into our story.

I arrived to work one night, and getting sign out from the day teams, was told about Person B.  I was told that Person B was already in the hospital, currently getting a liver transplant, and would probably go to the Surgical Intensive Care Unit post operatively.  In other words, good to know about Person B, but nothing really for me to specifically do in terms of his care.  Shortly thereafter sign out was interrupted by a text message from the transplant fellow.  Informing me of a new patient in the hospital, there for a liver transplant, could I do the History & Physical?  Very surprised that they would be doing two transplants the same night I responded, it would be no problem, would it be for that night or the next day.  His response, ‘tonight, 8pm.  Same liver. New recipient.’ Apparently while on the operating table, Person B had gone into Ventricular Tachycardia and then Atrial Fibrillation.  Case was cancelled.  Enter Person C. 

All the while the clock is ticking for the liver. Hence the need for urgency.  Person C was called up and told a liver was waiting, time was of the essence and get to the hospital 5 minutes ago. Time for my ‘appearance’ in the story.  The transplant fellow is entering orders into the computer.  Anesthesia is in the room interviewing the patient.  Nursing is in the room getting the patient ready according to the pre-op orders. And amidst all of that I sneak in, ask the appropriate questions etc, and sneak out again to enter my H&P into the computer.  And thus my ‘appearance’ ended. The liver was still waiting.

Person C is taken to the OR and the liver transplant commences.  At one point during the night a problem arises with another post-op transplant patient on the floor.  I attempt calling into the OR to talk with the transplant fellow and get turned away at the phone by the nurse saying very hushed that it just wasn’t a good time as hands were moving very rapidly.  Found out later that the patient’s portal vein had ruptured intra-op.  In the end however, Person C made it okay, liver securely transplanted, and transferred to the SICU post-operatively to recover.  And recover they do, both Person C and the liver recover from the transplant beautifully.

Don’t worry.  That isn’t the end of the story.  Not yet.  

I come into work the following night, to once again have sign out interrupted by this liver.  Person C had suddenly and dramatically died in the SICU.  Was doing absolutely beautifully, and after a simple, standard routine procedure started bleeding.  Within seconds heartrate had dropped, and within 2 minutes had flat lined.

And that’s it.  The end of the liver.  A crazy story of one liver and three people expanding no more than 48 hours total. Person B the only survivor….still waiting for a liver transplant.

I could go into much more detail about just what that simple standard routine procedure was and possible reasons behind Person C’s mystifying rapid demise.  But in the end, all would be, at best, nothing more than educated conclusions.

Much Love.

Estoy levantando cajas.

Not only was he still there when I got to the hospital that night, but he was there the following night as well.  How do I put this nicely?..... It is very unfortunate, the tremendous use of resources used by those noncompliant and yet unwilling to leave the hospital.  On more than one occasion I’ve seen a resident burst into our little conference room uttering some expression along the lines of “This is NOT a Hotel!” 

Remember that box analogy I used before?  I’m going to use it again.  The night started off with a box sitting waiting to be picked up. If it could talk, it was basically begging to be picked up.  However, interesting thing about this box was that it was already scheduled to be picked up in the morning.  And therefore during sign out I could tell that the primary team was trying to ignore it until the morning.  Easy for them to do…they weren’t there.  On the other hand, I was there, and it was impossible to ignore it.  It went from begging to demanding to be picked up.  So I assessed the box and called my senior.  He came but like the primary team, concluded that it’ll get picked up in the morning, no need to rush things.  I felt reassured.  However, as the night wore on the box kept getting angrier and angrier.  Eventually, to the point where I finally decided to myself that the box needed to be picked up NOW…not in the morning (which was only a few hours away at that point). I called up the chain again. 4^th year came, was unsure so called in the Chief.  Conclusion was still that it could wait until the appointed time of pick-up.  I was not reassured this time, but did feel better that even the Chief had at least assessed the box.  I wasn’t at the hospital when the box was finally picked up.  But I got the story when I came in the following night.  The bottom had basically fallen out, rotted through. It’s still a box now…but it’ll never again be the same. I guess it’s not one person’s fault, and the fact that I had called multiple times to have it picked up throughout the night in a way protects me.  If I’m honest with myself though I may have a bit of a chip on my shoulder against that primary care team now.  That they had seen the box, acknowledged the box and then tried to ignore the box in the first place.  Chip won’t stay for long, but for the moment it’s there.

Much Love.

Estoy leyendo.

When a friend visits, you don't question the possibility of seeing them. You just know you'll make it happen...somehow.  Even if that means sleep gets sacrificed. Some people are worth it.  Amber M. and Donna F. were visiting in Rockville last weekend. Left after I got off work Saturday morning and didn't leave to return until after church on Sunday just in time that I could get back to work on time.

 Amber and I

I've been making more of an active effort to get through my To Do List for the month of October.  I have this list specifically for this month because as I am working nights I have days that I could potentially use.  Went to the dentist yesterday.  I didn't think there was a problem, but at the same time, it's been many years since I've last had a dentist look at my teeth.  I just wanted to be reassured I guess.  Found my way into the Bronx to this little hole in the wall dentist office.  It didn't take long.  And he didn't really tell me anything, probably wouldn't have said anything either had I not asked him questions.  Made me miss Dr. Proesel and the thorough job they do at the dentist office in Gridley.  But at least now I've been reassured.  Good to go for another couple of years now! ;)

For the past couple of weeks there has been a liver transplant recipient in the hospital. For a while he was in the ICU, everyone thought he was going to die.  But then he was transferred to the floor. And yesterday he was told he's finally ready for recovery outside of the hospital.  He was to be discharged today.  Unfortunately, this patient does not want to be discharged. And last night he took a great big yank on his nephrostomy tube.  A tube placed percutaneously into his kidney to drain his urine. As his usual, this guy walks around with his nephrostomy bag trailing behind him anyways, but now with it halfway yanked out he was draining all over instead of just into his bag.  I patched it up best I could to get him through the rest of the night.  I'm interested to find out if he was actually discharged today as planned or if his nephrostomy is going to delay that. 

Much Love.

Estoy avanzando en el agua.

Sufficiently transitioned to the schedule of night float.  Never had trouble sleeping during the day this time, but staying awake through the night proved difficult at first.  Now I can say we are good to go for the rest of the month.

The least fun part of night float I've encountered so far are direct admits to the floor that no one knows anything about.  If I'm lucky I get a call from the nurse manager to let me know Mr. So-and-So will be arriving soon.  So I have at least some time to try and figure out who Mr. So-and-So is, why he's coming, and what I'm supposed to do with him when he does arrive.  If I'm not so lucky I get a call from the nurse manager to let me know that Mr. So-and-So is here....already....in his bed.  Leaving me with no time to figure out the who, why, and what.  I was unaware that clairvoyance was a necessity in this job. And it makes me wonder if such horrible lack of communication exists across the board....or if we are just extra special at WMC.

The most frustrating part of night float I've encountered so far is the expectation that I handle everything on the floors overnight, and yet without the independence to do just that. To put it in a picture.  It's like someone telling you to go pick up boxes, but oh wait, they first tie your hands behind your back. So really what they're saying is 'when you see a box, call someone to come pick it up.' Trouble I've encountered with this method of picking up boxes, is that No. One. Comes. Seriously, I had a patient who had a heart attack, the most I immediately could do on my own was order the labs and studies proving that he was in fact having a heart attack and then call Cardiology.  But actual treatment.....it took 6 hours before I could get my seniors to get back to me with the okay to order it. In the meantime, I had sufficiently lost my patience and gone ahead and ordered it at one point....which my senior than made me cancel.....so that he could then tell me to reorder it hours later when he finally conceded that yes, perhaps we should treat. Worse part about this 6 hour delay. None of my seniors actually physically came to the floor to see the patient. 

Overall, night float is not bad.  I'm learning how to deal with a lot of stuff.  Kind of like learning how to swim by throwing you in the water without the floaties.  Your head goes under a couple of times. Swallow a mouthful of water. And come up each time coughing and sputtering. Not the nicest way to learn, but perhaps the fastest way.

Much Love.

Estoy seguir siguiendo.

The sun was beautiful in New England this past Sunday morning.  God had really outdone himself.  The combination of feeling fresh and rested, smelling breakfast and that view was enough to make me forget all worries.  And for a moment, remember what it was like to not have a care in the world. 

It’s rejuvenating to be reminded that I am cared for in such an unearned simple manner, by the Creator of the universe.  And that He will have work for me to do no matter where I am.  There will always be people.  Those people for the time being happen to be the community that lives and works WMC.  Will it be the same a year from now?   I give a shrug, because for the time being I get to work one more day.  And I’m right where I’m supposed to be, for such a time as this.  

I realize I’m making myself sound very nonchalant about where God will be taking me next.  And I think I’ll leave it as such.  It’s how I’d like to think of myself; the picture I’d like to paint of myself. When in reality, I don’t think nonchalant is included in my genome. 

I believe that if you give God limits, whether consciously or subconsciously, that He will respect those limits.  Until you’re ready to take those limits away he’ll use you within the bounds.  But that’s just the problem, within the bounds, always in the comfort zone. 

…..I can feel myself wanting to pull out a soapbox and start droning on and on, so I’ll stop.  …pause… And now I feel like I haven’t really said anything despite letters being strung together in grammatically accepted patterns.  

Hmmmm, a moment.  That was my original point. Always wonderful to have those God-blessed moments that remind us anew of what is true, honest, just, pure, lovely and of good report. 

Much Love.

Estoy aqui en medio.

Another month.

Spent a lot of time on the phone tonight signing out all of our trauma patients to the two interns who will be taking up the trauma mantel. We are handing them a list roughly half the length of the list we received a month ago. Is it okay to feel some pride about that?  I know....probably not.

My conclusion about trauma: No. Not for me.
Granted this is an initial conclusion and subject to change as I gain more experience.
But....I was not the kind of doctor that I want to be this past month.
I'll go even further, I am ashamed of the kind of doctor I was this past month.

I could pass an entire day without seeing a patient.  The patient still got cared for.  The work was done.  If they needed studies, ordered and sent.  If they needed consults, called and seen. Plan clarified and seen through.  But, all without myself physically laying eyes on the patient. This wasn't a common happening, but....it wasn't rare either.

I rarely said goodbye.  Once I clicked that 'discharge' button....I immediately took out my paper list and wrote 'bedcheck' next to that patient's name. And in my mind I had already moved on to the pressing needs of those still 'admitted.'  Before I knew it, time had passed and they were long gone.  No goodbye.
Towards the end of the month there were a two goodbyes I made. Both had been patients since before my time. Really bad trauma cases.  Many many surgeries required for each. And despite the fact that both were young individuals with a long road of recovery in front of them...both were cheerful, pleasant individuals.
I got to spend some time one afternoon taking a bunch of complicated sutures out of her abdomen. She had been going to school to be a cop.  But not anymore.  Now.  Now she wants to be a surgeon.
And him.  His insurance kept denying his placement.  Let me tell you, talking with insurance companies is the absolute pits.  I'd so much rather deal with the government than with insurance companies.  But we got it eventually. And....he didn't look happy.  Truth be told, he was nervous. I told him he would be fine.  And he will, he'll be just fine.  I told him, I'd love to be there when he walks again.  He choked up.  "Seems like that would be a miracle," he said.  I said, "I believe in miracles."

I do kind of regret, that I don't take the time to tell stories more often.  You get some of the craziest stuff on trauma. And there's no way I'll be able to remember it all. But I'll be back for more soon enough.

I'm on Night Float for the month of October.  The night float intern takes signout from all of the surgery teams on the floor.  There's three floor teams. So one person carries three lists of patients through the night......and tries to not let any of them die, until morning when he/she can sign them back out again to their respective primary teams. Things I'm looking forward to about Night Float.  No daily progress note writing!  And no discharges, meaning no discharge dictations to do!  Except for the random crazy patient who decides to leave AMA at 2am I suppose. ;)

Trying to stay up late tonight....so I can sleep late tomorrow....so I can stay up all night tomorrow night!

Much Love.

Estoy trabajando.

JR is one of the patients on the trauma service.  JR is at school at West Point, but family is from South Carolina.  As per family request we've been trying to get JR transferred to North Carolina for proximity to family.  The social worker, Joseph, and I have been tag teaming this transfer.  Myself in communication with Carolina, and him in communication with West Point.  For about two weeks we'd been going back and forth.  Honestly, mainly with West Point. Each day he'd hand me another stack of papers the government wanted me to fill out.  But we kept at it. Today, we were on the edge of breaking through. Close enough that Joseph prepared me on how to proceed if I got a phone call over the weekend.   I didn't have to wait too long.  I could tell he was working on the situation from his home all evening.  I got a phone call from him 7:30....there was a problem.   Then another at 9:30....problem has been resolved, aaaand transport was arranged for Saturday evening!  Ball was now in my court. A couple of calls to the transfer center in Carolina later, the receiving team had a medical update and bed request was submitted. After two weeks of this, I was excited!  We had a bed AND transport to that bed arranged for this patient.  I wanted a pat on the back, a high five or something.  I texted out to the team we had an official discharge plan for the patient. Let's just say I got somewhat less than the 'Woohoo' I was looking for. But granted, they probably weren't too thrilled to have been reminded about work at 10pm on a Friday night. ;)

Much Love.