Estoy de mal humor.

I'm in a rather grumpy mood. I'd like to blame it on the fact that I get to start my vacation this coming Saturday. The closer it is, the harder it is to be content with caring that so-and-so's blood pressure is 164.

With each new consult I tell myself, just a few more days.  Just a few more days and then no one will call me.  I won't carry a pager.  I won't carry a badge. No one will ask anything of me. I won't be expected to perform. I won't be required to fulfill duties.

A short respite during which I can study uninterrupted. It'll be a welcome break. I don't get to travel this year as I did last time, but for good reason.  As I just mentioned I plan on studying this break, preparing for the in-service examination at the end of January.

In the meantime... just three more nights.  Come on Christy!  We got this!  We're good! Yes bring on yet another silly, half-prepared consult that won't end up going to the OR anyways! We would love to drop everything we are doing to address your concern. We can handle it! We can handle anything!

Much Love.

Estoy corriendo escaleras.

I get to finish out 2015 on nights at St. Vincent's. Of course my Attendings have completely booked the ORs with the biggest bestest cases this week. Every night I start thinking maybe I'll stay and do a case or two post call. Then every morning comes and all I want to do is sleep.  Must. take. more. caffeine.

Last night at 10pm I get a page from medicine.  Poor timing on their part is beside the point. Some guy had been trying to shoot himself up, missed the vein and instead now has a golf ball size abscess in his arm. I called my senior so I could verbally trouble-shoot possible complications considering its proximity to the cephalic vein. Such as, what if this lump was not an abscess but a pseudoaneurysm, or the best move to get control should I hit the cephalic.

After gathering supplies in the ED, my senior thought it a great idea to then run up the stairs to the 10th floor. Brilliant. Not so brilliant. In my out-of-shape state my heart was pounding so hard my hands shook. I then had to take up a scalpel and stab a guys arm. :/ 

Thankfully, while I stabbed, my senior gave the patient a lecture on how dangerous IV drug abuse is, and how lucky he is this infection didn't go straight to his heart.  In the end, the pus came out while the blood stayed in... well, most of it at least. ;)

Don't Do Drugs Kids!

Much Love.

Estoy una nube.

On those particularly crazy busy days.  Those days when the traumas don't seem to stop.  We look for a reason why. Why does it never stop? And usually we settle on the ominous "black cloud." The said "cloud" being a specific resident or Attending who when they take call coincides with these difficult days/nights.

I say "coincides" as if it happens by chance.  But it's legitimate enough that I inwardly grown when I see certain names on call, because I know to expect a super busy shift. 

At Westchester the trauma team actually made it official this year. They got a black cloud pin and at the end of each month they tally traumas for each Attending and award the black cloud to whomever saw the most trauma that month.

Today though we gave the black cloud a break and blamed the Winter Solstice instead. The earth rotated with too dramatic of a jolt.  All those unsteady of cane and wobbly of knee hit the ground hard.

Much Love.

Estoy necesitando más que palabras.

Much Love.

Estoy almorzando.

Something that has become important to me this year of residency is Team Lunch.  I can't recall any team lunches my entire intern year. Not sure why.  Food is good.  We should eat food.

Granted lunch doesn't happen everyday let alone team lunch, but when it does it's a wonderful thing. The months when Adi and I were on the same team, Adi really made an effort to make sure we got lunch as often as possible.  We eventually had put together a group text and started announcing team lunch to all the teams, and we'd get a few each time come and join us.

One thing I've noticed about Team Lunch. (other than food is good.) You're sitting around a table, eating, talking and laughing. By the end of the month the team has become a family. In my experience it only takes a couple. So out of a whole month, manage to grab a Team Lunch two to three or four times and it'll strengthen the team as well as your bodies. Like I said, food is good!

This month at Bridgeport one of our interns is an orthopod rotator. Really nice guy, good worker no one has any complaints. But he always made as quick an exit as possible. Nothing wrong with that. Then today we made some major progress!! At the end of the day when the night resident arrives it's always a question of timing between food (do people have time to get food before the cafeteria closes?) and running the list. This evening I made the decision to run the list first so we could hand off the pager to the night resident and then before any more consults came in go grab food as a team. I knew that by running the list first I was running the risk that our ortho friend would take off on us, but he didn't! He even commented on it himself saying, "I'm still here! Progress!"

Progress, indeed.  I tell you my friends. You need a team building exercise?  Team Lunch is a beautiful thing.

Much Love.

Estoy aprendiendo.

The role of the resident and the role of the Attending varies from surgery to surgery and is typically dictated by the familiarity of the Attending with any particular resident. In other words, the more you scrub with an Attending, the more comfortable that Attending gets with you and the more he/she will allow you to do in surgery. Or so it typically goes.

Usually the last and final element of a particular surgery relinquished by an Attending into the hands of a resident is the most high-risk part. For example, in the case of a cholecystectomy (removal of a gallbladder) this would be isolating and ligating the Cystic Duct and Cystic Artery. I finally got to do this myself just this past Friday. Afterwards, my attending said that my every move had given him a heart attack.  He was being facetious... I think.  I hope. 

I can understand why an Attending doesn't just hand over the knife to any resident, but at the same time... they should. I'm halfway through my second year of residency and have finally done my first gall bladder from start to finish. That's too late in my opinion. But finding that Attending who will relinquish control and at the same time have the patience to let us learn... a more rare finding unfortunately. 

I'm back in Bridgeport for the month of December.  In months past, I've rented a room across from the hospital for my rotations here.  This December I get to stay with Jenna Wiegand. Jenna moved to the East Coast this past summer from Oregon to work for a company based out of CT and lives 10 miles from the hospital.

 

I have never before appreciated large blow up Christmas yard decorations. But for some reason on a corner balcony... it's perfect!

 Taking a walk with Jenna. Crossing the Housatonic River.

  

Just to give you a visual image of the kind of chica I'm staying with this month...

 

 

She puts together amazing things like this.

A Hot Chocolate Bar and cozy night for the single sisters of the Rockville church. 

 

 

 Attempting to spread some Christmas cheer at work! ;)

Much Love.

Estoy bendecida.

What makes a life worth living?
A beating heart and breathing lungs?
A mind that creates?
Human interaction?
Fulfilling a purpose and hope?

Most would probably argue all of the above, with variability in percentages from person to person.

When the whole universe is dark, and silent, filled with pain, and without time. What makes a life worth living?
 I watched him as he struggled to breathe. Without an audible sound his face contorted revealing his distress. He managed a cough, spattering the back of his face mask with blood. I took my knuckles and rubbed against his sternum. There was no arousal from the all encompassing cloud of heaviness and struggle that is his world. I didn't merit acknowledgement from him so let him be. I increased the flow of oxygen being delivered via his face mask; in no way actually helping him, just merely placing a band-aide for the time being. I looked one last time at the boy's small crooked body and longed to see the day Jesus takes him in his arms.

I hadn't understood why? But as I walked away, my heart heavy; I was blessed to be able to witness this boy's bravery and patience in the face of nigh insurmountable handicap and disability. I wasn't the only one who longed to see him in Jesus's arms. The Son of God himself is anxiously awaiting the day as well. And he will see. And he will hear. And he will stand and walk and run. And he will be without pain. And he will smile. And he will be blessed as I have been blessed by him.

Much Love.

Estoy contando los minutos.

The night is drawing to a close and not a single trauma has rolled through those automatic sliding doors with EMERGENCY in red letters written above it. Will the calm last? Only the next 76 minutes will tell.

Very odd for a Friday night/early Saturday morning, but welcome nonetheless. Almost as if karma was making up for last night when I arrived to work to find all three trauma bays freshly filled. Two more traumas rolling in within the hour and the trauma pager signaling two more to soon follow. It had decided to rain yesterday and apparently the people of New York had missed the memo.

The month of nights is moving along. Three weeks down, one and fraction to go. It’s been educational so far. I’ve gotten to put a few tubes in chests and a few catheters in central veins. Need a couple more yet to get the process down pat and be comfortable to do it on my own. But getting past the first couple is the biggest step. Even had the opportunity to put in a chest tube while the patient was being coded. Having someone pumping up and down in an effort to push blood from a patient’s heart throughout it’s body creates a moving target for your tube. I’ll be honest… I didn’t exactly hit the bull’s eye on that, but I’m thankful I at least took the shot. Next time, it’ll be the bull’s eye.

Will plan on heading up to CT once I get off work. It’s a nice thing about being night float; being able to make it to church every weekend. Makes for a rough Sunday night at work, but all in all one can really tell a positive difference.

Much Love.

Estoy viendo por siempre.

World One

 

Last Saturday I met Ben and Ashley Wagenbach in the city. We went up World One and then visited the 9-11 Museum. It was Ashley's idea to go up World One, and I'm glad she suggested it. On a clear day the horizon extends for 45 miles. Wasn't quite "clear" last Saturday, but it was still an impressive view, just a gray one.

 

I hope to return in 50 years, on the 50th Anniversary of the World One Observatory. I want to come back to see what has changed. The price of a ticket compared to 50 years ago. Maybe the whole thing will be digitalized and there will be booths that you can click on a picture and you'll "fly" out from the Observatory and "hoover" over what you wanted to see closer.  Or maybe we'll all have flying vehicles by that time rendering a World One Observatory useless, and it'll be shut down before it even gets to it's 50th birthday. Either way... I wonder what will happen to those wine bottles.

The only picture I got of Ben and Ashley! :/

Looking down on the 9-11 Memorial

Even the Empire State Building looks small from here.

Brooklyn, Manhattan and Williamsburg Bridges over the East River

Slurry Wall. 9-11 Museum.

 

Twisted metal. 9-11 Museum. 

Look for the Silver Lining.

Much Love.

From The Eyes Of An MS3.

The following have been written by and then posted with the permission of the three 3rd year medical students currently completing their week rotation of nights with us.  They were asked to reflect and relate in as few or as many words as needed about their perspective surrounding the critical level 1 trauma we had a few nights ago.
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My name is Lydia Bunker and I'm a third year medical student at NYMC. I'm from the suburbs of Boston and I've always wanted to be a doctor.

Last night, my fellow classmates and I were working with the on-call trauma team when we got the page for a Level 1 motor vehicle accident. Within minutes the ambulance pulled up, the ER doors opened, and the prior calm of the trauma bay was shattered. The tall bulky young man on the stretcher looked to be beyond humanly help, but nevertheless two dozen people sprung into action around him, each with a look of extreme focus and determination to perform his or her role perfectly. Suddenly he regained a pulse and our interventions seemed less futile. There was a chance he could live, and that possibility lifted the feeling of dread I realized had enveloped me.

I wanted so badly to help with the resuscitation, but was afraid of getting in the way of the expert staff who were doing the real work of saving this young man's life. So I hovered on the margins of the crowded room, ready to jump at the first call for assistance. Anything - from doing chest compressions to simply offering a timely piece of tape. What struck me most was the thought of how we must have looked from above. Dizzying motion and cacophonous noise.

Miraculously, the patient stabilized, unknowingly advancing himself to the next step in the algorithm of trauma care. Almost as if forgetting that this young man had been essentially deceased an hour earlier, preparations started being made for the trip up to Interventional Radiology. We left the trauma bay strewn with empty plastic packets and stained gowns. The litterbug police in me thought absentmidedly about picking up a discarded syringe cap on the way out. Such an absurd thought when a life was on the line.

Over the next few hours, the resident and I occasionally left our trauma patient to attend to consultations elsewhere in the hospital. It was hard not to compare cases. A little kid with a bellyache seemed of such minor importance. Yet to him and his father, there was nothing more important that knowing whether he could go home or not. The teenager in critical condition upstairs meant nothing to them. It struck me that in medicine, you really can't think in "relatives". Each person's problem is uniquely important to them and we as physicians are challenged to adjust our delivery of care accordingly.

Later, back upstairs, we huddled around glowing screens in the CT control room, waiting for the next layer of digital information and keeping vigil for our patient. I watched the tired eyes of the attending surgeon as he scrolled through the images, up and down, up and down. I could see him envisioning the upcoming surgery, choreographing a plan of action, weighing benefits and risks.

The students were dismissed before our patient went into surgery, leaving the attending and residents to complete the work they have been primed to do. I drove home as the sun rose, wondering how they had the mental and physical strength to carry on through exhaustion. I hope that someday I'll have the knowledge and stamina to do the same, to stop at nothing for my patients. That's why we work so hard in medical school, why we spend long hours in the hospital, why we practice our skills at every opportunity- so that when the time comes, we will be ready.

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My name is Andrea, I am a medical student and this is my first surgery rotation ever. I have dreamt of being a surgeon for a very long time. The adrenaline of the job and the direct impact on patients are two of the reasons I am so attracted to this specialty. Funny enough both of these qualities came into play last night. Last night we attended to a level 1 trauma which is the most serious type of injury that requires immediate medical attention. Our patient came in unconscious and in cardiac arrest. All of a sudden the adrenaline rush that I had been so excited to feel turned into a feeling of nervousness when I quickly realized every move we made could be the patient's last chance to live. The patient's condition waxed and waned throughout the night and as each hour passed the trauma team worked harder and harder to keep him alive. This experience made me realize the immense impact that the medical team has on these emergency situations. I specially realized that the role of the surgeon is not only to cut, but their role is have the knowledge and experience to attend any situation. The most important lesson that I have taken away from last night and from my experience with the trauma team is that the adrenaline and spontaneity of the job do not compare to the satisfaction of being prepared with the knowledge and compassion to take on any situation and go home each day feeling that you did everything in your power to help someone's loved one.

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My name is Nathan Carberry. I am a third year medical student on my second week of my surgical rotation. I came to medical school because I wanted to be a source of healing for people in their most desperate of circumstances. In the years of training and dozens of exams that it takes to finally reach a position of utility in the medical world, I often find myself distanced from this primary directive. However, I feel closer after last night. I found myself as a member of a team for a level one trauma that received a young man who was facing darkness – no breaths, no heartbeats, no thoughts. The setting was deadly serious and the staff as solemn as a funeral, and I was in a terrifying position to help as the patient received compressions, chest tubes, and central lines. I watched as the man regained his own electrical rhythm and soon after vitality to his face. By the end of the long night, the young man had his life again and the parents their son. Very generously, the trauma team also gave me back my direction.
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Much Love.

Estoy tratando con la pérdida.

Moving into November means moving onto the next rotation. Had a nice call today to finish out my month on Vascular.  I switch to Night Float for November and therefore know that I should stay up super late tonight and then sleep to 4pm tomorrow.  But I so want to just go to sleep... and then still sleep till 4pm tomorrow!!

Together with our Vascular Chief for this past month. Half way through the month the three of us were given an extra task.  The task to train one of our colleagues returning from medical leave. With one intern out on medical leave and one second year out on paternity leave the entire gen surg residency had been stretched even thinner than usual. So of the usual teams the three of us were deemed the strongest option to be able to handle the undertaking of this task. It's the end of the month now, did we succeed? did we fail? only time will tell.  But we surely did try!

   This is Aditya (Adi). He has been my intern these past two months (ACS for September and Vascular for October). Last year I was his intern. We joke that should I become an intern again next year, then the two of us will never actually finish residency. We'll just keep taking turns being each other's senior.  But really, you see your team members for 14-16 hours a day... every day, all day! It's a huge blessing to enjoy your team members. By the end of two months working with Adi we'd made so many inside jokes we could laugh at just about anything. Yet be serious too when needed.  And there were more than a few times over the past two months when, as Adi puts it, our patients were "discharged to Heaven." 

In honor of my treasures.

 

Much Love.

Estoy sin disfraz.

I had the opportunity to go for procurement of organs last night. Donor patient was a dcd donor; much more rare than the typical brain dead donor. (dcd = donation after cardiac death)
Really great educational experience for myself came more from the surrounding conditions involved in handling a dcd donor rather than the actual anatomy in harvesting organs.
Us, the surgeons, were not permitted to even see family members let alone be in the same room as them. All things considered, with respect, it's better that way. Once the donor is taken off life support every second is counted.  Certain organs can only handle a certain amount of ischemic time. In this particular case we were going to be procuring the kidneys, which in New York, legally permits up to 60 minutes of warm ischemic time. The Attending I was with didn't think we'd be able to get the kidneys. But the donor went into asystole at around 45 min after withdrawal of care and 5 minutes later to the exact second skin was opened. Kidneys were out, skin was closed, and we were on our way home again about 60 minutes later.

Once I finally made it back to the hospital I grabbed my bag, excitedly told my colleagues in the trauma bay about the experience then headed over to a friends house for some pumpkin cake before heading home!

I only stayed for an hour (a.k.a. only paid for an hour of parking). Then complimented Dzeba once more on her cake/thanked her and headed home.

On the way home at 1am, to my own chagrin, I found myself in line for a spot police check. My story of 'got off work then went to a friend's house' didn't sound good. My red eyes and tired smile didn't look good. And I knew that if asked...I'd have trouble walking in a straight line, also not good. But I just honestly told the officer I hadn't had any alcohol and he waved me along.

There's something that I've been puzzling over the past couple weeks. What makes someone want to be a police officer?  Not really sure why I first started pondering the subject, but not having any officer friends myself I've no source of an answer, and therefore have continued to ponder. And last night just made me wonder all the more.

God makes all kinds!

Much Love.

Estoy festejando tres décadas.

Google wished me a Happy Birthday today.

 Turned 30 today. Completed 30 years of living. Pretty cool stuff.

I told a co-resident that yesterday to which she responded, "Thirty?! What?!, No way! You still look like you could be a star in High School Musical!!"  

Well, should I stand next to a high schooler it is easy to see how wrong that is, but the idea behind her comment was appreciated! ;)

Either way, whether I look it or not, I don't feel like I'm 30.  Although I've never chronologically been 30 before so I suppose this could be exactly what 30 is supposed to feel like.

I feel like time passes too quickly. I'm starting to feel like I'm running out of time, and there's still so much work to do. So I don't often allow myself to look beyond tomorrow.  Once in awhile a week or so, but only for special reasons (like trying to figure out when I'll next be able to go to church!).

I feel like I am incredibly rich in relationships. I think of the friends God has blessed me with over the years and I swell with pride. I think of those that have come into my life from all over this wonderful world even for a short time and I'm so thankful for each one.

 

I feel like this world, although it continues to Amaze me, has ceased to Surprise me. The horrors. The disgusting. The evil. The miraculous. The beautiful. and the good. It's amazing how they all exist and thrive among humanity all individually and yet sometimes all together.

 

I feel like one day it will all make perfect sense. When I see Jesus. And until that time as long as he's with me, then that's sense enough for me.  

 I feel like I'm tired. 

 

But join me yet in dancing to my birthday song!

Much Love.

(all photos taken today. October 16, 2015)

Estoy disfrutando este día de otoño.

 I let myself sleep until I woke up on my own. My covers weren't even wrinkled when I finally stirred from beneath to make myself some coffee. Looking in the mirror I could see the left side of my face was smashed. Even my eyelid was indented from lying in one place for so long. Coffee made, I grabbed the cup and took it back to bed with me. I propped myself up half under the covers and slowly enjoyed my coffee while reading in bed. It's the best part of a day off. Waking up without an alarm and then reading in bed with coffee.

I went for a run today. Hadn't done so in over a month, and within a quarter mile could feel the muscles of my legs switching form aerobic metabolism into anaerobic metabolism. But I kept going; it was my day off and therefore could pace myself as slow as needed. Ground was still wet from the rain yesterday so was going to bypass the park, but at the last second turned into the trail anyways.  It was worth it. The October sun. The clear air. The colored leaves starting to dot the trail and intermingle with the green of the trees. Even the mud was just the right amount!

I went on some errands to keep myself outside.  The majority I didn't necessarily need to actually complete, but I was just looking for excuses to stay outside as long as possible. I thought about buying a pumpkin, but realistically knew that it would stay sitting by my door probably until covered by snow and I'd forget it was there. Revealed anew in the spring after the snow melts away I'd finally dispose of it my head hung in shame at how poorly I take care of my decorations. So to save myself the inevitable shame I passed the pumpkins resisting the urge.

It's hard to explain the renewal one feels from having a day like today. A moment to sleep. A moment to relax and just be thankful. Thankful for today if nothing else.

I pray God has blessed your Fall day as beautifully as he blessed mine.

Much Love.

Estoy llevando dos localizadores.

I have often run into the general assumption that the use of pagers, or beepers, is antiquated, out-of-date and no longer used. Unfortunately they are still very much used in the hospital setting. We, general surgery residents, at WMC each carries his/her own beeper. There are then trauma beepers for those designated as trauma responders for the shift. And then there is one more.

There is the 0298.

Designated as the consult/critical value pager, it ends up being the catch-all of surgery pager. The 0298 is it's own rotation. A single resident is assigned this pager for the month rotation. And that's all they do, carry the 0298. No OR time for the duration of the rotation, as you have to be able to respond to pages as immediately as possible. I held the 0298 for the 1st time October 1. The consult resident for the month was post-call that day, so couldn't stay and therefore on my first day back on Vascular I was also honorary consult resident. I got a couple of comments about how I was "growing up" carrying it for my first time. As if its some sort of right-of-passage for a junior resident. In a way, it does carry a huge responsibility. Whoever carries the 0298 is in constant contact with the rest of the hospital. While everyone else is in the OR, he/she is out and talking with other services, answering questions, and putting out fires (not in a literal sense). It also carries with it the general understanding that whichever resident is carrying it will be able to discern between emergent and non-emergent and respond appropriately.

It is the month during which a resident carries the 0298 that is notorious for turning a gentle, kind and smiling soul into something close to resembling The Hulk! I won't go into details as to how and why, but it has a lot to do with 1) politics and 2) the general culture existing among all levels of staff/faculty at WMC that says 'well...that's not my job!'

I survived the day with only some difficulty, most of which was from the fact that I was trying to be both a vascular resident as well as the consult resident. Finished my last note before the clock struck 9pm and clicked save with a happy yessssssssssss (which rhymes with successsssssssssss) making the med student studying next to me laugh.

Much Love.

Estoy orando.

I had a plan this morning.  Why did I have a plan?  I really can't remember why I had thought that would be a good idea. Cannot honestly provide a reason for making a plan for my day other than momentary lapse in judgement.  As I'm sure you've assumed, the day turned out nothing like the aforementioned "plan." The fact that I'm writing on 10/1/15 is the perfect ending to such a day, as I had wanted to be writing on 9/30/15.

It just wasn't a good day... I mean it was a fine day. I was in the OR all day. But my chief was post-call and my intern (Adi) had to cover my other case as I was in an emergency case and therefore our team had no one on the floor. And it was our last day on service. So both Adi and I get out of the OR late, and back on the floor again even later and try to wade through the mess that had accumulated throughout the day in our absence. Takes extra time to get the service tee'd up to be handed off to the incoming team.  And then even extra time to receive sign out of our new service.  Both Adi and I are going to Vascular for the month of October. We had a quick Vascular team meeting in the trauma bay before finally heading home for the night. Hearing from our new chief and her expectations for the month. I was "punished" three times already and the month technically hasn't even started yet.

Much Love,

Estoy furiosa.

I had needed to vent. Needed to ever since seeing my very first patient early this morning. It upset me, can not explain just how much it upset me. However, I couldn't wait until arriving home this evening, it steamed out of me at the slightest of invitation that someone would join me in my outflow of words.  And now, I don't need to vent any longer. 

But I am still distressed. I am saddened and distressed.

As the 2nd year resident on the team my job in the morning is to round on the "outlyers" Meaning I must run around from ICU to ICU and between all the floors seeing all patient's not on our surgical floor.  Once done I then join the rest of my team on the surgical floor with the goal that I have done so prior to them finishing their own rounds and then we run the complete list of patients together.

My first stop, the MICU (Medical Intensive Care Unit). Last week we had emptied a patient's belly of over 5L of bloody ascites and old blood clot. Since then we've been waiting for a liver to come available for transplant. The patient was very sick, hence why a critical level of care was required. As per ritual I check the morning labs prior to rounding and and noticed this patient's to be completely out of whack, which was kind of normal as per the patient, but these were a little more out of whack than usual.

Let me set the scene for you that I found this morning. The MICU was quiet, lights dimmed. My patient's nurse was sitting calmly outside the room on her computer. The medicine residents sitting over by their own computers. No alarms sounding at all. I start conversation with the nurse to find out about the night's events. She informs me that the patient is probably going to be taken off the transplant list.  Surprised I ask why, to which she shrugs and says the patient isn't doing well. I whirl around and enter the room to try and figure out what's going on.


- Patient's vital signs were in the tank, covered-with-mud bottom of the tank. The last blood pressure showing on the monitor was 47/14, taken by a cuff set on cycle every 15 minutes, so who knows when that blood pressure was.  I clicked for a STAT measurement and it came up ??/??. I feel for a pulse at the neck, nothing. I move to the groin and find a thin, but strong pulse. Reassured that the patient wasn't already dead, I moved on.
 - What was being done for the patient's nonexistent blood pressure? One measly liter of fluid was being bolused via a TLC.  And not one, not two but three pressors were flowing in at max rates.
- By this time one of the residents had wandered over to observe what I was making a big deal about. I ask him about why an arterial line wasn't in this patient. Anyone on one pressor should have an arterial line, let alone three. In addition, the cuff BP had ceased to be reliable. To what end are you attempting resuscitation if you don't have a mean arterial pressure?!?!?!?! I asked in a quick pondering way in hopes the resident would take a hint and not offense at the suggestion. 
- And as for "attempting resuscitation", one liter was going to do as much for this patient as a drop would make a difference in the ocean. Blood was needed. I also hinted at massive transfusion protocol, in a way hoping to light some sort of urgency in this resident, a spark, a flicker, really just any kind of reaction out of him. He responded, that they were waiting for repeat labs to be sent and resulted!?!?!? (haha, oh ok I see, you're waiting for labs.  and in the meantime, THE PATIENT DIES!!!!!!!!!!!!!!!!!!!!!!!!)
- Thankfully a fellow had shown up at that time who seconded my opinion. He had come to scope that patient as admist all of this the patient had started bleeding from orifices. I was surprised that he was going to scope, and told him so.  At that time, without proper resuscitation, if scoped the patient was sure to Code.
- I turned to the resident again and reiterated the need for an arterial line. To which he muttered more under his breath than either to me or the fellow that was there, "why? the patient's been like this for the past 3 hours."  3 HOURS!!!!!!!!!!!

I am just a junior resident, and have just as much to learn as the next idiot out there, but even I could tell that this was wrong. This was so wrong. No matter what direction you looked at it. Wrong. I had to leave, I could not stand by and watch such poor mismanagement in action. The quick explanation above is only half of what I had encountered from the time I entered the MICU this morning to the time I left it again.

A couple of hour laters I come across my Attending who had been present at the time the fellow had attempted scoping the patient. The patient had indeed coded, for which no one in the MICU had responded. My attending was livid, even moreso than I had been. To the point he was threatening to have the MICU closed down!

I just don't understand. It is distressing me how I just don't understand how badly that situation had been allowed to become.  How anyone could have been sitting outside of a room when your responsibility is inside the room of an actively dying patient.

And one last question, where was the MICU Attending in all of this. Had it been TICU, and I the resident, I would have called for help immediately.

I am still so steaming mad that it makes me sad to the point of tears.  It makes my heart hurt.

Much Love.

Estoy una Mujer de Westchester

W.O.W.
Women of Westchester
Initiated by the female Chief Surgery Residents of 2014-2015.
First event of the 2015-2016 year was last night. We ate food, sat around and talked, took the opportunity to vent as needed. Even when the effects of the day's caffeine started to fade revealing the ever present lack of sleep, we stayed sitting there staring at each other through half-opened eyes determined to have just one more laugh before calling it a night.  And then one more. And one more.

And why are they all in sepia tone?... just felt like it when I went through editing.

 Dzeba and Monica

 Hanna, Alex, Heidi, Monica

 Hanna, Alex, Heidi, Monica

 Dzeba and Hanna

 Bravo, Dzeba, Hanna and Alex

 Hanna and Alex

 Monica, Dzeba, Hanna and her son, Tefari

 Bravo, Monica and Dzeba

 Terfari took this picture. Dzeba would never have looked that excited for me ;)

 I had told Tefari to go and hug his mommy. He happily obliged. :)

 Terfari and Alex having a stare-down.

 Hanna, Tefari, Alex, Heidi

 Hanna, Alex, Heidi

 Group picture with our W.O.W. shirts

 W.O.W

 Women of Westchester

 Monica, Hanna, Alex, Rachelle, Min Li

 Heidi, Monica, Hanna, Alex, Rachelle

Heidi, Monica, Hanna, Alex, Rachelle

Much Love.