Estoy trabajando tarde.

When it rains, it pours.

Today was a torrential downpour!

I ended up going to the OR until late today. I couldn't help it. There's so many cases to do! The Attending looks at me and asks, "Do you want to scrub in?" The YES!! was out of my lips before I could even realize what I was signing myself up for.

A huge benefit to the after hour cases are that you no longer have responsibilities on the floors at that point.  John W. had signed out our floor patients to the night intern.  So I could just turn the pager off and enjoy being in the OR.

The torrential downpour is to continue into tomorrow, mainly because half of our team will be gone tomorrow. I already know what is to happen.  Later to bed.  Even earlier to rise.  The edges around exhaustion a little bit more fuzzy than usual. 

And not a moment of regret.

Much Love.

Estoy contando el ritmo.

I've known since the time we did EKGs on ourselves in med school that I have sinus arrhythmia.

Sinus arrhythmia: an irregular cardiac rhythm in which the heart rate usually increases during inspiration and decreases during expiration.

If you count a heart rate to the millisecond you would notice the difference in rate with inspiration and expiration on everyone. There's nothing wrong with it. It's physiologic. My cardiovascular system is just on the lazier side of things and therefore it's a rather obvious arrhythmia instead of virtually imperceptible.  

The other day John W., myself and one of our med students had a few moments of down time.  We grabbed one of the portable doppler machines and started experimenting on ourselves. At a spot where you would feel for a pulse, when you use the doppler instead of a pulse you are determining what kind of signal you can pick up from the artery.  For example, the radial pulse.  Place the doppler and you should get a nice biphasic signal. While holding the doppler there simultaneously slowly apply pressure to the brachial artery. As blood flow is reduced through the radial artery the biphasic signal will turn to monophasic and then to nothing as eventually enough pressure is applied to cut off the flow.  It's all physics that I learned once upon a time, but could in no way actually explain now. 

John W., hypertensive thanks to his genealogy, had a nice crisp clear biphasic signal demanding to be heard.  When it was my turn, without applying any pressure to the brachial artery there was already a barely perceptible monophasic signal.  And with even light pressure applied to the brachial, distal flow was cut off and the soft signal disappeared. But then combine that with the sinus arrhythmia and it gave me a 'Jaws' feeling. A soft beat that doesn't come when it's supposed to, then races to catch up with two quick ones before it decides to pause too long again. 

Well... the first 50 seconds or so of 'Jaws.'


This is also why I dance when no one else can see me.  I can't actually dance.  I've got no rhythm! ;)

Much Love. 

Estoy matando arañas.

I was given today off from the hospital. President's Day, or something like that.  I didn't believe it when I saw it on the schedule.  I asked my chief over a week ago.  And then because I didn't believe his answer, I asked again at the end of last week.  And then because I still didn't believe him I asked again one last time yesterday when I was working. His answer never changed.  And therefore, out of the past 3 nights, I've gotten more than 5 hours sleep for two of them. I started dancing on my drive home from the hospital yesterday.  I've been dancing ever since. 

Don't get me wrong.  I love my job, but over the past three days I've actually been able to get some stuff done at home.  Stuff like...  A while ago I had quickly grabbed a shoe and smashed a spider on the wall, and there the poor thing stayed because I was on my way out the door or something like that.  I finally got to clean that spider off the wall.

I mean... wouldn't that make you feel accomplished as well?  You finally cleaned that spider off the wall!! Yes!! See... makes you want to dance as well eh? I told ya! ;)

Much Love.

My Valentine.

My Valentine keeps me feeling young. It's the way he wraps me in his arms and envelops me. Taking me up like I am oh so small and helpless, making me understand how desperately I'm in need of every ounce of His love.

My Valentine sings with me. He sings "I Won't Give Up" by Jason Mraz with me. He humors me time and time again, never telling me no when I ask if we can sing it again. We keep it semi-interesting by switching up who gets to sing which verses and when we join in together or simply take turns.  About a year and some ago we'd sing the song together almost every day, sometimes multiple times, and I'd cry every time.

 When I look into your eyes
It's like watching the night sky
Or a beautiful sunrise
Well, there's so much they hold
And just like them old stars
I see that you've come so far
To be right where you are
How old is your soul?

Well, I won't give up on us
Even if the skies get rough
I'm giving you all my love
I'm still looking up

And when you're needing your space
To do some navigating
I'll be here patiently waiting
To see what you find

'Cause even the stars they burn
Some even fall to the earth
We've got a lot to learn
God knows we're worth it
No, I won't give up

I don't wanna be someone who walks away so easily
I'm here to stay and make the difference that I can make
Our differences they do a lot to teach us how to use
The tools and gifts we got, yeah, we got a lot at stake
And in the end, you're still my friend at least we did intend
For us to work we didn't break, we didn't burn
We had to learn how to bend without the world caving in
I had to learn what I've got, and what I'm not, and who I am

I won't give up on us
Even if the skies get rough
I'm giving you all my love
I'm still looking up, I'm still looking up.

Well, I won't give up on us (no I'm not giving up)
God knows I'm tough enough (I am tough, I am loved)
We've got a lot to learn (we're alive, we are loved)
God knows we're worth it (and we're worth it)

I won't give up on us
Even if the skies get rough
I'm giving you all my love
I'm still looking up

My Valentine is my clarification. Life is hard. We work hard and love harder. And yet the world provides distractions galore, and with any glance to the side doubt resumes knocking at the door.  It can build to almost deafening if allowed to. And when my head starts to spin and I can no longer stand and am fully convinced that I don't know anything. I KNOW THAT I LOVE JESUS.


Much Love.

Estoy sintiendo el pulso.

There's a boy on our Vascular Surgery service currently. He hasn't been in the hospital the whole month so far, but... he's been there more often than not. The etiology of his disease presents quite the conundrum, specifically because no one is quite sure what exactly the etiology is. One can tell he's a good kid. Happy, making jokes, close with his parents.  And every time I walk out of his room, I'm thinking to myself, "He has no idea what this means for him." He's been told, but you can tell he doesn't understand. A lifetime of anticoagulation, and with that no sports. A string of never ending doctor's appointments, and future returns to the OR. He doesn't realize just how life altering this will be for him. And that makes me sad, because one day he will realize.  And I'm afraid with that realization he will no longer be happy.

Over the past two weeks, I've picked up on the fact that Vascular is a service that tends to hold onto its patients. The exact opposite of other services, for example trauma.  On the trauma service if a patient is on the floor, the biggest question is disposition. Where is the patient being discharged to? And, what needs to happen to make that discharge happen? It's also a service where the patient's never want to leave. Vascular on the other hand likes to sit on their patients. There are currently multiple patients that ask me every day if they can go home. I discuss their daily plan with them, to which they always respond, "okay, and then after that, then can I go home?" At which point I defer to future plan making based on the days events. If it were up to me I would set them up with the home services they yet needed and, yes, let them go. But it's not up to me, and unfortunately I don't see discharge anytime soon in their future.

Much Love.

Estoy roja.

My co-intern this month on Vascular is John W., one of the Neurosurgery interns who is rotating with us for a month. At first meeting he immediately comes off as a Nerd. But underneath the Nerd... the guy is really good at what he does! The medicine he Aces. And at first I was worried about his bedside manner, because at baseline he is abrupt with affect on the flatter side. But he does just fine with the patients and families as well. 

Our first day on Vascular was this past Monday. Myself, brand-new to the Vascular service, and Him, not only brand-new to Vascular but to General Surgery as well.  And on our first day on service, we were the entire service. Our chief was taking his ABSITE, and our other senior had worked the night before and so was post-call and off for the day. A few seniors from other services checked up on us throughout the day to make sure everything was okay.  And it was.  I wasn't worried. We rounded together in the morning to meet all of our patients and introduce ourselves. Then throughout the day we split. I took the cases and John W. handled the floors.

The cardiovascular system is one of my favorite systems of the human body. There are definite tedious parts to the surgeries, but the exciting parts are so satisfying. It is also very common for these surgeries to be on the "greater than" side of 4hours.  So they seemingly take a huge chunk out of the day for me, as we're still expected to manage everything on the floor patients.

As for the patients... if a patient is on the Vascular Surgery service... they are usually very sick. Horrible vasculature typically accompanies things like 'End Stage Renal Disease,' 'Congestive Heart Failure' 'Gangrene' 'Diabetes'.  In other words, they come in a carried bucket full of disease. Vascular surgery does its thing, and at best they walk out a bucket full of disease.

So far I'm liking Vascular. I'm also liking that I get to be on Vascular this month in particular. Red for St. Valentine's Day.  I like it!

Much Love.

Estoy lavando la ropa.

Test is over. No comment.

Moving on.

Another month of trauma is now over as well. Moving onto Vascular Surgery for the month of February. The past month started off manageable and then the first ice storm hit Westchester County and our list grew by 20 patients in approximately a 24 hour period of time. We spent the rest of the month recovering. There's so many stories to tell and no time to tell them. I want to tell you how this patient made me laugh.  And how this patient annoyed me so much. What happened during surgery with this patient. How I had an awful day.  How due to weather it seems I spend more nights sleeping at the hospital than at home. How a broken mug ment more than simply a piece of broken dish.

And now, post-ABSITE, I've claimed a chair against the wall of the laundromat and sit with my computer on my lap waiting for the dryer to stop spinning.  The white page opened and cursor blinking awaiting for all of the aforementioned stories.  But should I start, the impending snow would already be a foot deep before I finished. And I've got to get back to the hospital yet tonight before that happens so I can already be at work tomorrow and not die on my way trying to get there.

I've considered vlogging in the past. Many times actually. How easy it would be to just talk to a camera and then upload it. Soooo much faster. But who am I kidding, even if I did attempt to vlog I'd probably end up scripting the vlog before actually filming it, and in the process actually take twice as long instead of half as long. And therefore, I continue to blog and leave the camera on the shelf.

And so stories are left untold. Lost to mere memory.

This is my first time rotating on Vascular. I'm not quite sure what to expect.  If I'll like it or not? Time will tell. At least now I won't be trying to cram studying into my late evenings anymore. Therefore between looking forward to vacation, and planning for vacation I should have more time to write.  Perhaps.  We'll see what the month holds for us.

Much Love.