Estoy saliendo para vacaciones.

It's well after midnight.  I should have been asleep long ago. Time to leave will be here in a few short hours. I left the hospital today and bid adieu to its fading sight in the rearview mirror. I'll be saying 'hello' again soon, but before that happens...  there's places to go and faces to see!!  We'll start off by heading West.

I was not scheduled to work on the 31st (today) and therefore I took the liberty to schedule it as part of vacation.  Unfortunately, the past three days at work I've been by myself. Everyone is sick. Saturday and Sunday the other resident scheduled at least texted to let me know she wouldn't be able to come in.  So after being alone for the weekend I was looking forward to having another resident.  Three others were supposed to come in.  None of them showed up.  And this time, no one even texted to let us know. They just didn't come.  That was the part that annoyed me. I can cover for you. I'll do the work no problem.  Just let me know. Showing up to work and then finding out your work is 3-4x the expected.  Not cool.
And I would really like to know how out of 9 residents and fellows, I ended up being the only one not sick.  There's just something that smells fishy about that.  Granted, the fellow there today was hacking up a lung between every other word he managed to get out. So yea, sick. But, really? All 8 of them?  Tuna... Salmon... Halibut?

Much Love.

Estoy haciendo una lista.

The Attending this week in the TICU is Ukranian.  However, he is most commonly referred to as 'blonde hair' and 'Russian' and you immediately know of whom the patient is referring.  So we will just call him Dr. Russian. He always wears the same tan blood-stained shoes and either a red or lavender shirt underneath his scrubs. He has an abrupt personality and an aggressive approach to patient management. Not necessarily a 'dangerous' approach, but rather just the opposite of a 'cautious' approach.  Personally, I'm usually a bit winded by the end of rounds. If a patient has tubes, he wants them out.  If a patient has no tubes, he wants them in. As I said, an aggressive approach, the 'waiting and watching' option not found often in his management.  And on rounds in the TICU, as the patient's primary care giver, you should know and defend your plan for the patient from head to toe.  If your plan isn't adequate he'll interrupt you to ask, "Why patient ICU?"

He comes off to most as intimidating. Residents may even confess that they are scared of him.  Being forced to respond to a non-smiling, heavily-accented and demanding "Why patient ICU?" But if you just look at his eyes when he says that, you can see straight through to his inner teddy-bear. And it makes me smile.

I'm dropping down to cover the TICU tonight for just one night and then switch back to days again. It's really not cool that they schedule us as such. One blessing that came from it though; I was able to call up the eye doctor and squeeze into an opening that they had. Ordered new contacts (I was on my last pair) and replacement glasses. Able to check that off my list of things to do while on vacation. yesssss! more time to enjoy family and friends! As for the replacement glasses, they were needed as my current pair were over 8 years old and the wrong prescription. I picked a random pair and just went with it.  I laugh at myself now whenever I happen to catch myself in the mirror.  I have no idea what I was thinking!

I'm going to leave early for the hospital this evening and stop by the pharmacy. Pick up my malaria prophylaxis for Haiti!  I have to admit, it is a definite perk to be able to say to your co-worker. "Hey, can you call in a prescription for me?"

Five days!!

Much Love.

Estoy contando los dias.

The countdown has started. Current number is 8. I'm heading out in 8 days. April is my turn to rotate through my allotted month of 'Vacation.'

I put off counting down for as long as possible.  Because once you start... it's just that much harder to stay focused and content with the task of the here and now.

I first learned that lesson in Mexico.  I'd put off buying a ticket for as long as possible, because once it's official... it's incredibly hard to think about anything else but going!

As we rotate through 12 rotations throughout the year, one rotation for each month, it makes it easier for the program to schedule everyone's vacation in the same pattern.  Hence why we must take all of our vacation at the same time. In my experience, April is too long for an intern to go without a break. I hit a mental block back in February that I couldn't coax myself over by the usual mental self-pep talk/meditations, dance sessions and chocolate ice creams that I usually resort too. But like all things intern year you just keep on going.  And now look at where we are, 8!! Hard to believe just how fast time flies.

Much Love.

Estoy llevando la cruz.

I had an argument with one of my classmates back in medical school. We were arguing over the subject of the “broken heart.” His argument: to take the risk and fall frequent into love, that the resultant broken heart is part of life/a right of passage. My argument: to guard the heart, nonsensical to dive into something going no where and destined to end in a broken heart.  That argument has stayed very vividly in my memory as I thought I was going to live this life and prove my argument right! Foolishness! “What a fool I was, what an addlepated fool. What a mutton-headed dote was I”

I just spent some time googling “heart break, broken heart, etc” in an effort to find some inspiring words to lead into not so inspiring of a topic. It didn’t take long and I realized that, other than Eliza Doolittle’s, no words but my own would suffice. 

It’s that time of year again. Match time. No match to report this year. I’m really beginning to develop a strong dislike for the month of March. Thankfully I knew that I wasn’t going to match this year, and therefore when the email came at 12:00 on Monday I was not surprised. I’ve had some time to prepare; started many months ago when I started asking those involved in my own residency for advice. The very first Attending I talked to about it immediately laughed in my face. The idea of me continuing in surgery was comical to him. I stared him down, waited for him to regain his composure, and we continued on with the conversation. Thankful to say all subsequent conversations have not been a repeat of the first, but hard to forget something like that. But if nothing else it first prompted me to prepare for this reality.  Reality that this path will most likely not end with surgery.  Another fork in the road is approaching in the next couple of years and this time I fear the direction marked “Surgery” will be closed off.  A line of people in suits and long white lab coats standing shoulder to shoulder.  With the love and passion invested in this work and these people, the idea of their absence… it’s breaking. my. heart. 

I think back to my naïve argument that somehow we can prevent heart break. I’m almost embarrassed to think of it now, and must concede to my classmate that a broken heart is part of life and in its own way, yes, a right of passage.  I look to Jesus as my example of love...

Isaiah 53:3-4  “He is despised and rejected of men; a man of sorrows, and acquainted with grief: and we hid as it were our faces from him; he was despised, and we esteemed him not.  Surely he hath borne our griefs, and carried our sorrows: yet we did esteem him stricken, smitten of God, and afflicted.”

Mark 15:12-14 “And Pilate answered and said again unto them, What will ye then that I shall do unto him whom ye call the King of the Jews?  And they cried out again, Crucify him.  Then Pilate said unto them, Why, what evil hath he done? And they cried out the more exceedingly, Crucify him.”

Mathew 27:31 “And after that they had mocked him, they took the robe off from him, and put his own raiment on him, and led him away to crucify him.”

Luke 9:23 “And he said to them all, If any man will come after me, let him deny himself, and take up his cross daily, and follow me.”

Despised, rejected, mocked and crucified by the very ones He loved.  He carried my sins to the cross for me even before I loved Him back. Who better to understand a broken heart than Jesus? Perhaps this is now my cross to carry for a while. 

There is a fourth year medical student completing a sub-internship with us in the TICU this month. Monday did not bring happy news for him. I wanted to reassure him, hug him and tell him everything would be fine.  But I recognized the look on his face, and instead I told him to go home. And as the day progressed he wasn’t the only other with unfortunate news. My heart breaks anew for each one of my friends. I wish I had residencies to give them. I wish I could take that look from their faces and trade it for a smile.  I wish I could make it better for them. 

This is merely the next step. I love you. Jesus loves you.

Psalm 113:3 “From the rising of the sun unto the going down of the same the Lord’s name is to be praised.”

Estoy trabajando con anestesiologos.

I was originally scheduled to work tonight in the TICU.  But the schedule was changed, and I am no longer scheduled.  The reason being that some unspoken rule saying a first year can't be on nights in the ICU by him/herself has been instituted.  Now considering my very first week of residency EVER they had me on nights. in the ICU. by myself. I'm doing my very best to not be completely chagrined at this change.  Then, whether it was just over-looked, or forgotten about, but when I was taken 'off of' nights I wasn't 'put on' anywhere to make up for the period of work.  And I was suddenly looking at a three day weekend.   The Fellow who had made the schedule has made sure I am well aware that he gave me a two day weekend, and made a big deal that I know just who to thank for that.  So I was almost embarrassed to have a three day weekend knowing that two days is such a big deal. In reality I've had one two day weekend since I started last year, and never a three day. One of the other Fellows found out about this Thursday and her immediate reaction... "Oh we'll have to fix that!" There are some anesthesia residents rotating in the ICU with me this month, and they spoke up in outrage at that!  In a way I have my co-residents from Anesthesiology to thank for this three day weekend.  They fought harder for it than I did myself. :)

Much Love.

Estoy perdida.

Ben and Ashley Wagenbach took the train down from CT to spend the day with me in NYC last Saturday.  It had been too long since I'd made it into the city.

 

Ben couldn't resist checking out the Tesla on display. 

 

We ventured into Central Park to see how blankets of snow change the ambiance. Mr. Squirrel welcomed us to his home.  Pretty sure he was demanding hand-outs as payment for passage, but we pleaded the "tourist" and passed on without paying.

Ben, Ashley and myself enjoying Central Park.  We ended up being able to enjoy walking, skating and skiing all in a matter of minutes without ever having to change our footwear!  Thankfully sledding was not included in that list of activities.  ;)  

 

Ashley and myself in Central Park.

 

Bethesda Terrace

 

Believe it or Not... after 3 years this was the first time that I could actually see the front of St. Patrick's Cathedral.  Scaffolding has always hidden it from view before. 

 

I don't know why, but I had always wanted to find out what it was like to eat here. And now I know!! Not bad at all!  

Me, Ashley and Ben in GCT before heading home to CT.

Much Love.

Acts 2:38 "Then Peter said unto them, Repent, and be baptized every one of you in the name of Jesus Christ for the remission of sins, and ye shall receive the gift of the Holy Ghost."

Estoy cansada.

Massive transfusion is arbitrarily defined as the replacement of a patient's total blood volume in less than 24 hours, or as the acute administration of more than half the patient's estimated blood volume per hour.

But that's just a definition. In an ideal reality, once the Massive Transfusion Protocol (MTP) has been activated the first container of blood and blood products is sent in a matter of minutes and the second is being prepared.  There is a designated courier to run back and forth from the blood bank and the location under the thralls of the MTP.  And he/she keeps running back and forth until for one reason or another the MTP is cancelled. But that's just how it would work ideally.

You can guess what I'm leading up to.

We had a patient come to the Trauma ICU last night directly from the OR. Blood was pouring out of the drains.  Oozing from the orifices.  The patient was hypotensive, acidotic and hypothermic; the deadly triad. We set to work.  The MTP was activated and, as the intern, I spent the next 6-7 hours running back and forth through the hospital in between the Blood Bank and the TICU.  We spent those 6-7 hours flirting with the oh-so-stoic line between life and death. Raising the patient's core body temperature to a point where the blood would theoretically start to clot again.  Keeping the blood pressure to a level that would maintain perfusion to the patient's organs. But what we poured in just came out again even faster.

I lost track of how many trips I made over the course of those hours of hypervigilance. But one thing is an understatement... "replacement of a patient's total blood volume in less than 24 hours."  We had complete replacement of the patient's total blood volume hourly, at the least. At the end, the floor was cluttered with the numerous canisters filled with the hemorrhage that just never stopped.  Even with the hypothermia finally corrected, it just never stopped. 

Much Love.

Estoy irritada.

Things on the Vascular service were so exciting at the end of last month. We had some crazy pathology.  I was sad to leave at such an exciting time; feel like I'm missing out.  Things like complete occlusion of the aorta. The largest vessel in the human body, completely closed, and in a young person to boot! Pretty cool stuff!

I was finally able to make it to CT this past weekend.  It had been about 6 weeks.  Was all set to spend Sunday evening there as well, but the weather had other plans and I left directly after church.

I'm in the Trauma ICU for the present month. Started my Monday off first thing with a patient in respiratory distress requiring intubation. What a way to say Welcome Back! ;) I'm looking forward to having a set number of patients this month. A good thing about working in the unit is that there's only so many beds. Once they're full, your list is capped. On the floors, even if your floor is full the patients keep on coming and overflow gets placed on other floors.  No capping of a surgery list on the floors. My schedule is switching me to nights for the rest of the week.

Much Love.