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Year one done! Over! Finished! Completed! Terminado!

This really is of no consequence, and tomorrow is going to be just another day at the hospital same as today. But… in my head, I’m letting it be significant. All part of that mental pep talk that comes with walking by faith and not by sight. It means I’m somehow a step farther along this path of unknown duration.

What does second year mean?

1.       One is able to be scheduled for 24 hour shifts. (Which inevitably truly turn into 28-30 hour shifts)

2.       More time in the OR

3.       Less clerical work responsibility

4.       One no longer has ‘naivety’ available as a weapon in their arsenal as a reason for not knowing something or how to get something done.

5.       Along with #3, one is held to a higher expectation. And forgiveness is even harder to come by than it was the previous year. 

6. Responsible for teaching the new intern on how to be an intern.

Other than that it’s pretty much the same stuff as first year. Lots of work. The pager never stops. Getting bullied by a nurse here and there.  More work. Daily dose of dirt eating for your self-esteem.  Following every whim and notion of your chief. And of course, taking care of patients.

Finished up my last shift as a first year prelim on nights in the Trauma ICU.  The intern up on the floors for night float was Kristina Dzeba. We’d make sure our paths crossed at some point during our nights in the hospital. I roped her into helping me document my last shift of the year.

Much Love.

Estoy terminando este año de internado.

Tonight is the first of six which will end this month in the TICU for me.  Agon (an Albanian-Canadian who is a second year prelim) is scheduled for the same six nights.  Between our last row of six nights together, he had four days off and I was scheduled for three day shifts.  He tries not to feel too guilty about his good luck, and I... well, I try not to make him feel too guilty about it either. ;)  I did have last night off, so I just contented myself with having a nice evening off.  It was a Jane Eyre kind of night. I tell ya... lunatics, attempted murder, revenge, heartbreak all topped off with a happy ending...well done Charlotte Bronte, well done! 

We've recently had a string of admits to the Trauma ICU of individuals having gotten themselves inebriated past the point of typical mental impairment arriving at the edge of loss of any cognitive ability. You can take an easy guess as to what their combativeness and disregard for any and all caution for their own safety buys them... rapid sequence intubation and a tube down their throat.  Then as a package deal, their intubation buys them admission into the TICU. Prior to their arrival to us they are pan-scanned to determine extent of actual injuries. While we wait for all of their images to be finalized we keep them status quo. And then once their scans prove to be negative as long as they continue to fight we keep them chemically chilled-out.  Not until they can prove cognitive awareness and control (usually shown by following simple commands, 'show me two fingers,' ' give me a thumbs up,' 'wiggle your toes,' etc.) will we consider removing the tube from their throat. This makes me marvel at just how expensive a hangover can be.  A night in the ICU alone roughly $4,000. And God forbid, should cars be involved, how can you put a price on a life?  Am I allowed to hate something? Because strongly dislike just isn't enough for how I feel about alcohol. 

Much Love. 

Estoy diciendo Adios.

The residency year is drawing to a close. Last night I went to the graduation for our four graduating Chiefs. I didn't take any pictures myself, but then thinking about it I decided to go find one.  I figured that as I've alluded to my chiefs enough times over the past year, it would only be fair to give a face with the name. Plus, if I'm honest... I wanted the picture too.  My first chiefs. They shaped this past year for our program in so many ways.  They pulled for all of us, pulled us together.  Granted each in their own very unique ways, but it worked. And now they are done, and there's no guarantee I'll ever see any of them ever again.  I wish each one of them the absolute best life has to offer.

 L to R: Dr. Samir Pandya (Asst. Program Director), Dr. Jose Aquino (going to Nebraska for Plastic Surgery Fellowship),  Dr. Irlna Tantchou (going to Texas for Colorectal Fellowship), Dr. Alison Sweny-Alberton (going to Washington as General Surgeon), Dr. Arpit Amin (going to Long Island as General Surgeon), Dr. Whitney McBride (Program Director)

As the chiefs roasted our Attendings and then in turn we roasted our chiefs we all laughed the evening through. It held a mirror up to this past year for me, and one thing was glaringly obvious in the reflection. I Have Yet. So. Much. To. Learn.  A long stone's throw and far cry from where I am today. And one thing was clear, whether just one more year or more; We're not done here yet.

Here's two pictures from a party I went to last weekend.  A farewell party for our Chiefs hosted at the home of Dr. Babu in Tarrytown. (Not even half of the residents were actually able to attend.)

Much Love.

Estoy esperando trauma.

As May moved into June I transitioned back to the Trauma ICU. Unlike the last time I was here they have put me back on nights along with Rachelle. Both she and I moved from Vascular to TICU nights together.  So I've been burning the night oil all week long, but on the flip side 1:00 in the afternoon you'll find me curled up under my covers. It's trauma season; meaning, you wait for those level 1 traumas to come in each night. We've only filled up our beds one night of the six so far, although tonight is quickly heading in that direction as well.

There was a death in the TICU earlier today. An old individual with a broken neck. Lungs were no longer working.  Nor the kidneys. Brain stem reflexes... absent.  But we kept the breathing machine going as we waited for family to arrive.  We waited for over a week. And every night the daughter would call and have the same conversation with us.  Are they talking? No.  Can we take the tube out of the throat? No. They're getting better, right? No.
The daughter did finally come.  She came today.  She walked into the room and started talking to her parent. Within 10 minutes there was no more heartbeat. She had come for withdrawal of care, but no withdrawal was required. It was almost as if that patient had waited for the daughter.  Who knows, maybe they had.

Pain. It's all in the head.  Really.  That's not saying you do or don't hurt.  It's saying that you can have the exact same level of pain with a broken rib as without a broken rib, if the pain receptors in your brain are firing.  It is probably the single most area of medicine in which I struggle with empathy.  However... I'm not alone in that. This is the trauma ICU. Pain is status quo. And then you have grandma over in bed A with every single rib fractured on the left side.  Well, she's chillin' like a villain on nothing more than tylenol, doing her lung exercises like a champ! And we get an admit this evening, adult male with a couple of cracked ribs. There's five of us in his room to get him situated. Time to turn him and he throws a fit. It becomes quiet except for his complaints, and I can see in the eyes of each of my colleagues either emptyness (they've stopped caring, no longer listening to his excessive complaining) or numbers (1... 2... 3... as they make their way to 10 in an effort to prevent themselves from yelling at the patient).

Different individuals handle pain in different ways.  Or in other words, some do handle whereas others don't.  I will give you a helpful hint: The first step to handling your pain is to work with your caregivers. You show them you are on board with getting yourself better and they will gladly order the pain meds you need.

Much Love.