Estoy moviendo mis extremidades.

The human being typically is found to have four extremities.  Two arms. Two legs. It is through the movement of these extremities that the individual is able to move and work through time and space. I said 'typically' because there are times in which for one reason or another, the human being does not have the aforementioned four extremities. What could cause this? Congenital anomaly. Trauma. Sickness, illness, and disease. In the event of one or multiple of these, resulting in the absence/loss of one or more limbs, the human being (in it's amazingness) is able to adapt and often with the help of prosthesis is able to continue to move and work through time and space with minimal difficulty.


To paraphrase one of my Vascular attendings, "I don't understand why some people are so attached to their appendages!"

In my short time with Vascular Surgery I have already seen both extremes when it comes to patients and their emotional attachment to their appendages.  Well, perhaps emotional and then the-lack-thereof attachments.

For example, The Lack Thereof:
"Hello my friend, it's time to change the dressing on this foot."
"Ok"
{remove dressing}
"Ok my friend, do you see this part here?
"Yes"
"This is unhealthy skin, this wound will not heal with this black area.  We need to remove the bad part.  And you see how this toe is discolored, it is not healing either.  We may need to remove it as well."
"Ok"
"Do you understand what I'm saying my friend?"
"Yes"
"Can you tell me what is going to happen?"
"You're going to take my toes."
"Are you ok with that?"
"Yup"
"Do you have any questions?"
"Nope"

And then on the other hand, The Emotional:
"Good morning my friend, how are you doing today?"
"Good."
"How is the pain in your leg today?"
"Oh it's getting better, see what do you think?  Is the foot getting better?"
"My friend, I'm glad your pain is better today, but your foot still does not look good."
"Oh really?  I thought it was looking better."
"Do you remember what the Attending told you? About the angiogram?  You have no blood flow to your foot.  They weren't able to open the blood vessels during the angiogram."
"Oh yes I know, but I still thought it would get better."
"My friend, your foot is purple.  You can't move it and it is causing you pain.  Should we let it stay like this there is a high risk it will get infected and make you very very sick.  You could die from it."
"Oh really!? Well, I just don't know. Maybe it will get better."
(this exact same conversation was held with the patient multiple times a day for almost a week.)

In the end The Emotional patient was discharged to rehab as they had to that point refused any treatment other than pain control for their dead foot.  Discharged with instructions to return when the pain became unbearable and they had changed their mind. Hopeful that would happen before it was too late.  And they did, we got a page from the ED last Thursday.  This patient was back.  The foot which was purple and dark was now black and blistered.  Amputation is scheduled for Monday, we'll see if it happens.

And as for The Lack Thereof patient, amputation is scheduled for Tuesday.  I have no doubt it will happen.  I just perhaps question if the patient needs something more than just wound care for their all around well-being.

Much Love.

Estoy agradecida.

This past Saturday you could find me at the beach. I was so excited to be there I had to turn and tell my companions just how thankful I was to be there.  And then an hour or so later I had to turn and tell them again. 

I see the fact that I was actually there a little like an event that follows the swiss cheese model of accident causation. Except for the fact that the result was a good thing rather than a bad thing. There were multiple possible barriers that would have caused me to loose my weekend off, and God aligned those barriers just so that time hit a hole through each one.  I made it through and looking back was completely in awe that I was so blessed.  Hence my need to repeatedly inform my friends of just how excited I was to be there.

 

Anita Schlatter, Marcy Bahler and myself at Rocky Neck CT.

 

Back to the hospital and back to work today. I may have been more tired than when I left last Friday, but a tired so well worth it.  I'm at a stage where fellowship comes few and far between. Fellowship tops sleep.

Much Love.

Estoy lista.

Look at this guy!  Really, how can Little Lincoln be 1 already?

 

This is supposed to be my weekend off. I really am so thankful. I need a break. But even moreso, I need to go to church. 6weeks can just be, a really long time. Although ever since Tuesday I've had a sinking feeling, that I'm going to need to work this weekend. My chief is out sick since Tuesday (no I didn't get her sick... this is a bedrest kind of sick.) They haven't said anything to me about coming in to cover, and to be honest, I'm too scared they'll say 'yes' if I were to ask them.  So I'm a bit on edge every day waiting for someone to say something about my needing to cover at the hospital.

There was an ice cream cone in the cafeteria today. So we got a Vascular team picture.

3 students, 1 intern, 1 midlevel, 1 midlevel-interim-chief, just missing the actual chief.

Estoy sanando.

Finally on the mend again. It's been a pretty crazy past 12 days.  This virus has had a party everywhere from my lungs to my eyes, and then into every nook and cranny it could find within and behind them. I made it through my first 24 hour call on July 4th in such a state.  In a way, made it quite memorable.

Towards the last couple of days my lymph nodes had become so swollen and tender I thought they were going to just burst. I was starting to look to anything for relief and discovered ginger tea. Bought some ginger root upon the recommendation of another resident and went from there. Not bad. Made my throat burn when I drank it, but it did help.  In addition, for the duration in which I was drinking the tea and then for awhile after I actually had a short spell from coughing. I'm glad it was mentioned to me.

Part of my role as a second year is to take Vascular Surgery consults.  I had a fantastic one the other day for a fever... that wasn't even a fever by definition.  I went to see the patient and he was laying in his bed quite comfortable.  Let's just say I was more sick than this guy.  I talked to my attending and then wrote up a consult note determining "No indication for acute vascular surgical intervention at this time. Please call back as needed."

Much Love.

Estoy enferma.

It was just another day in the hospital, but I have to admit it felt nice to no longer be the intern. I went in for a case that ended up being about 3 1/2 hours and my pager only went off twice in that amount of time!  Amazing!! However as my chief calls it, I'm to be 'super-intern' for awhile until our new intern finds her feet.

Things were done at a slower pace, and yes it would have been faster to just do everything myself, but to no benefit of really anyone.  So we went slow.  Our new intern mentioned on multiple occasions how there were 'so many patients!!'  I didn't have the heart to tell her how fabulous the list currently is. (It's currently 1/3 the length of the list last time I was on Vascular).  She was already overwhelmed, I figured no sense in making it any worse. Besides, she will inevitably discover that on her own with time.

And at the end of the day, I told her she had done a good job!  Boom! Shakin' things up and breakin' the norm! She may never hear those words again, but I figured when an intern does a good job on their first day, well then they should hear them.  Even if it is just once.

My chief gave me today off as I'm on call all weekend. I had planned to sleep about 30 hours.  But my neighbor decided to undertake a construction project. So I am awake.  I'm also sick. Hence why I had really wanted to sleep so long. By the time I left work yesterday, my head felt like lead and my voice came out in squeaks.  I thought if I could stay in bed that long I'd wake up and be magically better. No such luck. I knew my turn to get sick was long overdue.  I'm just impressed my immune system held out as long as it did!

Much Love.