Estoy nueva.

 The view from 185 Canal Street. Deserted red brick buildings, their chimneys maintaining a cold smokeless defense. Boarded up doorways, overgrown with foilage. Perfectly splintered glass filling areas were windows once gleamed. 

 

Slide through the half opened rusty fence and you find yourself along the Housatonic. Benches dirty and empty; the couples who once sat looking out over the waters, a distant memory. 

 The Locks, marking the namesake of Canal Street, the gates now broken and weak no longer in functioning condition.

  It's amazing what you may find when you go where you haven't gone before.

 Jenna and I enjoying the famous New Haven style pizza!

Much Love.

Estoy realizando una melodía.

We were called about a lady with a chronic skin condition the other day. She was covered with lesions, almost like hard pebbles deep beneath the superficial layers of the skin. And she scratched. She scratched so desperately looking for relief. We weren't called about these bumps though. On the back of her left shoulder was a large raised area with a pin-point spot that would produce a bead of pus when massaged. I took a blade and cut down to the pocket of pus collecting beneath the skin. It was deep and the layers of subcutaneous tissue were so scarred and fibrotic from her condition that to break up the loculations of the abscess was like having to rake against entangled branches. I raked until the blood was no longer mixed with fresh pus, then I packed the cavity.

We were called back to the lady's bedside a few hours later. She was still bleeding. I took down the mountain of dressing the nurse had taped across this lady's back in an attempt to cover up the growing spot of red originating from the I&D site. One thing a surgery resident very quickly learns is to not be afraid of is bleeding. All Bleeding Stops. So I took my knuckles and dug them into the skin overlying the abscess cavity and held pressure. And there we stayed. For the next 15 min she sat on the edge of her bed with her head hanging down and me standing behind her leaning into the pressure I was creating against her shoulder.

At one point I started humming. It was unsolicited, unplanned and before I could catch myself the first few bars had blown past my vocal cords. But even more surprising... the second I caught myself and stopped the lady carried on. It was the same low halting hum that I had initiated, but without a doubt it was the same hymn and she had picked up exactly where I had left off. We finished together.

Much Love.

Estoy debil.

I called my first DOA (Dead on Arrival) the other day.

There are things a surgery resident just adjusts to and it becomes par for the course. "Normal" a very dynamic variable in the equation of life. Sometimes finding that corner of the psyche in which to compartmentalize takes a bit longer than usual. So instead of sitting here staring at a cup of tea I thought I'd spend some time talking to that great vast void of nothingness, a.k.a the interwebs.

One of the level 1's we had last night was a GSW to the right flank. The decision was made almost immediately to go straight to the OR. Therefore imaging was post-poned until post operatively. As my senior and I crowded around the images this morning we got quite the surprise. The path of the bullet projected straight through the body of one of the lumbar vertebrae. It had blaze through millimeters from transecting the spinal cord. Wow! I tell you what, Wow!
- Unfortunate that our guy happened to be in the wrong place at the wrong time. Fortunate that an EMS just happened to be driving by and saw him stumbling and then collapse. Fortunate that the bullet hit things fixable. Pushed down a path to a new normal in a split second of time.

There's a new song that has recently been playing on the radio a lot called, Tell Your Heart to Beat Again by Danny Gokey. I'm not sure why the artist wrote his song, but evey time I hear it I am transported to Trauma Bay 1 back at Westchester. I've played the song for a few colleagues and they agree with me that this song could be re-titled, Tell Your Heart to Beat Again, a.k.a. The Level 1 Theme song. I found it amazing how save one or two lines the song is perfectly applicable in a level 1 situation.

I picture the scene enfolding in front of me, muted. A blur of activity, all roles orchestrated for the goal of the patient. 


Much Love.

Estoy preocupada.

The 'History and Physical' is the legally accepted documentation at the start of any Physician-Patient relationship.

I remember taking hours to complete a single H&P in medical school. When we were observed for a grade at the end of each semester we had 1 hour to complete our interview and physical exam and then an hour to write up our report. Now granted, I did every aspect of a physical back then. Can't say I've actually taken out my ophthalmoscope since leaving Mexico. But really, when a patient has complaint of belly pain, the shape of their optic disk is of little consequence. Either way, it does not take me hours any more, not even close. The interview blazed through as I make my way down the checklist in my head, created from the practice of hundreds of H&P's.

Symptom?
Quality?
Where?
Duration?
Better?
Worse?
Associated symptoms?
Before?
Etc...

All-in-all it's pretty basic stuff, textbook. But then, once in a while I'm caught off guard.

Last week surgery was called to consult on a patient that had blood surrounding the spleen on CT scan, concern for rupture. The patient was young, not a child, but more like my age. Really no past medical history and had presented referred from a walk-in clinic with 3 days of left flank pain. They had suspected a kidney stone. However, the picture being painted on initial work-up in the ED was pointing more in the direction of leukemia. I went to see the patient. I talked with the ED doc first to get a general story before going in and was warned that even though the word leukemia was being plastered all over the patient's chart... it hadn't actually been mentioned to the patient yet. I acknowledged the forewarning... I wasn't about to be the one to use it first.

Besides, I had enough news to break to the patient as it was. "Hi, I'm from Surgery. We're here to be on board in case you start to exsanguinate into your belly, in which instance we would need to go in and take out your spleen.  But don't worry. You're fine. For now..."

Don't worry, I have a bit more finesse in real life. ;)

Either way, this patient seemed to sense what everyone wasn't telling him. Direct, single word answers whenever possible. Would make eye contact with me only when absolutely necessary. I quickly pieced together that the patient wasn't a typically happy individual at baseline and lacked a large support group. Pushing my way through to the end of my H&P checklist
"Do you smoke"
"Yes"
"How much?"
"about 10 a day"
"Do you drink?"
"Yes"
"Socially?"
"No" (eye contact was definitely avoided on that one)
"Do you use drugs?"
"Marijuana, but my spouse was gone last night so I did some coke."

And my heart sank. The road I saw laying out before this patient had suddenly gotten so much more difficult from a social and psychological stand-point.

I'll probably always wonder what happened. How that patient's story enfolded. The spleen aside...I'm not worried about the spleen. It was a beautiful spleen on CT scan. But in general, some stories stick more than others. This one wasn't even mine to worry about, but somehow I can't help it.

Much Love.

Estoy Everygirl.

The Everygirl 

A career woman, working to experience her life better lived.

Trying to incorporate a little creativity into her day. 

 Looking for the inspiration to achieve her dreams.

 

Saving up for a down-payment or that next big trip in the books.

  By the Grace of God, becoming the woman she was ment to be.

 

She is The Everygirl.

Rotations find me back at St. Vinny's in Bridgeport this month. I am blessed to once again be able to stay with Jenna in Shelton, CT. As Monday had me attempting to switch myself back to a day schedule from my past month of nights we decided to invite Amanda V down to the apartment for dinner. I don't know what really inspired me, I typically don't get creative with my cooking since it's just me. But I looked up some recipes and attempted my hand at fancy. It turned out... edible.  Jenna had taken a picture of one of the prepared plates with the ring of lemon making the chicken look classy on its bed of penne and side of asparagus/brussel sprouts. I had to actually show my co-workers that picture to get them to believe I had actually cooked. Apparently they all think I exist on granola bars. It was a fun evening. I'm so thankful for these amazing ladies I get to call my friends!

Much Love.

Reference: http://theeverygirl.com/