No estoy segura.

Acute arterial thromboembolism can cause acute arterial occlusion and in such situations is considered a vascular surgery emergency. The longer the dependent limb or area is without blood supply the higher risk of permanent loss of function. Best case scenario, to the OR emergently with vascular surgery with removal of fresh clot and restoration of blood flow to the dependent area. No harm done. Unfortunately an acute arterial occlusion can present with sudden neurological deficit. For example, sudden loss of sensation and movement of a leg or arm. Followed by frequent misdiagnosis and delayed trip to the OR.

This unfortunately happens too often. Just recently, the Reverend came in and was diagnosed with a stroke, was actually treated for a stroke. It was over 12 hours later, when the pain in his leg continued to persist that a different diagnosis was considered, vascular surgery was called and he was taken emergently to the OR.

The following day, one leg saved, attention turned to the Reverend's other leg. Also compromised, it was in need of emergent intervention. Yet one by one, to my increasing frustration, my Attendings were convinced it was okay.
The Reverend: "It always looks like that." "It turns blue like that when I get out of the shower." "No it doesn't hurt at all."
I'd hate to say that a Reverend would lie... but none of that was true!! The only thing I ultimately could not argue with was... "I don't want anything more done. I don't want surgery."

By the time the Reverend finally did admit that he was having severe pain from the other leg, it was already hurting his heart as well. Which was then hurting his kidneys, and so on and so forth. My Attendings, finally acknowledging the patient needed surgery for the other leg, and... it was too high risk to do anything. Too late.

Did we miss that small window of time immediately after the first surgery, when we could have saved the other leg? With this leg now hurting the heart, at this point should we just take the leg? Life over limb? Or had the initial lost 12 hours doomed us either way?

Ultimately, the only thing that remained in control was the Reverend himself, "I don't want anything more done."
Which can stop the rest of us from action, but can't stop the What if's and why's. I wish I knew those answers.

Much Love.

Estoy pidiendo ayuda.

It's been a week longer than usual. The American College of Surgeons annual meeting was this week and multiple chiefs had decided to attend this year leaving the rest of us scratching our heads each morning trying to figure out case coverage.

The late nights, it is what it is. At sign out the other day I was attempting to sign out to the night intern and all I can remember now is the laughing. We weren't laughing about anything. Just the fact that I was exhausted, and I was hungry, and so I just had to laugh. And God bless her, she just laughed with me. I think I eventually made it through my list...at least I hope I did.

My sister stopped by the hospital!!! She had been vacationing up in Maine. Stopped by the week prior on her way North and now once again while heading back West. Unfortunately due to the busy schedule, we had approximately 15 minutes this time, and even then I was ignoring the fact that my attending was waiting on me to go round. But it was enough time to swallow a sandwich and take a picture. Plus it was just really cool to have my sister stop by all the way out here! It's a first!

Much Love.

Estoy comiendo cupcakes.

I can no longer say I'm 30, but rather I am now "in my 30s" The difference between those two is much more noticeable than I was expecting. At least I can be "in my 30s" for the next 9years though. Maybe I can spend those 9 years catching up in maturity to what 30s stereotypically signifies. But... something in me highly doubts it. Forever young!

That being said, if I am honest with myself, I am a little bit sad to move on from 30. Thirty treated me well. If I look back a year ago at where I was on this day, future still shrouded in the all-too-familiar uncertainty, I have so much to be thankful for. I could spend the rest of my life saying Thank You and not be able to make a dent in acknowledging what Jesus has done for me. I get to be a surgeon some day. I give this path, and my life back to Him in thanks.

Thank you Lord, for granting me yet another year of life. Your blessings and care given so richly. All my Love, Christy

And now since it's that day again. Join me in dancing to my birthday song!! :)


Much Love.

Estoy uno de un millon.

Mid-life crisis. I am going to take the idea and correlate it to a mid-residency crisis. I figure in a 5 year residency I'm technically in the 3rd year, theoretically the middle. No one has ever really mentioned a mid-residency crisis before, but I'm pretty sure it's a thing. Whether medicine, psychiatry, radiology, etc. etc. etc. There is a point when the resident has to transition from a "feed me" learning to a trial-and-error learning, based on their own decisions and actions.

Unfortunately, there is no outline to follow. No step-wise algorithm to guide ones steps.  It can be quite stressful for an individual to navigate. To take the examples they have seen thus far and really for the first time start to implement them. 

Am I having a rough patch? Perhaps. But really, who doesn't from time to time. It's only normal to feel like you need a break, a respite, some R&R. Even Jesus walked away from it all when he needed to. Only difficulty with that in this particular case, is I can't exactly take that break. Frustration, stress just stays pent-up and borders on anger at it's inability to be released.

We push on nonetheless. When we hear the medicine resident slam down the phone in its cradle across the trauma bay, heads pop up at the sudden sound, but settle right back down again. We've all been there. Or when the chief yells that someone has touched their coat, everyone carefully tip-toes until safe to resume normal speed again. They weren't really mad about their coat. 

We'll make it through. As so many have done before and many many more will do for years after us as well. I'm just a small one of a million, all the same, no different from my fellow co-residents. Neurosurgery, Pediatrics, Oncology alike approach that mid-residency crisis when faced with staying true to themselves yet realizing what it means to be a Neurosurgeon, a Pediatrician and an Oncologist when in the trenches and on the front lines.

Much Love.

Estoy enseñando.

As I am able to progress through residency, claim more experiences under the belt, my role as teacher has become a little less daunting. 

Over the past three or four years I've become a firm believer that the role of the student is to surpass the teacher.  The role of the teacher, to help their student(s) achieve just that. If it does not play out accordingly, shame on the student. And, shame on the teacher. 

I have it easy as a teacher in the fact that, for the most part, medical students want to be there. That being said, I respond in teaching to what the student brings. If they are willing to invest in the service of surgery, I will reciprocate with investment in them. And I will do so with as little propaganda as possible. For the most part, students are incredibly sensitive and vulnerable. They listen to everything, and take everything to heart. I soon realized that if a student is interested in pursuing another area of medicine there is only a minute amount of time to impact him or her before they go off into their desired area and forget all about surgery.  Only a minute amount of time to encourage them to be the best doctor EVER. 

I broke my own rule the other day. My rule about no propaganda. I do not want to tell any student to go into surgery. I believe they have to make their own decision. Because that day will come when they are exhausted, cranky and facing a 24 hour call and they will have to fall back on their initial decision. But the other day, a student approached me about her future. She is an excellent student, still not sure what she wants to do, and therefore interested in everything. Or that's what she says, but her every action screams surgery. I can see it, her fellow classmates can see it, and honestly, she knows it just won't admit it. She came to me almost as if she needed me to say it. And for the first time I told a student to choose surgery. Yes, keep an open mind, I told her. Yes, feel free to apply to any and all specialities you desire. But make sure that surgery is one of them. And she nodded. I hadn't told her anything she didn't know.

Much Love.